Family Matters

Why Most Moms Don’t Reach Their Own Breast-Feeding Goals

American women's low breast-feeding rates aren't due to lack of desire, a new study finds. Moms say they want to breast-feed, but they end up falling short of their goals. Experts believe it's due to lack of support.

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Few new mothers actually hew to the public-health recommendations that they breast-feed exclusively for the first six months, but it’s not for lack of desire.

A new study in the journal Pediatrics finds that most mothers want to breast-feed their babies exclusively — offering just breast milk, not infant formula — for at least three months, but just under a third of those women reached their goal.

“We’re not supporting women to meet their own intentions, which is just sad,” says lead author Cria Perrine, an epidemiologist at the Centers for Disease Control and Prevention (CDC) who focuses on infant feeding.

In a negative commentary on how likely women were to reach their breast-feeding goals, Perrine noted that those women who intended to breast-feed for the least amount of time were the most likely to succeed.

The American Academy of Pediatrics recommends that mothers feed their babies only breast milk for the first six months of life and continue to breast-feed, along with introducing table foods, until baby’s first birthday or beyond because breast-feeding offers myriad health benefits for baby and mom.

Previous research has documented that few U.S. mothers meet the guidelines; only about 15% of moms are still exclusively breast-feeding at six months. But experts didn’t know if the low breast-feeding rates resulted from mothers’ lack of interest in breast-feeding or because other factors were making it difficult to persevere.

(MORE: Extended Breast-Feeding: Is It More Common than We Think?)

Now Perrine has showed that it’s the latter. She and colleagues looked at data from an infant feeding study launched in 2005 that followed 3,000 women in their third trimester of pregnancy. The women were asked about their intentions regarding exclusive breast-feeding; those intentions were then tracked monthly over the course of a year. They found that 60% of moms said they wanted to breast-feed exclusively; 85% of that group wanted to do so for three months or more and 58% said they planned to continue for at least five months, but just 32.4% actually met their goals.

Of the 85% who said they wanted to breast-feed exclusively for at least three months, just 45% succeeded; of the 58% who said they planned to nurse for at least five months, only 25% did. “One of the biggest shockers is this entire group we looked at wanted to exclusively breast-feed,” says Perrine. Just 1% of them said they intended to breast-feed exclusively for less than a month, but 42% stopped within that first month. “To me, that demonstrates we are not supporting mothers to feed their infants the way they’d like to,” says Perrine.

In other findings, married mothers and those with other children were more likely to achieve their goals; obese mothers and those who smoked were less likely. Some factors tended to improve the odds of success, including initiating breast-feeding soon after delivery and not giving newborns supplemental formula or pacifiers in the hospital. Moms whose babies didn’t receive formula in the hospital were 2.5 times more likely than moms whose babies got formula to meet their stated breast-feeding goals. Forty percent of babies received supplemental formula in the hospital.

Hospitals play a critical role in jump-starting a successful breast-feeding relationship, and those that are most committed to getting breast-feeding off to a good start — by encouraging babies to remain in their mothers’ hospital rooms where they can nurse on demand, for example, or breaking the tradition of sending new moms home with free formula samples in diaper bags paid for by formula manufacturers — are getting certified as “Baby-Friendly” facilities. But only 4% of hospitals can claim that distinction.

(MORE: Fewer Hospitals Hand Out Free Formula to New Moms)

“I think it starts with hospitals, which need to support mothers to feel confident when they leave,” says Perrine. “Employers and families have to be on board, and communities have to be comfortable with women breast-feeding in public. But hospitals are the front line. If women don’t even get started, there’s no way they can meet their goals.”

Once they’re released, moms also need follow-up care. “Most women are in the hospital two days and that is not enough time to feel confident,” says Perrine. “Just because breast-feeding is natural doesn’t mean it’s easy.”

Or intuitive. Breast-feeding moms could set themselves up for greater success by setting reachable goals, says Bettina Forbes, co-founder of Best for Babes, a breast-feeding advocacy organization that decries the “booby traps” they say new mothers face when trying to establish breast-feeding. Those traps include cultural disapproval of nursing in public, too few Baby-Friendly hospitals, insufficient legal and employer protection and physicians who “appear to support breast-feeding but are woefully under-educated on even the basics of lactation management or how to refer moms to a specialist.”

