Breastfeeding Support Groups and Community Resources

Need for New Forms of Breastfeeding Support

Breastfeeding was never totally abandoned. The perception that formula was “as good as breast milk” increased, and the knowledge about breastfeeding and support for breastfeeding within the community and the medical profession diminished. Nevertheless, there were always groups of women who prepared themselves for childbirth and read and researched feeding and nutrition and chose to breastfeed.

In the mid-1940s, Dr. Edith Jackson began the Rooming-In Project at Yale University in New Haven, Connecticut. Families in New Haven who sought “childbirth without fear” and an opportunity to room-in with their infants usually chose to breastfeed. In the rooming-in unit, breastfeeding was often “contagious” because one mother successfully nursing would encourage others to try. Hospital stays averaged 5 to 7 days, during which time a mother-infant couple was cared for as a pair. More than 70% of the patients left this hospital breastfeeding. The national average of breastfeeding initiation at that time (1945 to 1955) was less than 25%.

Students and staff who were exposed to the philosophy of this unit went to many parts of the country, taking with them tremendous commitment to prepared childbirth and nurturing through breastfeeding. The classic article on the management of breastfeeding by Barnes et al. ³ was published as a result of counseling hundreds of nursing mothers. The students of Dr. Jackson inoculated many hundreds of hospitals and communities with a zeal for breastfeeding.

La Leche League

The La Leche League, developed by a group of seven mothers to meet these needs, was established in Franklin Park, Illinois, in 1957. The original intent was to provide other nursing mothers with information, encouragement, and moral support. Thousands of local chapters and a network of 32,000 state and regional coordinators synchronized their activities with the headquarters in Schaumburg, Illinois. La Leche League International’s (LLLI’s) 4000 groups are now in 66 countries, including the United States, Canada, parts of Europe, New Zealand, Africa, and other parts of the world.

An excellent publication, The Womanly Art of Breastfeeding , ⁴ was first published in 1958 (8th edition and update in 2007) by the original group of mothers involved in the La Leche League. La Leche League continues to provide information and updated publications about common questions that arise during lactation. Local groups offer classes for preparing mothers to breastfeed. They help with suggestions about the nitty-gritty details of preparation, nutrition, clothing, and mothering in general. They also provide every mother with a telephone counselor. To be qualified to serve as a counselor to another mother, a member must demonstrate knowledge and expertise in breastfeeding and an understanding of how to counsel and render support. “Telephone mothers” do not give medical advice and are instructed to tell a troubled mother to call her own physician for such advice. Interested local physicians provide medical expertise for the group when a medical opinion is appropriate. The league provides support for mothers to reduce the time the physician needs to spend counseling on the nonmedical aspects of lactation. Most information needed by new mothers is not medical.

Doulas

In the 1960s in the United States, along with the “natural childbirth” movement, came the concept of another woman supporting the pregnant woman through the process of pregnancy, childbirth, and the postpartum period. Dana Raphael used the term doula to describe such an assistant in an anthropologic study and popularized that term in her book, The Tender Gift: Breastfeeding . A doula is described as a professional person trained to provide physical, emotional, and informational support to a mother throughout her transition into motherhood. There are various international programs to train doulas. Research supports the concept that personal, continuous physical and emotional support in addition to regular nursing care is associated with better childbirth outcomes. ⁵ , ⁶ , ⁷ Additional data demonstrate the benefits of doulas into the postpartum period and specifically for increasing duration and exclusivity of breastfeeding in black and Hispanic mothers. ⁸ Other forms of breastfeeding support in addition to La Leche League are available. Similar programs have been developed as needed to provide support based on local and cultural practices of breastfeeding and infant nutrition in more than 70 other countries. Examples of such programs include the Ammehjelpen International Group in Norway, the Australian Breastfeeding Association, and in the United Kingdom the National Childbirth Trust.

The Breastfeeding Association of South Africa is an example of a nongovernmental, nonprofit, voluntary organization. It was founded in 1978 by South Africans for the express needs of South African women. Their particular issues and solutions are well described by Bergh. ⁹

Individual Groups and Special Needs

Support groups for all of life’s events, especially those covering health and specific illnesses, have become commonplace. Pregnancy and prenatal classes have evolved to provide mothers and fathers with information and support through pregnancy and childbirth. In the broader field of perinatal care, groups are available for infertile couples; couples who are expecting; those who have experienced pregnancy loss, loss of a premature infant, or loss of a term baby; those who had a cesarean delivery; and so on.

