Category: lactation care

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April is Stress Awareness Month

 

How Breastfeeding Helps Reduce Maternal Stress: The Biology of Calm

Did you know that April is Stress Awareness month? I didn’t either! So, let’s spend a little time talking about maternal stress and the ways breastfeeding can help reduce a mother’s feelings of stress and anxiety.

In the early days of motherhood, stress can feel like a constant companion. Between physical recovery, sleep disruption, and the demands of caring for a newborn, many mothers find themselves navigating a profound emotional transition. Yet within this intensity lies a powerful, built-in mechanism for calming the maternal body: breastfeeding.

Far from being just a method of infant feeding, breastfeeding is a neurobiological process that actively supports maternal stress reduction. Through hormonal pathways, physical contact, and emotional connection, breastfeeding can help mothers regulate stress and promote a sense of calm and well-being.

The Hormonal Foundation of Calm

At the heart of breastfeeding’s stress-reducing effects is oxytocin, often called the “love hormone.”

During breastfeeding, oxytocin is released in pulses in response to nipple stimulation and infant contact. This hormone has several profound effects:

  • Promotes the milk ejection (let-down) reflex
  • Lowers levels of stress hormones like cortisol
  • Reduces blood pressure and heart rate
  • Enhances feelings of relaxation and emotional bonding

Oxytocin doesn’t just support feeding—it actively shifts the maternal nervous system away from a stress response and toward a state of calm.

Another key hormone, prolactin, contributes to feelings of relaxation and caregiving behavior. Elevated during breastfeeding, prolactin has been associated with reduced anxiety and increased maternal responsiveness.

Breastfeeding and the Stress Response System

The body’s stress system—known as the hypothalamic-pituitary-adrenal (HPA) axis—is designed to respond to threats by releasing cortisol and adrenaline. While this system is essential for survival, chronic activation can be harmful.

Breastfeeding helps modulate this system in several ways:

  • Blunted cortisol response: Breastfeeding mothers often show a reduced cortisol response to stressors compared to non-breastfeeding mothers.
  • Faster recovery from stress: After a stressful event, breastfeeding can help the body return to baseline more quickly.
  • Improved emotional regulation: Hormonal changes during lactation support resilience and coping.

This means that breastfeeding doesn’t just feel calming—it measurably changes how the body experiences and processes stress.

The Power of Physical Contact

Breastfeeding inherently involves close, sustained physical contact between mother and baby. This contact is a powerful regulator of the nervous system.

  • Skin-to-skin contact enhances oxytocin release
  • Infant warmth and rhythmic sucking promote relaxation
  • Physical closeness reduces maternal anxiety

This type of contact activates the parasympathetic nervous system, often referred to as the “rest and digest” system, which counteracts the stress-driven “fight or flight” response.

Emotional Benefits: Connection and Confidence

Stress is not only physiological—it is deeply emotional. Breastfeeding can support maternal mental health by fostering:

  • A sense of competence: Successfully feeding and soothing a baby builds confidence
  • Emotional bonding: Close interaction strengthens the mother-infant relationship
  • Attunement: Mothers learn to read and respond to their baby’s cues

These experiences can reduce feelings of overwhelm and help mothers feel more grounded in their new role.

Breastfeeding as a Mindfulness Practice

Interestingly, breastfeeding can function similarly to mindfulness or meditation.

During a feeding session, mothers often:

  • Sit or lie still
  • Focus on their baby
  • Engage in repetitive, rhythmic patterns (suck-swallow-breathe)

This creates an opportunity to slow down, breathe deeply, and be present—conditions known to reduce stress and improve emotional regulation.

Long-Term Stress Protection

The stress-reducing effects of breastfeeding may extend beyond individual feeding sessions.

Research suggests that breastfeeding mothers may experience:

  • Lower rates of postpartum depression and anxiety
  • Improved stress resilience over time
  • Enhanced sleep-related hormonal regulation (despite frequent waking)

While breastfeeding is not a guarantee against mental health challenges, it can be a protective factor when combined with adequate support.

When Breastfeeding Feels Stressful

It is important to acknowledge that breastfeeding does not automatically reduce stress for every mother. Pain, latch difficulties, concerns about milk supply, or lack of support can turn feeding into a source of anxiety.

