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From the UNC Gillings School of Global Public Health

Dr. Alison Stuebe

More women than ever are choosing to breastfeed with widespread recognition of the benefits. Breastfeeding is recommended as the sole source of nutrition for the first six months in a child’s life, followed by continued breastfeeding with the addition of nutritious complementary foods for at least a year and beyond. A newly released state-of-the-art review provides guidance for health care practitioners to help them assess and manage exclusive breastfeeding during the first week of life.

The review article, published today in Pediatrics, incorporates research from UNC-Chapel Hill and a team that includes senior author Alison Stuebe, MD, MSc, professor of obstetrics and gynecology, professor of maternal and child health and distinguished professor in infant and young child feeding at the Carolina Global Breastfeeding Institute at UNC Gillings School of Global Public Health.

Even though exclusive breastfeeding is recommended by physicians, for some moms it’s not always possible. Important clues can help identify when supplementation is medically necessary. The review provides an algorithm to help clinicians recognize when infants have sub-optimal nutrition intake. It also helps determine whether mothers can provide their own expressed milk or if supplementation with donor human milk or infant formula is needed.

“While the incidence of breastfeeding has been on the rise, many infants and mothers encounter difficulties starting out breastfeeding during the first week after delivery,” said lead author Lori Feldman-Winter, MD, MPH, from Cooper University Hospital-Cooper Medical School of Rowan University. “Health care practitioners need the appropriate knowledge and skills to identify those at risk for breastfeeding problems to provide evidence-based solutions for breastfeeding management.”

Just as breastfeeding has become more popular, more mothers today have complications that make breastfeeding difficult. These reasons can include rising rates of obesity, more first births among older mothers and more pregnancies that are the result of assisted fertility.

“This state-of-the-art review highlights these evidence-based solutions and summarizes new tools that can be used to monitor and manage breastfeeding in order to help mothers achieve their personal breastfeeding goals,” Feldman-Winter said.

“In the late 70’s and early 80’s, as few as 1 in 5 women even tried breastfeeding, so we lost a generation of doctors and nurses as well as family members and support people who had experience with exclusively breastfed babies,” explained co-author Ann Kellams MD, IBCLC, from the University of Virginia. “Now that the benefits of exclusive breastfeeding are well-known, it is important for families and the doctors and nurses caring for them to be able to do so safely and identify those at risk of complications.”

Most mothers can produce adequate colostrum and mature milk, and most newborns are able to breastfeed exclusively. Nevertheless, conditions that require medical supplementation are common and important to recognize. The decision to supplement with infant formula or donor human milk requires thoughtful consideration of the risks and benefits and discussion with the family to reach a shared decision. Early term and late preterm newborns are at higher risk of complications, and this often warrants more careful monitoring, detailed assessments and case-based interventions around feeding.

Careful risk assessment, targeted support and open communication are also critically important for the wellbeing of mothers, according to Stuebe.

Too often, mothers blame themselves when breastfeeding comes undone,” said Stuebe, who is also a professor of obstetrics and gynecology at the UNC School of Medicine. “Tailored support in the first week is essential so that every mother has the opportunity to nurture her baby at the breast.”

Further research is needed to identify the best methods to support exclusive breastfeeding in high-risk populations and is currently underway at Gillings through a grant awarded to Stuebe and co-PI Kristin Tully, PhD, for a project titled Re-engineering Postpartum Unit Care and the Transition Home to Reduce Perinatal Morbidity and Mortality.

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