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Why Do Women Quit Breastfeeding? Lack of Support

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Monday, December 05, 2005

A new study appearing in Pediatrics suggests that if American women received more support during the days and weeks after giving birth, they would be more likely to establish successful breastfeeding relationships with their babies. While that may be a surprise to researchers, it's nothing new to moms.

The American Academy of Pediatrics (AAP) released a new policy statement on breastfeeding this past February. It reads:

"Although economic, cultural, and political pressures often confound decisions about infant feeding, the AAP firmly adheres to the position that breastfeeding ensures the best possible health as well as the best developmental and psychosocial outcomes for the infant."

The new study, written by the CDC's Indu Ahluwalia, included more than 32,000 U.S. mothers that gave birth in 2000 or 2001. The study found that half of the mothers in the study breastfed for longer than four weeks, 13 percent breastfed for up to four weeks, 4 percent gave up breastfeeding after less than one week and a third of mothers did not attempt to breast feed at all.

The thing that upset me about the study was the reasons given for quitting:

1.) Sore, cracked or bleeding nipples
2.) Not producing enough milk
3.) Baby had difficulty breastfeeding
4.) Baby "not satisfied" with breastmilk

Here's why...

1.) Sore, cracked or bleeding nipples are the result of a baby with an improper latch. That tells me that women are heading home from the hospital without having had proper help from a lactation consultant. Breastfeeding, while natural, doesn't always come naturally to a mother and baby. It takes hard work and the help of a skilled lactation consultant to make sure that a mother and baby have established a good latch. It's that lack of support and education that often leads to problems of sore and bleeding nipples and to mothers that understandably give up in frustration from the pain.

2.) and 4.) Not producing enough milk is rarely a "real" issue. While it happens, nine times out of ten a perceived lack of milk is either the result of supplementing with formula (which causes the baby to want to nurse less which keeps milk from coming in properly to meet demand) or is simply a problem of a Dr. that doesn't understand that breastfed babies often gain weight less quickly than their formula fed counterparts.

3.) Babies DO have difficulty breastfeeding. So do mom's. It's hard, hard work. That's why it's essential that moms leave the hospital with easy access to help from someone skilled in the art of nursing. Whether it's with a phone number for a La Leche League representative or with the number of a lactation consultant, new moms need to be prepared mentally and physically for the challenges of establishing a nursing relationship with their child.

Having gone through these issues myself when I tried to nurse Nora, I completely understand why women give up. Bottles of formula sitting on the shelf and repeated "encouragement" from well-meaning friends and family make it all too easy to give up and switch to formula. In other words, exactly when women should be encouraged to stick with it and should be getting industrial strength emotional support, they are instead bombarded with messages of failure disguised as "understanding." That's not to say that people don't have the best of intentions and it is of course essential for moms to keep their sanity if they are going to be good parents, but it is to say that the United States has a long way to go before every mother is given the support and encouragement she needs to breastfeed if she wants to.


  1. Blogger the SmockLady | 3:23 PM |  

    You know, I've been thinking a lot about these things lately and you've really hit the nail on the head. But one thought that has been racing in my mind lately is about number one. First, there's the lack of support. You've addressed that and it is so true that many women leave the hospital without a good support system. Secondly, I (and others) have experienced the lactation specialist of the hospital come in to 'help' only to hinder by such manhandling of the breast that by the time they are done no mother woudl ever want help or support again - being left eith the idea that what they had just experienced was lactation support.
    There comes a time that a mother may need 'hands on' assistance, but not always. A little understanding of the mother's feeling should be taught to these lactation professionals. Just because a woman has born it all (pun intended) to a great number of people in the birth of her baby doesn't mean that she is not a modest person or maybe even *gasp* shy to show her breast to another woman. A little incouragement, a little kind talk, and maybe even permission to touch the breast would be well accepted. I for one slapped the nurses hands when she reached for my breast without even the slightest comment before grabbing at me. My husband never even groped me like that. A little, "If you wouldn't mind my hands helping I could show you" goes a long way.

    My cousing experienced such Naziness from her LLL lactation consultant that by the end of a week and no success had been reached her husband jumped in with, "if it doesn't work this time I going out for a bottle." Now don't judge hime yet. The LLL consultant had her feeling so bad about it "not working" and how "she wasn't doing it right" that my cousin was in tears and the baby was starving and hadn't peed in three days. They wanted to at least give hime some water and Ms. LLL told them breastfeeding would never be successful if they gave him a bottle. The pressure she was under was enormous. Imagine struggling with a new baby who is so beyond hungry that he can't slow down his cry enough to latch on, and mom being told she isn't doing it right, and stressing out as a result of said LLL Nazi that the stress alone was killing the process. Hubby kicked out Ms. LLL and told her they would do it their way. Hubby took baby from mom, gave mom hot tea, told her to calm down, had a nice talk about the fact that formula is not poison and he would do whatever she wanted him to do. She had a good cry, pumped to relieve pain and pressure, gave baby a few sips of that sweet breastmilk in only a nipple, rubbed some on her nipples, and baby boy latched on just fine and all was well with the world and she has successfully nursed three beautifully babies!

