Tackling Breastfeeding Challenges

“Breast is best.”

This phrase has gained traction in recent years as research continues to link breastfeeding to numerous health benefits for both mother and baby.

According to the Office of Women’s Health, U.S. Department of Health and Human Services, infants who are breastfed are at lower risk for asthma, obesity, type 2 diabetes and SIDS, while their mothers show fewer incidences of type 2 diabetes, breast and ovarian cancer as well as postpartum depression.

“The benefits of breastfeeding are unparalleled,” noted Mary Lovegreen, BSN, RNC, IBCLC, clinical nurse at Newport Hospital, Newport, R.I. “Not only does the practice support healthy outcomes, but it also plays a key role in mother/baby bonding.”

Patient Education

While the benefits of breastfeeding are widely known and supported by a plethora of research, it can seem like a daunting task for new mothers.

For a successful breastfeeding experience, patient education must begin well before a mother gives birth and continue after they go home with their new baby.

“If moms aren’t informed about what they can do to have the best possible experience in the birth hospital, oftentimes ideal care doesn’t happen, which then gets breastfeeding off to a bumpy start,” explained Diane L. Spatz, PhD, RN-BC, FAAN, professor of Perinatal Nursing & Helen M. Shearer Professor of Nutrition, University of Pennsylvania School of Nursing, and nurse researcher-Lactation, The Children’s Hospital of Philadelphia (CHOP).

“It is important for nurses to be able to provide evidence-based support and care before, during, and after birth,” she added. “We have a special delivery unit here at CHOP and we meet with moms prenatally to discuss the value of breastfeeding.”

At Newport Hospital, a “Baby-Friendly“-designated facility, mothers can participate in a prenatal breastfeeding class. “We provide the knowledge mothers need to ensure they understand the benefits as well as challenges of breastfeeding,” said Lovegreen.

Additionally, a breastfeeding support group meets weekly. “Mothers are given the opportunity to work with professionals and fellow mothers to overcome any challenges they may be having,” explained Lovegreen. “Continued education and guidance is imperative to ensure mothers are able to continue breastfeeding successfully.”

Fostering Comfort

Facilities must provide mothers with an environment where they feel comfortable and supported by staff members.

“When soon-to-be mothers come to the hospital they should be in an environment that is supportive and accepts breastfeeding as the norm,” noted Lovegreen. “We do all we can to help mothers make a decision about breastfeeding before they arrive for delivery, but we continue to offer guidance and support throughout and after their stay.”

“So many women can be faced with breastfeeding barriers as soon as they deliver their baby, which is why policies must be in place to support them,” stressed Spatz. “A baby should be put skin-to-skin immediately following birth and the baby should remain there until he/she is able to breastfeed.”

“The baby should also be rooming-in with mom and breastfeeding on-demand,” she added. “As health professionals it is our responsibility to teach mothers how to recognize feeding queues.”

“Crying is a late sign of hunger, and if mothers wait to pick up a baby until they are crying and frantic the feeding will not usually go well, which is why close proximity is vital.”

At Newport Hospital, these practices are in place and nurses as well as certified lactation consultants are on hand to provide mothers with individualized support throughout their stay.

It is just as important for mothers to have access to a support system following delivery.

“At home moms can run into challenges with latching and if the baby doesn’t attach well then they can end up getting sore nipples or skin breakdown,” Spatz emphasized. “If they don’t think the baby is getting enough that might lead them to supplement with formula, which in turn will interfere with the breastfeeding process.”

Breastfeeding Barriers

Some mothers may find themselves facing hurdles that could limit their ability to breastfeed, but with help from nurses and other healthcare professionals the majority will be able to breastfeed.

“There are very few true contraindications to breastfeeding,” explained Spatz. “In the United States, a mother who is HIV positive cannot breastfeed. Also, if a mother were an active illegal drug user we would recommend she not breastfeed, but other than that most moms are able to do so.”

“There are very rare instances when a mother can’t produce a sufficient amount of milk for her baby, known as glandular hypoplasia, which is the true absence of adequate glandular tissue in the breast,” she added. “This condition is only reported in about 1% to 2% of the population.”

Sometimes glandular hypoplasia only affects one breast, which would allow a mother to breastfeed exclusively from the other breast, reported Spatz. “The instance of true glandular hypoplasia is very small,” she emphasized.

According to Spatz, when women first begin to breastfeed they may have what is called a “perceived insufficient milk supply.”

“Mothers may think they aren’t producing enough milk, which could lead to formula supplementation,” she said. “As a result the baby’s desire to breastfeed will decrease, which in turn down-regulates the mother’s milk supply. This is why follow-up appointments are crucial. A mother has to have someone she can go to with her concerns.”

“Women may face anatomical issues, such as tubular breasts, flat or inverted nipples, that can make breastfeeding challenging, but not impossible,” added Lovegreen. “That is why it is important that nurses and other health providers are there to help mothers understand and overcome these difficulties.”

Breast surgery can hinder breastfeeding as well. “Certain breast surgeries can cause very poor breast performance,” stated Spatz. “A mother who underwent surgery might not be able to make a full milk supply, but it would be better for them to provide at least some of the milk for the baby then not provide any breast milk.”

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