Booby Traps Series: Why don’t we get better breastfeeding care from our nurses?

At a conference last year, I heard a nurse speaking about the importance of helping mothers with breastfeeding.

“If you were a nurse,” she said, “and you knew for a fact that 80% of your patients were going to have gall bladder surgery, you’d be sure to know a lot about how to help someone who is having gall bladder surgery, right?

“Well,” she said, “80% of our moms are going to initiate breastfeeding, so don’t you think all maternity nurses should know a lot about how to help with breastfeeding?”

You’d think so.  But the unfortunate truth is that the care we get from our nurses can be very uneven.

Of course, there are outstanding, wonderful nurses who go far out of their way to help moms with breastfeeding.  “Angels” is how one mom recently described those nurses to me.  I know many personally.

But there is also no question that many moms get substandard breastfeeding care from their nurses.  And research confirms the problem.  Here are just two studies which illustrate the problem:

  • A decent sized study of nurses in pediatric offices in North Carolina found that “The nurses surveyed were involved in breastfeeding support, yet many had incorrect information and negative attitudes toward breastfeeding.”
  • This small study of baccalaureate nursing students in Virginia who had completed their obstetric nursing training in breastfeeding found that most (85%) did not know that breastfeeding is recommended for the first year of an infant’s life, only five of the 80 surveyed participants knew the proper management of mastitis, and well over one third (41.3%) of the participants opposed breastfeeding in public.

Why is this?  There are likely many factors, including:

  • Poor or inadequate training:  One review found that “There is currently a lack of comprehensive breastfeeding content in nursing curricula across the United States”
  • Attitudes get in the way.  One study of nurses at a hospital where breastfeeding rates were very low concluded that “nurses need support and continuing education to identify personal bias and knowledge deficits which hinder breastfeeding promotion.”
  • Too little time?  Breastfeeding support is sometimes viewed as too time consuming given the demands placed on nurses.  But this doesn’t explain why some hospitals seem to do it better than others under similar conditions.

Fortunately, evidence is building that, just as with pediatricians, if you provide good training to nurses their skills will improve and moms will be more successful with breastfeeding.

As Diane Spatz, who has written for Best for Babes about breastfeeding in NICUs, says, “educated health professionals transform breastfeeding culture.”  If this is true, we need to do a far better job of training and fostering supportive attitudes among our nurses.

Did you have great breastfeeding care from your nurses?  Substandard care?  How did it impact your breastfeeding experience?

10 thoughts on “Booby Traps Series: Why don’t we get better breastfeeding care from our nurses?

  1. I’m a night postpartum nurse who is still breastfeeding her nearly two year old son and I am in every way a breastfeeding advocate with my patients. The biggest problem as mentioned is lack of staffing, if I had three moms instead of four or five, I’d have all the time in the world to help with latches, etc. I would love it! The next biggest problem which has not been addressed is the mother themselves. If a mom is having a hard time latching baby and feeding but can keep her cool and not freak out, then I can help. But the moms wo snap at me when I’m trying to help them latch (at their , request!) or get so anxious that they will not be receptive to help, or have allowed their baby to be passed around all day and miss skin to skin time and go too long between feedings, by the time I get on shift their babies are so wound up, anxious and hungry that they are too upset to latch for hours, I am unable to help them in the way they expect, which is to shake my magic nurse wand and get their baby on a comfortable deep.latch. kind of get the picture? So moms, meet us halfway. Keep your baby with you, feed frequently during the day, do skin to skin, and take some deep breaths. Remember I am human and am fresh out of breastfeeding magic.


  2. I went through nursing school in the late ’80’s. There were 2 paragraphs on “infant feeding” in my pediatrics textbook, one on breastfeeding and one on formula feeding, with the actual recommendation that breast feeding was preferable, but basically made them seem equivalent. My peds instructor gave us info about breastfeeding that she had learned from her friend. I realized that I knew very little once I started working as a peds and then labor and delivery nurse. I was always an advocate and did as much as I could do to support breastfeeding but didn’t know how to help when things didn’t go well. Now, I have been an IBCLC for 17 years, went for training because I was frustrated that I didn’t know enough to really help new mothers and frustrated at hospital policies and practices that undermined mothers’ efforts. Recent grads seem to have more basic knowledge; more IBCLCs are on staff in hospitals, and in some regions (I am lucky I guess to live in the NW where breastfeeding is getting to be the norm…) the hospital culture is changing in support of breastfeeding education. We still have a long way to go. RNs have to be super task oriented and more and more efficient, with higher patient loads and shorter hospital stays. Their jobs are incredibly challenging. We need to incorporate education in nursing curricula across the board. It is a big task, and I do see small changes. Then they can and will be more helpful.


