AAP Voices Blog

Many mothers start out breastfeeding with the best intentions but often are unaware of how to approach breastfeeding challenges. As a mother of two who experienced breastfeeding roadblocks, I can relate to the experiences of many new mothers.

I had to formula feed in the first few days after delivery of my first child while I worked on my milk supply. I struggled with multiple breastfeeding challenges, from delayed onset of lactogenesis II (period of copious milk production), medication use, and breastfeeding pain. Even though I was aware of the numerous benefits of breastfeeding, I seriously considered switching to formula at every challenging point.

Early attempts at breastfeeding within the first postpartum hour helped set the pace and reinforced my breastfeeding intentions. I was able to maintain my milk supply by regularly expressing milk while I worked with lactation professionals to resolve the pain issues.

Receiving timely support from trained lactation professionals during the most crucial postpartum period along with family support were key to overcoming those personal challenges. Many breastfeeding problems arise within a critical window in the first few days after birth. An AAP policy statement recommends that a trained lactation professional perform an assessment of breastfeeding effectiveness every 8 to 12 hours during the hospitalization of the mother-infant dyad, including once within eight hours of hospital discharge.

After overcoming my early breastfeeding challenges, I felt my breastfeeding journey was set. However, there were broader societal factors that I was about to face as I returned to work as a pediatric trainee. I am certainly not alone in this experience.

I had my first child during residency at a time when there were no wearable breast pumps. My first rotation, after five weeks of maternity leave, was in a busy intensive care unit in New York. I needed to take pumping breaks every 3 to 4 hours to avoid the discomfort of engorgement and clogged ducts. I had to often ask to leave patient rounds and take pumping breaks at odd times. I often needed to ask colleagues who were equally stressed to cover for my patients.

Even though I was among pediatricians, I remember being afraid of asking for break times for fear of facing hostility from colleagues and supervising physicians.

I tried switching to formula, but my baby did not take any of the kinds I tried. A turning point came when a pediatrician colleague encouraged me to focus on maintaining my breast milk supply instead of pursuing an acceptable formula option for my child. I was an exact breast milk producer, so I knew the key was that I needed to regularly pump at work every 3 to 4 hours to maintain my breastmilk supply.

I was already on the career path of getting more breastfeeding training and advocating for breastfeeding among patients, but I needed the support of co-workers and that nudge from a physician colleague to stay on track. Mothers now have access to wearable breast pumps that can minimize some challenges to pumping at work.

There is more that employers can do in this realm, however. We cannot underestimate the effect of a supportive workplace environment and peer-to-peer support on a successful breastfeeding journey.

After I completed my lactation training, I was ready to start advocating for breastfeeding in my practice. I soon discovered disparate challenges faced by low-income mothers in communities of color. As I shared the benefits of breastfeeding with every mother, I closely observed disparities in breastfeeding practices among low-income non-Hispanic Blacks in my practice.

Many women struggle to continue breastfeeding after returning to work and often stop breastfeeding after a few weeks. Many refugee women in my practice report feeling uncomfortable with feeding pumped breast milk and using a breast pump at their workplace.

“Health care providers can play a critical role in serving as breastfeeding advocates by sharing culturally sensitive breastfeeding information, discussing the safety of expressed human milk and the importance of regularly expressing milk when returning to work to maintain supply.”

Health care providers can play a critical role in serving as breastfeeding advocates by sharing culturally sensitive breastfeeding information, discussing the safety of expressed human milk and the importance of regularly expressing milk when returning to work to maintain supply. Every employer needs to show support for breastfeeding by creating a breastfeeding-friendly environment with space for breast milk expression and allowing time off for that without fear.

As we mark National Breastfeeding Month, we know that breastfeeding has numerous benefits, but it can be especially challenging for new mothers, low-income mothers, and women of color. Public health advocates should consider multi-contextual constructs to provide targeted breastfeeding interventions in different communities. The AAP policy statement encourages social and systemic changes to improve the well-being of every mother and child. It takes a village to raise a child, but it takes multi-level interventions, including families, peer support, health professionals, and policymakers, to work together to implement systemic changes that address breastfeeding barriers, laying a healthy lifestyle foundation for every infant.

Together, we can promote breastfeeding and support mothers who choose to breastfeed.

*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.