Adolescents are an example of a subset of women who need special support to improve the outcome of their pregnancies, to encourage them to breastfeed, and to establish the special relationship with, and commitment to, their infants. A study done in the Breastfeeding Educated and Supported Teen Club in Melbourne, Florida, looked at the impact of specific breastfeeding education provided by a lactation consultant in group classes. Teens were randomly assigned to the program or as a control; ethnicity and age were not significant factors. Of the 43 adolescents in the education group, 28 (65%) initiated breastfeeding, but of the 48 control subjects without education, only 7 (14.6%) initiated breastfeeding ( p < 0.001). The authors concluded that targeted education makes a difference in adolescents initiating breastfeeding. ¹⁰

A similar study was performed involving low-income women using a community-based program. It examined interventions in a hospital, a home visit, and telephone support system provided by a community health nurse and a peer counselor for 6 months. After random assignment, those receiving the interventions breastfed longer. The infants in the intervention group had fewer sick visits and use of medications than the group with “standard care.” The cost of the program per mother was $301, which was offset by the savings on the cost of formula and health care. ¹¹

In another study, adult women without a personal breastfeeding support system at home were randomized to receive or not receive support. The support group received assistance and support in the hospital and at home from a practicing midwife in the community. The midwife made daily visits to the hospital. After discharge, she telephoned within 72 hours and then weekly for 4 weeks. At home the participants had access to the midwife by phone and pager. One home visit was made the first week and then as necessary. In the supported group, 26 of 26 were still breastfeeding at 1 month, but only 17 of 25 (68%) in the unsupported group were breastfeeding, proving that intensive professional support works. The costs of the program were not provided. ¹²

There are numerous other examples of effective breastfeeding support in many forms. ¹³ Active individualized support outreach clearly affects the duration of breastfeeding and ultimately saves health care dollars.

Peer Support Groups

There are many forms of support that have been successfully provided to breastfeeding mothers. The Centers for Disease Control and Prevention (CDC) has published a guide to various strategies for support, including maternity care practices, professional education, access to professional support, support in the workplace, breastfeeding education, and information and social marketing that positively influence breastfeeding. ¹³ Systematic reviews of peer support programs have found them to be effective in increasing breastfeeding. ¹⁴ , ¹⁵ , ¹⁶ Significant increases in initiation, duration, and exclusivity were observed among women who received support from a peer or other lay person providing the counseling. Often peer support, added to other components of breastfeeding support, leads to increased maternal satisfaction and trust in the education and care provided.

Resources

As different forms of breastfeeding support were identified to be effective there was a need to make the support readily available to all mothers. Many hospitals started to provide training in preparation for childbirth. Part of those programs were about the new infant and how to plan for neonatal care. These programs often serve as the initial stimulus to consider breastfeeding. Often such programs are given by hospital-based lactation consultants.

When a large health maintenance organization looked at 5213 new mothers enrolled in a commercial managed care plan by telephone survey at 4 to 6 months postpartum, 75% had breastfed for some time. Of these, 75% breastfed for more than 6 weeks. Breastfeeding for more than 6 weeks was associated with level of education, employment status (part-time, 84%), and adequacy of postpartum information. The authors of the report concluded that health plans and employers should consider promoting breastfeeding. ¹⁷

Because hospitals have become competitive and are marketing their services, many are developing birthing centers and are trying to capture the attention of the childbearing public with special services. These services often include classes on child-rearing, including breastfeeding. Physicians should investigate the programs and printed materials distributed by the hospitals where their patients deliver. Pediatricians can assist mothers and families in coping with the flood of patient information from conflicting sources by being familiar with the different materials and being able to competently answer parental questions. This is especially helpful if the patients give birth at more than one hospital or more than one lay advocacy group is active in the community. Hospital procedures and policies can influence the success or failure of breastfeeding mothers. ¹⁸ Pediatricians should be aware of the policies at the hospital(s) with which they are associated and support those policies that effectively support breastfeeding.

Trusted Information and Trusted Sources

In a couple of decades, we have gone from a paucity of support groups and resource literature to an overwhelming flood. The flow is greatest over the Internet. Health care books and childbearing and family-rearing advice books are cascading off the presses, written by everyone from qualified experts to poorly informed freelance writers. Some are written by health care professionals who have personal and professional experience in childbearing. Websites, blogs, Twitter, Facebook, etc., send an avalanche of information with the smallest question or search. Physicians should be familiar with a few good references/websites for parents, provide a list of references/websites for patients to access and be ready to review the sources of information their patients are using. Along with that, physicians should openly demonstrate respect for their patients’ concerns and questions, legitimize their search for information and dilemmas with inconsistent information, and support their ongoing decision-making and choices regarding infant feeding and breastfeeding.