“A strategy of building on success works well in all aspects of life from training for a race or planning to lose weight,” says Forbes. “Why should breast-feeding be any different? If every expecting mother were seen by a board-certified lactation consultant that can help her set goals appropriate for her situation, and work with her to develop a plan to overcome any barriers along the way, breast-feeding rates would skyrocket, and we would all benefit.”

MORE: Bring Back the Binky? Study Finds Pacifiers Actually Boost Breast-Feeding

4 comments
lizfbistudio
lizfbistudio

The elephant in the room is employment. As a working mom I can attest to the pump-at-work situation. It's slightly uncomfortable and incredibly impractical. I can see why many women opt not to go there. 

I have three kids. Breast fed each of them with no formula whatsoever, for two plus years, each. When I was much younger I was sort of annoying when it came to this issue. But by the time I had my last child I realized just doing the nursing and acting as if it is normal (which is was, for us) is the best way to deal with people who don't get it. I don't mean whipping it out for everyone to see. I mean discretely nursing while your baby is in a sling while you grocery shop, or pumping in a nice clean area you and your boss set aside, and not acting ashamed when you go to and from. I don't mean being a jerk about it. Jut be proud of what you're doing and treat the act as a commonplace, no biggie thing. That's what helped me. Because in the end it's not just what you do, but the WAY you do it, which will help change things.

EmilyBarlow
EmilyBarlow

This country sucks. Period. I have breastfed my daughter for three and a half years. Yup people. I can almost feel some of you raising your eyebrows.... and guess what... I don't care. That's how I lasted this long. I did what felt right for me and my kid. Not what some bunch of jump start idiots thought was the cool fad of the decade or the century. A couple of hundred years ago if your baby ate mud water instead of breast milk, he or she was gonna die. No doubt about it. The US has one of the highest infant mortality rates TODAY. Here's why, in my opinion. I went back to work when my infant was a miserable six weeks old. And she got sick A LOT in daycare. I breastfed her but it took a while for me to get sick with the illnesses she picked up in the daycare, whereupon I produced antibodies and she got better. But it took a few days. She was hospitalized a few times, fever etc. It sucked and was scary. But she didn't get too dehydrated, never got an ear infection and never had diarrhea for very long. I attribute all these things to the breastfeeding. She also got flu but was never hospitalized for pneumonia, unlike some of the other kids in daycare who weren't breastfed. But guess what dudes? I did it all on my own. No help from employers, judgment up the whazoo from office manager ("why are you still breastfeeding a twelve month old?") absolutely exhausted BEYOND BELIEF coz the little ones revert to "reverse cycling" when mommy works. Which means they feed all night when mommy is around. So you, as mommy you get NO SLEEP. So you get sick and burnt out and your employer hates you. Basically life sucks if you are a mother in the US of a breastfeeding kid. Plus, jump forward a few years, God Forbid you tell a pediatrician that you are still breastfeeding a 3.5 year old kid, that pediatrician (Male, no kids, no boobs) tells you that "there's no longer and nutritional value in your breastmilk" (contrary to what the la leche league says on its website) basically he can go DO SOMETHING INDECENT TO HIMSELF because I don't care what he says!!! I'm going to do what feels right for me and my kid. And all mothers out there should do the same. Screw everyone else. They aren't the one up at 2 am with your kid. You are. You get to make the decisions. Your instinct rules supreme. Especially in cultures around the world where women are vauled (most of these cultures got eradicated by white MALE christian colonialists but that doesn't matter). Yup I'm a feminist too. But only became one when I became a mother and realized how women only TRULY get donkey pooed on when they become mothers.