  3. In my experience as a LLL Leader helping moms and talking with nurses, I think that one of the biggest problems is the nurse’s own experience/expectations/bias, and those of her friends. Nurses who did not breastfeed, did so for a short period of time with problems, whose friends were unsuccessful at breastfeeding, or who view low income mothers as not likely to breastfeed successfully were much less effective helpers, no matter how much book knowledge they had been given, than those nurses who believed that most mothers can breastfeed successfully. It’s really no different from the mothers and mothers-in-law out there with similar attitudes. Recreating a breastfeeding culture means dealing with those attitudes as much as giving nurses actual knowledge and skills. The vast majority of effective helpers I know are either women who successfully breastfed or helpers who were successfully breastfed themselves as infants. They believe it will work, so when they are given training in effective methods they believe in that training. At the core of their being women who failed at breastfeeding, or whose mothers, sisters, or friends failed at breastfeeding frequently don’t really believe that any methods will necessarily work and they want to protect their patients from experiencing that failure. I’m not sure what it’s going to take to heal that attitude, but in large measure it’s healing that needs to happen in order for them to be effective helpers.


  4. I am a labor and delivery nurse and a Certified Lactation Consultant. While I agree that lactation support in hospital is inconsistent, for a variety of reasons, e.g., lack of training, inadequate staffing, lack of education, I believe think that you may have overlooked one of the major issues, which is either no hospital policy or one that is not enforced. BF support should be treated like any other part of our professional practice- ACLS,BCLS, NRP, IV insertion, Electronic Fetal Monitoring interpretation, the list goes on and on. Would you imagine leaving any other practice, especially one as critical as infant feeding and nutrition, up the individual RN. I believe it is the onus/responsibility of the hospital to establish policies, that are consistent and based on evidence and best practices, and monitor and enforce them. It’s time for hospitals to be held responsible for their breastfeeding rates; in the same way that they are for hospital readmission, infection rates and any other indicator that measures the quality of care.


  5. I had great breastfeeding care from my nurses! At the hospital I went to, many of the nurses were also IBCLCs and the ones that weren’t had breastfeeding training. They were fantastic with helping whenever I needed help, day or night and incredibly supportive that I could do it and to hang in there.


  6. I just looked at that Night Nurse Nation website. One page says that breastfeeding mothers must drink 13 (that’s THIRTEEN) 8-ounce glasses of fluid daily. I have NEVER heard that advice before. You’d sure be spending a lot of time running to the bathroom!


  7. The nurses when I had my daughter told me to nurse every 2 hours for 20 minutes. Ten days later, when my daughter was admitted to a major children’s hospital for what turned out to be an overreaction on new daddy’s part (I can laugh now…) told me that I should not nurse my daughter for two hours straight — a healthy 10 day old who was under stress with an IV and had yet to regain birthweight) — because she was burning more calories than she was taking in. The nurse at my pediatrician’s office told me that after 20 minutes, my daughter was “using me as a pacifier” and to cut her off. It is a bleeping miracle I managed to keep going through all of this. It’s what drove me to become an LLL Leader, though, and so when the nurses at a different hospital told me that my son was nursing too often (“We have to chart and we can’t chart if you’re nursing him 20 times a day”), I was able to ignore them confidently. I know there are wonderful nurses out there, I just wish I had gotten some of them.


  8. I am a Family Nurse Practitioner and IBCLC. In my former inpatient role, I was one of 2 LC’s, neither of us full time, and only worked the day shift. I think every OB unit needs to budget for LC’s on ALL shifts to not only support and assist mothers, but to support and assist the night shift. I know the night shift has less staffing, but babies tend to not care about that. I also know that in my former employment, the night shift had its own “culture” and “leaders” and some of them were much more (negatively) influential on the nursing staff than the LC’s who rarely saw the night staff…such as getting all the bsbies in the nursery at midnight for weights then not taking then back out until later, or even going as far as “mom is asleep” and giving formula to breastfeeding moms. The LC’s went repeatedly to manager about this, but no changes were made. I left that job several years ago when I became a FNP, and while I still do some LC in the clinic, I still hear from my LC inpatient co-horts that the night shift continues to be a major stumbling block, unfortunatly.


    1. Helen,

      Thank you for this!

      I think that what happens on the night shift has an unappreciated impact on how breastfeeding goes. You’re right that the needs of babies don’t decline just because the sun is down, and it seems like the time when a lot of breastfeeding meltdowns happen. I also wonder if it’s the time when moms can really focus on breastfeeding because the visitors are gone and the other interruptions are a little less frequent. And working in hospitals I also noticed that night shift nurses don’t always have the training opportunities (including breastfeeding management) that day shift nurses have.

      I think I feel another post coming on… 🙂



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