Prenatal Baby Feeding & Lactation Support Enhances Maternal and Infant Wellness

Highlights

1. A mother’s breastfeeding expectations vs. reality has strong impacts on postpartum mental health. Women who had initiated breastfeeding and had planned to exclusively breastfeed their child, but did not, were 2.5x more likely to have postpartum depression symptomatology at 8 weeks postpartum.
2. 47.9% of mothers resume exclusive breastfeeding after lactation consultations.
3. Mothers who underwent a lactation counseling + and educational intervention were 2.4x more likely to be exclusively or predominantly breastfeeding at 6 months postpartum compared to mothers who only received education.
4. A longer duration of breastfeeding has been shown to improve child health and increase secure attachment of infants with their mother, promoting healthy growth and development long-term.  
5. Breastfeeding for >12 months significantly impacts future cancer occurrence, reducing the risk of breast carcinoma by 26% and ovarian carcinoma by 37%.

‍

What is breastfeeding?  

The process of feeding a mother's breast milk to her infant, either directly from the breast or by expressing (pumping out) the milk from the breast and bottle-feeding it to the infant (NIH Child Health and Human Development, 2017).

‍

The Problem: 

Many women are unable to accomplish the recommended breastfeeding frequencies and durations. Contributing factors, as well as subsequent health outcomes, are discussed below:

‍

Limited Access to Breastfeeding Support

Inadequate breastfeeding support is a main reason for premature weaning in mothers (McFadden  et al., 2017). Mothers seek breastfeeding and baby feeding guidance through both informal and professional sources. A study examining social media pages related to breastfeeding support found that 42% of requests for assistance were regarding breastfeeding management, including timing/frequency of feeds,  positioning, breast refusal, and painful nipples (Bridges et al., 2018). When seeking more formal support, lactation consultation services can be difficult to find, typically requiring access to an additional provider beyond the mother and baby’s physician team throughout the perinatal period, as these providers often do not have training in lactation. This access can be especially difficult for individuals in rural areas and is compounded by challenges with health insurance coverage. Thus, access to informed practitioners is limited and a parent’s decision regarding breastfeeding and cessation is strongly related to influences of social and structural determinants of health (McFadden et al., 2017), creating inequities starting as early as infancy. 

‍

Decrements in Maternal Mental Health with Suboptimal Breastfeeding

Absence of breastfeeding, or its early cessation, especially due to inadequate support, is associated with worse mental health outcomes. In general, a discordance between one’s expectations of their breastfeeding experience and one’s true experience is related to poorer mental health outcomes (Yuen et al., 2022). This is further supported by a study that demonstrated a significantly heightened risk of postpartum depression in mothers who had planned to breastfeed but ultimately did not breastfeed (Borra et al., 2015). Specifically, women who had initiated breastfeeding and had planned to exclusively breastfeed, but did not, were 2.5 times more likely to have significant postpartum depression symptomatology at 8 weeks. Additionally, a mother is 2 times more likely to have anxiety or depressive symptomatology if they are dissatisfied with their breastfeeding progress (Falah-Hassani et al., 2016) and maternal stress and social support “substantially moderate” the relationship between non-exclusive breastfeeding and postpartum depression (Islam et al. 2021). Thus, breastfeeding intentions and subsequent breastfeeding outcomes evidently play an important role in maternal mental health. 

‍

Greater Burden of Physical Health Conditions with Suboptimal Breastfeeding

Suboptimal breastfeeding has been associated with a higher rate of physical health diseases in both mom and baby. Babies with no exposure to breast milk have a higher likelihood of sudden infant death syndrome (Hauck et al., 2011), gastrointestinal infections & disease, otitis media, and lower respiratory tract infections (Duijts et al., 2010). Robust evidence also indicates that maternal physical health may also be impacted by inadequate breastfeeding duration as higher rates of chronic diseases, such as cancer and type 2 diabetes have been concluded in the literature (Chowdhury et al., 2015). 

‍

Overall, receiving sufficient support for breastfeeding and baby feeding concerns remains an essential component of perinatal care. 

