Latch On: Nurse Practitioners and the Breastfeeding Conversation
Learn why breastfeeding support falls on every clinician, not just lactation consultants.
August is National Breastfeeding Month, and most nurse practitioners (NPs) can recite the evidence: breastmilk is, in the World Health Organization’s (WHO's) words, “the ideal food for infants,” and the benefits run both ways; women who breastfeed carry a lower risk of breast and ovarian cancers. The harder question is why so many families who want to breastfeed stop earlier than planned.
The American Academy of Pediatrics and WHO both recommend exclusively breastfeeding for the first six months of life, followed by continued breastfeeding alongside complementary foods. Despite these recommendations, the numbers tell a different story. Globally, fewer than half of infants under six months are exclusively breastfed, according to WHO. In the United States, of the more than 3.5 million babies born annually, 84% start out breastfeeding — but less than 30% of infants meet the six‑month exclusive breastfeeding goal.
“Mothers want to breastfeed their babies but face challenges that lead to stopping earlier than planned because they lack sufficient support,” says pediatrics expert Laura Searcy, MN, RN, APRN, PPCNP‑BC, FAANP. “NPs and other health care providers can help address these issues.” Searcy spoke with the American Association of Nurse Practitioners® (AANP) about how NPs can help improve breastfeeding rates through practice and policy.
An NP’s Case for Showing Up Early
While Searcy is also an expert on policy and topics like substance use prevention and more, her passion for pediatrics is very evident when she begins to speak about the many advantages of raising healthy babies through breastfeeding. “Human milk provides a whole lot more than calories,” she says. “It’s a dynamic, very bioactive living fluid that provides nutrition — plus immune and anti-inflammatory support, antibodies, enzymes, growth factors, hormones, stem cells.”
She adds that breast milk is also “tailor-made for human babies,” and whereas the “gold standard” for artificial formula is to “get as close to breast milk as possible, it’s never been done and I’m not sure it’s even possible. Babies can grow and thrive on other supplemental formulas and other ways of feeding. But breast milk is so far superior that it just needs to be encouraged as much as possible.”
New Moms Need More Than a Pamphlet
Searcy emphasizes the importance of NPs communicating with expectant mothers about breastfeeding before the baby is born. “It is critical for health care providers to ask their patients what their desires are and goals are, and to help them make it happen,” she notes. “The choice to breastfeed or not breastfeed is often made prenatally. For my NP colleagues or nurse midwife colleagues that work with pregnant women — expose those patients to the reasons why it’s desirable and good for mom and baby to breastfeed. That education needs to happen before labor and delivery because there’s so much going on.
“In a recent clinical role of mine, I managed infants in the mother/baby unit of a very large suburban hospital. Moms are exhausted by childbirth and then are overwhelmed by the sheer volume of information they are expected to absorb, all in a very short postpartum stay — leaving little time for meaningful, hands‑on breastfeeding.”
Where new mothers especially need support, Searcy argues, is “when they get home after they get out of the hospital. Find out what parents’ desires are, what their challenges are and just help remove barriers to breastfeeding as they come up. A lot of breastfeeding pain, fussy babies, can be corrected with better latching and changing positions and assessing for a tongue tie. There’s just all kinds of things that need to happen to address the challenges that moms are having — see if you can remove those barriers.”
Policy Is Patient Care
Of course, support for breastfeeding can’t only fall on individual NPs and health care providers — to truly be successful, encouraging breastfeeding and supporting breastfeeding has to also be a priority for policymakers. “I have a big health policy background, and you can't talk to me about anything without getting a policy perspective as well as the standards of care and the guidelines perspective,” says Searcy. “We’ve made some strides in removing public stigma about breastfeeding and removing some workplace barriers to support breastfeeding. By far the biggest policy barrier that makes the United States unique among other industrialized nations is the lack of a sufficient paid parental leave policy. Pressure to return to work and maternal isolation when their partner returns to work after only a few days off do not help establish successful breastfeeding.
“Also, availability and insurance coverage for postpartum resources like doulas, maternal home visiting programs, nurse midwives and lactation consultants are limited and fragmented. All these services have been shown to have positive benefits for both mothers and babies.”
Searcy also points out that financial pressures can complicate breastfeeding decisions. With childcare costs climbing, many mothers return to work earlier than they would prefer, often before breastfeeding is well established. Although remote work is often viewed as a solution, Searcy notes that it is not always the advantage people imagine. Emerging research shows that working from home does not guarantee breastfeeding success; the blurred boundaries, constant multitasking and heavy demands of work and infant care can make exclusively breastfeeding even more difficult to maintain than working outside the home.
Searcy concludes that “I think we need to recognize that we need to do more to encourage and help parents who breastfeed, because we’re at the point now where probably less than around 30% of American infants are exclusively breastfed for the first six months of life. I think we can do better than that, and I think the health of our moms and our babies would improve if they had that good solid nutritional start that breastfeeding gives them.”
However, Searcy is clear that NPs have to meet the patient where they are, and only by working together on agreed-upon goals will we get anywhere near to surpassing the 30% statistic. “We all need to remember that we can’t make a mother feel like a failure as a parent, or that somehow she’s letting herself or us down if she chooses not to breastfeed,” cautions Searcy. “Breastfeeding is a choice, and a mom who’s trying to breastfeed when she really doesn’t want to isn’t going to be successful at it. So, while we want to encourage breastfeeding, we don’t want to make mothers feel guilty if they make another choice.”
Find Your People in the Pediatrics Community
Whether you’ve spent two decades in pediatric primary care or you’re still deciding on a specialty, AANP’s Pediatrics Community is where NPs and NP students trade clinical questions, resources and hard-won advice. Dr. Searcy, along with Stacia Hays, DNP, APRN, CNE, CCTC, FAANP, co-chair AANP’s Pediatrics Community. Join the conversation!