In these situations, the stress-reducing benefits of breastfeeding may be diminished—not because breastfeeding itself is harmful, but because the conditions surrounding it are challenging.

Support is key:

  • Skilled lactation care
  • Emotional reassurance
  • Practical help at home

When barriers are addressed, many mothers are able to experience the calming effects breastfeeding can offer.

A Biological Design for Mutual Regulation

Breastfeeding is not just about nourishing a baby—it is a system of co-regulation, where mother and infant help stabilize each other.

As the baby feeds:

  • The infant becomes calmer and more regulated
  • The mother’s body releases calming hormones
  • Both participants experience reduced stress

This reciprocal relationship is one of the most elegant aspects of human biology.

Conclusion: Breastfeeding as a Tool for Maternal Well-Being

In a world where new mothers are often overwhelmed and under-supported, breastfeeding offers something remarkable: a built-in pathway to calm.

Through hormonal shifts, physical closeness, and emotional connection, breastfeeding helps regulate the maternal stress response and promote well-being. When mothers are supported in their breastfeeding journey, they are not only feeding their babies—they are also nurturing their own mental and emotional health.

Supporting breastfeeding, therefore, is not just about infant nutrition. It is about creating conditions where mothers can feel calmer, more connected, and more resilient in one of life’s most transformative seasons.

 

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From Labor to Latch: How Interventions Affect Early Breastfeeding

A guest post by Donna Walls, RN, BSN, CLC,ANLC

I have heard this more times than I can count- “So, what’s labor got to do with breastfeeding?”. We tend to think of pregnancy, birthing and breastfeeding as all very separate parts of bringing a baby into the world. But, in reality it is just one connected, seamless, flowing process. Breastfeeding begins about halfway through the pregnancy as colostrum, or newborn milk, starts production. Our bodies know that growing a baby means eventually feeding that baby. So, we know that pregnancy affects breastfeeding but does what happens during the labor process affect breastfeeding? The answer is YES!

Intrapartum interventions are relatively new in the history of birthing and sadly, many of the early interventions began long before we studied the effects of these interventions on lactation, rather, focusing on the effects on the fetus and the labor progress. But the good news is that we now have great research on the concerns regarding many birth interventions on the initiation and continuation of milk production.

Specific interventions like epidurals, forceps, vacuum extraction, and pain medicines have been associated with negative effects on breastfeeding and here are some of these concerns.

The use of  Oxytocin

Cadwell and Brimdyr presented the disadvantages of using synthetic oxytocin for breastfeeding and these include:

-reduced maternal endogenous oxytocin with increased risk of breast edema and engorgement

-reduced neonatal rest in the first hour

-suckling reflexes may also be reduced resulting in newborns being less likely to initiate suckling in the first hour of life and delayed lactogenesis 2.

-“High doses of oxytocin can potentially weaken the milk-ejection reflex and may reduce the expression of primitive breastfeeding reflexes in the newborn.”

Research (Seyedi, R, et al.) also demonstrates a dose related association of Pitocin with increased risk of neonatal jaundice on day 2.

 Pain medications in labor

A Cochrane review confirms increased neonatal sleepiness, reduced early suckling reflexes, and fewer early effective breastfeeding attempts with the use of maternal pain medications. Opioids have been shown to suppress newborn breastfeeding behaviors and may lead to more irritability in newborns babies who then have difficulty breastfeeding effectively. These concerns are more profound with larger doses and longer exposures to the drugs.

Research by Lind also shows a relationship between the use of pain medications and a delayed onset of lactogenesis 2.

Higher doses are also associated with lower neurobehavioral scores in babies, less breast-seeking behaviors and less successful breastfeeding sessions and less stimulation for optimal breastfeeding production.

Newborns of mothers who received obstetric analgesia had a higher rate of complementary formula feeding while newborns born unmedicated had a higher rate of breastfeeding in the delivery room and less formula feeding in the hospital.

