Q&A: ‘Honor her goals’ for breastfeeding

August is National Breastfeeding Month in the United States.

According to the HHS, this month was established to promote the benefits of breastfeeding for both the mother’s and the offspring’s long-term health.

Additionally, National Breastfeeding Month is dedicated to supporting families in their breastfeeding goals.

Healio spoke with Clare Cardo McKegney, DNP, APN, CPNP, an assistant professor of nursing and co-director of the Pediatric Nurse Practitioner/Doctor of Nursing Practice residency program at Columbia University in New York City, and the secretary of the New Jersey chapter of the National Association of Pediatric Nurse Practitioners, to learn more about how to support patients’ breastfeeding decisions in practice.

Healio: Why is it important to recognize breastfeeding?

McKegney: It is important to recognize the mother’s thoughts and feelings about breastfeeding because without an understanding of her goals, one cannot prepare a successful plan for mother and baby. A practitioner cannot simply identify the breastfeeding dyad, they need to support them. By identifying that a mother wants to breastfeed, the practitioner needs to be comfortable and knowledgeable about breastfeeding. The practitioner should be able to counsel the mother or have expert breastfeeding specialists that can enter into a relationship with the mother and baby.

Healio: How do you help a patient decide whether they should breastfeed?

McKegney: I do not decide for mother and baby. I support and guide new mothers with their decision to breastfeed. Although breastfeeding appears to be a natural process, it does not come naturally for most, especially a new mother. Each mother and baby I meet, I treat as individuals. It is a privilege to support a new mother with her decision to nurse her baby, and I honor her goals. Therefore, when I am working with a breastfeeding dyad, I consider the mother’s goals above mine. I educate mothers and families on the benefits of breastfeeding — not only for baby but mommy as well — and develop a plan that is specific to each family dynamic.

Healio: What are the current trends in breastfeeding?

McKegney: The CDC publishes its Breastfeeding Report Card approximately every 2 years. Most recently, data were released in 2020. They tracked the rate of breastfeeding over a period of time before the pandemic. The National Immunization Survey [conducted by the CDC] also releases breastfeeding trends and statistics. The most recent data reports the rate of breastfeeding from 2012 to 2019. Both outlets look at different trends and feeding patterns. Within the reports, rates of exclusive breastfeeding (meaning only breast milk — no water, juice or formula) vs. breastfeeding with supplementation of formula, as well as the trend of breastfeeding rates at birth vs. the rate of breastfeeding as babies get older, are examined. The data support that the highest rate of breastfeeding is in the first month of life. Approximately 84% of babies born in the U.S. are given some breast milk at birth, with that number dropping to around 50% at 6 months. These statistics are different when applying “breastfed only” to the research. Approximately 40% of the babies that initiate breastfeeding are exclusively breastfed through their first 3 months of life. This number drops to about 25% between 3 and 6 months of life.

Healio: How can providers best support breastfeeding patients?

McKegney: It is important for providers to understand that breastfeeding is an art form in some respects. I often find myself speaking with families and explaining that not every baby and mother work the same. Just like with any art form — whether it be a Picasso or a Rembrandt, jazz or rock ’n’ roll, tap dancing or ballet — we still consider it art. The breastfeeding dyad will take on their own “dance,” and the provider needs to support that so long as the baby is thriving and the mother is enjoying the experience.

Support starts in the prenatal period. The OB/GYN must encourage mothers to seek educational resources regarding breastfeeding and preparing for the experience. Families should be encouraged to find pediatric practices that are breastfeeding friendly. The initiative to have breastfeeding-friendly hospitals, albeit wonderful, is a very short stay for mother and baby. Mother and baby must be supported in the pediatric office.

I have had the privilege of bringing my expertise to the practice I currently work in, and I was afforded an area in the office that is designated as a lactation suite. This supports the family in a comfortable, non-stressed environment that then affords me the ability to offer breastfeeding consultations. However, I understand not all providers have the interest or time to work with a breastfeeding dyad.

I urge all pediatric providers to stay current in the trends of breastfeeding, understand signs of the difficulties surrounding breastfeeding and have experts in their community that can offer support for the nursing mother. They must partner with the breastfeeding experts to ensure that a multidisciplinary approach is established for the mother and baby’s nutritional goals.

Healio: Is there anything else that is important to highlight about breastfeeding?

McKegney: A successful breastfeeding experience can be a rewarding experience for mommy and is the optimal nutrition for the infant. However, it is important to note that “fed is best.” It takes time for a mother and baby to demonstrate a routine, and therefore it sometimes takes time for the human milk production to become established. It is important for the pediatric provider to routinely check in with the breastfeeding mother to validate a mother’s efforts and determine her level of confidence in the process. The hormonal changes post-birth and [during] breastfeeding can cause a sense of vulnerability in a mother. Pediatric providers should assess a new mother’s emotional state utilizing the Edinburgh Postnatal questionnaire to prevent any women from silently suffering with postpartum “blues,” anxiety or depression.

References:

• August national health observances: immunization, children’s eye health and safety, and breastfeeding. https://health.gov/news/202207/august-national-health-observances-immunization-childrens-eye-health-and-safety-and-breastfeeding. Published July 25, 2022. Accessed Aug. 23, 2022.
• Breastfeeding Report Card. https://www.cdc.gov/breastfeeding/data/reportcard.htm. Updated Nov. 24, 2021. Accessed Aug. 22, 2022.
• Results: Breastfeeding Rates. https://www.cdc.gov/breastfeeding/data/nis_data/results.html. Updated Aug. 1, 2022. Accessed Aug. 22, 2022.