    I'm sorry to rant and rave, my point is that sometimes the kind of support that people receive is not always good even if they are trying to be. Negative support in the name of help is not a good thing.

    I for one am so pro breastfeeding myself that one day when I grow up I want to become a lactation consultant so I can help too - but in a much more sensitive way than I wrote about. I've nursed five beautiful children and I think I've gleaned more knowledge from my five children than I have from the numerous articles and books I've read.

    I suffered through inverted nipples, a preemie, a hypotonic child with nursing difficulties, and three with severe, weight losing, reflux.

    I love your blog!

  2. Anonymous VacationMamma | 9:07 PM |  

    You can say that again! This goes beyond lack of support in those early weeks, which I personally found plentiful (if not a bit rough like smocklady illustrated so well!). There is an overwhelming lack of support for breastfeeding beyond the intial 6 weeks. Didn't have trouble in the beginning? No one checks in later to encourage you to keep bf when you go back to work? Struggling with breast, bottle, travel, stress, siblings, and and mother in law? Ha! Their too busy telling you how to add cereal etc. to get that fussy baby to sleep.

    Many people in US have now accepted that breast is best, at least in the beginning. As long as it doesn't interfere with their lives. I was fortunate to have amazingly supportive bosses and coworkers (and maintenance to install curtains in my office) with my first child. Honestly, though, when the milk seemed to be vanishing at 10-12 weeks, everywhere I reached out was useless. I just figured it must be me, and too much stress from work. Not until my second child, and the luxury of being a stay at home mom, did I figure out that this reduction in milk was normal, expecially for me. Oh how a little support would have changed everything!

  3. Anonymous Anonymous | 6:43 AM |  

    How about this for a milk bank T-shirt: You can take THESE to the bank!

  4. Blogger Jennifer | 8:06 AM |  

    I'm glad I'm not the only one...quite honestly, I blame my own lack of knowledge and the nurses where I delivered for the problems that I had nursing Elnora.

    I nursed her about twenty minutes after she was born and she latched on like a champ. For the first 12 hours, we had no problems at all...everything was fantastic. Then, the second night, my husband had to go home for the night and I didn't have anyone to stay with me. I wasn't able to get in and out of bed while holding Nora, so I had to let her go to the nursery for the night while they promised to bring her back when I needed to nurse her. (HA! Right!)

    I woke up three or four hours later and she hadn't been back...so I called for them to bring her. THREE TIMES! The last time I pitched a royal fit and she finally showed up about five minutes later. By then, she was screaming because she was so hungry. I simply could not get her calmed down enough to latch.

    I called for a nurse to help and her solution was to place her hand on the back of Nora's head and SHOVE her face first into my breast. (and if that's not going to terrify a baby I don't know what will.)

    That was the beginning of the end. This went on for 40 minutes while I kept trying to get the nurse away from me. I finally had to pitch another fit. Of course I was then left with a still screaming baby and no one to help me figure it all out.

    By the time I left the hospital she'd hardly nursed at all (though I tried every hour) and had lost quite a bit of weight. She was also jaundiced with bili levels of 19. That gave the on-call ped good excuse to "threaten" that we couldn't take her home unless we were supplementing because they'd take her back and put her under the lights.

    (Now I realize there's a little something called AMA and heading to your own ped.)

    So the ped came back with literally a GARBAGE bag full of those little 2 ounce formula bottles. I took one look and said I want the LC in here NOW! She came in, we kicked the ped out and she spent three hours trying to help us latch. No luck. So I suggested that maybe I could pump and supplement with my milk while we tried to work on nursing. She thought that was a great idea and told off the ped when she pitched a fit.

    So we went home with a hospital grade pump. Nora got 1/2 ounce of formula that first night, but after that, I had no problem expressing enough milk for her. By the second day home when I'd had no sleep and she'd not yet nursed once, I gave up. I switched to pumping and pumped exclusively for the next year.

    With the right support, I have no doubt I could have made it. It kind of makes me sad.

    Needless to say, we won't be going back to that hospital...in fact, we probably won't be going back to a hospital at all. ;)

  5. Anonymous Mama C-ta | 9:21 AM |  

    Wow great comment smocklady. I sure hope you do become an LC!

    I had a really rough time in the beginning and I utilized every support outlet available: comments left by my blog readers, LC in person, LC's online. I eventually got through it but my Lord it was so exhausting and frustrating. If I wasn't so darn stubborn I would have given up too!

    Before Julian was born I told my husband that there will be times when BF will be hard and frustrating and stressful and I'm sure I'll want to quit everyday but he needed to encourage me to keep going. You know how many guys want to just "fix it" and with that mentality he would have told me if it was too hard to go to formula thinking he'd be helping me. So I told him up front he needed to be my support team. He was great and through all the crap we've gone through and still go through he keeps me going.