‍

The Solution: 

Prenatal lactation and baby feeding support programs. These services offer evidence-based assistance to expectant mothers, providing education, counseling, and practical guidance on breastfeeding, infant formula feeding, and other feeding methods. By offering anticipatory guidance, these services address potential challenges and empower mothers with knowledge and skills that ultimately improve the health and well-being of mothers and their infants.

‍

The Evidence: 

Lactation & Baby Feeding Support in the Prenatal Period Improves Baby Feeding Success

Research indicates that prenatal lactation support increases the initiation and duration of breastfeeding while reducing the risk of early cessation (Wood et al., 2016; McFadden et al., 2017). In a study examining breastfeeding support that was delivered by professional healthcare workers, counselors, or trained peer supporters, mothers experienced significantly increased breastfeeding initiation (Balogun et al., 2016). Furthermore, 47.9% of mothers who had ceased breastfeeding practices had resumed exclusive breastfeeding after lactation consultations (Chrzan-Dętkoś et al., 2021). Interventions that are regularly delivered, longitudinal, predictable, and individually-tailored have the most preferable outcomes, being associated with longer duration and more exclusive breastfeeding (McFadden et al., 2017). Interestingly, however, general prenatal breastfeeding education is not sufficient and does not similarly promote breastfeeding initiation and continuation in mothers like individualized support (Lumbiganon et al., 2016; Kronborg et al., 2012). A randomized controlled trial that specifically examined these intervention differences found that mothers who participated in both lactation and educational counseling were 2.4 times more likely to be exclusively or predominantly breastfeeding at 6 months postpartum compared to mothers who only received education (Mattar et a., 2007). There are additional advantages of this type of support, including the prevention of breastfeeding-related complications, such as mastitis, engorgement, and sore nipples, which is a leading cause of breastfeeding cessation in mothers (Cooklin et al., 2018; Vieira et al., 2018). That being said, few studies have sought to examine this and additional research is warranted. 

‍

Prenatal Lactation and Baby Feeding Support are associated with Improved Maternal Mental Health Outcomes

There is an evident bidirectional relationship between breastfeeding and maternal mental health, particularly depression, where challenges with breastfeeding impact postpartum depression and vice versa (Yuen et al., 2022). Accordingly, shorter breastfeeding duration is associated with higher rates of postpartum depression (Dias & Figueiredo, 2015) and initial breastfeeding self-efficacy is negatively correlated with mental health symptom burden (Chrzan-Dętkoś et al., 2021). This has prompted further examination of breastfeeding-related interventions in the prenatal period and their impact on postnatal mental health. A systematic review demonstrated that research studies that included a short-term prenatal support program have been ineffective at achieving statistically significant improved mental health results, whereas longitudinal interventions had a much stronger positive impact on psychological outcomes (Pezley et al., 2022). For example, the Maternal Infant Health Outreach Worker Program, which provided maternal support throughout pregnancy, spanning from counseling on breastfeeding to general lifestyle choices, demonstrated significant reductions in postpartum depression through 6-months postpartum (Lutenbacher et al., 2018).  More research is needed to further reinforce the impact of prenatal breastfeeding support on maternal mental health outcomes. Lastly, breastfeeding and the correspondent mother-infant bonding that occurs serve a crucial role in improving stress and empathy levels for the mother (Kim et al., 2011; Mezzacappa et al., 2002). This likely relates to the hormones, specifically oxytocin, released during breastfeeding as well as the closeness and relationship-building that develops through skin-to-skin contact, more frequent touch by the mother, and responsiveness to infant cues (Linde et al., 2020). Thus, by increasing breastfeeding initiation and duration, prenatal support serves an important role in a mother’s emotional states and subsequent sensitivity to their child. 

‍

Prenatal Breastfeeding Support Encourages Improved Infant Growth & Development 

The state of attachment between a mother and her infant, influenced significantly by breastfeeding practices as being among a baby’s first interactions, has further impacts on a child’s attachment security with their parent(s) that ultimately affects their relationships with others (Lewis et al., 2000). This attachment is the foundation for a child’s internal schemes of self and others (Bowlby, 1982). A longer duration of breastfeeding has been shown to increase secure attachment of infants with their caregiver (Gibbs et al., 2018; Jackson, 2016; Weaver et al., 2018). Research on the direct impact of prenatal breastfeeding interventions on attachment have yet to be performed, although their efficacy at increasing rates of initiation and duration of breastfeeding may suggest their capability of supporting secure attachment styles. 

