1. Section Editor(s): Simpson, Kathleen Rice PhD, RNC, CNS-BC, FAAN

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It is well known that breast milk is the ideal source of nutrition for newborns and infants; however, breastfeeding rates in the United States could be higher. According to the latest data from the Centers for Disease Control and Prevention (2018) on births in 2015, more than four out of five new babies were initially breastfed (83.2%), suggesting a high intention to breastfeed among new mothers. However, breastfeeding rates gradually deceased over time (6 months, 57.6%; 12 months 35.9%). The rate of exclusive breastfeeding at 6 months was 24.9%. As many new mothers have found, breastfeeding often is associated with challenges. It may take several days or weeks for the baby and the mother to learn the process. Some mothers worry about not having enough milk; experience sore, cracked, and bleeding nipples; develop mastitis; have difficulties with incision pain or perineal pain and finding a comfortable position to breastfeed; or are not well enough after birth to breastfeed their babies. Some mothers have babies that can't seem to latch on correctly, want to nurse constantly, fall asleep at the breast, or seem to cry more than normal, thus prompting worries about adequate feeding. Other mothers have given birth preterm or to babies with medical complications and must initiate pumping to be able to supply breastmilk for their babies. For some, these types of challenges in the first few days are the basis for stopping breastfeeding.


In this special topics series, challenges in breastfeeding are covered from four perspectives, breastfeeding-associated pain, breastfeeding a baby with ankyloglossia (also known as tongue-tie), breastfeeding a baby in the neonatal intensive care unit within the context of Orthodox Jewish religious traditions, and breastfeeding for women with preeclampsia. Jackson, Mantler, and O'Keefe-McCarthy used qualitative methods to explore the experience of breastfeeding-related pain and how it affects breastfeeding. Pain is often a factor in breastfeeding cessation. Anticipatory guidance for new mothers on what to expect during breastfeeding and discussion of possible solutions may help mothers reach their breastfeeding goals. Hill conducted an integrated review on the implications of ankyloglossia on breastfeeding. Early identification and treatment can be helpful in promoting breastfeeding; however, a valid and reliable screening tool for ankyloglossia does not exist. Newborns are not routinely assessed for ankyloglossia. Candelaria, Bressler, and Spatz offer information on how to best care for Orthodox Jewish women who are breastfeeding and whose babies are in the neonatal intensive care unit. Personalized, culturally and religiously tailored education and counseling can ensure that Orthodox mothers are able to meet their personal breastfeeding goals even if their infant requires hospitalization at birth. Burgess, McDowell, and Ebersold studied the effect of breastfeeding on postpartum blood pressure. This is an important topic because in recent studies, lactation has been found to be cardioprotective, which can be significantly beneficial for women with preeclampsia who are predisposed to cardiovascular disease later in life. We hope you enjoy reading these articles and are able to apply the new knowledge and evidence to your clinical practice to offer help to women who want to breastfeed but are experiencing challenges.




Centers for Disease Control and Prevention. (2018). Breastfeeding report card. Retrieved from Atlanta, GA: Author. [Context Link]