Use of epidural anesthesia

It is generally recognized that negative effects are more highly associated with receiving antenatal pain medications than the use of epidural anesthesia. That being said, medications used in the epidural can pass into the placenta resulting in newborn’s lowered ability to initiate the breast crawl and complete the 9 Stages. Other studies have noted increased newborn sleepiness in the first hours after birth which delays initiation of breastfeeding.  These factors too often result in early formula supplementation impacting the establishment of a healthy newborn microbiome.

On postpartum day 1, the women who were randomly assigned to receive high-dose fentanyl reported difficulties (ineffective, uncoordinated suckling) with breastfeeding and at 6 weeks postpartum, more women who were randomly assigned to high-dose fentanyl epidural were not breastfeeding. Effects can vary with the type of medication used in the epidural and the length of exposure to the fetus.

A few studies have linked epidural use to lower breastfeeding rates at six weeks postpartum and some studies have concluded that breastfeeding success was much lower in women who underwent epidurals during labor.

Use of intravenous (IV) fluids

IV fluids, especially in larger amounts (large amounts are considered a total of >2 litres) can cause breast edema in the mother, potentially leading to breast pain, congestion and engorgement. This early breast edema interferes with correct latching and optimal breast stimulation and emptying as well as a delayed onset of lactogenesis 2.

Maternal  IV fluids intake are shown to increase the newborn’s  urine output in the first days and this output is mistaken for weight loss, sometimes  leading to early formula supplementation. Although the AAP recommends assessment when weigh loss exceeds 7%, too often this step is skipped and formula supplementation is ordered. Waiting to perform the initial weight can help reduce this unnecessary supplementation.

Use of Forceps/Vacuum Extraction

These methods have been implicated in possible trauma to the infant’s head and mouth and can lead to difficulty with suck-swallow-breathe coordination, compromising efficient suckling and milk transfer. The use of these instruments can also lead to longer vaginal repairs and delayed initiation skin to skin care.

Separation of mother and baby

One of the first and greatest concerns post birth is the delay or denial of immediate, uninterrupted and continuous skin to skin care. No other mammals separate themselves from their newborns- think about that!!!

Separation of the mother and newborn results in increased cortisol levels in both while immediate skin-to-skin contact stabilizes the newborn’s respiration, heartbeat and temperature while stimulating maternal oxytocin necessary for bonding and flow of colostrum.

“Separating mothers and newborns at birth, or delaying or disrupting skin to skin care, has adverse consequences on newborns’ transition to life outside the uterus; their innate protective behaviors; and, breastfeeding initiation, duration, and exclusivity and a mother’s sensitivity and attachment to her newborn”. (WHO & UNICEF, 2018).

Also, post partum rooming-in reduces newborn stress. Morgan  et al compared sleep cycles of 2-day-old newborns while having skin to skin care for 1 hour to sleeping alone (separated) for 1 hour. Separated infants had an 86% reduction in quiet sleep, a 176% increase in autonomic nervous system activity, and higher levels of cortisol. They concluded that maternal separation stresses newborns and that this stress may not be benign.

“Withholding skin-to-skin contact would now be considered unethical, as there is enough evidence to show that the practice improves newborn health and survival,” says Karin Cadwell, senior author and Executive Director and Lead Faculty of Healthy Children Project’s Center for Breastfeeding.

Cascading events can lead to early cessation of breastfeeding

In most “modern” western hospitals we see interventions as normal and routine. In fact it is not unusual to see more than 1 intervention used. Usually, one intervention requires another eg; epidurals require IV fluids to prevent hypotension in the mother which in turn leads to breast edema and engorgement.

These cascading interventions often interfere with the infant’s ability to initiate suckling, which in turn delays stimulation of milk production, which in turn can lead to  jaundice, which in turn often requires introduction of artificial formula supplementation, which in turn increases the infant’s risk of dysbiosis in the gut and diminishes breast stimulation, which in turn may, far too often, lead to abandonment of breastfeeding. There does appear to be a dose-response effect between number of interventions received and odds of each unfavourable breastfeeding outcome.

What we can do to optimize breastfeeding success in the hospital setting?

-Encourage prenatal education which emphasizes a risk-benefit-alternative focus for all interventions in labor.

-Offer evidence-based resources for education for both families and hospital and office staff.

-Encourage families to work with their caregiver to make a plan which minimizes labor interventions whenever possible or opt for birth centers that offer labor support with minimal interventions.

