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Thursday
Dec012011

Why do moms quit breastfeeding? 

Most moms who wanted to breastfeed, but ended up formula feeding, will be able to cite a reason or two. Breastfeeding advocates generally say that most of those hurdles can be overcome most of the time. The divide between these two perspectives -- of insurmountable versus surmountable problems -- often results in heated discussions and hurt feelings. Moms feel like they are being told that they didn't try hard enough and breastfeeding advocates are frustrated at the lack of recognition of other contributing factors.



In Canada, around 90% of women initiate breastfeeding, which is great. But things go downhill quickly. The World Health Organization and Health Canada both recommend six months of exclusive breastfeeding, with continued breastfeeding until 2 years or longer. How do the Canadian statistics stack up against that recommendation? At 3 months, 68% of moms are breastfeeding and 51% are exclusively breastfeeding. At 6 months, 54% are breastfeeding and 14% are exclusively breastfeeding.

Or, in other words, by the time a baby is 6 months old:

  • 10% will have never been breastfed

  • 36% will have been weaned

  • 40% will have been supplemented at some point (either with formula or early introduction of solids, other milks, juice, etc)

  • 14% will have met the recommended duration of exclusive breastfeeding


Why are so few moms meeting the recommended duration of exclusive breastfeeding?

Reported Reasons


According to a Today's Parent Survey (by John Hoffman), only 1 in 10 women report "problem-free" breastfeeding. That means that 90% of women who chose to breastfeed have to overcome some sort of hurdle in order to continue breastfeeding. Some of the are able to overcome those hurdles with help or with time. But others are not.

According to the Today's Parent Survey, three types of breastfeeding problems were particularly prevalent among moms who weaned early:

  • Low milk supply

  • Low baby weight gain

  • Baby who seemed uninterested in nursing or nursed inefficiently


Some other reasons I've frequently heard moms moms give for supplementing prior to six months include:

  • Wanting or needing to leave baby temporarily (work, date night, weekend away) and not wanting to pump or not being able to pump enough.

  • Doctor or parenting book advised them to introduce solids before 6 months.


Contributing Factors


The reasons that moms give for stopping breastfeeding are an outcome -- low milk supply, low baby weight gain. There need to be reasons for those outcomes. In a small percentage of women, there are legitimate insurmountable medical reasons for those outcomes. However, for most mothers, it is other contributing factors (likely in combination with difficult but surmountable breastfeeding challenges) that can lead to that result.

Those contributing factors include:

Twice as likely, 3.5 times as likely, twice as prevalent, much more likely, four times as likely, and so on -- it all adds up.

Moms don't usually name a formula sample, a not-so-knowledgeable doctor, or a lack of comfort nursing in public as the reason for their low milk supply, but in a lot of cases it probably is a contributing factor. That doesn't mean that these moms didn't try hard enough (and really, hard enough is subjective and will be different for each person), but it does mean that these are issues worth tackling. They are hurdles, or barriers or booby traps, or whatever you want to call them. They are silent killers of breastfeeding relationships.

What is Missing?


We can compare the statistics on actual breastfeeding duration with the recommended duration and see that Canadian mothers come up short. But that doesn't tell the whole story. The key information that is missing from these statistics is information on women's breastfeeding goals. We need a long-term study that asks pregnant women how long they plan to breastfeed exclusively and when they plan to wean and that compares that with what actually happens. Is there a gap? If so, how big is it? What reasons do the moms give for the gap? What other contributing factors came into play? A comparison between the recommended duration of breastfeeding (6 months exclusive, continued nursing for 2 years or more), women's own breastfeeding goals, and actual length of breastfeeding is essential to a full understanding of where and how things break down.

More Data, But What Else?


Yes, we need more data. That said, there is already some evidence that a lot of women stop breastfeeding earlier than they planned to. According to the Today's Parent survey, at least 1/3 of breastfeeding moms stopped earlier than they had planned and the numbers are probably higher for first time moms.

In the meantime, however, we need to keep working on breaking down the barriers and tackling those contributing factors. They should be eradicated wherever possible. Or, where that isn't (yet) possible, we need to at least make moms aware of the danger so that they can protect themselves and their breastfeeding relationship.

Breastfeeding advocacy doesn't really need to focus on the 10% of women who choose not to breastfeed. It needs to focus on the large numbers of women want to breastfeed and are devastated when things don't go the way they wanted them to. Breastfeeding advocates need to create awareness among those women (before it is too late) and help them to navigate the minefield.

What do you think should be the first priority in tackling those contributing factors?
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Reader Comments (118)

This is such a great point. I attended a couple of LLL meetings after my son was born. Before he was born, and before I had actually nursed a baby (you know, back before I actually had kids but was an expert on them), I thought that extended nursing was for weirdos. I didn't feel that way after he was born and attending a LLL meeting certainly made me realize that not everyone there was a weirdo! They were normal people...like me...nursing their babies. It was great to not only see that. but also to feel supported and share stories with everyone.

