By Jan Tedder, BSN, FNP, IBCLC; President of HUG Your Baby; See Roadmap to Breastfeeding Success Online Course
Research confirms that a woman's misunderstanding of normal child development is an important, and often over-looked, cause for abandoning breastfeeding. Though these issues are covered in depth in The Roadmap to Breastfeeding Success online course, we must be aware of the other, complex variables that may impact a woman's ability to initiate breastfeeding and to continue to breastfeed.
Demographic variables
Demographic variables that make women less likely to begin and continue
breastfeeding include: prenatal smoking (Bertino et al., 2012); lower
socio-economic, racial or ethnic status; having an unplanned
pregnancy or not having a partner; being less-educated (Li et al.,
2008); participating in a WIC program (Thulier & Mercer, 2009); and being obese, which is associated with a delay in
milk coming in (Stuebe et al., 2014).
Social Variables
Other research moves demographic data to a wider screen by
identifying particular social variables that impact initiation and duration of
breastfeeding: worries about breastfeeding in public (Stuebe & Bonuck,
2011); lack of partner support and marital distress (Stuebe & Bonuck, 2011;
Hinsliff-Smith et al., 2014); giving birth at a non-Baby-Friendly
hospital; and returning to work.
We know that breastfeeding rates increase when pregnant women get
together with successful breastfeeding mothers. In addition, an important study
demonstrates that women who
observe breastfeeding role models through videos (and who receive praise from
their partners or their own mothers for breastfeeding) have significantly higher levels of confidence in and commitment
to breastfeeding than do mothers who lack this kind of support (Kingston,
2008).
It is important to
ask what kind of help and support new mothers need. A study from China showed
that a grandparent in the home, among other variables, is associated with shorter breastfeeding duration (Liu et al., 2013). Research in Japan showed that the more fathers were involved with care of
their infant the less anxiety their partners had—but the more formula the baby received (Ito et al., 2013). Both of these studies
may indicate that loved ones need to be shown ways other than feeding to connect
with a baby and help a new mother.
Biological Variables
Biological variables that impact breastfeeding include: a mother
having physical challenges such as sore nipples, engorgement, mastitis, or
plugged ducts before a baby is four weeks of age.
Remember that a woman who identifies any breastfeeding concerns at day 3 and 7
postpartum is less likely to be successfully
breastfeeding at 2 months (Wagner et
al., 2013). Mothers with early complaints need careful follow-up and ongoing
support.
Interesting work by Kathleen Kendall-Tackett makes a connection
between a woman’s experience of postpartum pain and its impact on breastfeeding
(Kendall-Tackett, 2007). She explains that pain increases the body’s
inflammatory process. This inflammatory process causes neuro-hormonal changes
that are associated with depression. Kendall-Tackett concludes that pain from
c-sections, or with breastfeeding, may create the conditions that result in
postpartum depression.
Studies also show that mothers who have pain the first two weeks
postpartum—and do not receive the help they need—are more likely to have
postpartum depression at two months (Watkins et al., 2011). These studies
confirm the importance of getting immediate lactation help for women having
postpartum pain.
As one would expect, physical problems in the baby—such as
prematurity, illness, or tongue-ties—also contribute to decreased
breastfeeding duration and require both special medical care and more lactation
support.
Psychological Variables
Though more research has been focused on how psychological
variables impact the initiation rather than the duration of breastfeeding (De Jager et al., 2012), current literature
suggests that at least four psychological issues influence breastfeeding
success: postpartum depression, a mother’s intention and confidence to
breastfeed, her sensitivity to her baby, and maternal-child attachment.
Postpartum depression occurs in 13% of mothers (Borra et al., 2014). Work by Kathleen
Kendall-Tackett and others explores how the hormones of pregnancy help protect
women from postpartum depression, a process, they say, that explains why women
who breastfeed have a lower incidence of depression (Kendall-Tackett,
2010).
In addition, other research
shows that women with postpartum depression or anxiety often misread
their baby’s body language (Arteche et al., 2011). Studies show that a woman with postpartum
depression or anxiety can accurately identify her baby’s distressed face,
as do mothers without these psychological conditions. However, the depressed or
anxious mother will see her baby’s neutral face as distressed.
And, this same mother seems unable to see her baby’s happy face (Arteche et al., 2011) Therefore,
helping a mother with postpartum depression accurately read her baby’s
body language may increase both that mother’s confidence and her
breastfeeding duration.
Second, a women’s intention to breastfeed is a
contributing factor to breastfeeding duration. Women who decide prenatally to
breastfeed are more likely to be successful breastfeeding mothers
(Meedya et al., 2010). Besides identifying an expectant woman's intention
to breastfeed, helping her also say how long she plans to breastfeed has
been shown to be important.
However, it is important to bear in mind that if a woman intends
to breastfeed, and then is unsuccessful in meeting her breastfeeding goals, she
will suffer a higher incidence of depression than if she had not
intended to breastfeed in the first place (Borra et al., 2014). This research
reinforces the need for immediate and effective breastfeeding support as soon
as any breastfeeding problem arises.
Lack of confidence leads many women to give up breastfeeding
when there are challenges to overcome. Fortunately, work by Dr. T. Berry Brazelton
and others (Kadivar & Mozafarinia, 2013) demonstrates the remarkable power
of using the baby’s behavior to enhance the confidence of
young parents (Brazelton & Sparrow, 2006; Nugent et al., 2007).
Third, research indicates that prenatal women who establish their
intention to breastfeed exhibit increased sensitivity to their infants’ cues. In
addition, these mothers show an increase in both their duration of
breastfeeding and in their exclusive breastfeeding rates (Thulier & Mercer,
2009; Tharner et al., 2012).
Helping a father experience his baby’s ability to interact, or a
mother see her baby’s ability to turn toward her face when she calls her name,
are techniques that have been shown to increase parent-child bonding and to
boost parent confidence. Other studies show that mothers who are highly
confident about breastfeeding are more likely to be exclusively breastfeeding
at one week and at four months postpartum (Blyth et al., 2009).
Fourth and finally, the issue of maternal-child attachment and
breastfeeding is important, both to parents and to the health care providers
who serve them. A 2012 study used the well-accepted Ainsworth Sensitivity
Scales to assess the impact of breastfeeding on attachment and continued
breastfeeding. Mothers who breastfeed to six months demonstrate the highest
levels of maternal sensitivity and secure attachment to their baby (Tharner et al., 2012).
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©HUG Your Baby 2015
