Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months

Abstract

Objective: We characterized breastfeeding concerns from open-text maternal responses and determined their association with stopping breastfeeding by 60 days (stopping breastfeeding) and feeding any formula between 30 and 60 days (formula use).

Methods: We assessed breastfeeding support, intentions, and concerns in 532 expectant primiparas and conducted follow-up interviews at 0, 3, 7, 14, 30, and 60 days postpartum. We calculated adjusted relative risk (ARR) and adjusted population attributable risk (PAR) for feeding outcomes by concern category and day, adjusted for feeding intentions and education.

Results: In 2946 interviews, 4179 breastfeeding concerns were reported, comprising 49 subcategories and 9 main categories. Ninety-two percent of participants reported ≥ 1 concern at day 3, with the most predominant being difficulty with infant feeding at breast (52%), breastfeeding pain (44%), and milk quantity (40%). Concerns at any postpartum interview were significantly associated with increased risk of stopping breastfeeding and formula use, with peak ARR at day 3 (eg, stopping breastfeeding ARR [95% confidence interval] = 9.2 [3.0-infinity]). The concerns yielding the largest adjusted PAR for stopping breastfeeding were day 7 "infant feeding difficulty" (adjusted PAR = 32%) and day 14 "milk quantity" (adjusted PAR = 23%).

Conclusions: Breastfeeding concerns are highly prevalent and associated with stopping breastfeeding. Priority should be given to developing strategies for lowering the overall occurrence of breastfeeding concerns and resolving, in particular, infant feeding and milk quantity concerns occurring within the first 14 days postpartum.

Keywords: breastfeeding; concerns; infant; lactation; problems.

Figures

FIGURE 1

Flow diagram of participant screening, enrollment, and follow-up in the Early Lactation Success study. a Maternally reported breastfeeding concerns and problems are referred to as “breastfeeding concerns” throughout the text. b Overall, 46.4% (194/418) fed any formula between 30 and 60 days and 22.7% (95/418) stopped breastfeeding by 60 days postpartum.

FIGURE 2

Prevalence of maternally reported breastfeeding concerns (main categories) by interview time point. At the prenatal interview, women were asked about their breastfeeding concerns. At each postpartum interview, women who had breastfed or expressed their breast milk since the previous interview were asked to describe any problems or concerns they had (currently or since the previous interview) about feeding their infant. Main categories in legend are presented top to bottom in order of prevalence at the day 3 interview. “Maternal health and medication” and “too much milk” main categories are not shown (prevalence ≤ 2% at any time point). Prevalence results are not adjusted for confounders.

FIGURE 3

ARR of having fed any formula between 30 and 60 days and stopped breastfeeding by 60 days by main category of breastfeeding concern at each interview time point (referent = no concern within the specified category at the same time point). Models were adjusted for Infant Feeding Intention Scale category and maternal education level. All main categories significant at ≥1 time point are shown (with the exception of “signs of inadequate intake” at day 14: ARR of feeding any formula days 30–60 = 1.70, P < .01). Postpartum interviews were only conducted with women who had breastfed or expressed their breast milk since the previous interview. The fed any formula model was restricted to mothers with prenatal intent to provide breast milk as the sole milk source for > 2 months (sample size, range 328–354 per interview time point). The stopped breastfeeding model was restricted to mothers with prenatal intent to breastfeed > 2 months (sample size, range 373–406 per interview time point). Significant relationships (P < .05) at each interview time point are indicated by a filled square.

FIGURE 4

Adjusted PAR for select breastfeeding concerns based on estimated risk adjusted for prenatal Infant Feeding Intention Scale category and maternal education level. For each time point, total bar height denotes overall incidence of having stopped breastfeeding by 60 days (per 100 study participants with prenatal intent to breastfeed > 2 months and breastfed 1 or more times since previous interview time point). Solid portion of each bar denotes percent “stopped breastfeeding” attributable to report of specified breastfeeding concern for same time point: closed square = infant feeding difficulty; open square = milk quantity concern.