Q&A: Breastfeeding success starts before birth

Key takeaways:

• Breastfeeding has multiple benefits for mothers and infants such as providing antibodies and certain cancer benefits.
• The most common breastfeeding barriers are lack of knowledge, support or resources.

Breastfeeding is different for every new mother, and the most important aspect is making sure the mother has all the knowledge and support needed to successfully breastfeed her newborn.

“So much of successful breastfeeding comes down to having the knowledge, having the education and setting women up for success from the get-go,” Elizabeth Stuesse, MSN, RNC-IAP, RNC-OB, RNC-MNN, C-EFM, C-ONQS, CLC, CBS, CCE, CHBE, clinical assistant professor of nursing at Maryville University of St. Louis, told Healio. “This gives them a leg up right from the get-go, rather than starting from scratch trying to teach women right after they gave birth. That’s a lot of information for a new mom to absorb. If she’s got a bit of a foundation laid, then we can just build her up from there.”

Healio spoke with Stuesse on the benefits of new mothers breastfeeding their infants and the most common barriers women face when attempting to breastfeed and how these barriers can be overcome.

Healio: What are some benefits to breastfeeding for both the mother and the infant?

Stuesse: For the baby, the first one that comes to mind for most people is that breastfeeding provides certain antibodies to help fight infection. They’re really protected against illness when they’re breastfed. There’s also a reduced risk for certain things like eczema, asthma, type 1 diabetes and sudden infant death syndrome. For mom, it provides protection against certain cancers — largely reproductive organ cancers like breast and ovarian cancer — and protection against high blood pressure and type 2 diabetes. The benefits are also about bonding between mom and baby, and it’s considered a bit more of a cost saver compared to formula.

Healio: Are there any downsides to breastfeeding or a reason a woman might be recommended against breastfeeding?

Stuesse: I wouldn’t say downsides, per se, but there’s certain challenges or aspects of breastfeeding that some might view as inconvenient. Especially in the early days and weeks, there may be some pain or discomfort and some stress centered on breastfeeding. There may be a little less freedom in the early days and weeks as mom is the only one putting baby directly to the breast. She needs to be a little bit more mindful of what she’s eating or drinking, but I wouldn’t say these are downsides, just certain initial challenges.

A pretty rare condition for babies is called galactosemia, and that’s really the only thing where they cannot receive the breast milk. But for mom, if she has certain diagnoses like infections with HIV, active and untreated tuberculosis or certain other infections, illicit drug use, or are undergoing cancer treatment, those are kind of the big ones where we would recommend against breastfeeding.

Healio: What are the most common barriers to women breastfeeding?

Stuesse: Lack of knowledge would be the first barrier that kind of comes to mind. Just a lack of knowledge around breastfeeding and what is normal and what is to be expected. A lot of women think that there’s going to be a challenge with perceived insufficient milk and they hear a lot more of the negatives, and that’s not necessarily true or the case. Also, a lack of family or societal support, especially whenever mom may be looking to return to work, if she’s going to go back to the workplace down the line. I would say lack of knowledge and insufficient support are the more common barriers.

Healio: What are some things about breastfeeding that many mothers tend not to know about but should be aware of?

Stuesse: If they don’t know what’s normal and if they haven’t sought out education or gone to prenatal classes that are specifically about breastfeeding, they don’t know necessarily what a normal sleep-wake cycle is for a newborn, or how long babies can go between feedings or how often they should be feeding. There are differences between breastfeeding and formula feeding, and so they may perceive that they are not doing well or they’re not providing enough food for their babies. So, if they don’t have that knowledge of what’s normal, then they don’t realize that what they’re doing is perfectly normal and exactly what they and their baby need to be doing.

Healio: How can women become more educated on lactation?