‍

Furthermore, breastfeeding offers a plethora of benefits for infant growth and physical development. A study that examined breastfed vs. bottle-fed babies identified that breastfed babies reached lower body weights compared to bottle-fed babies at one year, ultimately achieving near 50th percentile in growth in comparison to the potentially-overfed 75th percentile bottle-fed babies (Jooste et al., 1991). This was further supported by a study that found increases in body mass index, or BMI, as well as increases in adipose tissue among babies who had a shorter duration of breastfeeding (Tulldahl et al. 1999). These findings suggest that breastfeeding may promote healthier growth and body weight compared to formula. In addition, the nutrients in breastmilk have far-reaching positive effects due to the unique composition of protein, fat, carbohydrates, micronutrients, milk oligosaccharides, hormones, cytokines, and microbes that, in culmination, nurture appropriate growth regulation and metabolism (Eriksen et al., 2018). These important elements are not present in formula, further reinforcing the importance of breastfeeding interventions to promote proper infant nutrient intake. . 

‍

Breastfeeding Support Prenatally is associated with Reduced Health Complications for Mom and Baby

Besides the obvious advantages of breast milk providing babies with immune support to avoid numerous infections (Gertosio et al., 2015), a longitudinal cohort study also demonstrated that infants who breastfeed have lower rates of asthma and other allergy-related diseases (Scholtens et al., 2009). A breastfeeding intervention trial in the Republic of Belarus identified that recipients of breastfeeding interventions had improved infant immune systems compared to those who did not receive the intervention (Kramer et al., 2001). Beyond the immune system, studies also indicate that infants who breastfeed for longer durations have greater protective effects against being overweight and experiencing obesity through adolescence (Kalies et al., 2005), an outcome that failed to similarly emerge from an intervention only addressing activity level and dietary education (Summerbell et al., 2005). Other benefits supported by high-quality evidence include lower rates of Type 2 diabetes (Horta et al., 2007) and hypertension (Horta et al., 2007), as well as lower cholesterol levels (Owen et al., 2003). It is hypothesized that these effects are related to the composition of breast milk and its ability to develop optimal endothelium structure, as well as hormone receptors, that are conducive for preventing vasculature-related complications (Owen et al., 2002; Horta et al., 2007). Lastly, the risk of sudden infant death syndrome, known as SIDS, which is a leading cause of infant mortality, is reduced with breastfeeding, where longer duration of breastfeeding is associated with lower risk (Vennemann et al., 2009). 

‍

Prenatal lactation support promotes successful breastfeeding, which lowers the risk of maternal health complications in both the short-term and long-term. Interventions that involve lactation consultants, or focus on the management of breast pain, demonstrate lower rates of nipple pain and nipple trauma during breastfeeding, which are among the most common reasons for breastfeeding cessation (Patel & Patel, 2016; Lucas et al., 2019). A research study conducted in Turkey also demonstrated a reduction in breastfeeding complications following an educational intervention during pregnancy (Karadağ, 2008). Moreover, there have also been links between breastfeeding history and reduction in rates of chronic illnesses. A systematic review and meta-analysis discovered that breastfeeding for more than 12 months has significant impacts on future cancer occurrence, reducing the risk of breast carcinoma by 26% and ovarian carcinoma by 37%. The longer the duration of breastfeeding, the stronger the protective effect (Collaborative Group on Hormonal Factors in Breast Cancer, 2002). Furthermore, a lengthier breastfeeding duration was associated with lower rates of hypertension (Qu et al., 2018) and myocardial infarction (Bartick et al., 2013), as well as had effects on lowering the risk of type 2 diabetes by 32% (Chowdhury et al., 2015). There is mixed evidence as to the effects on osteoporosis development (Chowdhury et al., 2015).  Prenatal breastfeeding interventions with proven increases in breastfeeding initiation, frequency, and duration have the potential to have broad positive impacts on both parent and baby. 

