Mothers’ Perspectives on Effective Assistance With Breastfeeding Problems

Wide Variation in Healthcare Providers’ Breastfeeding-Related Competence

Several women expressed appreciation for the HCPs who assisted them with breastfeeding. The IBCLCs at a nearby Baby-Friendly hospital were mentioned repeatedly, not only by the participant who gave birth at that hospital, but by others as well: women from other towns whose HCPs referred them to the hospital’s outpatient breastfeeding services and women whose friends had delivered at the hospital or used its outpatient services. “These IBCLCs are at the top of their game,” stated one participant. Some participants reported that it was straightforward for them to have their babies assessed and/or treated for ankyloglossia.

These experiences of fruitful partnerships were far from universal, however, particularly regarding supplementation. Multiple mothers felt embattled after conflicts with HCPs, particularly physicians and nurses.

Another mother, who was pumping successfully for her near-term baby, was given a formula sample by her physician and advised to use it in lieu of her milk: “Take it home and try it until she gets a little energy.”

One participant described difficulties with her daughter that were consistent with oversupply/overactive milk ejection reflex (OAMER): Although she could pump 8 oz at one sitting, her daughter’s weight gain was slow. Although the baby’s latch was initially good, and breastfeeding attempts in the hospital were successful, after 2 weeks, her daughter, who frequently seemed distressed, began to detach from the nipple a minute into every feeding. Of course, it is not possible to determine the true cause of this clinical presentation in hindsight, but the mother stated that no one—not the pediatrician, not the nurses, not even the two lactation consultants she asked for help—ever suggested oversupply/OAMER as a possibility. This mother, who transitioned to exclusive pumping, and then to formula feeding, found the advice of a labor and delivery nurse to be particularly memorable:

Another mother, whose baby was immunocompromised as a result of complex medical needs, reported that her child’s medical team repeatedly urged her to wean.

Social Media Support: Uses and Limitations

In tandem with their frustration over inadequate medical advice, mothers reported seeking support and problem-solving assistance from their peers. Peer support is hardly a new concept in breastfeeding assistance. Several of these mothers, however, reported heavy reliance on peer support via social media—most commonly through Facebook. The most emphasized advantage of SMS was real-time assistance and encouragement. Multiple mothers described their experiences attempting to feed a fussy baby in the middle of the night. A Facebook post to a breastfeeding support page usually garnered immediate responses from other mothers who might offer advice or commiseration.

Many participants mentioned a large closed Facebook group designed to provide mother-to-mother breastfeeding support for women in the region, stating that they appreciated both its diversity and its unity. Mothers valued the varied experiences of participants in this group, who could share their perspectives on a range of problems.

At the same time, they typically welcomed the group’s shared understanding of the importance of breastfeeding, describing the contrast between the pro-breastfeeding advice offered through the group and the counsel of HCPs or family members who casually recommended weaning.

In addition, participants welcomed the wide-ranging options for engagement. Some of them posted frequently, sharing many details about their lives, whereas others described themselves as “lurkers,” who read the content without posting. Still, others moved across multiple levels of engagement, depending on their specific concerns and their other obligations at a given time.

Just as mother-to-mother support is not a new phenomenon, difficulties with mother-to-mother support are also familiar to IBCLCs who have led support group meetings. Attendees at a face-to-face meeting may report feeling judged or being reluctant to bring up sensitive issues in a group of casual acquaintances. These problems can be amplified in a social media context, where large numbers of unfamiliar people may be able to view a post asking for help and where a comment can easily be misinterpreted in the absence of nonverbal cues. One mother stated,

Mothers also reported concerns about “one-size-fits-all” breastfeeding advice.

Speaking more broadly of the tone of interactions among group members, a few mothers felt put off by the perceived militancy of some Facebook group participants.

Another mother concurred,

Face-to-Face Support Groups Remain Important

Although the influence of SMS was a highly prevalent theme across these interviews, the women also highlighted the importance of face-to-face support groups. One mother, comparing SMS and in-person support groups, said, “The human interaction, I think, is a lot better.” Another said, “It’s harder to maintain those personal connections [via social media].” Some women emphasized the value of La Leche League (LLL) meetings, particularly the opportunity they created to hear the experiences of women who had overcome difficulties. A participant who struggled with low supply described the impact of hearing from women who had achieved their goal of exclusive breastfeeding after a period of supplementation. “That inspired me,” she said. She explained that although she was not able to stop supplementing with her first daughter, their stories encouraged her to persist with her second daughter, who was exclusively breastfed. Another woman, who battled a serious skin condition, was moved to tears as she described finding acceptance and “permission” to discontinue breastfeeding through LLL.

Although there are several active LLL groups in the region, mother-to-mother meetings were mentioned less often in these interviews than a support group led by IBCLCs at one of the Baby-Friendly hospitals in the area. These meetings came up repeatedly in mothers’ responses to questions about the most helpful sources of support available to them. Some described finding solutions to vexing problems; others reported that the supportive environment was valuable for them even in the absence of difficulties. One mother who was extremely uncomfortable with public breastfeeding attributed her eventual confidence with nursing in public to her experiences at the support group. The mothers there felt free to nurse their babies, she reported, and their attitude was contagious.

Support Synchrony

A final theme that emerged from these interviews was the importance of “support synchrony.” Mothers who were strongly motivated to continue breastfeeding in difficult circumstances reported that they appreciated HCPs who continued to support their efforts and offer new ideas but felt frustrated by HCPs who told them they were working too hard at breastfeeding.

Conversely, the mothers whose difficulties led them to partial breastfeeding or weaning felt angry with providers or peers who offered simplistic solutions or exhorted them to keep trying without acknowledging their difficulties.