Factors associated with weaning in the first 3 months postpartum

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Original Research

Factors associated with weaning in the first 3 months postpartum

J Fam Pract. 2002 May;51(5):439-444

By

Kendra Schwartz, MD, MSPH

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References

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ABSTRACT

OBJECTIVE: To determine the demographic, behavioral, and clinical factors associated with breastfeeding termination in the first 12 weeks postpartum.

STUDY DESIGN: This was a prospective cohort study.

POPULATION: Breastfeeding women in Michigan and Nebraska were interviewed by telephone at 3, 6, 9, and 12 weeks postpartum or until breastfeeding termination.

OUTCOMES MEASURED: We measured associations of demographic, clinical, and breastfeeding variables with weaning during the first 12 weeks postpartum.

RESULTS: A total of 946 women participated; 75% breastfed until 12 weeks. Women older than 30 years and women with at least a bachelor’s degree were more likely to continue breastfeeding in any given week. Mastitis, breast or nipple pain, bottle use, and milk expression in the first 3 weeks were all associated with termination. Beyond 3 weeks, women who expressed breast milk were 75% less likely to discontinue breastfeeding than women who did not. Women who used a bottle for some feedings during weeks 4 to 12 were 98% less likely to discontinue breastfeeding than women who did not use a bottle. "Not enough milk" was the most common reason given for termination in weeks 1 through 3 (37%) and weeks 4 through 6 (35%); “return to work” was the most common reason given in weeks 7 through 9 (53%) and weeks 10 through 12 (58%).

CONCLUSIONS: Younger women and less educated women need additional support in their breastfeeding efforts. Counseling and assistance should be provided to women with pain and mastitis. Exclusive breastfeeding for the first 3 weeks should be recommended. After the first 3 weeks, bottles and manual expression are not associated with weaning and may improve the likelihood of continuing breastfeeding, at least until 12 weeks.

KEY POINTS FOR CLINICIANS

Younger and less educated women may need extra support for long-term breastfeeding success.
Exclusive breastfeeding for the first 3 weeks decreases the risk of early weaning. At least 7 daily feedings of 10 or more minutes per feeding are recommended.
The use of bottles and manual expression of milk after 3 weeks does not increase the risk of early weaning.

Family physicians are strongly encouraged to support and promote breastfeeding, the optimal form of infant nutrition.¹ Despite its known benefits (fewer infant infections^2-6 and decreased maternal risks of premenopausal breast cancer⁷ and post-menopausal hip fractures⁸), only 64% of mothers initiated breastfeeding in 1998⁹ and only 29% of mothers fed their 6-month-old infant by breast, well below the Healthy People 2010 goal of 50% breastfeeding at 6 months.¹⁰ Clearly, determining the factors that influence breastfeeding beyond the early postpartum period would be beneficial.

Returning to work is a consistent risk factor for weaning.^11-14 The impact of early bottle-feeding on the duration of breastfeeding has been studied with less consistent results.^15,20 Insufficient milk supply is a common subjective reason given for termination.^15,19,21,22 Older women and those with a higher level of education are at less risk of early breastfeeding termination.^{9,11,15,16,21,23,24}

Few investigators have described how breastfeeding patterns may affect breastfeeding duration. Little is known about the effects of timing, frequency, and duration of individual breastfeedings, or the roles of breast pain and infection, sleep, and manual expression on early weaning. We studied women who indicated their intent to breastfeed prenatally to identify demographic factors and breastfeeding patterns associated with weaning in the first 12 weeks postpartum.

Methods

Population

We interviewed breastfeeding women by telephone at 3, 6, 9, and 12 weeks postpartum to investigate lactation mastitis risk factors and predictors of weaning. Pregnant women intending to breastfeed were recruited from 2 geographic sites between June 1994 and January 1998. In suburban Detroit, Michigan, women attending orientation at a freestanding birthing center were asked to participate. In Omaha, Nebraska, women at a single large company were recruited when applying for maternity leave.

Data collection

During the computer-assisted interview, subjects were asked to recall each of the previous 3 weeks. The initial interview, which collected demographic information, typically lasted 15 to 20 minutes; subsequent interviews were shorter. The survey addressed breastfeeding practices and recent health events. Exclusive breastfeeders were women who fed their infants only by breast. We did not collect information on pacifiers; therefore, exclusively breastfed infants may have also received pacifiers. Women who manually expressed or used a device to assist in expression were classified as “pumping” their breasts. Respondents were asked if they had bottle-fed the infant; they were not asked about bottle contents or volume.

Subjects were queried on potential difficulties including breast or nipple pain while nursing, nipple cracks, and mastitis (diagnosed by a health care provider), as well as other health problems and behaviors. Subjects who had stopped breastfeeding in the previous 3 weeks were asked when and why, given a list of possible explanations and an open-ended opportunity. Respondents could provide multiple reasons for termination.