Thriving Beyond

By Bibi Chaterpateah

An interview with Marina Magalhães, PhD student at the University of Florida on breastfeeding support and lactation services

Breastfeeding is a strategy key to improving public health

Maternity care practices that support and encourage breastfeeding are important for improving public health and meeting key indicators set forth by Healthy People 2030. The two main indicators for breastfeeding are: 

  1. Increase the proportion of infants who are breastfed exclusively through the age of 6 months 
  2. Increase the proportion of infants who are breastfed at 1 year 
Marina Magalhães

Q: What is lactation and what significance does it play in the health of mothers and babies? 
A: Lactation is simply the production of milk by the mammary glands. The American Academy of Pediatrics (AAP) and World Health Organization recommend that all infants receive breast milk and nothing else until age 6 months, and age-appropriate complementary foods beyond the age of 6 months. Breast milk is unique because it has many protective components which are not found in any other infant formulas or supplements, such as enzymes, antibodies, and an active microbiome of healthy bacteria. For this reason, breast milk is often described by lactation researchers as a living tissue. Breast milk has many benefits for infants which include decreased risk for infection, allergies, respiratory diseases, and childhood cancers. Breastfeeding also protects women from postpartum depression, breast cancer, ovarian cancer, and diabetes mellitus. These health benefits have led to national and international public health
initiatives to increase breastfeeding rates.


Q: How does lactation differ for a mother whose baby is in the NICU vs. a baby who is otherwise healthy? 
A: While critically ill infants receive the most protection from breast milk including fewer complications, their parents have distinct challenges with breastfeeding and lactation. The reasons for shorter lactation and lower milk volume among these parents are not fully understood. However, infants who are too premature or sick to breastfeed are often fed through a tube in their nose or mouth that delivers the milk directly to the stomach. This means that many mothers are separated from their infants for long periods of time and are dependent on a breast pump to express milk. However, there are many resources such as lactation consultants,
support groups, and resources to help pumping mothers optimize their milk volume.


Q: What are some strategies for improving lactation?

A: There are a few strategies to improve lactation.

  • Skin-to-skin contact: Skin-to-skin contact (SSC), also known as kangaroo care, is when the undressed infant is placed directly on the mother’s bare abdomen or chest. SSC immediately after delivery is known to reduce time to first breastfeed, reduce in-hospital formula supplementation, decrease infant stress, and increase maternal-infant bond.
  • Early initiation: Breastfeeding within the first hour postpartum is predictive of breastfeeding duration and delays are associated with self-reported insufficient milk supply. Research among mothers of preterm very low birth weight infants suggests that pumping within the first 3-6 hours postpartum is predictive of milk production at 6 weeks postpartum. The first 2-3 days postpartum are characterized by small volumes of nutrient-rich colostrum, and early initiation facilitates the let-down of copious volumes of milk as the infant requires greater volumes of milk.
  • Lactation support: Internationally Board-Certified Lactation Consultants (IBCLC) are trained to help breastfeeding and pumping moms with any concerns they may have, such as how to use a breast pump, comfortable breastfeeding holds, getting a good latch, addressing nipple pain, and more. Find a local lactation consultant here. Mother-to-mother support groups, such as La Leche League and peer support groups at your local hospital, are also great resources.
  • Frequent feeding or pumping: One of the most common reasons for short lactation or low milk supply is thought to be insufficient pumping or breastfeeding frequency. Because milk is produced by a positive feedback system involving the pituitary gland and lactation hormones, it is important to pump milk 6-12 times per day to stimulate milk production. Insufficient pumping frequency is associated with low milk volume and shorter lactation.


Q: What are some common misconceptions about lactation and how are these addressed? 

Myth: Breastfeeding comes easily and immediately.

Breastfeeding and expressing milk take practice using different techniques, tools, and positions. Many moms try different holds and pumps to get a good latch and suction that is comfortable for them.


Myth: Painful nipples are expected. 

