December 13, 2023
By Nicole Vieria, Drexel University College of Medicine
During my Women’s Health Education Program (WHEP) elective, I had the privilege of spending a month learning from international board-certified lactation consultants and caring for lactating parents at St. Christopher’s Hospital for Children. As a medical student, I knew only that chest feeding led to better health outcomes. However, what I now know is that U.S. parents who chest feed tend to be of higher socioeconomic statuses, be disproportionately white, and have job flexibility, social support, low stress levels and higher levels of education. So, although studies show that chest-fed babies have lower rates of obesity, diabetes and hypertension as adults1, the causation may not be as clear as we have been sold. Undoubtedly, human milk has health advantages for both parents and infants, but the full story is more complex than that.
When spending time with families at the clinic, I was struck by how all-consuming the newborn period is for birthing parents. Childbirth alone completely exhausts the body, and as soon as the baby comes out of the uterus, they require constant care. The newborn period is a daunting task, even for someone with no shortage of resources. It is even more challenging to a parent who is a teenager.
One mother I worked with was 18 years old and exclusively chest fed her baby for the first two months. However, upon starting birth control, her milk supply began to decrease. She had been pumping every two hours at school in the nurse’s office. It is good that her school gave her a safe space to pump, but it is hard to imagine how much class she was missing. She was expected to perform as well as her peers despite having to wake up several times a night to chest feed, pumping four times a day at school, and enduring the bodily stress of pregnancy and childbearing.
To provide some aid, Philadelphia has the Education Leading to Employment and Career Training (ELECT) program, which supports pregnant and parenting students under 21. The parent must be enrolled in school or a GED program, participate in quarterly home visits and agree to complete school assignments and maintain grades. This program is available in over 90 schools in Philadelphia.2 This mother told me that her case manager meets with her weekly to see how she can support her. Although this provides some assistance, there is still much that can be done.
Adolescent parents, defined as any birthing parent below age 20, face many special challenges; chest feeding is no exception. The latest meta-synthesis of current research published in 2020 regarding teen birthing parents demonstrated that supports available to lactating teens are insufficient to mitigate the current barriers.1 Some of these challenges include judgment from health care professionals, lack of support and fear of the male gaze when exposing the chest in public.
To combat the reluctance of exposing their chest in public, lactating teens resort to chest feeding in public restrooms, staying home, feeding in the car or bottle-feeding in public. Furthermore, many spaces are inhospitable to their situations. In one instance, a mother was not allowed to bring her infant to her mandatory dorm during her first year of college.1 Other factors that deterred lactating teens from chest feeding included early experiences of pain, exhaustion, fear, embarrassment and misinformation.1 Furthermore, painful or leaking chests, tensions in relationships, withdrawal of support from partners or family and the babies preference led to the end of chest feeding for teen parents.1
According to recent studies, most lactating teens chose to initiate chest feeding because they wanted to be good parents. Lactating teens who chose to chest feed were more likely to continue if they had strong support from family or clinicians. However, such supports were limited by lack of knowledge about chest feeding and the community favoring early solid initiation and formula feeding.1 Lactation support also varied widely: some with reports of judgmental and stigmatizing interactions, while others had encouraging and helpful experiences. Overall, a lack of lactation support contributed to a decrease in perseverance with chest feeding. With this context, it is not surprising to learn that rates of chest feeding are significantly lower in adolescent parents compared to older parents. Only 19.3% of lactating parents younger than 20 years old exclusively breastfed to 3 months compared to 36.4% of those aged 20-29 and 45% of those ≥30 years old3.
So, what can we do to support these parents? The first thing to do is treat them with respect and recognize our own bias to create a safe space for our patients. Challenge the stigma against young parents and welcome teen parents into clinical settings. It is important not to pressure teen parents to chest feed, as teens reported fear of letting people down or confirming stereotypes if they stop chest feeding1. One systemic review of interventions from high-income countries showed that only a combination of education and counseling provided by a lactation consultant and peer counselor showed significant improvement in chest feeding initiation and duration.4 Thus, a multidisciplinary approach may be the best method to support young lactating parents.
Another study found that five factors were significantly associated with breastfeeding outcome: chest feeding within the first hour of delivery, hospital encouragement of chest feeding on demand, not using pacifier in the hospital, not receiving a gift pack with formula at the hospital and feeding the infant only breastmilk in the hospital. However, only 7% of teen parents experienced all these practices, and almost 10% did not experience even one.2 These practices should be implemented for all lactating parents, especially adolescents. Most of all, let us aspire to treat these parents with the respect they deserve and be sensitive to their unique challenges and resilience.
Sources/Resources:
- SmithBattle L, Phengnum W, Punsuwun S. Navigating a Minefield: Meta-Synthesis of Teen Mothers' Breastfeeding Experience. MCN Am J Matern Child Nurs. 2020;45(3):145-154. doi:10.1097/NMC.0000000000000609
- Philadelphia TSDo. Pregnant & Parenting Student Services. 2/18/23, 2023. Accessed 2/18/23, 2023. https://www.philasd.org/face/programs-services/elect/
- Olaiya O, Dee DL, Sharma AJ, Smith RA. Maternity Care Practices and Breastfeeding Among Adolescent Mothers Aged 12-19 Years--United States, 2009-2011. MMWR Morb Mortal Wkly Rep. Jan 22 2016;65(2):17-22. doi:10.15585/mmwr.mm6502a1
- Sipsma HL, Jones KL, Cole-Lewis H. Breastfeeding among adolescent mothers: a systematic review of interventions from high-income countries. J Hum Lact. May 2015;31(2):221-9; quiz 321-2. doi:10.1177/0890334414561264