jtsmeep
jtsmeep

  When did formula become the bad guy? Its presence doesn't indicate it is the CAUSE of breastfeeding failure. I am a mom of 4, ALL of whom were breastfed. With the first, I had no one to turn to for advice, except a hospital lactation consultant I only saw a couple of times. I was so frustrated. It hurt; that can't be right? Is she getting enough? There's no way to measure. She's starting to lose weight and become jaundiced! What do we do? All of these are typical concerns for first-time breastfeeding moms. Notice I didn't mention formula in any of those concerns. Formula is just the often-proposed solution to all those problems. There's a perception that if any of those things are happening (breast/nipple pain, weight loss, jaundice), that the mother should give up breastfeeding immediately before her child suffers further damage. It's the perception, the incredible PRESSURE of those around you, thinking you're a bad mom or that you must not be doing it right; or the fear of hurting your new little baby.  These pressures makes us give in too easily, and formula is there to step in. It doesn't hurt anybody, but it makes it a lot easier to give up.

   With my first, I gave in and gave her formula.  I kept trying to breastfeed occasionally, and then when we were both frustrated, I gave her a bottle.  In the beginning, she had much more formula than breastmilk.  She had trouble latching (because I didn't know what I was doing), and eventually started preferring the bottle.  After a month, I'd had it.  She was not going to starve to death in a day...I only offered her the breast until we both figured it out.  It was a painful few days of a screaming baby, an angry husband, and frowning lectures by my mother (who only bottle-fed).  Stubbornness won out; and eventually we got it.  I breastfed her for 5 more months.  

   The rest of my children were so much easier.  I knew to expect pain and tenderness at the beginning (hello, you're letting something stretch and pull at an extremely sensitive part), and I knew that even though a newborn has a teeny little mouth, you have to flatten out your nipple (pinch the side) and shove it as far in as you can (don't worry, they won't choke).  Most people mess up right there.  If you don't put your breast waaaaay in there, the baby will just suck on the tip and chew to get the milk out, which will cause so much pain that you'll swear the baby has knives in its mouth.  I also knew to expect weight loss at the beginning - all of mine lost around a pound before gaining again, which the doctors frowned upon (because they're not used to it; formula causes much quicker weight gain).  One child even took three weeks to get back to his birth weight.  The question shouldn't be, "Are they back to birth weight yet?"  Rather, it should be, "Are they gaining every day?" and "Are they having wet/poopy diapers?"  If they are, they're going to be okay.  As for jaundice, well, a lot of breastfed babies get it.  You just have to keep feeding constantly and let them flush it out.  It might take a couple of weeks, or it might take a prescribed bili-blanket (my first child looked like a glowworm).  Think about it; your milk doesn't come in the first day.  Colostrum isn't as liquid as formula or breastmilk.  Things move a little slowly in the beginning.

   What am I saying here?  I'm saying DON'T GIVE UP.  KEEP TRYING.  And don't listen to negativity.  Your baby will be okay.  People have fed children this way for the majority of the population for the majority of the history of the world.  You can get it.

   Back to formula.  If you breastfeed first, you can give formula after.  Don't be frustrated with pumping; formula can supplement your supply while your baby is at the sitter.  Pumping is more to keep your supply up while you're away, anyway.  No pump is going to work as efficiently as a baby.  The amount you get from a pump is smaller than what the baby gets, and it's really frustrating to try to pump twice as much to make what your baby will need while you're away.  Don't fall into the I'm-not-making-enough trap.  There's ALWAYS milk in there.  You don't run out.  You just can't measure it.  Just pump around feeding times or when you can; there will be a drop in supply for the next real feeding, but the baby will just nurse extra and by the feeding after that, you'll produce more.  

   People are so stressed out when they try to breastfeed.  There's so much pressure built up around getting it perfect the first time.  For newbies, it's nearly impossible to get it perfect the first time without an experienced woman right there, helping you.  Then the pressure is to immediately switch to formula and not go back.  I think people just need to relax.  You can do both (formula and breastmilk).  Don't stress; do the breastfeeding first, and feel good about the try.  Do formula if you're really worried (not enough wet diapers), and feel good about that, too.

tilly
tilly

@EmilyBarlow I only read your first sentence.  Then leave.  Go see how great it is elsewhere.