-Work with local and national maternal-child health focused groups and organizations to assure that non-separation and skin to skin care is the standard of care for all mothers and newborns.

-Work with local hospitals and birth centers to offer classes that include alternative pain reduction techniques including simple breathing techniques, mindfulness, water therapies, positional comforting, massage and companions and doula care.

-If analgesia is used- opt for the smallest dose whenever possible.

-Encourage parents and hospital staff to wait 24 hours for the initial newborn weight.

-Educate and encourage families to room in with the newborn.

As breastfeeding advocates we sometimes are called to expand our own “lactation world” and take a look at all the factors that might help or hinder families in the early hours, days and weeks of breastfeeding. Developing a program of education and care that encompasses then pre-breastfeeding influences might be a good place to start that journey.

References

 Hulman, A., et al. Impact of different obstetric interventions and types of delivery on breastfeeding: a nationwide cross-sectional survey of Hungarian women. BMC. 2024 Jul 11;24:473. doi: 10.1186/s12884-024-06666-x

CDC, Strategies for Continuity of Care in Breastfeeding, https://www.cdc.gov/breastfeeding/php/strategies/public-health-strategies-for-continuity-of-care-in-breastfeeding.html

 Takahata, K. et al. November 2023. A longitudinal study of the association of epidural anesthesia and low-dose synthetic oxytocin regimens with breast milk supply and breastfeeding rates. Scientific Reports volume 13, Article number: 21146 (2023)

 Andrew, M. et al. The association between intrapartum interventions and immediate and ongoing breastfeeding outcomes: an Australian retrospective population-based cohort study. International Breastfeeding Journal volume 17, Article number: 48 (July, 2022)

Crenshaw, J. Healthy Birth Practice #6: Keep Mother and Newborn Together—It’s Best for Mother, Newborn, and Breastfeeding. J Perinat Educ. 2019 Apr 1;28(2):108–115. doi: 10.1891/1058-1243.28.2.108

Kajsa Brimdyr PhD, CLC. 2015. Birth Issues in perinatal care. The Association Between Common Labor Drugs and Suckling When Skin-to-Skin During the First Hour After Birth. https://doi.org/10.1111/birt.12186

WHO.  Compendium on respectful maternal and newborn care. August, 2025.  https://www.who.int/publications/i/item/9789240110939

Seyedi, R. et al. 2017. The Effect of the Use of Oxytocin in Labor on Neonatal Jaundice: A Systematic Review and Meta-Analysis.  Department of Midwifery, Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

Lind, J. et al. 2014 May. Relationship between Use of Labor Pain Medications and Delayed Onset of Lactation. Journal of Human Lactation. 167–173. doi:10.1177/0890334413520189

Dekker, R. Evidence on: IV Fluids During Labor. August, 2022. https://evidencebasedbirth.com/iv-fluids-during-labor/

Mahmoodi, F. et al. 2019. Breastfeeding and its outcome in Women Receiving Epidural Analgesia for Childbirth. https://pmc.ncbi.nlm.nih.gov/articles/PMC6714128

 

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Ethical Practice in Lactation Care

Lactation and Ethics: Navigating Care with Compassion and Integrity


Ethics in Practice: Autonomy and Shared Decision-Making | AAO-HNS Bulletin

The Heart of Lactation Care

At its core, lactation support is about connection—between parent and baby, between families and professionals, and between evidence and empathy. Yet, with that connection comes a deep ethical responsibility. Every conversation about feeding touches on personal values, cultural identity, health, and autonomy.

As lactation professionals, we don’t just offer information—we navigate complex ethical terrain, balancing science, compassion, and respect for every family’s unique journey.

Principle 1: Informed Choice and Respect for Autonomy

One of the foundational principles of healthcare ethics—autonomy—is just as essential in lactation work. Parents have the right to make informed choices about how they feed their babies, free from pressure, judgment, or coercion.

Ethical lactation care means:

  • Providing complete, unbiased information about feeding options.
  • Respecting decisions even when they differ from our own values or recommendations.
  • Recognizing that informed choice includes emotional, cultural, and practical realities—not just medical facts.

