The majority of women expecting their first child plan to breastfeed, based on past research. But their plans don't always work out as they expect.
A recent study found that women's breastfeeding problems and concerns played a large part in whether they stopped breastfeeding sooner than they planned.
The most common concerns reported by the women were difficulties with their baby feeding at the breast and concerns about their milk supply.
Another commonly cited problem was breastfeeding pain. The greatest number of concerns were reported in the first week after the women gave birth.
This study, led by Erin A. Wagner, MS, of the Perinatal Institute at Cincinnati Children's Hospital Medical Center, looked broadly at women's breastfeeding concerns and their breastfeeding or formula-feeding rates two months after giving birth.
The researchers interviewed 532 first-time mothers between 32 and 40 weeks of pregnancy about their breastfeeding attitudes and intentions.
Then, they interviewed the women within 24 hours after giving birth and then 3, 7, 14, 30 and 60 days after giving birth.
By the two-month mark, 418 women remained in the study with complete interview information.
The researchers found that the greatest number of concerns were reported by women on the third day after giving birth. At this time, 92 percent of the women reported at least one problem or concern with breastfeeding.
The women who reported breastfeeding concerns three days after giving birth were nine times more likely to stop breastfeeding within two months of giving birth. They were also three times more likely to feed their children formula between the first and second month of the babies' lives, even if they had not planned to use formula.
Three concerns topped the charts on the third day after giving birth. A total of 52 percent of the women reported difficulties with their babies' ability to feed at the breast, and 44 percent reported breastfeeding pain.
In addition, 40 percent reported concerns about the amount of milk they were producing.
The researchers estimated that 32 percent of the women who stopped breastfeeding within two months after giving birth would not have stopped if not for the infant feeding difficulties they reported one week after giving birth.
In addition, 23 percent of the women who stopped breastfeeding would not have stopped if not for the concerns about milk quantity that they reported two weeks after giving birth.
The researchers identified 34 women who were unusual because they did not report any breastfeeding concerns at any point before or after giving birth. These women were more likely to be younger than 30, to be Hispanic and to have an unmedicated vaginal delivery.
They were also more likely to have confidence about their ability to breastfeed before giving birth and to report having strong breastfeeding support after giving birth.
Although 79 percent of the women reported breastfeeding concerns before giving birth, the researchers did not find that concerns before giving birth played any part in whether women stopped breastfeeding or used formula in their babies' first two months.
The researchers wrote that this finding means the difficulties other women faced "...do not appear to be simply the 'self-fulfillment' of anticipated problems."
The researchers noted that concerns reported in the first week after giving birth were most likely to influence mothers' decisions to stop breastfeeding early.
"Overall, our results reinforce the recommendation of the American Academy of Pediatrics that all breastfed newborns receive an evaluation by a provider knowledgeable in lactation management within two to three days post-discharge," the researchers wrote.
Stephanie Tillman, MSN, a certified nurse midwife in the Chicago area, said this study reveals how important it is to provide support to new moms who want to breastfeed.
"Breastfeeding is not always easy for every mom and baby," Tillman said. "It can take a village, ideally of people supportive of breastfeeding and experienced with feeding newborns, to support a woman in her first breastfeeding venture."
She said that moms sometimes believe a baby's irritation and seemingly inconsolable crying on the second night after birth can lead a mom to question whether she has sufficient milk for her baby, then leading to more doubt and discouragement in general about breastfeeding.
"As in the early days of pregnancy, providers should be available to women during this time of uncertainty to discuss normal body changes and address concerns for what is normal and what needs a provider's attention," Tillman said.
"It takes time for new mothers to learn the baby's signals and become accustomed to the full spectrum of signs and symptoms of hungry babies, full babies, and comfort measures (not including food) for moms struggling to get through the first week," she said.
Tillman noted that postpartum support in the US is greatly lacking, which is a disservice to moms and their babies.
"Providers can bill time for these visits under 'Postpartum care of the lactating mother,' and mothers can benefit not only from additional breastfeeding care but also assessments for postpartum depression, pediatric care coordination and time to answer the questions of all new mothers that otherwise may never be addressed in the first few days of the new family," Tillman said.
The study was published September 23 in the journal Pediatrics. The research was funded by the National Institutes of Health and the Perinatal Institute at Cincinnati Children's Hospital Medical Center.
One author has received funds for presenting a lecture at the 2012 National WIC Association meeting. The other three authors reported no conflicts of interest.