‍

SimpliFed’s Role in Achieving Positive Outcomes:  

SimpliFed integrates prenatal lactation and baby feeding support into existing healthcare services, including routine prenatal care visits and childbirth education programs, ensuring comprehensive and accessible support for expectant mothers. This support, in conjunction with an individual’s additional healthcare team, allows for a strong collaboration between healthcare providers, lactation consultants, and community organizations that fosters a multi-disciplinary approach, ensuring continuity of care and addressing the diverse needs of expectant mothers. This encouragement of multifaceted coordinated care is especially important due to the complex nature of breastfeeding cessation, breastfeeding self-efficacy, and maternal mental health. SimpliFed aims to incorporate parents and providers into an integrated web of support in a manner most conducive for achieving optimal health of parent and baby. 

‍

Conclusion: 

Prenatal lactation and baby feeding support programs have significant value in improving baby feeding success, enhancing maternal wellness, promoting optimal infant growth, and avoiding negative outcomes. By investing in these programs, health providers, healthcare systems, and health payors can contribute to the overall health and well-being of mothers and infants, resulting in long-term positive health outcomes for individuals and society.

‍

References (APA Format):

1. Aune, D., Norat, T., Romundstad, P., & Vatten, L. J. (2014). Breastfeeding and the maternal risk of type 2 diabetes: A systematic review and dose–response meta-analysis of cohort studies. Nutrition, Metabolism and Cardiovascular Diseases, 24(2), 107-115.
2. Babic, A., Sasamoto, N., Rosner, B. A., Tworoger, S. S., Jordan, S. J., Risch, H. A., ... & Terry, K. L. (2020). Association between breastfeeding and ovarian cancer risk. JAMA oncology, 6(6), e200421-e200421.
3. Balogun, O. O., O'Sullivan, E. J., McFadden, A., Ota, E., Gavine, A., Garner, C. D., ... & MacGillivray, S. (2016). Interventions for promoting the initiation of breastfeeding. Cochrane Database of Systematic Reviews, (11).
4. Bartick, M. C., Stuebe, A. M., Schwarz, E. B., Luongo, C., Reinhold, A. G., & Foster, E. M. (2013). Cost analysis of maternal disease associated with suboptimal breastfeeding. Obstetrics & Gynecology, 122(1), 111-119.
5. Borra, C., Iacovou, M., & Sevilla, A. (2015). New evidence on breastfeeding and postpartum depression: the importance of understanding women’s intentions. Maternal and child health journal, 19, 897-907.
6. Bowlby, J. (1982). Attachment and loss: retrospect and prospect. American journal of Orthopsychiatry, 52(4), 664
7. Bridges, N., Howell, G., & Schmied, V. (2018). Exploring breastfeeding support on social media. International breastfeeding journal, 13(1), 1-9.
8. Chowdhury, R., Sinha, B., Sankar, M. J., Taneja, S., Bhandari, N., Rollins, N., ... & Martines, J. (2015). Breastfeeding and maternal health outcomes: a systematic review and meta‐analysis. Acta paediatrica, 104, 96-113
9. Chrzan-Dętkoś, M., Walczak-Kozłowska, T., Pietkiewicz, A., & Żołnowska, J. (2021). Improvement of the breastfeeding self-efficacy and postpartum mental health after lactation consultations–Observational study. Midwifery, 94, 102905.
10. Collaborative Group on Hormonal Factors in Breast Cancer. (2002). Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease. The lancet, 360(9328), 187-195.
11. Cooklin, A. R., Amir, L. H., Nguyen, C. D., Buck, M. L., Cullinane, M., Fisher, J. R. W., ... & CASTLE Study Team. (2018). Physical health, breastfeeding problems and maternal mood in the early postpartum: a prospective cohort study. Archives of women's mental health, 21, 365-374.
12. Dias, C. C., & Figueiredo, B. (2015). Breastfeeding and depression: a systematic review of the literature. Journal of affective disorders, 171, 142-154.
