1. Spatz, Diane L. PhD, RN-BC, FAAN

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Many healthcare professionals are familiar with UNICEF's Ten Steps to Successful Breastfeeding As a nurse scientist, educator, and clinician who works with families on a daily basis, I have actively worked to delete the word "success" from any conversations, research, and/or publications on provision of human milk or breastfeeding. The opposite of "success" is failure. When mothers make the decision to start breastfeeding, many do so with trepidation and concerns that breastfeeding will not work and if a mother runs into problems, you may hear a woman say: "I feel like a failure." Instead of the word "success," we must change our messaging and our approach to promoting breastfeeding and supporting women through the process.


Martucci and Barnhill (2016) recently questioned whether it was ethical to present breastfeeding as "natural." They were concerned that promoting breastfeeding as "natural" may bolster beliefs that "natural" approaches are healthier, which can present challenges in other contexts such as childhood vaccination (Martucci & Barnhill). Here is an alternative view as to why "natural" may be problematic. For any new mother, breastfeeding may not come intuitively or naturally and it may require a lot of work. We must present a realistic view that the health benefits of breastfeeding are substantial for mother and child, but that it will require her to invest time, effort, and commitment to establish a breastfeeding relationship with her baby. We need to help mothers set realistic short-term, midterm, and long-term goals for breastfeeding and provide women with evidence-based education, support, and care to reach these goals. All women deserve to make an informed decision about the provision of human milk and breastfeeding. We must share the science of human milk and breastfeeding with mothers and their families and help them understand their dose-response benefits. Awareness of the power of human milk and breastfeeding promotes commitment to the process. If a mother believes in her ability to breastfeed, she will more likely do so. We need to provide realistic expectations of early breastfeeding and its challenges. Persistent nipple pain, often due to incorrect positioning and attachment, is one of the most common reasons mothers stop breastfeeding (Kent et al., 2015).


Women may also face other challenges, such as low milk supply due to ineffective or inadequate breastfeeding sessions or the true inability to establish a normal milk supply due to breast surgery or glandular hypoplasia. Recently, I worked with a new mother who had glandular hypoplasia, and despite all efforts to make milk for her child, she could produce only less than 10 mL/day. In this case, it was important to recontextualize breastfeeding. Physically, it would be impossible for this mother to be the primary source of nutrition for her child. However, every drop of milk she produced for her child was a medication, providing immunobiological and developmental substances that are not available in infant formula. She needed to adjust her breastfeeding goals but was able to do so and feel good about what she was able to do for her child versus "feeling like a failure."


Please eliminate the word "success" from breastfeeding promotion and instead help women set realistic goals. If mothers face breastfeeding challenges, it is our obligation as healthcare professionals to help them get appropriate research-based breastfeeding assistance, support, and care so they can achieve their personal breastfeeding goals.




Kent J. C., Ashton E., Hardwick C. M., Rowan M. K., Chia E. S., Fairclough K. A., ..., Geddes D. T. (2015). Nipple pain in breastfeeding mothers: Incidence, causes and treatments. International Journal of Environmental Research and Public Health, 12(10), 12247-12263. doi:10.3390/ijerph121012247 [Context Link]


Martucci J., Barnhill A. (2016). Unintended consequences of invoking the "natural" in breastfeeding promotion. Pediatrics, 137(4). doi:10.1542/peds.2015-4154. [Context Link]