  6. Anonymous Anonymous | 12:14 AM |  

    Our baby was in special care due to low blood sugar and as a result was straight on the bottle in hospital as he was not taking to the breast. Actually he was tube/drip-fed for a few days early on too.

    We really wanted to breastfeed for so many reasons and tried so hard to breastfeed for two weeks but when your baby constantly pushes you away and screams PLUS is also screaming through hunger it is tough. You cannot starve the child. The most important thing is that they eat, not that they breastfeed. The bottle was easier for him and what he got used too very quickly due to special care.

    Even in special care with loads of support (at least three midwives showed us what to do and they could not do it) he would not take to the breast. We were well-informed and knew what to do...but he was not interested.

    My wife expressed a good 200ml of collustrum (sp?) in the first week for him which he got so that is something...he got his immunity I guess.

    We knew what the problem was (bottle was easy and over-flowing with milk) and did not know how to solve it. The way we understood it we were running up a slippery slope as the bottle is the enemy and once he got on it getting him off was gonna be tough.

    Will be hard to ever forgive ourselves.

    At the end of the day we did our best...guess this is the first thing we screwed up for our son. Oh well...who said we were ever gonna be perfect eh?

  7. Anonymous Anonymous | 6:39 AM |  

    Breastfeeding is wonderful and healthy and natural etc., but the difficulties of making it work are never adequately communicated by lactation educators. The most common misleading advice is that "if it hurts, you're not doing it right." This is a lie. Every mother's nipples hurt in the first few weeks, regardless of the quality of the latch. The pitfalls of such misinformation is that new mother's are second guessing themsevles constantly. The lactation advocate community should be more forthright with the truth about breastfeeding: it hurts alot initially, it is EXTREMELY DIFFICULT to accomplish, it wears on mothers and dads emotionally, and there is no easy way to know for sure that your baby is eating enough (baby scale rentals, sure, but that's not easy). I'm not against breastfeeding, but I'm a little turned off by the peace-love-and-harmony subculture of lactaction. It seems like the audience they have in mind is always those mothers that are so poorly educated that they have no clue about infant health to begin with, and can be as easily duped by poor or partial information about breastfeeding from the lactation experts, as they can be duped by poor or partial information from the formula-feeding advocates. But for the rest of us who are not so easily duped, just tell us the TRUTH...we can take it.

  8. Anonymous WICNutritionist | 7:33 AM |  

    Hi, I am a nutritionist for the WIC program in FL, and we of course promote BF over formula feeding even though we provide formula for women who decide not to BF for many reasons: Prerogative, HIV+/AIDS, cancer (though we did help one woman with cancer in one breast BF on the other), and a whole bunch of reasons for not nursing.

    Many of the women who were not in WIC while pregnant, tell us the horror stories from the hospital....We try our best to provide classes, and information individually to raise awareness and to "encourage", and not make women feel bad or inadequate, whether they decide to BF or not.... We also provide pumps for women in more serious situations such as the woman who wanted to BF her triplet preemies... or the woman breastfeeding twins.....We even have been successful in getting babies who were initally bottle-fed in the hospital for the first 5-weeks of their life...Plenty of women who had preemies come home after many weeks successfully latched their babies on when they babies came home! That makes me feel like anything is possible and is worth giving a try...The key is workingto keep the milk supply up:) Whether you hand-express or pump manually or with an electric pump....If it doesn't work...its okay! Even if the baby gets a few sucks, keep trying is what we encourage....
    It does take a lot of discipline, support, and diligence on the mother's part, but it also takes plenty of gentle, not aggressive support from LLL counselors and LC's, and anyone who calls themselves a Breastfeeding Support Counselors-which we often employ at WIC...Many of them are LLL, or IBCLC, but many of them are licensed nutritionists who have logged thousands of hours helping BF mothers and have done so successfully without current "certifications" though the certifications are favored....Many of them have decided not to renew their certifications for financial reasons, but they are still knowledgable and supportive....I myself am looking to become IBCLC certified also.....
    We also work with women who's milk may not come in completely for weeks, and we encourage them to try again once they experience leaking....1 try is better than NO tries! For some, it works well, for others, it doesn't...

    I am so sorry that many women are not offered help beyond those first 4-6 weeks, and I do my best (though not in my particular job description right now) to follow-up and refer clients who are BF to the counselors, or try to troubleshoot basic problems myself with my current knowledge....I have been very successful only because I am not aggressive, nor am I pushy...I have had very frustrated moms in my office walk out feeling better (whether our tries worked or not)....its raising the mom's sense of ability to succeed and feelings of self-worth are important to me...I will continue to fight the good fight, and support or mom's whether they decide to BF or not.....All I can say is remember that you and your baby is born to breastfeed and many can do it!...Be encouraged, and stay positive!

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