Abstract
The importance of breastfeeding for babies and children is widely known, both by parents and society. Less known is the influence of breastfeeding on maternal health. Several maternal diseases have been identified, that are influenced by breastfeeding, mostly in a dose–response relationship: the longer the total duration of breastfeeding is during the lifespan of a woman, the clearer is the influence on maternal health. The incidence of breast and ovarian cancer, cardiovascular diseases, and diabetes mellitus are clearly higher in women who do not breastfeed or breastfeed only for a short period. 1
The above addressed three types of disease are, in general, connected to lifestyle. All have a high morbidity and mortality rate, and preventive strategies are often used to address these lifestyle factors, although breastfeeding is not often directly mentioned. However, it has been shown that breastfeeding could reduce the incidence and the individual burden of these diseases, and reduce the costs of treatment, which are high and often life-long. 2
The awareness of this heightened risk for maternal disease when a woman chooses not to breastfeed after birth in the general population is not very high. Male and older respondents lacked knowledge, but even among women, only 28% were aware that breastfeeding could protect against breast cancer, 16.3% knew that breastfeeding could protect against high blood pressure, and 17.3% acknowledged that breastfeeding could protect against diabetes mellitus. Most participants responded neutral, but around 10% of women actively disagreed with the statement that breastfeeding could be a protective factor. 3
The reasons for this lack of awareness can be speculated. It must be acknowledged that maternal protection is often not clearly related to the breastfeeding period and is only visible through demographic statistics, which are often difficult to trace because of confounders. Thus, even physicians may not be aware to the full extent of the importance for women to breastfeed for their own sake.
It could also be assumed that physicians are hesitant to inform their patients in pregnancy about the risks of not breastfeeding for their infants and for themselves. The fear of causing pressure and anxiety around breastfeeding in this vulnerable phase, perhaps resulting in feelings of shame and guilt by the mother, when breastfeeding is not possible, might be greater than the urgency of sharing the information about possible negative effects of not breastfeeding somewhere later in life. Pressure of health care workers and social environment can result in anxiety and may have a negative influence on maternal mental health, caused by the fear of not being able to breastfeed. This fear can turn into a self-fulfilling prophecy, having a negative impact on breastfeeding exclusivity and duration, 4 and it can have negative consequences for mothers and infants.
However, it is essential that physicians do not withhold information and encourage breastfeeding, not only for the sake of the newborns but also for the sake of the own health of the mother too. Mothers have the right to make an informed decision about breastfeeding. Such information should be given in a way that is “morally neutral and practical, setting realistic expectations for the demands of breastfeeding…” as stated in the recent research of Tan et al. 5
There is not “one model to fit them all.” In some cases, it might be necessary to be very clear to the parents about the consequences of not breastfeeding for themselves and for their babies; other mothers might profit more from a less direct approach, but nevertheless: Parents have the right of information and these themes should be addressed. Of course, parents do not only need correct information, but all breastfeeding dyads need optimal support during their breastfeeding period, both at the start, and when breastfeeding has been established, to help them reach or even exceed their own breastfeeding goals. This also includes removing barriers on a societal level, such as the absence of paid maternity leave and the lack of individual specialized breastfeeding care by trained physicians and lactation consultants in case of lactation problems.
Breastfeeding as preventive medicine is one of the underestimated opportunities to reduce the risk of morbidity in females. Breastfeeding as a rewarding investment in maternal health is still not getting the attention that it needs. In prenatal visits, this aspect should have the same emphasis as the impact of breastfeeding on the health of the child. Public health information about this topic should be available to the general population. Physicians should inform individual mothers in a personal and sensitive way and afterward support the informed decision of these mothers about the way they want to feed their children and help them to indeed succeed in breastfeeding. Moreover, women should be aware that in making the decision to breastfeed, they also support their own health. And only then a well-informed decision about breastfeeding is possible.