Although a large majority of US mothers now begin breastfeeding, exclusive breastfeeding rates fall far below national health objectives, with vulnerable populations being least likely to breastfeed exclusively. This article explores common personal and societal barriers to exclusive breastfeeding and offers evidence-based strategies to support mothers to breastfeed exclusively, such as ensuring prenatal education, supportive maternity practices, timely follow-up, and management of lactation challenges. The article also addresses common reasons nursing mothers discontinue exclusive breastfeeding, including the perception of insufficient milk, misinterpretation of infant crying, returning to work or school, early introduction of solid foods, and lack of support.
Key points
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Barriers to exclusive breastfeeding include lack of prenatal education, comfort and ease with formula feeding, perception of insufficient milk, misinterpretation/understanding of normal infant crying, inadequate support, maternal employment, and early introduction of solids.
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Despite the brevity of the postbirth hospitalization, the provision of supportive maternity care practices, especially exclusive breast milk feeding, represents an evidence-based intervention to increase exclusive and extended breastfeeding.
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When supplementation is required for a breastfed newborn, using mother’s own expressed milk provides the health benefits of exclusive breast milk feeding and helps ensure an abundant milk supply.
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Potential sources of essential support to help mothers increase breastfeeding exclusivity in the first 6 months postpartum include the federal WIC program, Nurse-Family Partnership (NFP), families, mother-peers, health care professionals, and employers.
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A newborn follow-up visit at 3 to 5 days and a second ambulatory visit at 2 weeks are critical to evaluate the onset of breastfeeding, monitor infant weight gain, discuss infant feeding cues, and provide ongoing support to the mother.
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