Early Worries Predict Breast-feeding Discontinuation
First-time mothers who expressed concerns about breast-feeding their new baby 3 days postpartum were 9 times more likely to stop breast-feeding by 60 days postpartum than mothers who reported no concerns in a new study.
The study was published online September 23 in Pediatrics.
Erin A. Wagner, MS, clinical research coordinator, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Ohio, and colleagues, assessed prenatal intent to breast-feed, postnatal support for breast-feeding, and concerns about breast-feeding among 532 expectant primiparas who took part in a prospective cohort study at the University of California Davis Medical Center. The researchers interviewed the women between 32 and 40 weeks' gestation and then postpartum on days 0, 3, 7, 14, 30, and 60 postpartum or until the mother reported she was no longer breast-feeding. Overall, they conducted 2946 interviews and tallied 4179 breast-feeding concerns.
They found that any expression of breast-feeding concern postpartum was associated significantly with an increased likelihood of discontinuation of breast-feeding within 60 days postpartum, with the peak adjusted relative risk at day 3 of 9.2 (95% confidence interval [CI], 3.0 - infinity). The authors adjusted for maternal education and prenatal breast-feeding intention.
Maternal concerns that associated with the largest adjusted population attributable risk (PAR) for discontinuation of breast feeding were "infant feeding difficulty" on day 7 (PAR, 32%) and "milk quantity" on day 14 (PAR, 23%). PAR stands for the excess proportion of mothers no longer breast-feeding who, theoretically, could have kept breast-feeding with the right intervention at the right time.
Concerns expressed on day 3 represented the highest relative risk not only for discontinuation of breast-feeding but also for the use of formula between days 30 and 60 (adjusted relative risk, 3.3; 95% CI, 1.7 - 15.0).
Almost all study participants (92%) reported at least 1 concern on day 3 postpartum, the peak day for expression of concern. The most frequent concerns were difficulty with the infant feeding at the breast (54%), breast-feeding pain (44%), and milk quantity (41%). Day 3 was the peak day for reporting of infant feeding difficulties, and day 7 was the peak for reports of pain at breast-feeding (47%). Breast-feeding pain remained the most prevalent concern at later interviews. Milk quantity concerns peaked at day 3 (41%).
The concerns that most significantly associated with discontinuation of breast feeding by day 60 or use of formula between days 30 and 60 were a mention in at least 1 postpartum interview of concerns about milk quantity, infant feeding difficulty, uncertainty about breast-feeding ability, and "sign of insufficient intake."
Thirty-four women expressed no breast-feeding concerns on day 3, and only 1 of those had stopped breast-feeding by day 60. In a post hoc analysis, the authors found that these 34 women were more likely to be younger than 30 years, Hispanic, and report strong breast-feeding support. They were also more likely to have expressed a strong prenatal breast-feeding self-efficacy and have had an unmedicated vaginal delivery.
Prenatal expression of a desire to breast-feed exclusively for at least 60 days was no guarantee mothers would do so. Among the 354 women who planned to use breast milk alone for more than 2 months, 47% (166) used at least some formula between days 30 and 60. Of 406 women who planned prenatally to breast-feed for more than 2 months, 21% (86) had stopped breast-feeding by day 60.
One coauthor received a stipend for presenting a lecture at the National WIC Association meeting in 2012. The other authors have disclosed no relevant financial relationships.
Pediatrics. Published online September 23, 2013. Abstract
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