Helping Mothers Reach Their Exclusive Breastfeeding Goals

As a healthcare provider, you may not see the vital role you play in reaching breastfeeding goals. Or maybe you do! And, if that’s the case, kudos to you! There was a point in my career when I did not see the impact I had on a mother’s ability to reach long-term exclusive breastfeeding goals. Once I did, though, it was a game changer. Did you know that lack of support is one of the main reasons mothers stop breastfeeding early? Do you know how important you are to mothers reaching their breastfeeding intentions?

When a baby is born prematurely or requires intensive care after birth, feeding at the breast may not be possible. Mothers needs support, encouragement, and education from healthcare providers about the importance of initiating milk supply. If mother and baby are separated, pumping should begin as soon as possible after delivery using a hospital-grade (multi-user) double electric breast pump. The early postpartum period represents a critical time for mothers to establish a milk supply. When pumping isn’t initiated early after birth, or if mother isn’t pumping  and stimulating her breasts frequently, she may not develop a full milk supply. This can negatively impact her long-term milk production goals. Early initiation should be adopted as standard of care practice in the hospital setting.

How to Become Better Prepared to Support Mothers Initiating Milk Supply for Exclusive Breastfeeding

• Educate yourself about breastfeeding
• Ask the mother about her LONG-term breastfeeding goals
• Encourage skin-to-skin contact for mother and baby
• Teach the mother how to use a hospital grade (multi-user) double electric breast pump
• Teach the mother how to hand-express her colostrum
• Ask the mother about her pumping habits and encourage her to pump 8 - 12 times per 24 hours

A colleague once shared an analogy that I would sometimes use, as I felt it really helped mothers understand that pumping ounces of milk on day 1 was an unrealistic expectation: “Think of pumping like putting money in the bank. The more money you put in your account, the more interest you earn - but you won’t see this interest on day 1 of opening your account. Pumping is money and the interest is your milk. The more you pump, the more milk you will see but you won’t see this milk on day 1 of pumping.”   

This analogy is just one example that could be used in teaching with mothers and may not be appropriate for all mothers; you just have to know your patients. But, it is helpful for mothers to see that their hard work is going to pay off. Pumping and hand expression frequently in the first few days after birth will help a mother to have more milk available for her infant and will make her more likely to maintain this milk volume weeks later as well. Which brings us back to that question of: What is your long-term breastfeeding goal?

You may be asking yourself, “why do I need to ask a mother about her LONG-term breastfeeding goals?”  Every mother has a different goal and, while the messaging and education on how to achieve the goal doesn’t change, it’s helpful to know so you can be a cheerleader for her! I’ve worked with mothers who’ve told me their goal was to breastfeed for 1 week, until they returned to work, 1 year, 2 years, as long as baby wanted. If a mother was pump-dependent to initiate her milk supply, I would start my first conversation with her by asking about her goals for breastfeeding and talking about the importance of the first few days after the birth of her baby. I would provide education about the frequency of pumping and teach hand expression alongside pumping. Be sure to help her celebrate and encourage her to continue every step along the way as she is reaching her goal. Ask her if her goals have changed.

When I first became a nurse, I was very narrow minded. I didn’t see the impact I had on breastfeeding long-term. I was focused more on the tasks to get mom and baby discharged, as I worked in an LDRP setting. Then, I became an IBCLC and started to see the mother and baby post-discharge and talked to the mother on the phone: listening to her concerns and troubleshooting her questions and her problems. It was then that I started to see the bigger picture and how those first few days in the hospital set her up for meeting future goals. As a healthcare provider, you are with your patients for a short period of time, which, as said before, is a very KEY time for milk-making. The support you provide during the initiation period is critical to the long-term duration of breastfeeding.

What Factors Influence Cessation of Partial or Exclusive Breastfeeding?

• Lactation and latching issues
• Concerns about infant nutrition and weight
• Mother’s concern about medication use during breastfeeding
• Returning to work and/or unsupportive work policies
• Lack of family support and/or cultural norms
• Unsupportive hospital policies and practices

As a healthcare provider, you have the ability to positively impact the breastfeeding factors that may cause a mother to discontinue breastfeeding early.

• If not already being done, incorporate routine skin to skin care while the mother is pumping. Holding her infant skin to skin has great benefits for the baby, but can also help the mother when pumping.
• Provide hospital-grade (multi-user) breast pumps for use in the hospital and ensure she has access to a double electric breast pump after she is discharged.
• Make sure the mother knows where to turn for support; lactation consultants, nurses, or other healthcare providers.

Be supportive of the mother and her pumping habits. Recognize that in the early days postpartum, she may be struggling with sleep deprivation, the baby blues, pain and/or discomfort from childbirth, and she needs your support! When she brings colostrum to the NICU, cheer her on! When she can switch from the Initiate program of the Symphony breast pump to the Maintain program, this is cause for celebration! Way to go, mama! All that hard work is paying off. You may never see the mother and baby couplet again after discharge to know if their breastfeeding goals were met, but research tells us the long outcomes of breastfeeding are based upon the early days of initiation. Without support from healthcare providers like you, mothers wouldn’t be able to reach their breastfeeding goals.

References

• Breastfeeding Report Card | Breastfeeding | CDC
• The Surgeon General's Call to Action to Support Breastfeeding | Breastfeeding | CDC
• Facts | Breastfeeding | CDC
• Setting Your Breastfeeding Goals | WIC Breastfeeding Support (usda.gov)
• Facts | Breastfeeding | CDC
• Reasons for Earlier Than Desired Cessation of Breastfeeding - PMC (nih.gov)
• Initiate, Build and Maintain Human Milk in the NICU | Medela
• Initiate. Build. Maintain.™ for Health Care Professionals | Medela
• How nurses can help. The Surgeon general's call to action to support breastfeeding (cdc.gov)