In 2014, the Centers for Disease Control (CDC) reported the breastfeeding initiation rate among American women continued its rise. The most current data identifies 79.2% of American women initiate breastfeeding (The United States Breastfeeding Report Card 2014). This continued increase in initiation rate is encouraging and reflects the continued work of multiple national and local campaigns. The data tells us that mothers want to initiate breastfeeding. Unfortunately, the data also demonstrate only 40.7% of women are exclusively breastfeeding their infants at 3 months. More than one-half of US mothers don’t achieve their intended breastfeeding goals supplementing their infants very early in the post-birth period with infant formula or stopping completely earlier than they planned.1, 2 A recent report suggested that 60% of mothers who initiate breastfeeding did not continue to breastfeed for as long as they intended.
Mothers cite a variety of reasons for not continuing breastfeeding, many related to infant health concerns including concerns about the lactation process and breastfeeding challenges. However, the perception of insufficient milk supply is cited as the major reason to supplement with infant formula and often complete weaning.3-5
There are a number of evidence-based strategies and technologies clinicians should consider to help combat these milk volume issues. Employing these strategies begins prenatally through education, helping a mother set realistic expectations and by helping to increase her confidence about her breastfeeding abilities. Breastfeeding assistance continues in the immediate post-birth period by ensuring healthy infants initiate breastfeeding within the first thirty to sixty minutes of life and continue breastfeeding at the frequency of 8-12 times in twenty-four hours during the first few weeks after birth. Any delay in the initiation of lactation may affect subsequent milk production and volume. In the absence of pathology, the frequent and continued sucking of the healthy, term infant will drive milk synthesis, producing copious volumes of breast milk. With minimal assistance, the healthy, sucking infant and his mother will experience successful lactation.
Some infants may not exhibit a robust start at breastfeeding. They may have difficulty latching or be ineffective at removing milk. In such cases, mothers should be advised to begin regular and frequent milk removal as soon as possible. The use of breast pumps and hand expression are two methods of milk removal utilized by mothers.
The use of a hospital-grade, double electric breast pump has been recommended to help mothers remove breast milk when their infants are unable to breastfeed or adequately remove breast milk. The Medela (McHenry, IL) Symphony® Breastpump Preemie+ ™ with Initiation Technology™ incorporates the sucking pattern utilized by healthy term infants during the first few days post birth. This initiation pattern has effectively demonstrated a greater daily milk production of milk between days 6-13 post birth in mothers of premature infants and term infants.6, 7 It is recommended that mothers double pump when using an electric breast pump to decrease the time spent pumping as well as increasing milk volumes.
Assessment of breast shield fit should be considered whenever mothers utilize a breast pump. Breast shields, that portion of the breast pump collection kit that comes in direct contact with the mother’s breast, nipple and areola areas should be frequently evaluated to ensure they correctly fit. An incorrect fit may result in incomplete breast emptying leading to the down regulation of milk volume and subsequent insufficient milk volumes.
Regardless of the cause, earlier than expected cessation of breastfeeding should be a concern to health care personnel. The early cessation of breastfeeding can negatively impact both the mother and the infant; the infant does not receive the health benefits of exclusive breast milk feeding and the mother may encounter emotional distress by not meeting her lactation goals. I have heard many mothers sadly relate stories of not meeting their individual breastfeeding goals months and even years later. Every mother deserves the best opportunity to successfully breastfeed and the best chance to meet her personal lactation goals. Intervening early prenatally and in the initial post birth period with evidence-based lactation strategies and technologies may make a difference in helping the mother in meeting her personal lactation goal.
1. DiGirolamo A, Grummer-Strawn L, Fein S. Infant Feeding Practices Study II: study methods. Pediatrics. 2008;(suppl 2):S28-35.
2. Perrine CG, Scanlon KS, Li R, Odom E, Grummer-Strawn LM. Baby-Friendly hospital practices meeting exclusive breastfeeding intention. Pediatrics. 2012;130(1):54-60.
3. Li R, Fein SB, Chen J, Grummer-Strawn LM. Why mothers stop breastfeeding: mothers’ self-reported reasons for stopping during the first year. Pediatrics. 2008:122(suppl 2):S69-76.
4. Odom EC, Ruowei L, Scanlon KS, Perrine CG, Grummer-Strawn L. Reasons for earlier than desired cessation of breastfeeding. Pediatrics. 2013. 131(3):e726-e732.
5. Wagner EA, Chantry CJ, Dewey KG, Nommsen-Rivers LA. Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months. Pediatrics. 2013;132(4): e865-75.
6. Meier PP, Engstrom JL, Janes JE, Jegier BJ, Loera F. Breast pump suction patterns that mimic the human infant during breastfeeding: greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J Perinatology. 2011; 31:1-8.
7. Torowicz DL, Seelhorst A, Froh EB, Spatz DL. Human milk and breastfeeding outcomes in infants with congenital heart disease. Breastfeed Med. 2015;10:31-7.