Support Systems

Breastfeeding may be more difficult than you expect. The right help can make all the difference.


Like many pregnant women, Joy Chudacoff fully intended to nurse her baby. To help ensure success, she read two books on the subject and attended breastfeeding classes—all before having the baby. "I thought that I would have Jack, he would latch on and all would be well," says the 42-year-old mother from Marina del Rey, Calif. But it wasn't. In the hospital, Jack lost weight. To top it off, nursing was painful for Chudacoff. So the minute she was discharged, she headed straight to The Pump Station, a nearby breastfeeding support center. There, a lactation consultant changed the way Chudacoff held Jack so he could latch on better—but still there were problems. "I got the idea about how it was supposed to feel," Chudacoff says, "but at home we struggled." Two weeks later, in tears from both pain and frustration, she seriously considered giving up.

* It may be harder than you think Chudacoff's experience is more common than most people realize. In 1999, 67 percent of new mothers left the hospital breastfeeding, according to a Ross Laboratories Mothers' Survey. After six months, only 31 percent were still breastfeeding; at 12 months, the figure had dropped to 17 percent. Those numbers fall woefully short of recommendations from the American Academy of Pediatrics (AAP). Noting the many health benefits for infants and mothers, the AAP recommends that women begin breastfeeding within an hour of giving birth and continue until the baby is at least 12 months old. "Most women realize that breast is best, but they aren't receiving the support they need," says Julie Gazmararian, Ph.D., associate research professor at the Rollins School of Public Health of Emory University in Atlanta. In a study of more than 5,000 new mothers, Gazmararian found that although education about breastfeeding is important during pregnancy, postpartum support is more critical to success—but far less common. "Our society does a tremendous disservice by making breastfeeding appear natural and easy, but it's not easy until women have the routine and rhythm down," says Gazmararian. "That's why lactation support is so important." A recent study at the University of Toronto upholds this. In a group of 256 first-time breastfeeding women, those who received telephone support from an experienced breastfeeding mother reported greater satisfaction with nursing than those who received no such support. In addition, 81 percent of those who received peer support were breastfeeding at three months after giving birth, compared with 67 percent of those who didn't receive support. Chudacoff knows all about this from firsthand experience. She continued to work with her consultant, and by week four, things really started to click. "Now it's like clockwork," Chudacoff says. "I'm so glad I didn't give up."

* Got problems? Get help The most common reasons women give up on nursing in the early weeks are nipple pain and the often false belief that the baby isn't getting enough milk, says Sallie Page-Goertz of Overland Park, Kan., immediate past president of the International Lactation Consultant Association. To prevent and relieve nipple pain, women need to make sure their babies are latching on properly, taking the entire nipple and some of the areola in their mouths. Applying a lanolin-based nipple cream and wearing breast shells can help ease discomfort. As for the second obstacle, women usually need a shot of confidence, along with knowledge of what to look for to ensure that the baby is getting enough milk. The general rule is that beginning four to five days after birth, an infant should have six to eight wet diapers and three or more bowel movements a day. The baby also should want to feed eight to 12 or more times in 24 hours and seem content after nursing. Other problems, Page-Goertz says, include new-mother anxiety and fatigue (which can inhibit milk production), a return to work (although many terrific pumps are available), engorgement (prevented by frequent feeding and relieved by frequent feeding or pumping and placing cold compresses on the breast between feedings), and lack of family support. To help counteract such obstacles, experts offer these tips: * Don't expect breastfeeding to come naturally. Most nursing mothers need some kind of support. * Reach out. Many problems can be solved by talking to a friend or relative who has successfully breastfed a baby. * Group support can really help. Contact La Leche League International (847-519-7730, * Call your insurance company to see if it covers lactation support. Even if it's not covered, consider paying the cost yourself; one or two visits with a lactation consultant will usually resolve any problems or concerns. * If you do experience problems, call a lactation consultant immediately. The earlier you seek help, the better. Chudacoff admits that she can see why even determined women give up on breastfeeding. "It was a mistake to think I could learn it from a book," she says. "If it hadn't been for my family's support and the lactation consultants, I would have said, 'Forget this.'"