7 Clinical Takeaways for Providers Caring for Lactating Parents and Breastfeeding Infants

National data show that 60% of mothers do not breastfeed for as long as they intended. The most significant influence of drop-off, which tends to occur around three months postpartum, is a lack of support.

For mothers and gestational parents who choose to breastfeed, support must be consistent, easy to access and tailored to the patient population, explains Heidi Szugye, DO, IBCLC, Medical Director of Breastfeeding Medicine Clinic. Dr. Szugye is dually board-certified in general pediatrics and pediatric hospital medicine and is an International Board-Certified Lactation Consultant.

Dr. Szugye and team launched the clinic in 2022 after observing a significant need to bolster breastfeeding services and resources for patients and providers across the health system. More than 12,000 live births occur annually in Cleveland Clinic birthing hospitals, making it the highest-volume center in northeast Ohio. She says their goal is to work collaboratively with parent-infant dyads to add one more layer of support in conjunction with routine OB/GYN and pediatrician visits.

“These care teams are really good at identifying when something is not going well: mom’s having pain or baby is losing weight, for example,” she says. “Our job is to investigate the root of the problem, and not surprisingly, it’s often multifactorial and requires more than a one-size-fits-all approach.”

A new era of breastfeeding

Dr. Szugye argues that the explosion of evidence and updated AAP recommendations on breastfeeding and the use of human milk are defining a new era within the discipline. Emerging scientific data juxtaposed with social media content that can be misleading or inaccurate has made it more complicated to navigate.

“Protocols and guidelines have expanded significantly in the last decade or so. This is shaping the practice in new ways and negating some of the long-held ‘truths’ about what works and what doesn’t,” she says.

Takeaways for clinicians

The team developed a survey for 400 providers in pediatric primary care and hospital medicine, women’s health, medical and surgical breast services, and lactation services to assess what misconceptions providers treating breastfeeding patients are seeing in practice. Dr. Szugye comments below on the seven key takeaways this work revealed.

1. Normalize that breastfeeding is not intuitive. “Many families assume latching a baby is “natural” or will happen flawlessly after birth without need for support, instruction, or time. On the contrary, it can be more like learning to ride a bike and require more practice. Getting early, ongoing support is so important to navigate early challenges to avoid early cessation.”
   
2. Offer prenatal education and support. “It’s never too early to refer a patient. We recommend patients seek breastfeeding support and education even prior to the birth of baby especially those with risk factors for breastfeeding challenges such as history of breast surgery, polycystic ovarian syndrome, gestational diabetes, or inverted nipples. Lactation consultants often offer prenatal education classes and breastfeeding medicine physicians can see patients with more complex medical conditions.”
   
3. Provide counsel on supply – undersupply and oversupply. “It’s very normal for patients to make only a small amount of colostrum in the beginning, and babies often don’t latch right away. I commonly see patients who report a perceived supply issue. But, upon closer evaluation, the baby is gaining weight just beautifully. In fact, an oversupply puts patients at risk for mastitis, plugged ducts and abscesses. Certainly, there are times when supply is actually low, and we work through that in clinic, but it’s important to look at the whole picture and use the history and infant’s weight along with tools such as the newborn weight tool® [NEWT] to guide interventions.”
   
4. Practice caution with ‘pumping and dumping.’ “Talk to your patient about their list of medications and therapeutic alternatives. There are more resources available than even before.* When in doubt, ‘pump and save’ rather than ‘pump and dump.’”
   
   “Common exceptions include some radiotracers, chemotherapy, anesthetics and other L5 medications. Most over the counter prescription medications are compatible with breastfeeding, and the amount that gets into breast milk is very minimal. When it comes to alcohol, many sources advise limiting intake to 8 oz of wine or two beers and waiting two hours after drinking to resume breastfeeding.”
5. Present alternatives and provide support in the ongoing journey. Sometimes getting a baby to latch and achieving a full supply takes longer than expected. It doesn’t always all come together that first day. Sometimes pumped milk, donor milk or formula are needed but baby may go on to exclusively breastfeed,” she says.
   
   “When there are long-term latching or supply challenges, I tell patients to check in with themselves every day. Is it enjoyable? Is it sustainable? Is it negatively impacting your mental health? If any of those are raising red flags, we need to tweak something. Ongoing shared medical decisions and conversations are so important.”
6. Identify barriers to breastfeeding support and take action. “It’s well-documented that factors including race, socioeconomic status, age, and location play a role in breastfeeding rates and health outcomes. We are involved in several projects investigating where the barriers are the highest and how we can deliver targeted measures to break down these barriers. One such project includes a grant-funded partnership program with Birthing Beautiful Communities to facilitate use of doulas for patients in underserved populations. Another initiative involves an embedded electronic health record dashboard to visualize breastfeeding metrics across the enterprise.”
   
7. Support those whose breastfeeding journeys are different than they expected. “Reinforce that self-worth as a mother is not tied to breast milk production. Language and our chosen words matter. Be mindful that words like ‘failure,’ ‘goals’ and ‘insufficient’ can be really triggering for patients. Be sure to acknowledge, listen and validate patients’ concerns, and know when referral to psychologists and therapists who specialize in breastfeeding-related grief is warranted.”

* InfantRisk.org and LactMed® are two free resources for clinicians.

Editor’s note: While the term breastfeeding is used in this article for the sake of simplicity, Dr. Szugye emphasizes use of gender-inclusive language, such as chest feeding and breastmilk feeding, when appropriate for the patient.