I wonder how things would be if instead of cans of formula, the hospital gave away info on the local LLL? What's the difference, right?? Just providing a free way to help feed the baby.

December 5, 2011 | Unregistered CommenterCarrie

I am joining this discussion a bit late but wanted to share my experience. I WAS one of the 1% whose milk never came in. Due to issues during and after delivery, I never got to see my baby from a day or so after birth. The birth weight dropped and the peditrician freaked out. I tried exclusive BFing for the first 3 weeks but was discouraged due to lack of weight gain. Tried all sorts of medicines, herbs, consulted lactation consulants and also tried pumping. It did not work.
Finally figured out that it was probably hereditary. My mom never had a good milk supply to feed my brother or me, that trait probably got passed on.
I wanted to breastfeed, but never worked out. I am tired of defending myself to other moms and at this point just want to enjoy my LO.

December 9, 2011 | Unregistered CommenterAPK

I agree with those that said that the "partial" data needs to be more specific. We started solids around 5 months because my daughter was just sooooo eager to try food. I attended La Leche League meetings, and the common consensus was to not start on solids until your baby shows real interest and an ability to sit straight and swallow. Well, mine showed interest from 4 months, and we waited until 5 just to be sure. We started slowly, just a few spoonfuls of pureed fruits/veggies once a day or so (never did cereals), to satisfy her curiosity, and slowly built up from there. Always careful to feed solids AFTER she'd had her breastmilk.

At 14 months, we are still breastfeeding, but the bulk of her nutrition comes from table foods (the same ones we eat), and she also drinks cow's milk from a bottle. I would hate to be counted as part of the group that "failed" to meet the goals just because my kid started having some pureed veggies before 6 months.

There's a wide range in people who are complementing. We also started giving our girl a bottle of formula for her middle of the night feed after 6 months. I did this so I could keep breastfeeding. I was too exhausted and it was affecting my supply. So in our case, using formula helped us achieve our breastfeeding goals. Once again, that would have been counted as a negative in the study, and it doesn't represent the real intentions.

For the record, I credit our breastfeeding success on having exactly the type of support system you talk about. My mother breastfed me, as well as both my grandparents. My hospital was baby friendly, and even on the 2nd day, when I was recovering from my c-section and just wanted to rest and give the kid a bottle already, they helped me position her so I could rest and breastfeed at the same time (ditto for no pacifiers or sugar water, and we roomed with our baby). We never got any formula samples in the mail, and neither my pediatrician nor my OB ever gave me formula samples. I had access to lactation support, both in the form of a local La Leche League chapter, and our pediatrician's office held lactation support sessions once a week. We were also lucky to not have major problems, just a painful latch the first few weeks.

Great Blog post!

December 9, 2011 | Unregistered CommenterCupcake's Mama

Sorry if someone's mentioned this, but I wouldn't agree that 'partial breastfeeding' is necessarily the best term for the non-exclusive-breastfeeding category. It suggests a mother who's mixed feeding on an ongoing basis, whereas in fact the category covers any mother who's given ANYTHING other than breastmilk at ANY time for ANY reason. A mother who gave her baby a bit of sugar water as a one-off when trying to get started and nothing else except breastmilk from then until six months would therefore end up in the 'partial breastfeeding' category, which doesn't make a lot of sense to me.

(Of course, the real problem there is the heavy reliance placed on 'exclusive breastfeeding' as a category - for most purposes in the Western world, I think it's pretty meaningless, and 'full breastfeeding' - nothing but breastmilk on a day-to-day basis, but allowing for the baby having had occasional feeds of something else - would be more useful.)

December 10, 2011 | Unregistered CommenterDr Sarah

I think that we need more/better education for new mom's as well as better/easier access to LC's/support. I also do not think that a nurse should be able to provide feeding advice to a mom in the hospital who has said that they are going to breastfeed. Get me a real LC or leave me alone! I don't want your advice that I should supplement because my newborn is eating every 4 hours which to you is 'too frequent'.

December 12, 2011 | Unregistered CommenterJen

I am in the same boat minus the pre-eclampsia, but I did fight kidney stones and had surgery during my maternity leave. I would love to be a sahm but giving up cable and new clothes does not replace much needed insurance. I have EBF for 3 months and am about to return to work. Good luck to you!

December 29, 2011 | Unregistered CommenterMollie

Mrs Rochester, the idea that the only options are group daycare or care from a SAHM is a myth. My children were at home full-time with their father during their early years while I worked. If I'd been the SAH parent, he'd have had to continue a job he hated while I gave up one I loved - and for what? I've yet to see any evidence that absence of a Y chromosome is a prerequisite for providing loving care for ones children.

December 29, 2011 | Unregistered CommenterDr Sarah

Uh, I know this is about as far off topic as it's possible to get... but, in response to what Cassaundra said, I'm pretty dubious about the claim that *any* section of feminism has ever claimed that it's empowering to be forced to work as a prostitute. Maybe I'm wrong, but I think it's much more likely that somebody's view is being misunderstood/misrepresented here. Cites, please?