13. Duijts, L., Jaddoe, V. W., Hofman, A., & Moll, H. A. (2010). Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy. Pediatrics, 126(1), e18-e25.
14. Eriksen, K. G., Christensen, S. H., Lind, M. V., & Michaelsen, K. F. (2018). Human milk composition and infant growth. Current opinion in clinical nutrition and metabolic care, 21(3), 200-206.
15. Falah-Hassani, K., Shiri, R., & Dennis, C. L. (2016). Prevalence and risk factors for comorbid postpartum depressive symptomatology and anxiety. Journal of affective disorders, 198, 142-147.
16. Gertosio, C., Meazza, C., Pagani, S., & Bozzola, M. (2015). Breastfeeding and its gamut of benefits. Minerva pediatrica, 68(3), 201-212.
17. Gibbs, B. G., Forste, R., & Lybbert, E. (2018). Breastfeeding, parenting, and infant attachment behaviors. Maternal and Child Health Journal, 22, 579-588.
18. Hauck, F. R., Thompson, J. M., Tanabe, K. O., Moon, R. Y., & Vennemann, M. M. (2011). Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis. Pediatrics, 128(1), 103-110.
19. Horta, B. L., Bahl, R., Martinés, J. C., Victora, C. G., & World Health Organization. (2007). Evidence on the long-term effects of breastfeeding: systematic review and meta-analyses.
20. Islam, M. J., Broidy, L., Baird, K., Rahman, M., & Zobair, K. M. (2021). Early exclusive breastfeeding cessation and postpartum depression: Assessing the mediating and moderating role of maternal stress and social support. PloS one, 16(5), e0251419.
21. Jackson, D. B. (2016). The association between breastfeeding duration and attachment: a genetically informed analysis. Breastfeeding Medicine, 11(6), 297-304.
22. Jooste, P. L., Rossouw, L. J., Steenkamp, H. J., Rossouw, J. E., Swanepoel, A. S. P., & Charlton, D. O. (1991). Effect of breast feeding on the plasma cholesterol and growth of infants. Journal of pediatric gastroenterology and nutrition, 13(2), 139-142
23. Kalies, H., Heinrich, J., Borte, N., Schaaf, B., Von Berg, A., Von Kries, R., ... & Bolte, G. (2005). The effect of breastfeeding on weight gain in infants: results of a birth cohort study. Eur J Med Res, 10(1), 36-42.
24. Karadağ, F. (2008). Gebelere lohusalık bakımı ve bebek bakımı konusunda verilen eğitimin etkinliğinin değerlendirilmesi (Master's thesis, Afyon Kocatepe Üniversitesi, Sağlık Bilimleri Enstitüsü).
25. Kim, P., Feldman, R., Mayes, L. C., Eicher, V., Thompson, N., Leckman, J. F., & Swain, J. E. (2011). Breastfeeding, brain activation to own infant cry, and maternal sensitivity. Journal of child psychology and psychiatry, 52(8), 907-915.
26. Kramer, M. S., Chalmers, B., Hodnett, E. D., Sevkovskaya, Z., Dzikovich, I., Shapiro, S., ... & PROBIT Study Group. (2001). Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. Jama, 285(4), 413-420
27. Kronborg, H., Maimburg, R. D., & Væth, M. (2012). Antenatal training to improve breast feeding: a randomised trial. Midwifery, 28(6), 784-790.
28. Lewis, M., Feiring, C., & Rosenthal, S. (2000). Attachment over time. Child development, 71(3), 707-720.
29. Linde, K., Lehnig, F., Nagl, M., & Kersting, A. (2020). The association between breastfeeding and attachment: A systematic review. Midwifery, 81, 102592.
30. Lucas, R., Zhang, Y., Walsh, S. J., Evans, H., Young, E., & Starkweather, A. (2019). Efficacy of a breastfeeding pain self-management intervention: A pilot randomized controlled trial (RCT). Nursing research, 68(2), E1.
31. Lumbiganon, P., Martis, R., Laopaiboon, M., Festin, M. R., Ho, J. J., & Hakimi, M. (2016). Antenatal breastfeeding education for increasing breastfeeding duration. Cochrane Database of Systematic Reviews, (12).
32. Lutenbacher, M., Elkins, T., Dietrich, M. S., & Riggs, A. (2018). The efficacy of using peer mentors to improve maternal and infant health outcomes in Hispanic families: findings from a randomized clinical trial. Maternal and child health journal, 22, 92-104.