For example, we might be working with a family that has expressed they want to feed the baby both breastmilk and formula. We know this is not optimal for the health of the baby. We know this will negatively affect the baby’s microbiome. It is not our job to convince them to make a different choice. It is our job to give them the information regarding their choices in a compassionate and honest way. When families feel empowered rather than persuaded, we create space for trust and collaboration to flourish.

Principle 2: Justice and Equity in Access to Support

Ethics in lactation isn’t just about individual encounters—it’s also about systems and access. Not every family has equal opportunity to receive skilled, culturally competent breastfeeding support.

An ethical commitment to justice means:

  • Acknowledging disparities in breastfeeding rates and access to care, especially among marginalized communities.
  • Advocating for policies that make lactation support accessible and affordable.
  • Valuing the lived experiences of parents from all backgrounds.

When we champion equitable systems, we uphold the ethical duty to support all families, not just those with resources or privilege.

Principle 3: Nonmaleficence and Beneficence

Two classic ethical principles—do no harm (nonmaleficence) and do good (beneficence)—guide every aspect of lactation practice.

Doing good means using evidence-based strategies to help parents meet their feeding goals.
Doing no harm means avoiding practices or language that may cause guilt, shame, or unnecessary distress.

For example, ankyloglossia, or tongue-tie, has been increasingly diagnosed in the last 10-15 years resulting in an alarming increase in infant frenotomy. However, as this article tells us, simply doing a frenotomy on an infant does not improve breastfeeding and in many cases may be doing harm.

Ethical lactation care asks us to pause before offering advice and consider:

“Will this information help or hurt this particular family right now?”

Principle 4: Professional Boundaries and Integrity

As with all healthcare professions, maintaining professional boundaries is an ethical cornerstone. Lactation support often happens in intimate, emotionally charged spaces—hospital rooms, nurseries, and homes.

Practitioners must balance empathy with professionalism by:

  • Preserving confidentiality.
  • Avoiding conflicts of interest (for example, accepting sponsorships from formula companies that violate the WHO Code).
  • Practicing within their scope and referring when care exceeds their expertise.

Scope of Practice is critical to maintain and understand in the lactation field. Both CLC and IBCLC are viewed as professional lactation care providers by the CDC. You can find the Scope of Practice for IBCLC here and for CLC here. You will see they are nearly identical. Both designations are entry level certifications and both are equipped to help families with simple and complex lactation situations. And both must know when to refer on for more in depth medical assistance.

Ethical practice protects both the professional and the family, ensuring that care remains trustworthy, safe, and centered on the parent-baby dyad.

Ethics as Everyday Practice

Ethics in lactation is not an abstract concept—it’s every conversation, every touchpoint, and every policy that shapes how families experience care.

It’s in the way we frame our words, the way we honor choices, and the way we use our voices to advocate for systemic change.

Because ultimately, ethical lactation care is about upholding dignity—for parents, babies, and the professionals who serve them while we all traverse the Milky Way.

 

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Modifiable behaviors to improve breastfeeding

We all know breastfeeding is critical for both mothers and babies. Most of us are supporters, advocates, counselors, mothers, grandmothers and just generally breastfeeding cheerleaders! We want to help and sometimes it can be hard to know how to help. In a groundbreaking new article, nine unique elements have been identified as modifiable behaviors that can increase breastfeeding success. We always knew there were things we could do! Now we have clear definitions of what those things are. Truly incredible!

The article was recently published in Acta Paediatrica and you can find it here.  The research was an observational study conducted in Masaka, Uganda. It looks at 300 newborns in the postpartum unit as well as 166 infants attending the 6-week postpartum clinic. The research team utilized the Lactation Assessment & Comprehensive Intervention Tool (LAT). A tool chosen because it did not aggregate assessment items and has been validated.

What the research found was that there are nine elements that were significantly related to effective breastfeeding: the infant state and feeding cues pre-feeding, four postitioning elements including tummy-to-mummy, infants arms around the mothers breast, the breast not being held or shaped, and the baby’s head being free of restriction, and three latching elements which include the gape, the baby’s head tilt, and the baby’s lower lip reaching the breast first.

I was delighted to speak briefly with Dr. Anna Blair, the lead author on this remarkable paper to ask her few questions on the research and the findings.

