Challenges with Breastfeeding: Pain, Nipple Trauma, and Perceived Insufficient Milk Supply

Guidelines for Primary Pediatric Care Professionals to Help Patients Establish and Protect Milk Supply

ABSTRACT

The first well-child encounter for healthy, full-term newborns occurs within the critical window for the establishment of the milk supply. Frequent, effective removal of human milk from the breast is essential to achieving a robust milk supply. Nurses in primary care settings are crucial in providing quality and timely lactation care to ensure the parent is experiencing effective milk removal. Identification of risk factors and barriers to achieving a milk supply requires adept assessment and knowledge of lactation physiology. Not all nurses receive formal education on human milk and lactation. This resource can be used by primary care nurses to prioritize establishing and protecting the milk supply among families with a desire to breastfeed.

The Breastfeeding Experiences of Mother-Infant Dyads and the Effects of an FMR1 Mutation

This study examined the early breastfeeding experiences of mothers with an FMR1 premutation (FXPM) and their infants with and without fragile X syndrome (FXS) to identify early feeding needs and potential opportunities for intervention. Data collection occurred through a retrospective national survey that captured data on breastfeeding experiences and co-occurring conditions of mother and child. Participants were 246 mothers with an FXPM. Of their 384 infants, 287 had FXS and 97 were unaffected (i.e., they did not have FXS or an FXPM). Unaffected infants had a longer breastfeeding duration relative to infants with FXS, and infants of mothers who had postpartum depression (PPD). Additionally, infants who were reported to display aggressiveness towards others later in childhood had a shorter breastfeeding duration than those who did not go on to display aggression. Approximately 42% percent of mothers reported difficulties with breastfeeding infants with FXS compared to only 17% of unaffected infants. The most common reason for breastfeeding cessation for mothers of children with FXS was perceived difficulties in breastfeeding for the child (37%), whereas the most common reason for mothers of unaffected infants was a personal choice to stop (37%). This study provides preliminary evidence that infants with FXS show early phenotypes that make breastfeeding more difficult. Future research should investigate whether interventions for infants with FXS could improve breastfeeding outcomes.

Perinatal maternal factors influencing postpartum feeding practices at six weeks

OBJECTIVE

Despite the World Health Organization's recommendation of exclusive breastfeeding for the initial 6 months, breastfeeding rates decline within the first 6 weeks after delivery. This study aimed to (1) investigate the breastfeeding rate at 6 weeks postpartum and (2) explore the influence of perinatal factors on feeding patterns at 6 weeks postpartum.

METHOD

A total of 635 participants were enrolled from February to August 2023 at outpatient clinics in three tertiary hospitals in Nantong City. Variables were collected through questionnaires during the third trimester of pregnancy, including demographic information, pregnancy stress, anxiety, depression, sleep, and resilience. At 6 weeks postpartum, information regarding feeding patterns, delivery and postpartum situations, postpartum stress, anxiety, depression, sleep, and resilience was gathered. Initial single-factor analyses were conducted using feeding pattern as the dependent variable, and variables with significance were chosen as independent variables. The disordered multi-classification logistic regression model was then established using the stepwise forward method.

RESULTS

Within the first 6 weeks, 35.28% (224/635) of postpartum women exclusively breastfed their infants. Factors influencing exclusive breastfeeding and formula feeding at 6 weeks postpartum included breast pain, sleep quality, mental resilience, difference between postpartum and late pregnancy anxiety, insufficient milk supply, and maternal herself caring for the infant (P < 0.05). Factors influencing the transition from exclusive to partial breastfeeding were insufficient milk supply and maternal herself caring for the infant (P < 0.05).

CONCLUSION

The study reveals a relative low rate of exclusive breastfeeding in China's first 6 weeks postpartum, along with a comparison of perinatal factors affecting three different feeding patterns. Our findings may contribute additional evidence to the association between perinatal factors and feeding patterns. This study guides healthcare professionals in developing strategies to promote exclusive breastfeeding and improve personalized counseling for exclusive breastfeeding and mental health.

Psychosocial predictors of post-natal anxiety and depression: Using Structural Equation Modelling to investigate the relationship between pressure to breastfeed, health care professional support, post-natal guilt and shame, and post-natal anxiety and depression within an infant feeding context

High perceived pressure to breastfeed and poor perceived quality of health care professional support have been associated with early breastfeeding cessation, guilt, and shame. This is problematic because guilt and shame significantly predict post-natal anxiety and depression. No previous attempts have been made to provide quantitative evidence for relationships mapped between the post-natal social context, infant feeding method and post-natal emotional well-being. The current study aimed to empirically investigate aforementioned pathways. Structural equation modelling was applied to survey data provided online by 876 mothers. Guilt and shame both significantly predicted anxiety and depression. Poor health care professional support and high pressure to breastfeed increased anxiety and depression, and these effects were explained by indirect pathways through increases in guilt and shame. Formula feeding exclusivity was negatively correlated with post-natal anxiety symptoms. This finding may be explained by feelings of relief associated with observed infant weight gain and being able to share infant feeding responsibilities others e.g., with one's partner. This relationship was counterbalanced by an indirect pathway where greater formula feeding exclusivity positively predicted guilt, which increased post-natal anxiety score. While guilt acted as mediator of infant feeding method to increase post-natal depression and anxiety, shame acted independently of infant feeding method. These identified differences provide empirical support for the transferability of general definitions of guilt (i.e., as remorse for having committed a moral transgression) and shame (i.e., internalisation of transgressive remorse to the self), to an infant feeding context. Recommendations for health care practitioners and the maternal social support network are discussed.