April 9, 2024 – Breastfeeding is hard, and most new moms need more help than they’re getting. At stake is their babies’ health, and their own.
That’s the message from an influential federal advisory group that is renewing its call for more breastfeeding support for new mothers. More than 90% of moms-to-be say they intend to breast feed, yet less than 60% are doing so when their babies reach 6 months old. Even fewer – just 27% – exclusively breastfeed at that point.
The benefits of breastfeeding for both Mom and Baby are huge. Breastfed babies are less likely to have respiratory illnesses, skin conditions, and stomach and intestinal problems like diarrhea. They have a lower risk of sudden infant death syndrome, and a long-term reduced risk of obesity, diabetes, and childhood leukemia. Breast milk contains antibodies that can help boost babies’ immunity against a range of infections, including measles. Among the benefits to mothers are reduced risks of postpartum depression and breast cancer.
Despite all this, the medical and public health sectors have yet to provide a clear set of tools to reliably help mothers.
Providing breastfeeding supports at multiple time points is more successful than a single intervention, according to the statement, published Tuesday in TheJournal of the American Medical Association, by the U.S. Preventive Services Task Force. In other words: Ongoing and readily available support is crucial.
For new and expecting moms, that’s your cue to be proactive. “Any intervention to support you during pregnancy and breastfeeding may help you achieve your breastfeeding goals,” said pediatrician Michelle Shepard, MD, PhD, an assistant professor at the University of Vermont Larner College of Medicine. “Don’t be afraid to tell your providers what you need.”
Setting Yourself Up for Success
Barriers to breastfeeding are complex, ranging from physical and psychological challenges (trouble latching, stress), to social and financial pressures like formula companies’ marketing tactics or the need for some moms to return to work just weeks after giving birth.
The best time to address these issues is before they start: Advocates say mothers should make a breastfeeding support plan and a list of resources ahead of time so it’s at the ready.
“Arrange support now rather than waiting till after birth, when you may be exhausted and overwhelmed,” said Jill Demirci, PhD, RN, an associate professor at the University of Pittsburgh School of Nursing.
You can find community support groups through ZipMilk (a site that provides listings for breastfeeding resources by ZIP code), or by asking what’s offered at your pediatrician’s office. Consider connecting in advance with an lactation consultant – telelactation, where you connect via video call, may be an option and is sometimes covered by insurance, Demirci said. Eligible people can also seek expert support via the federal Women, Infants, and Children (WIC) program. (Ask your OB/GYN or pediatrician about your local WIC program and whether you might be eligible.)
“Since breastfeeding is pretty much a full-time job for the first couple weeks, don’t forget to think about support with housework, cooking and meals, and your own mental health and sleep,” Demirci said.
“Postpartum doulas can be amazing and a great investment if you can afford it or your health plan covers or offers it,” she said. “If not, rally your village – family, friends, colleagues – to request things like meal trains or help with errands. Support is out there, but it may not be completely straightforward and easy to find in a pinch. It pays to have a plan before birth.”
Dealing With Challenges
When breastfeeding doesn’t go to plan, which is very common, it’s also important to get social and emotional support, Demirci said.
“Breastfeeding grief is real, and mental health practitioners with experience in the perinatal period can help,” she said. “Connecting to other mothers and families on social media or online support groups specific to new parenthood or breastfeeding may also work well for you.”
A lactation consultant can help you consider options like combination formula and breastfeeding, and help you avoid problems like mastitis during weaning. And for those who may stop due to challenges, relactation (restarting breastfeeding) is possible with guidance, even if it’s been six weeks.
For mothers who are trying to decide whether to continue or stop breastfeeding, Demirci and Shepard offered this advice:
- Grab a pen. Make a list of the pros and cons of stopping and what you would need to keep breastfeeding. Having trouble getting started? It may help if you make one pro-con list for yourself and a separate list for your baby.
- Talk about it. Tell your support people (partner, family) and your doctor or midwife and the baby’s primary care provider so you can be supported in your decision-making.
- Know your options. Remember, it’s still considered breastfeeding to give expressed (pumped) breast milk or donor milk via a bottle.
- Postpone your decision. Postpartum, your mood and situation can change a lot from day to day. “You can make a decision to ‘not make a decision,'” Demirci said. “See how things evolve and how you feel in a few days.”
- Sleep on it. “Sleep helps tremendously in mood and executive functioning like decision-making,” Demirci said. “Unfortunately, sleep is also hard to come by postpartum.” Aim to get at least two uninterrupted four-hour stretches of sleep per 24 hours. Have your support people do feedings and diaper changes during those times. “Some moms will pump right before they go to bed for the first stretch so that a bottle of expressed milk is ready to go for the first wakening of the night,” Demirci said.
- Take a break. “Ask a partner, family member, or friend to do a few feedings (pumped milk or formula in a bottle, for example) or all feedings for a couple of days; get rest and see how you are feeling about things in a day or two. Then you can make the decision,” Demirci said.
New moms who may be sensitive to the topic might want to consider a plan for setting boundaries for these conversations, too.
“A direct approach is always appropriate,” Demirci said. Try: “I don’t want to talk about my decision not to breastfeed. It’s a hard topic for me, and I’m comfortable with my decision to move on to formula.”
Or even simpler: “This is my personal decision, and I prefer not to discuss it,” Shepard said.
“The most important thing I tell families is that healthy parents make healthy babies,” Shepard said. If you’re having trouble or stress related to breastfeeding, let your health care provider know. “We are here to help, not judge.”
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