Redefining Breastfeeding Success by Defining Lactation Acuity
By: Gloria Dudney, RN, IBCLC, RLC
In Rebecca Mannel’s article entitled “Defining lactation acuity to improve patient safety and outcomes”1, she provided a risk stratification framework to better quantify lactation staffing ratios. By asserting that patients with multiple lactation risk factors require more intensive care, she aligned healthcare of the breastfeeding dyad with most other areas of healthcare—we care for patients differently and have different expectations for patients based on their risk profiles.
The next logical step is to take a well-defined patient acuity and apply it to expectations for breastfeeding outcomes. For example, if a patient has multiple risk factors that resulted in limiting her breast milk production to 50% of her infant’s intake, this may feel like a failure to the patient, but can be defined as a success in light of her ability to continue producing at her maximum physiological capacity. There is a growing need for earlier and more comprehensive breastfeeding education and flexible infant feeding plans in light of growing patient acuity and the demands of modern life.
Were you aware that:
- At delivery, 84% of mothers are exclusively breastfeeding2
- By two weeks postpartum, 1 in 4 mothers has returned to work3
- By one month postpartum, only 57% continue to exclusively breastfeed2
- By six months postpartum, 25% are exclusively breastfeeding2
Did you ever wonder:
- Why breastfeeding seems to be increasingly challenging for patients?
- Why some mothers struggle with their milk production even when they are completely compliant with the plan of care?
- Why some mothers feel shamed when feeding their babies infant formula?
- Why we continue to recommend “triple feeding” when it is often unsustainable?
- Why so many babies seem to be intolerant of cow’s milk protein?
- Why we don’t take advantage of the prenatal season to educate families about infant feeding?
- Why many mothers struggle with their milk production after returning to work?
- What can be done about all of the above?
Yes, me too. Co-author Kirsten Frank and I endeavored to address some of the most pressing challenges related to early infant feeding in the most recent edition of the “Science on Your Seat” article published by Mead Johnson Nutrition. Entitled, “Supporting the Supplementers: The Clinician’s Role in Protecting Breastfeeding Duration in the Setting of Combination Feeding”, the content provides an evidence update as well as suggestions for meeting the needs of families.
And, in the corresponding article for which continuing education credit can be earned, entitled, “I didn’t want to let go of the dream”: Exploring women’s personal stories of how their low milk supply was discovered”, you will explore the themes gleaned from the stories of hundreds of women who struggled with insufficient milk production and learn more about how the authors “identified a mismatch between women’s expectation and reality”4 In their discussion, the authors share that “when faced with the experience of low milk supply, many women described feeling unheard and misunderstood…The long-held unsubstantiated belief that less than 5% of mother-infant dyads are inherently unable to breastfeed may contribute to women with low supply feeling unheard and misunderstood. This percentage, originally reported 85 years ago, is incongruent with the existence of many factors which can impact a woman’s ability to make a full supply. These findings highlight the importance of health professionals practicing reflexivity and believing the stories women share with them.”4
Despite their intentions, plans, and often substantial investments of financial, physical, and emotional resources, the vast majority of mothers are not meeting their infant feeding goals. There are many risk factors involved in this reality; some are modifiable, some are not. In the “Supporting the Supplementers” text you will learn about the reasons for the struggle and identify multiple ways that clinicians can come alongside parents on the journey to provide evidence-based care and compassionate support.
References
- Mannel R. Defining lactation acuity to improve patient safety and outcomes. J Hum Lact. 2011 May;27(2):163-70. Doi: 10.1177/0890334410397198. PMID:21527797.
- CDC Breastfeeding Report Card. Breastfeeding Data. https://www.cdc.gov/breastfeeding-data/breastfeeding-report-card/index.html. Published June 11, 2024.
- Jonathan Simonetta, U.S. Department of Labor, Pozniak A, et al. The Family and Medical Leave Act (FMLA) Final Report: Detailed Results Appendix. Abt Associates Inc.; 2012: https://www.dol.gov/sites/dolgov/files/OASP/legacy/files/FMLA-Detailed-Results-Appendix.pdf
- Kam RL, Bennetts SK, Cullinane M, Amir LH. “I didn’t want to let go of the dream”: Exploring women’s personal stories of how their low milk supply was discovered. Sex Reprod Healthc. 2024;40:100953.doi:10.1016/j.srhc.2024.100953
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
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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.
