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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.

A healthy diet is desirable.

What are mothers' common and valid concerns about breastfeeding?

Common and valid concerns often held by mothers include:

Women may think they should not breastfeed

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

Breastfeeding is a learned art; many women do not find it easy especially in the first few weeks. Having a realistic idea of the needs and behaviours of infants, especially those that are breastfed, enables parents to adjust their expectations and goals for this time of their life accordingly. It will also help them to determine when they need to seek assistance from a trained professional, community resources or family and friends to provide physical, emotional and informational support. Developing support networks such as these prior to the infant's birth is very beneficial.

Discuss the most appropriate outcome depending on individual circumstances

Many women continue to breastfeed while they are in the paid workforce; however, a delay in the return to work allows breastfeeding to become well-established. 1 Work options (e.g. part-time, job share, working from home, flexible working hours), child care options (e.g. on-site child care, a child care centre near the work place, individual care that allows for the infant to be brought to the mother for breastfeeding) 2 and feeding options (e.g. expressed breastmilk; formula when separated, breastfeed when together; 3 or complementary foods if baby >6 months) can be explored; the most appropriate outcome depends on individual circumstance. If providing expressed breastmilk for the infant is not possible or appropriate, combining breastfeeding and formula-feeding is a viable option.3

Encourage both parents to develop their own unique roles

Feeding is only one part of infant care and, while fathers are unable to breastfeed, they can play an important role in the other aspects of caring for their children. While bathing, playing or settling their child a father begins to develop a unique relationship that is not dependent on supplying food. It is often a joyful experience as the infant becomes more interactive and responsive. By being aware of the reasons why breastfeeding is important and providing physical and emotional support for the mother, the father also contributes to successful breastfeeding outcomes.4

Support breastfeeding with confidence, anywhere the mother and baby may be

Learning to breastfeed takes time. Many new mothers feel awkward, uncomfortable and apprehensive about breastfeeding away from home until their baby is able to attach to the breast and breastfeed easily. If mothers feel more comfortable, breastfeeding can be done very discretely with clothing that lifts from the waist, or a wrap or shawl draped across the breastfeeding infant. Parenting rooms are also becoming more common as are venues designated 'breastfeeding friendly'. Regardless, a woman's right to breastfeed in a public place is protected by law in most parts of the World. 5

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

Diet has little effect on the volume and adequacy of the breastmilk produced for the vast majority of women, although a well-balanced diet is recommended for the woman's health and well-being. 12 Women who are poorly nourished, or have a specific deficiency (eg mothers following a vegan diet may become Vitamin B 12 deficient and produce milk that is vitamin B 12 deficient) may need to supplement their diet, or supplement their breastfed infant. 13 Some countries also recommend pregnant and lactating women have iodine supplements. 14

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

  1. # Guendelman S et al. (2009) Juggling work and breastfeeding: effects of maternity leave and occupational characteristics.
  2. # Hawkins SS et al. (2007) The impact of maternal employment on breast-feeding duration in the UK Millennium Cohort Study
  3. # McVeagh P (2001) Breastfeeding - help!
  4. # Tohotoa J et al. (2009) Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia.
  5. # Brobribb W (ed) (2012) International and National PerspectBreastfeeding Management in Australia
  6. # Donath SM et al. (2004) The relationship between maternal smoking and breastfeeding duration after adjustment for maternal infant feeding intention
  7. # Giglia R et al. (2006) Maternal cigarette smoking and breastfeeding duration.
  8. # Woodward A et al. (1990) Acute respiratory illness in Adelaide children: breast feeding modifies the effect of passive smoking
  9. # Einarson A et al. (2009) Smoking in pregnancy and lactation: a review of risks and cessation strategies.
  10. # Ladomenou F et al. (2009) Environmental tobacco smoke exposure as a risk factor for infections in infancy.
  11. # McAfee G ( 2007) Drugs of abuse and breastfeeding.
  12. # Butte NF et al. (2005) Energy requirements during pregnancy and lactation
  13. # Hopkinson JM (2007) Nutrition in lactation
  14. # National Health and Medical Research Council (2010) Iodine supplementation for pregnant and breastfeeding women.