A New Day Dawns in Breastfeeding Research and Practice
Part 1 – We’ve come a long way, baby!
By: Gloria Dudney, RN, IBCLC, RLC
“Drum roll… Drum roll please,” Clark requests as he prepares to connect the last extension cord and power up the 25,000 twinkle lights that drape every inch of his home in the classic National Lampoon’s Christmas Vacation movie. His loyal wife and obliging children provide the vocal percussion drum roll as his first attempt fails spectacularly and then they lovingly encourage him not to give up as they abandon him in the cold dark night to recheck the bulbs.
This is how it has felt to be a high-risk breastfeeding mother in the new millennium—and by empathetic extension, this is how it has felt to be her nurse—scampering about on high ladders and steep roofs trying to make breastfeeding beautiful. But when breastfeeding wasn’t working, we just kept “checking the bulbs” again and again—is something wrong with the latch? is something wrong with the pump? —instead of realizing the power wasn’t connected…something was wrong with the foundational biology.
In response to changes in hospital breastfeeding policies earlier this century, US mothers were advised that exclusive breastfeeding was the “biological norm” and therefore breastfeeding exclusivity became synonymous with breastfeeding success. But what if her “biology” wasn’t “normal”? What if the “power” to the mammary gland wasn’t fully connected?
In response to faltering US breastfeeding duration rates, particularly within the first month post-delivery1, the Academy of Breastfeeding Medicine convened a multidisciplinary workgroup of pioneering researchers to unravel the complex mystery surrounding early and unintended weaning. Their work has been shared in a special open access issue of the ABM’s journal, Breastfeeding Medicine2, where the group has provided, “… a framework for the study and practice of early, unplanned cessation of lactation; an integrative review of point-of-care techniques that can be leveraged to address this problem; five original research articles; and a commentary that translates these concepts and principles into actionable practices…”
This is marvelous news for maternal-child health professionals—as it is widely understood that the first step to conquering a problem is to first admit that you have one.
In August of 2018, I wrote a letter3 (published in 2019) to Dr. Kathleen Kendall-Tackett, editor-in-chief of Clinical Lactation, the journal for the United States Lactation Consultants Association to ask her and my peers a few pressing questions:
- Would now be a good time to rethink a system of care that continues to fail patients?
- Could agreeing about maternal-infant risk factors provide the common ground necessary to begin revising policies so that they better address the individual needs of our patients?
- Could we prevail upon our national, multidisciplinary leaders to develop a policy framework and clinical outcome expectations based on an assessment of risk factors for impaired lactation?
- Could we initiate policies that define and acknowledge the victory of partial breastfeeding for the at-risk dyad rather than unintentionally create a victim of the at-risk mother unable to achieve exclusive breastfeeding?
- Could we help new mothers feel like a success instead of a failure by re-defining what breastfeeding success looks like in an at-risk setting?
- What good is exclusivity without duration?
In July of 2025, Dr. Arthur Eidelman, the editor-in-chief of ABM’s Breastfeeding Medicine2 said the following as he introduced the special issue focusing on “Early, Unplanned Cessation of Lactation in Healthy and at-Risk Dyads”:
“One must remember that while breastfeeding initiation rates in the hospital are well over 80%, by 3 months the exclusive breastfeeding rate drops by nearly half to only 45%. Simply put, the war to support breastfeeding is already lost in the immediate weeks and months after the birth of the infant, even in mothers whose intention from the start was to breastfeed. Clearly, debating if duration should be 1, 2, or 3 years is irrelevant to the majority of mothers who have long stopped nursing, especially those who terminate breastfeeding well before the infant is 3 months old…we need to stop lamenting about an undesired situation after the fact and focus our attention where it should be with the aid of a framework provided by Drs. Meier and Parker and their colleagues in this landmark special issue.”
Breastfeeding advocates rejoice! Our leadership acknowledges the core challenge and has the courage to meet it! A new day is dawning in breastfeeding research and practice—let the paradigm shift begin!
In Part 2, we will examine the content of the special issue and highlight portions that can serve as actionable intelligence for our practice.
References
- https://www.synovaassociates.com/redefining-breastfeeding-success-by-defining-lactation-acuity/
- https://www.liebertpub.com/toc/bfm/20/7
- Dudney, G. (2019). [Letter to the editor]. Clinical Lactation, 10(1):9-10.
ABOUT THE AUTHOR
Gloria Dudney, RN, IBCLC, RLC
Gloria Dudney, RN, IBCLC, RLC has been practicing maternal-child nursing for 31 years and has been board-certified as a Lactation Consultant for more than 20 years. She has inpatient experience in addition to 24 years in a large pediatric practice where she launched the first outpatient lactation clinic in the region. She now serves as the Director of Lactation Services for East Tennessee State University Health where she has pioneered an innovative antenatal lactation program that includes both patient care and OB resident training.
Gloria is an advocate for increased access to expert breastfeeding support and recently led a successful campaign to secure Medicaid coverage for lactation services in the state of Tennessee. She authored the book, “Mommy-Friendly Breastfeeding” and speaks nationally on various topics related to maternal-child health. Her vision statement is, “If mom’s ok, everyone’s ok.” Her mission statement is, “Make mom ok”. She is married to Bo and together they have 4 children and 7 grandchildren
Learn more about Mead Johnson Nutrition
The material presented in this blog represents the opinion of the author(s) and not necessarily the views of Synova Associates. Synova Associates does not endorse any specific products or organizations but strives to connect its industry partners with leaders interested in product/educational innovation.