December 30, 2011 | Unregistered CommenterDr Sarah

I think Cassaundra was engaged in a bit of hyperbole. What a certain sector of feminist thought argues is that sex work can be *chosen* and is a legitimate and potentially empowering choice for women. Those that disagree will often retort that no one would choose prostitution if other options were reasonably available and though they may not be "forced" at gun point they are "forced" by lack of access to education, poor support for addictive illnesses, shredded social safety nets, etc.

December 30, 2011 | Unregistered Commenterjessica

[...] written before about the wide variety of reasons why women may quit breastfeeding and the many societal barriers to breastfeeding. This study shows once again, the importance of [...]

I am the sole income earner in my household. If I give up my job, none of us eats. So, yes, being a SAHM is an unaffordable luxury for some women.

Thanks for the interesting post and discussion. I haven't had my little one yet but am trying to work out how long I can breastfeed for. My government encourages exclusive breastfeeding until 6 months to the extent that mothers who return to work before 6 months have passed are entitled to 60 mins per day of paid breastfeeding breaks. Employers are obliged to provide a lockable room where mothers can express, or nurse (if the baby is brought to them). Breaks can be taken as agreed with the employer - 4 x 15 mins, 3 x 20 etc. Or mother can come in late and leave early.

July 31, 2012 | Unregistered CommenterEm

yes clearly mom's income in required/desired in various circumstances. My point is that for some families (again no relative numbers) the "luxury" of having a SAHP is akin to claiming that everyone who has access to personal shelter has the "luxury" of a home (single family/appt/etc). Of course it could be a comparative luxury when we considering those without, but we do know that many who have personal shelter really struggle to maintain access to it, doing without other things in order to do so. So too do some families struggle in order to maintain a SAHP (or to engage in work that allows for parent-only caregiving, possibly sacrificing more lucrative and stable career paths). Some families will choose to run out of food on the 25th of the month or take chances with a parent not having health insurance or whatever in order to be their children's primary/only caregivers - this is not a luxury, it is a choice (within the context of our various social boundaries) and it is dismissive of the unpaid care-giving work that these parents do to frame it as something they just lucked in to. Particularly by families who do not live so much on the edge, owing to their choice to opt into nonparent-care for their children.

Good luck with your new little one! It sounds as if your government is making some useful moves towards supporting families.

July 31, 2012 | Unregistered Commenterjessica

I appreciate your clarification, Jesisca, that you're talking about SAHPs more generally rather than SAHMs.

July 31, 2012 | Unregistered CommenterEm

The "mom" part came about because the original post was in regards to breastfeeding, but the whole parent care thing would certainly involve all parties ;-)

July 31, 2012 | Unregistered Commenterjessica

The fact of the matter is that statistically speaking, even one bottle of formula alters gut flora for days and weeks, and sometimes permanently. So the partial feeding category is quite valid, when one or two feeds of something other than breastmilk is not considered exclusive breastfeeding. It would be more accurate if WHAT the baby was fed besides breastmilk, and how often, could be included in research. Then again, exclusive breastfeeding used to not really be exclusive on a consistent basis, in former studies, which skewed the data, and made breastfeeding look as if it had a less impact on a baby's health.

August 1, 2012 | Unregistered CommenterHelen

@Helen: Yes, but there doesn't seem to be any evidence (that I've been able to find) that those changes in gut flora actually translate into changes in clinical outcomes. I mean, if you look at the Scariati study (http://pediatrics.aappublications.org/content/99/6/e5.full) it looks as though even regular supplementation doesn't affect gastroenteritis or otitis media rates unless it's at fairly high levels. Obviously we could do with more evidence, especially on the effects of supplementation in the early weeks of life which weren't covered by that study - but, at the moment, there seems to be very little evidence that a one-off bottle of formula makes a significant difference to outcomes for a breastfed baby.

August 1, 2012 | Unregistered CommenterDr Sarah

I am an extremely modest person, I will not even change in front of my own mother, and I would never ever nurse in public if it weren't for nursing covers. I just would never feel comfortable. I do agree that no one should ever be made to feel like they have to cover up if they don't want to. BF definitely needs to be normalized in society so that women can feel comfortable in nursing their children whenever and wherever the need may arise. However, it bothers me when moms like me who choose to cover up are made out like we are doing something wrong by others in the BFing community. I see and validate the thoughts of previous posters about reasons why they feel that those with covers may wean sooner, I just wish there wasn't such a polarized spectrum of what's "right" in regards to BFing. If you are comfortable nursing without a cover, that's great! I thank you for your contribution to the fight for normalizing BF in public! But please, don't assume that my nursing with a cover is because I am ashamed of BF, or make me feel that I am contributing less to the fight of normalizing BF because I am modest. I just think that many times the BFing community can alienate each other when we should be supporting each other and lifting each other up and coming together to promote the goodness of BFing and the diversity of the women and families that BF.

November 14, 2012 | Unregistered CommenterJenna

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