Stuesse: Education starts prenatally. Getting some education from the get-go to start to lay that foundation is so important. Going to those prenatal classes, specifically those that are centered on breastfeeding, and then seeing what other support is available, either at the hospital they give birth at or in their community after the birth. The support doesn’t end after they’ve given birth. There are so many community resources that are helpful if they’ve laid that foundational work to give them that good basis, and then once they’ve gotten some hands-on experience themselves, knowing where to turn if they do find that they’re struggling or having some challenges and knowing where they can go for help will really help set a lot of women on a successful path with breastfeeding.

Healio: How can nurses help teach women how to successfully breastfeed?

Stuesse: So much of this comes back to solid knowledge and education. Nurses need to have that foundation themselves. Have they sought out training or education and do they have a good foundation of what’s normal and what’s not normal, so they know how to provide that education to the new moms? Nurses should let them know what they should experience or what they might anticipate experiencing in these early days and weeks, and help reiterate what moms maybe have learned prenatally. Nurses should also be able to provide community resources so moms have those at their fingertips whenever they are sent home, and they know where they can turn to start looking for additional help and support.

A lot of it comes from nurses taking initiative themselves to seek out education, unless they have gone through breastfeeding themselves and they are mothers who have that experience. Aside from what you get on the job training, there are additional trainings you can do, and a lot of those are more above and beyond what is from nursing school or on the job training. It does take a bit of self-drive and initiative, but there are trainings, classes, courses and things out there specific for breastfeeding that they could look into as part of larger educational opportunities. There may even be opportunities within their hospital where a hospital might contract somebody to come in and provide this training, or work with their in-house lactation department. If that hospital has a dedicated lactation unit, or staff personnel, they can work specifically with the nurses caring for those moms postpartum and share their expertise and knowledge rather than having to go seek anything out. That’s probably an easily, readily available resource if they have lactation in the hospital.

Healio: Are there any racial disparities in breastfeeding? If so, what are they and how can they be improved?

Stuesse: There are. Generally, we see certain ethnic groups like non-Hispanic Black or American Indian/Alaska Native women having a lower breastfeeding initiation rates. They’re also less likely to continue offering breast milk for the recommended 6 months. Those are probably the big ones that come to mind. A lot of these disparities come from not having support, not having follow-up and they’re maybe not provided education that they need from the get-go around breastfeeding and how to seek out additional support. A lack of general support groups can probably contribute to that. A lot of this comes back to educating. Where are these women living? Where are their community resources? Are they easily accessible, and if they’re not accessible, are there other resources that we can connect them with that work for their lifestyle or their situation? If they can’t leave the home and get there, what can we provide them to offer that support and meet them where they’re at?

Healio: For those struggling to breastfeed, what would you recommend?

Stuesse: Seek help. Know that you are not alone. Peers and loved ones are great resources, but knowing more formal support groups, especially those that have lactation professionals at the forefront are also great resources. So many hospitals have those support groups available within them. There are great community resources through things like the La Leche League. More informal support is great, but knowing there is more expertise and formal support out there and being aware of where to go for that is important.

There are outpatient lactation appointments, support groups and social media groups that women can connect with. Just knowing that the help doesn’t end whenever they’re discharged from the hospital is so crucial. You’ve got that training before you gave birth, we were there for you in the hospital, and knowing that we can keep being there for you when you go home — that’s what we want. We want women to know not to struggle alone. There are people out there who have experienced similar situations and have so much insight that they can share.

Healio: In your experience, have many women who struggle to breastfeed seek this support?

Stuesse: It’s kind of a mixture. I work at a hospital setting and we provide resources as part of the discharge paperwork and part of those prenatal classes is letting them know what resources are out there. I do see a lot of women taking advantage of those resources because they’re aware of them. But if they live in, perhaps, a more rural area, where they’re not able to get to those areas as much, there are other ways where they can connect. Maybe it’s not driving to the hospital setting, but there might be somebody in their community who still has that lactation background that’s willing to meet with them, either virtually or on the phone or meet them at their home. As long as women are aware of those resources, they’re more likely to take advantage of them. We just need to make sure that they know about them.