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

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In the past 2 weeks, I have had three acquaintances give birth. All of them had very strong prenatal intent to breastfeed; however, none of them had an ideal start of lactation or a smooth lactation journey. As nurses, we must change how we prepare families for lactation. During prenatal care, nurses and health care providers should be assisting parents in developing a proactive management plan for lactation to ensure that the lactating parent is able to effectively establish milk supply and ensure long-term milk production.


Breastfeeding support increases duration and exclusivity of breastfeeding (McFadden et al., 2017). Effective support includes standard antenatal and postnatal care provided by trained personnel (McFadden et al.). Visits need to be scheduled, on-going, and tailored to family needs (McFadden et al.). Care can be provided by either lay or peer supporters, professionals, or a combination of both, with face-to-face interactions more likely to improve exclusive breastfeeding rates (McFadden et al.). Unfortunately, not all families have equal access to breastfeeding support, nor are all families provided with research-based information on the importance of a breastfeeding support team that starts in the antenatal period, continues through intrapartum and postbirth. At the first prenatal visit, nurses and other health care providers should be starting the conversation with all families about setting up their breastfeeding support team.


Doulas also can improve breastfeeding outcomes (Acquaye & Spatz, 2021). Doulas can provide both prenatal and intrapartum support that encourages breastfeeding initiation (Acquaye & Spatz). Doulas are also critical in providing breastfeeding support at home and in the community (Acquaye & Spatz). Unfortunately, most (94%) American families do not use or have access to doula services (Haelle, 2019). As nurses we must inform our families of the value of doula support for both birth and breastfeeding, advocate for insurance coverage of these services, and refer families to doula services in their community. If your hospital does not currently have doula services available, this is another area that you can advocate for to promote enhanced maternity care.


Families should be informed and must understand that there is a critical window for milk supply to effectively be established (Spatz, 2020). As nurses we must teach families the anatomy and physiology of lactation and the critical importance of effective breast stimulation and emptying to effectively turn on prolactin receptors sites in the breast. Skin-to-skin contact between mother and newborn is not always prioritized in birth hospitals, many infants have challenges latching on and suckling effectively, and many families are discharged without being assisted with breastfeeding. The COVID-19 pandemic has increased these challenges.


During prenatal care, nurses must ensure that all families have pump access prior to giving birth and a plan as to how they will access a hospital-grade breast pump immediately following birth if their infant is not effectively latching or if there is a maternal or infant risk factor that could affect coming to volume (Spatz, 2020). Protecting and promoting milk supply is imperative to improving short- and long-term breastfeeding outcomes.




Acquaye S. N., Spatz D. L. (2021). An integrative review: The role of the doula in breastfeeding initiation and duration. The Journal of Perinatal Education, 30(1), 29-47.[Context Link]


Haelle T. (2019). What is a Doula? And do you Need One? The New York Times, NYT Parenting. What Is a Doula? And Do You Need One? - The New York Times ( [Context Link]


McFadden A., Gavine A., Renfrew M. J., Wade A., Buchanan P., Taylor J. L., Veitch E., Rennie A. M., Crowther S. A., Neiman S., MacGillivray S. (2017). Support for healthy breastfeeding mothers with healthy term babies. The Cochrane Database of Systematic Reviews, 2(2), CD001141.[Context Link]


Spatz D. L. (2020). Getting it right-the critical window to effectively establish lactation. Infant, 16(2), 58-60. [Context Link]