Breastfeeding fraught with early challenges for many first-time mothers

CINCINNATI -- Most new mothers in the United States begin breastfeeding when their children are born, but new research shows that those who report early concerns or problems with breastfeeding are nearly 10 times more likely to abandon breastfeeding within two months.

In a new study 92 percent of new moms reported at least one breastfeeding concern three days after birth. The most predominant concern, in 52 percent of mothers, was infant feeding at the breast, which refers to the behavior of the baby, such as not "latching on" properly. Other common concerns included breastfeeding pain (44 percent of mothers) and milk quantity (40 percent of mothers).

"Breastfeeding problems were a nearly universal experience in the group of first-time mothers in our study, with some of the most common problems also being the most strongly associated with stopping breastfeeding," says Laurie Nommsen-Rivers, PhD, a researcher in the Perinatal Institute at Cincinnati Children's Hospital Medical Center, assistant research professor of pediatrics at the University of Cincinnati College of Medicine and lead investigator of the study. "Priority should be given to enacting strategies for lowering the overall occurrence of breastfeeding problems and, in particular, targeting support for mothers with infant feeding or milk quantity concerns within the first week after leaving the hospital."

The study is published online in the journal Pediatrics. Researchers included Kathryn Dewey, PhD, and Caroline Chantry, MD, at the University of California Davis Medical Center, and Erin Wagner, a clinical research coordinator at Cincinnati Children's.

The researchers conducted a series of six interviews with 532 first-time mothers, beginning in pregnancy and also at three, seven 14, 30 and 60 days after giving birth. The researchers received reports of thousands of breastfeeding problems and concerns. Those concerns reported at interviews conducted at days three and seven postpartum were strongly associated with subsequently stopping breastfeeding, according to Nommsen-Rivers.

"This may be related to the fact that these interviews captured a time when there is often a gap between hospital and community lactation support resources," she says. "Our findings indicate helping mothers meet their breastfeeding goals requires a two-pronged approach: Strengthening protective factors, such as prenatal breastfeeding education and peer support, and ensuring that any concerns that do arise are fully addressed with professional lactation support, especially in those first few days at home."

The 8 percent of mothers who did not report any breastfeeding problems or concerns at day three seemed to have protective factors that prevented them from experiencing concerns that led to formula use, says Nommsen-Rivers. These factors include prenatal self-confidence about breastfeeding, youth, unmedicated vaginal birth and strong social support.

The study was supported by grants from the National Institutes of Health (NIH HD063275-01A1) and (MC 04294).