We’d like to think that breastfeeding happens in a safe little bubble. It doesn’t. Sometimes, we must recognize that the mother’s physical, emotional, and social well-being has an impact on the breastfeeding experience.
Physical well-being
It’s likely that most women of childbearing age are in very good health. Yet, many are not. I distinctly remember being the clinical nurse specialist for a high-risk labor/delivery unit in a major metropolitan medical center. Some days, I noticed that everyone who was in labor — all about my age or even younger — had serious health issues. Later, I realized how these same issues impact breastfeeding and lactation.
Metabolic and hormonal issues
Maternal metabolic and hormonal problems have a serious impact on feeding issues. Women with diabetes, including gestational diabetes, are at high risk for having large-for-gestation (LGA) babies. And LGA babies have all sorts of feeding issues in the early days, most notably low glucose levels. Although this may be arguable, some sources say that a delay in milk “coming in” is more likely to occur in diabetic mothers.
Hormonal disorders do create a problem for milk-making. Low thyroid and postpartum thyroiditis, if uncorrected, can affect milk supply and well-being. And, polycystic ovarian syndrome (PCOS), although not well-understood, is often associated with inadequate breast tissue, which in turn impacts milk supply.
Musculoskeletal issues
We don’t usually think of musculoskeletal issues as having an impact on the breastfeeding experience, but they certainly can. Conditions such as carpal tunnel syndrome, or myasthenia gravis may create difficulties for the mother when handling and positioning the infant.
Nutrition and weight issues
Nutritional deficits in the pregnant and/or lactating woman can seriously impact the nutritional value of the mother’s milk and hence, the infant’s nutritional status. Such deficiencies can and do affect the mother herself. Expert Carol Wagner gives some excellent insights into Vitamin D deficiencies.
Additionally, women who have had bariatric surgery can and should breastfeed. But, as Dr. Allison Childress emphasizes, they need to be diligent in taking their nutritional supplements.
Infectious disease
Infectious diseases can also impact the breastfeeding experience. Separation may be necessary, and formula-feeding may be less risky than breastfeeding.
- Certainly, HIV can be transmitted to the breastfed infant. In the US, the current public health recommendation is to formula feed. (I suspect that will change.)
- Tuberculosis doesn’t “go through the milk” but in developed countries, the mother and infant are separated because the disease is spread by droplet.
- Other issues, such as maternal herpes, can be lethal if transmitted to the baby during the first month of life. Some infectious diseases, such as COVID-19, are not at all understood at this time.
Cancer
In many cases, women who are diagnosed with or have survived cancer have breastfed. True, they cannot breastfeed while they are on an anti-cancer drug, such as Tamoxifen™. True, if they have had radiation to the breast, they are unlikely to produce milk, or enough milk.
Unfortunately, a big stumbling block for these women is the erroneous advice they get from the healthcare system. Check out my podcast with Ciara Devine as she describes her uphill battle against the healthcare professionals, and also listen to Dr. Olivia Pagani, MD who says that breastfeeding is not contraindicated after the treatment and effects of chemotherapy are over.
In short, there are multiple system-level physical issues which have a substantial impact on the breastfeeding experience
Emotional well-being
Make no mistake, there’s still a lot of social stigma about emotional well-being. But it does have an impact on the breastfeeding experience and perhaps even milk-making and failure to thrive infant.
Women who have eating disorders don’t have a stomach, appetite, or gastrointestinal problem. Eating disorders are about the need for control. Yet, focusing on the new baby might motivate a woman to seek and help for and overcome her problem, as Jacklyn Novatt helped us understand.
There’s a common myth that women who breastfeed are more likely to have postpartum depression. That’s patently false. Similarly, mothers with postpartum depression are often erroneously advised to wean and wean abruptly. That’s likely to only exacerbate the condition.
My interview with psychotherapist Sandra Reich helped us to understand anxiety and depression are two sides of the same coin. Unquestionably, anxiety can affect the dyad.
Then, there’s the issue of dysphoric let-down, which I’ve discussed in my interview with Alia Macrina Heise. (And, to be clear, it is not the same postpartum depression.)
For many of us, breastfeeding is a joyful, peaceful experience that adds to our sense of empowerment and fulfillment. But emotional issues can have an impact on the breastfeeding experience that might not be immediately evident to those of us in a helper role.
Social well-being
We may never know how much social well-being (or lack thereof) contributes to the breastfeeding experience. Certainly, domestic violence has an impact.
Contrary to popular assumption, however, breastfeeding is not precluded for women who have survived sexual abuse. But issues such as nighttime breastfeeding and some stimuli or interactions do substantially impact their breastfeeding experience. Several studies have shown that these mothers are likely to discontinue breastfeeding fairly quickly.
Some women have access to breastfeeding help but are socially marginalized and encounter a number of obstacles in understanding and accessing such support.
Lack of social support is arguably the number one key for overcoming the four biggest obstacles to breastfeeding. More specifically, pressure to wean has a major impact on initiating or continuing to breastfeed.
Impact on the breastfeeding experience: The big picture
When we think about the impact of physical, emotional, and social factors, it seems to me that these can be observed as:
- lack of or delay in breastfeeding initiation
- early discontinuation of breastfeeding
- milk supply; volume of milk
- nutritional deficits; quality of milk
- failure to thrive
I’d imagine that I’ve only scratched the surface here. But in the meanwhile, remember that breastfeeding doesn’t happen in a bubble. There are many factors that can and do impact on the breastfeeding experience.
What kinds of outside factors have you seen that have an impact on the breastfeeding experience? How do you help clients overcome these obstacles? Share in the comments below!
Limited lactation support at our hospital has really affected breastfeeding support. We have one fulltime experienced educator who works 3 nights per week and that’s it. Most of our moms never see a lactation consultant. The responsibility falls on the nursery nurse who often is responsible for 5 babies. They hear the word “formula” from mom and are very quick to have her sign a formula release and stick a bottle in the baby’s mouth. IMO they don’t understand the long term impact that supplementing the first 3 days post partum has on the health of the mother, the infant and the breastfeeding future and they truly believe they don’t have time to encourage a mom who is on the fence. I floated to nursery last night, had a 5 baby assignment, all of whom were “breast/formula” and consents were signed. All babies had received multiple bottles and moms were not adequately educated on the risks and the need for frequent breast stimulation. 4 babies needed 36 hour labs and the 5th one needed a bath. We do not have a tech. 2 moms had seen lactation the night before, 3 had not received any education (1 wasn’t interested in hearing it). I educated the 2, left a packet with the 3rd, reinforced education with the other two, assisted 4 with latching but all of them continued to supplement throughout the night. I worked through lunch and clocked out an hour late. It’s really frustrating to not have the support we need from upper management to provide adequate lactation coverage and our moms and babies are suffering because of it.
Angela, I hear you, I do. From where you sit, it feels like all that you’ve done (and are doing) to promote breastfeeding is falling apart. And, from where I sit, it seems that you did more you were expected to do, and more than you get paid to do; your passion and commitment is evident. However, from where “upper management” sit, it probably looks very different. I say this because I spent a relatively short period in a director-level position, and I can tell you, it gets really hairy when there’s the usual issues plus a pandemic that has now lasted more than a year. Even the best of intentions and the highest standards can become eroded under such conditions.
Wouldn’t you still encourage a TB positive mother to pump breastmilk for her baby even if separation occurs in the US? Your drills say she needs to wait for negative cultures.
Angela, please read the question on the drill questions carefully. I’m not looking at the question at the moment, but it’s all about context and about whether the situation is in a developed country, or an underdeveloped country.