Q: What would you say are the key takeaways from the research?

Dr. Blair: There are certain predicable, easily explained things that parents can do to help their baby breastfeeding effectively, before the baby even touches the breast. We found that having the baby tummy to mummy, for example, really matters. It’s best not to hold the breast. Watch that the head is free of restrictions. There’s been a lot of focus on assessing infants already at the breast, but the pre-feeding behaviors and attaching matter.

Q: Was there anything in the results that surprised you?

Dr Blair:  Many of these elements we’ve believed for years – written about in numerous texts by experts – but now we have clear findings from research.

I think it was interesting that the baby’s head being free of restrictions mattered more with the infants in post partum than at the 6 week checkup.

Breasts being held have become such a common practice and this research shows it is negatively associated with effective breastfeeding. I was not surprised by that because there has been some previous research on breast shaping having a negative impact on breastfeeding. But look at the images of people breastfeeding and the instructions from hospitals – they largely include breast holding and shaping , which is so unfortunate.

Q: What has you excited about this research?

Dr. Blair: What we found in this study has easy to follow, straightforward ways to improve breastfeeding effectiveness and feeding and I think that is very exciting.

I hope the article sparks as much excitement for you as it did for me and for the research team.  I also hope it sparks lots of conversations in your communities and workplaces around these specific, modifiable behaviors and how it might change our practice and the way we help moms and babies.

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Paying it forward through Milk Banking

Sometimes when we have a frustrating experience, or a situation where we feel unsuccessful in some way, we choose to move on and let it go. Sometimes the experience stays with us and motivates us to have a different experience the next time around. Quinn G falls into the latter category and her story is inspiring!

Quinn struggled with breastfeeding with her first child. She saw many people about it, but no one was able to help her. Once lactation professional even said to her that she was a unicorn and there was no answer for her problems. Ugh. She wound up weaning very early and was heartbroken about it.

At that point, she started learning everything she could about breastfeeding in preparation for the next baby. She got really interested in the science of it and the deeper research around lactation. As we often say, hindsight is 20/20 and she determined that a lot of her issues started when she started pumping. So, for the second, she decided the way to not run into the same issues was to only nurse at the breast and to not pump.

You know what they say about best laid plans? Yup, you guessed it. Quinn delivered at 34 weeks and the baby was in the NICU for 24 days. As a result, she wound up exclusively pumping! Luckily, everything she had learned still came in handy and she ended up with a completely different experience. That baby is now 18 months old and they are still breastfeeding! And…wait for it…she has donated over 16,000 ounces of breastmilk!

All of the pumping Quinn did while her baby was in the NICU led her to have a bit of an oversupply. Her first experience involved a lot of milk blebs so this time around she not only pumped, but after each pumping session she had expressed to be sure there was no milk left in the ducts. Hence the oversupply! When her baby came home they worked very hard on getting him to latch, which he did. However, she was reluctant to ease off the pumping for fear of supply issues. Fears created from her first-time breastfeeding, and those emotional scars we wear from a bad experience are difficult to overcome.

After filling the entire freezer, and buying a second one, she decided to look into donating. She connected with the Mothers Milk Bank of North Texas. At first it was just small amounts because she was still nervous her supply would just go away. But eventually, she started donating larger amounts.

The milk bank reached out to see if she would be willing to help with social media and getting the word out to folks about milk donation. Quinn had been off social media for several years at this point but decided this was worth jumping back in. She now has over 18,000 followers on TikTok and 15,000 on Instagram. She shares evidence-based information about breastfeeding and particularly information on pumping and hand expression. (her handle is @momsmilkmentor)

Towards the end of the conversation, Quinn and I bonded over what I call breastfeeding salvation. When you experience a difficult situation breastfeeding you can feel inadequate and like a failure as mother and woman. I mean, come on, you can’t even meet the most basic needs of your child. However, if you are given a second chance, if you have a successful breastfeeding experience after an unsuccessful one it can heal so much of that pain. It almost feels like a phoenix rising from the ashes. Quinn is an incredible, inspiration example of this and I feel honored to have had the chance to speak with her.

If you would like more information about milk banking, please check our the Human Milk Banking Association of North America or your local milk bank.

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