Breastfeeding support helps new moms stick with it, doctors say

Mothers breastfeed their babies while attending a rally to raise public awareness and support for breastfeeding near the steps of New York City Hall in Manhattan (Copyright Reuters 2016)

Women who want to breastfeed their babies may be more likely to try it and to stick with it when they receive education and support, new U.S. guidelines conclude.

Updated recommendations issued today by the U.S. Preventive Services Task Force (USPSTF) recognize the many health benefits of breastfeeding for both mothers and babies while also accepting that women need to make a personal choice about how to feed their infants, said task force member Ann Kurth, dean of the Yale School of Nursing in Orange, Connecticut.

"Evidence suggests that any breastfeeding appears to be more beneficial than no breastfeeding, and health benefits continue to increase the longer a woman continues to breastfeed," Kurth said by email.

Pediatricians recommend that mothers exclusively breastfeed infants until at least six months of age because it can reduce babies' risk of ear and respiratory infections, sudden infant death syndrome, allergies, childhood obesity and diabetes.

Mothers can benefit too, with longer periods of breastfeeding linked to lower risks of depression, bone deterioration and certain cancers.

Programs such as one-on-one counseling from lactation experts, education about the health benefits of nursing, provision of supplies like nursing bras and breast pumps, and peer support groups for nursing mothers may all help encourage breastfeeding, the USPSTF concludes in guidelines published in JAMA.

The task force analyzed 43 previously published studies and found that support efforts can help increase how many women breastfeed and how long they continue to do it.

These studies didn't offer clear evidence that one type of support is better than another, but they did suggest timing matters, said Carrie Patnode, lead author of the USPSTF research review.

"Interventions that included prenatal education, support at or around the time of delivery, and postpartum support were more beneficial than those that only provided prenatal support, for instance," Patnode added by email.

The USPSTF, a government-backed independent organization that reviews medical evidence, last updated its breastfeeding guidelines in 2008. Then, as now, the task force urged support of breastfeeding during pregnancy and after delivery. These guidelines are widely used to determine whether insurance will pay for screenings and treatments and are widely followed by primary care physicians.

This time around, though, the recommendations also take extra care to avoid putting unnecessary pressure on mothers who don't breastfeed their babies, said Dr. Valerie Flaherman, a researcher at the University of California, San Francisco, and author of an accompanying editorial.

"Doctors and nurses should provide mothers with information and education regarding the benefits of breastfeeding, but we should not pressure mothers to breastfeed, and mothers should not be made to feel guilty if they are unable to breastfeed or decide that it is not the best decision for their family," Flaherman said by email.

Beyond just making mothers feel guilty for giving babies formula, there's a potential to ratchet up feelings of anxiety or increase the odds of postpartum depression, Kurth noted.

Still, some women may need more support than they get, Dr. Dimitri Christakis of Seattle Children's Research Institute notes in a separate editorial in JAMA Pediatrics.

Roughly four in five U.S. mothers start breastfeeding, Christakis writes. This suggests that most new mothers are motivated to breastfeed.

But within three months, only 43 percent of mothers exclusively nurse their babies. By six months, just 22 percent of women exclusively breastfeed their infants.

This suggests a missed opportunity to offer help, and an opportunity for doctors to prioritize conversations about breastfeeding.

"Of the myriad topics one might discuss, why not start with the ones that caregivers are most interested in," Christakis writes. "Breastfeeding is surely one of those."

"We might very well add breastfeeding support right after vaccinations," Christakis adds.