33. Maimburg, R. D., & Vaeth, M. (2015). Postpartum depression among first-time mothers–results from a parallel randomised trial. Sexual & Reproductive Healthcare, 6(2), 95-100.
34. Mattar, C. N., Chong, Y. S., Chan, Y. S., Chew, A., Tan, P., Chan, Y. H., & Rauff, M. H. J. (2007). Simple antenatal preparation to improve breastfeeding practice: a randomized controlled trial. Obstetrics & Gynecology, 109(1), 73-80.
35. McFadden, A., Gavine, A., Renfrew, M. J., Wade, A., Buchanan, P., Taylor, J. L., ... & MacGillivray, S. (2017). Support for healthy breastfeeding mothers with healthy term babies. Cochrane database of systematic reviews, (2).
36. Mezzacappa, E. S., & Katkin, E. S. (2002). Breast-feeding is associated with reduced perceived stress and negative mood in mothers. Health Psychology, 21(2), 187.
37. Owen, C. G., Whincup, P. H., Odoki, K., Gilg, J. A., & Cook, D. G. (2002). Infant feeding and blood cholesterol: a study in adolescents and a systematic review. Pediatrics, 110(3), 597-608.
38. Owen, C. G., Whincup, P. H., Gilg, J. A., & Cook, D. G. (2003). Effect of breast feeding in infancy on blood pressure in later life: systematic review and meta-analysis. Bmj, 327(7425), 1189-1195.
39. Patel, S., & Patel, S. (2016). The effectiveness of lactation consultants and lactation counselors on breastfeeding outcomes. Journal of Human Lactation, 32(3), 530-541
40. Pezley, L., Cares, K., Duffecy, J., Koenig, M. D., Maki, P., Odoms-Young, A., ... & Buscemi, J. (2022). Efficacy of behavioral interventions to improve maternal mental health and breastfeeding outcomes: a systematic review. International Breastfeeding Journal, 17(1), 67.
41. Qu, G., Wang, L., Tang, X., Wu, W., & Sun, Y. (2018). Association between duration of breastfeeding and maternal hypertension: a systematic review and meta-analysis. Breastfeeding Medicine, 13(5), 318-326.
42. Scholtens, S., Wijga, A. H., Brunekreef, B., Kerkhof, M., Hoekstra, M. O., Gerritsen, J., ... & Smit, H. A. (2009). Breast feeding, parental allergy and asthma in children followed for 8 years. The PIAMA birth cohort study. Thorax, 64(7), 604-609.
43. Summerbell, C. D., Waters, E., Edmunds, L., Kelly, S. A., Brown, T., & Campbell, K. J. (2005). Interventions for preventing obesity in children. Cochrane database of systematic reviews, (3)
44. Tulldahl, J., Pettersson, K., Andersson, S. W., & Hulthén, L. (1999). Mode of infant feeding and achieved growth in adolescence: early feeding patterns in relation to growth and body composition in adolescence. Obesity Research, 7(5), 431-437
45. Vennemann, M. M., Bajanowski, T., Brinkmann, B., Jorch, G., Yucesan, K., Sauerland, C., ... & GeSID Study Group. (2009). Does breastfeeding reduce the risk of sudden infant death syndrome?. Pediatrics, 123(3), e406-e410.
46. Vieira, E. D. S., Caldeira, N. T., Eugênio, D. S., Lucca, M. M. D., & Silva, I. A. (2018). Breastfeeding self-efficacy and postpartum depression: a cohort study. Revista latino-americana de enfermagem, 26.
47. Weaver, J. M., Schofield, T. J., & Papp, L. M. (2018). Breastfeeding duration predicts greater maternal sensitivity over the next decade. Developmental psychology, 54(2), 220.
48. Wood, N. K., Woods, N. F., Blackburn, S. T., & Sanders, E. A. (2016). Interventions that enhance breastfeeding initiation, duration, and exclusivity: a systematic review. MCN: The American Journal of Maternal/Child Nursing, 41(5), 299-307.
49. Yuen, M., Hall, O. J., Masters, G. A., Nephew, B. C., Carr, C., Leung, K., ... & Moore Simas, T. A. (2022). The effects of breastfeeding on maternal mental health: a systematic review. Journal of Women's Health, 31(6), 787-807.
50. Zhao, Y., Lin, Q., Zhu, X., & Wang, J. (2021). Randomized clinical trial of a prenatal breastfeeding and mental health mixed management intervention. Journal of Human Lactation, 37(4), 761-774.