1. Characteristics of breastfeeding practices
Katherine Shealy,¹ MPH, IBCLC, RLC
Judith Labiner-Wolfe,² PhD
Sara Fein,² PhD
Laurence Grummer-Strawn,¹ PhD
¹ Centers for Disease Control and Prevention
² Food and Drug Administration

2. Background
Health professionals providing breastfeeding education infrequently observe normal and effective breastfeeding (in its ‘natural habitat’)
Anticipatory guidance provided about breastfeeding may not reflect actual experiences of breastfeeding dyads
Experiences that are inconsistent with teaching points given to pregnant women and new mothers about breastfeeding can be confusing and discouraging

3. Background, continued
Social Cognitive Theory suggests that dissonance between behavioral expectations and actual experience would lead to termination of the behavior
Little research exists documenting typical breastfeeding over time
Infants who only receive breast milk when it is expressed and fed by bottle (exclusive pumping, or EP) have not previously been documented as a population

4. Objectives
Describe major characteristics of typical breastfeeding education
Identify the major aspects of breastfeeding behavior related to individual practices and patterns over time

5. Data characteristics
Characteristics of breastfeeding behaviors – Detailed information was gathered in each survey as long as respondents indicated they were still breastfeeding
A more detailed breastfeeding module was also completed once per respondent upon termination of breastfeeding

6. Data characteristics
Sample cohort consists of breastfeeding mothers at each sample period
m2 n=1466, m12 n=462
Includes mothers who are:
Exclusively breastfeeding
Breastfeeding & formula-feeding
Breastfeeding & complementary feeding
Breastfeeding, formula-feeding, & complementary feeding

7. Percent of women who met their own breastfeeding goal*
Yes No
*Self-reported answer of “yes” to the question:
“Did you breastfeed as long as you wanted to?”

8. Typical breastfeeding education
Teaches how-to & biology of breastfeeding
Includes anticipatory guidance re:
Frequency of feeds per day
Always feed both breasts at each feed
Length of feeds
Inter-feed interval
Fosters sense of uniformity and predictability across all breastfeeding dyads
Generally does not address variation among individuals

9. Clinical Experience
Clinicians note wide variation among healthy, adequately nourished dyads in:
Frequency of feeds per day
Always feed both breasts at each feed
Length of feeds
Inter-feed interval
Predictability is that there can be wide variation from one dyad to another

10. Mean breastfeedings per day by survey month
5th Percentile
95th Percentile
Neonatal 9 6 13 m2 8 5 12 m3 m4 m5 7 4 10 m6 m7 m9 3
m10 2
m12 1

11. Mean breastfeedings per day by survey month
5th Percentile
95th Percentile
Neonatal 9 6 13 m2 8 5 12 m3 m4 m5 7 4 10 m6 m7 m9 3
m10 2
m12 1

12. Mean breastfeedings per day by survey month
5th Percentile
95th Percentile
Neonatal 9 6 13 m2 8 5 12 m3 m4 m5 7 4 10 m6 m7 m9 3
m10 2
m12 1

13. Mean breastfeedings per day by survey month
5th Percentile
95th Percentile
Neonatal 9 6 13 m2 8 5 12 m3 m4 m5 7 4 10 m6 m7 m9 3
m10 2
m12 1

14. Mean breastfeedings per day by survey month
5th Percentile
95th Percentile
Neonatal 9 6 13 m2 8 5 12 m3 m4 m5 7 4 10 m6 m7 m9 3
m10 2
m12 1

15. Mean breastfeedings per day by survey month
5th Percentile
95th Percentile
Neonatal 9 6 13 m2 8 5 12 m3 m4 m5 7 4 10 m6 m7 m9 3
m10 2
m12 1

16. Mean breastfeedings per day by survey month
5th Percentile
95th Percentile
Neonatal 9 6 13 m2 8 5 12 m3 m4 m5 7 4 10 m6 m7 m9 3
m10 2
m12 1

17. Infant typically nursed from both breasts by survey month
64%
57%
41%
29% 6% 2%

18. Average length of feeds by survey month

19. Mean longest interval between feeds per 24h by survey month

20. Conclusions
Although most women in the sample began breastfeeding, the majority did not meet their own breastfeeding goals
Current anticipatory guidance may not match actual experiences of breastfeeding dyads
Anticipatory guidance that matches actual experiences may help women feel more successful at breastfeeding and play a part in helping women meet their own breastfeeding goals
Unclear if dissonance reflects pathology or normal variation – further exploration needed

21. Conclusions, continued
Frequency of feeds/day diminishes gradually, still a factor during complementary feeding
Proportion of infants typically nursing one side increases over time, while those typically nursing both sides at a feed remains relatively stable
Possible because those receiving only pumped milk also slightly declined
Small but consistent percentage of infants receive breast milk only when it is expressed and fed by bottle
Mean length of feeds decreases across the year
Longest interval between feeds doubles over the first year

22. Conclusions, continued
Advice versus experience
Most mothers begin breastfeeding 8-12 times per 24 hours, consistent with professional advice
Many dyads continue high-frequency feeds past when professional advice would anticipate
Better understanding of dissonance between advice and experience can improve breastfeeding outcomes and maternal child health

23. Thank You
Contact information:
Katherine Shealy, MPH, IBCLC, RLC