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Providing perspectives on recent research into vitamins and nutritionals


What Are the Most Common Breastfeeding Concerns for Women?

By Julia Bird

Breastfeeding is the recommended way to provide infants with the nutrition that they need early in life. Even though breastfeeding initiation rates are generally high in many countries, the proportion of infants that are exclusively breastfed for the advised period of 6 months is low. The reasons why women stop breastfeeding are diverse ye t is important to know what is going on so that women who want to breastfeed can be assisted as much as possible. A recent publication by Wagner and colleagues identified a large number of breastfeeding concerns from a group of over 400 pregnant women and followed them until 2 months postpartum to identify the most common problems and whether they were related to breastfeeding discontinuation.

The survey was conducted as part of the Early Lactation Success in a Multi-Ethnic Population study conducted in California, USA. 532 women expecting their first child were interviewed during the last two months of pregnancy, then within 24 hours of birth, and 3, 7, 14, 30 and 60 days postpartum. Women were asked an open-ended question about any problems or concerns that they had breastfeeding as part of a series of other questions. The responses were then categorized by the research team to identify which factors may affect breastfeeding continuation.

During the study, the majority of women expressed concerns with breastfeeding. During the prenatal interview, around 80% of women had concerns about breastfeeding, which rose to 90% by day 3 and decreasing to 60% by day 60. The most common reasons for concern fell under the “infant feeding difficulty” category (including problems with latch, sleepy neonates, the infant being fussy at the breast or refusing to breastfeed), accounting for half the concerns on day 3 and thereafter a decline to 20% by day 60. Day 3 was also the peak for concerns about milk quantity; this the time at which most new mothers’ milk should have come in, and milk production by this time was found to be a predictor of exclusive breastfeeding (Brownell).  Interestingly, the concern “inadequate infant intake” was much less prevalent than related concerns about the adequacy of milk production. By day 7, breastfeeding pain was the prevailing concern, experienced by about half of women. After day 7, concerns related to the process of breastfeeding were in decline, however mother/infant separation and the “other” category that included infant feeding and spitting up was starting to increase through to 2 months postpartum.

Aside from information about the prevalence of breastfeeding concerns, the authors also looked at which concerns were linked to breastfeeding cessation. Using the adjusted odds ratio, women with any concern about breastfeeding on days 3 and 7 postnatal were 14 and 7 times more likely to discontinue than women with no concern. At other time points, any breastfeeding concern roughly doubled risk. The categories most associated with formula feeding or breastfeeding cessation were concerns about milk quantity, infant feeding difficulty and insecurity about breastfeeding.

On the whole, these results show that most women have concerns about breastfeeding. The highest level of concern appears to occur between days 3 and 7, after women with uncomplicated pregnancies have been discharged from the hospital but before their infants’ 2-week checkup. Some concerns in particular appear to be related to premature discontinuation of breastfeeding; women should be counseled as to whether their supply is adequate, they can improve their technique to make breastfeeding easier or there are other issues.

TalkingNutrition would also like to mention that breastfeeding women need to pay close attention to their diet. In addition to increased calorie needs, Dietary Reference Intakes are also increased for carbohydrate, protein, vitamin A, vitamin C, vitamin E, thiamin, riboflavin, niacin, vitamin B6, vitamin B12, copper, iodine, molybdenum, selenium, zinc, biotin, choline, pantothenic acid, potassium, and chloride compared to non-pregnant, non-lactating women.

Main citation:

Breastfeeding Concerns at 3 and 7 Days Postpartum and Feeding Status at 2 Months. Pediatrics 2013. doi: 10.1542/peds.2013-0724d.

Related citations:

Brownell E, Howard CR, Lawrence RA, Dozier AM. Delayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding. J Pediatr. 2012 Oct;161(4):608-14. doi: 10.1016/j.jpeds.2012.03.035. Epub 2012 May 9.

Centers for Disease Control and Prevention. 2013. Breastfeeding Report Card.

Institute of Medicine. 2011. Dietary Reference Intakes. Reference table available here

World Health Organization. Breastfeeding. 2013.