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The notion of new mothers easily and comfortably breast-feeding their newborns is challenged by new research that indicates nursing problems are a near-universal experience among first-time moms, and those reporting early concerns are nearly 10 times more likely to abandon breast-feeding within two months.
"We're mammals and we've evolved through this. Even so, I was still surprised by the magnitude of breast-feeding problems and didn't expect to see such a strong link with stopping breast-feeding," said study author Laurie Nommsen-Rivers, an assistant research professor of pediatrics at Cincinnati Children's Hospital Medical Center. "We as a society need to look at how we provide new mothers with breast-feeding support at home."
The study is published online Sept. 23 in the journal Pediatrics, in advance of its October print issue.
More than 75 percent of American mothers begin breast-feeding when their babies are born, but only half meet their own goals for how long they continue. And just 13 percent exclusively breast-feed for six months, the duration recommended by the American Academy of Pediatrics, according to study documents.
Nommsen-Rivers and her team conducted a series of six interviews with more than 500 first-time mothers beginning in pregnancy and then at three, seven, 14, 30 and 60 days after birth. About 92 percent of participants reported at least one breast-feeding concern -- such as the baby not latching properly, breast pain or milk quantity -- and issues reported at three and seven days postpartum were most strongly associated with discontinuing nursing.
In total, the new mothers reported more than 4,100 breast-feeding concerns over nearly 3,000 interviews. Breast-feeding issues were broken down into nine predominant themes and also included mothers' uncertainty about their own breast-feeding ability, their own health or medication issues and making too much milk.
Pediatricians weren't surprised by the findings.
"This study gave us information that most pediatricians are very well aware of," said Dr. Cliff Nerwen, medical director of the division of general pediatrics at Cohen Children's Medical Center of New York in New Hyde Park. Nerwen wasn't involved in the research. "Most moms know that breast-feeding is best for their baby, but it's hard work ... and the milk supply doesn't come in for three or four days. Most of these impediments can be overcome with reassurance and by spending time with medical professionals."
Only 8 percent of first-time mothers reported no breast-feeding concerns at day three, and these women tended to be in the youngest group, had an unmedicated vaginal birth, expected to succeed at nursing and were familiar with other women who breast-fed.
Nommsen-Rivers said strategies should be enacted to support new mothers with breast-feeding or milk-supply concerns in the first days and weeks after childbirth, including using lactation consultants and seeking advice from pediatricians and other health care professionals.
"We need to ramp up support, especially when moms get home from the hospital," she said. "That's when [breast-feeding] problems start to peak. Ninety-five percent of the problems are addressable, and if we can reach moms during the first few critical days at home it can make the difference between meeting or not meeting their breast-feeding goals."
Nerwen agreed, noting that it's ideal if a newborn is seen by a pediatrician with its mother within 48 hours after hospital discharge.
"The most important thing I can do for a new mom is reassure her, trying to relieve her anxiety and helping set realistic expectations," Nerwen said. "If I say, 'You're doing a great job nursing your baby,' those kinds of phrases are probably more helpful than anything else I can do."
La Leche League International offers answers to frequently asked questions about breast-feeding.