While breastfeeding can sometimes be uncomfortable when learning how to feed a newborn infant, it should not hurt with a comfortable hold and good latch. Breastfeeding parents experiencing nipple pain can request the help of a lactation consultant, who is trained to address this commonly resolved issue.


Myth: My newborn baby is waking up all the time to breastfeed because he is not getting enough milk.

In the first 2-3 days postpartum, it is normal to produce small volumes of colostrum. Newborn infants have small stomachs, but they are growing very quickly and need to breastfeed 8-12 times per day. Sometimes they may want to breastfeed more frequently in “clusters”; this is normal and not an indication that they are not getting enough milk. However,
parents can track dirty diapers to monitor their infant’s milk intake.


Myth: I need to wean my baby when going back to work. 

Know your rights! While returning to the workplace can be challenging after the birth of a new child, most employers in the U.S. are required by law to provide a pumping break for lactating moms in a private, clean space that is not a restroom. Certain states have additional protections for pumping at the workplace or breastfeeding in public. Check with your health insurance to see which breast pumps are covered, as the Affordable Care act requires that most health insurance companies cover the cost of a breast pump.


Myth: Many mothers have insufficient milk supply.

While there are many factors that can affect milk volume, most lactating parents can produce enough milk for their infant. It is very important to initiate early with a good latch and breastfeed or express milk frequently enough to stimulate milk production.


Myth: You shouldn’t breastfeed if you are sick or taking medications.

In the United States, breastfeeding is not recommended for HIV+ mothers or for mothers taking certain medications. However, breastfeeding is safe even with most medications and illnesses, including COVID-19. It is important to consult with your health care provider and pharmacist to discuss if breastfeeding is safe for your infant.


Q: How accessible are lactation services ? 

A: As part of the Baby Friendly Hospital Initiative, many U.S. hospitals provide routine lactation support to postpartum mothers. However, even those who did not have a lactation consult in their hospital or birthing center can receive insurance-covered lactation counseling and a breast pump. Medicaid-eligible women are also eligible to enroll in the Special Supplemental Nutrition Program for Women (WIC), which offers breastfeeding support and many other nutrition services.


Q: What role does lactation play in public health? 
A: UNICEF has described improving breastfeeding rates as the smartest investment a country can make because of its potential for sustainably improving health and wellbeing across the lifespan. Breastfeeding and lactation have long been considered to be women’s issues, but optimizing child health during the early years is fundamental for the health of the public as a whole. Addressing breastfeeding support as a collective public responsibility is necessary, as common reasons for short lactation are related to the lack of social support and infrastructure for breastfeeding women such as paid maternal leave. Cultural, workplace, and policy-level changes are needed to realize the potential for breastfeeding in public health.


Q: What are some resources to learn more about lactation?


CDC Guide on Breastfeeding with COVID-19

Safety and Benefits of COVID-19 Vaccine for Breastfeeding and Lactating Parents

How Breast Milk Could Pass Along COVID-19 Immunity

March of Dimes Breastfeeding Help

USDA WIC Breastfeeding Support – Explore the stages of breastfeeding!

U.S. Breastfeeding Committee – CDC Supported Non-Profit with latest legislation and resources for breastfeeding and lactation

U.S. Office on Women’s Health

CDC Guidelines, Data, and FAQs about Breastfeeding

How to Clean your Breast Pump

AWHONN Breastfeeding Resources for Parents

About Marina Magalhães:

Marina Magalhães is a PhD student at the University of Florida conducting research focusing on strategies to support lactation among mothers of critically ill infants. Marina is a registered nurse who served three years in the only level 4 Neonatal Intensive Care Unit located in Gainesville, Florida. Marina is a maternal and newborn health advocate with a strong interest in high-risk pregnancies and newborns, and perinatal health inequities. She is a member of the American Public Health Association (APHA) and a Student Fellow of the Maternal Child Health Section of APHA.

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