1.4 Common breastfeeding concerns

Key Points - Case Study A
Joanne, aged 32, a regular patient, comes to see you when she is 12 weeks pregnant with her first baby. She has just returned from a trip around Australia and her pregnancy was confirmed by a doctor in the town they were in at the time. She has copies of her baseline blood tests with her and all are normal.
Would you discuss breastfeeding at this visit?
- Topic 1.1: Discussing breastfeeding
- It is important that doctors discuss infant feeding decisions and breastfeeding with women early in a pregnancy rather than waiting until the third trimester or after the baby is born.
What information would you give?
- Topic 1.2: What information to give
- When discussing infant feeding with mothers it is important to note that alternatives to breastfeeding have many undesirable outcomes.
Why do breastfeeding alternatives have different effects?
- Topic 1.3: Effects of Breastfeeding alternatives
- These effects are due in part to the presence in breast milk of substances and systems that act against infections and inflammation.
What are mothers' common and valid concerns about breastfeeding?
- Topic 1.4: Common breastfeeding concerns
- Exploring her concerns and providing information and reassurance is useful in allaying anxiety and prepares the parents for their changing role.

A healthy diet is desirable.
What are mothers' common and valid concerns about breastfeeding?
Common and valid concerns often held by mothers include:
- uncertainty regarding their chances of success
- how they can return to paid work and continue to breastfeed
- whether their partner will feel left out if they breastfeed
- embarrassment about breastfeeding in public
Women may think they should not breastfeed
- if they smoke
- have an occasional alcoholic drink
- eat 'junk food'
Exploring these and other concerns and providing information, reassurance and other resources is useful in allaying anxiety and preparing the parents for their changing role.
Topics to discuss
Encourage acquiring knowledge and support networks
Discuss the most appropriate outcome depending on individual circumstances
Encourage both parents to develop their own unique roles
Support breastfeeding with confidence, anywhere the mother and baby may be
Assist women to quit smoking and limit alcohol intake while breastfeeding, but it's better to be breastfed than formula fed even if the mother smokes.
While nicotine and alcohol enter breastmilk, any adverse effects in the infant are much smaller than the adverse effects of alternatives to breastmilk.
Women who smoke are less likely to initiate breastfeeding, 6 and breastfeed for a shorter duration. 7 Their infants are exposed to nicotine and other substances through the air they breathe and their skin regardless of the method of infant feeding. Breastfeeding significantly modifies the effect of smoking on the risk of respiratory tract infections in the infant. 8
9 however, it is more detrimental for an infant of a mother who continues to smoke to be formula fed than breastfed. 8 10
Alcohol passes readily into milk with levels peaking 30-60 minutes after ingestion. As the mother metabolises the alcohol, levels in milk reduce in parallel to maternal plasma levels. By 2 hours following the ingestion of one standard drink there is minimal amount of alcohol in breastmilk.
11
Discuss healthy eating for maternal well-being

Case Study Activity
Think about what your response would be to the scenario presented, write it into the exercise, then submit it and read the suggestions given.
Notes
- # Guendelman S et al. (2009) Juggling work and breastfeeding: effects of maternity leave and occupational characteristics.
- # Hawkins SS et al. (2007) The impact of maternal employment on breast-feeding duration in the UK Millennium Cohort Study
- # McVeagh P (2001) Breastfeeding - help!
- # Tohotoa J et al. (2009) Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia.
- # Brobribb W (ed) (2012) International and National PerspectBreastfeeding Management in Australia
- # Donath SM et al. (2004) The relationship between maternal smoking and breastfeeding duration after adjustment for maternal infant feeding intention
- # Giglia R et al. (2006) Maternal cigarette smoking and breastfeeding duration.
- # Woodward A et al. (1990) Acute respiratory illness in Adelaide children: breast feeding modifies the effect of passive smoking
- # Einarson A et al. (2009) Smoking in pregnancy and lactation: a review of risks and cessation strategies.
- # Ladomenou F et al. (2009) Environmental tobacco smoke exposure as a risk factor for infections in infancy.
- # McAfee G ( 2007) Drugs of abuse and breastfeeding.
- # Butte NF et al. (2005) Energy requirements during pregnancy and lactation
- # Hopkinson JM (2007) Nutrition in lactation
- # National Health and Medical Research Council (2010) Iodine supplementation for pregnant and breastfeeding women.