BREASTFEEDING/CHESTFEEDING WITH MATERNAL/PARENTAL HEALTH CONDITIONS
There is little research on the effect of disability or chronic health problems in the breastfeeding/chestfeeding parent. Several studies have shown lower initiation and continuation rates in those with a disability. Two studies have noted that mothers with learning disability and multiple types of disability had the lowest initiation rates - around 65% compared to 83% in those with no self-defined disability, although these groups also had demographic and antenatal/intrapartum differences as well. Facilitating factors like skin to skin contact and staff assistance were also lower.
A Canadian study of mothers with chronic physical disease such as diabetes or heart disease found that initiation rates and any breastfeeding at six months was similar to women without chronic disease, but the rate of exclusive breastfeeding at six months was lower (adjusted odds ratio for early cessation of exclusive breastfeeding was 2.5). Another study confirmed that birthing parents with only physical disability were equally likely to initiate breastfeeding and exclusively breastfeed in hospital.
Mothers with physical disabilities are more likely to have caesarean birth, both planned and emergency - which will bring its own challenges to establishing breastfeeding. Mothers with disability also report poorer communication, respect and involvement in decision making generally during their antenatal, intrapartum and postnatal care.
A qualitative study of mothers with serious physical disabilities reported that factors increasing success for breastfeeding were:
1. Adapting breastfeeding positions and using pillows (another study praised breastfeeding supporters who were creative in working with the parent's specific abilities to achieve sustainable positioning)
2. Expressing milk (with assistance if needed) if direct breastfeeding was impossible
3. Physical assistance from others with positioning or holding the baby
4. Peer support from others with similar disabilities
Mothers with disabilities spend longer in hospital, and those with mental health and learning disabilities receive more postnatal midwife contact so there is ample opportunity to provide intensive breastfeeding/chestfeeding support.
1. Lack of flexibility and understanding from breastfeeding supporters, or lack of support offered
2. Concerns over whether breastfeeding was safe for the infant - because of maternal medication, or whether it was safe for the parent - for example concern over osteoporosis in existing bone disease
3. Physical difficulties with positioning and attachment due to the limitations of the disability
4. Lack of disability-specific knowledge from health care providers and lack of experience with inclusive communication (such as describing positioning and attachment without reference to vision for blind parents, or speaking in a way that facilitates lip reading).
5. Delayed initiation of effective breastfeeding due to the learning curve of best positioning, with subsequent impact on milk supply
Another qualitative study noted that breastfeeding could exacerbate pain in some conditions (either through the specific positioning required, the increased demand on the mother rather than other caregivers' ability to feed the baby and/or breastfeeding causing disease flare), and parents felt conflicted about prioritising their health over their baby.
Some people with autoimmune rheumatic disease reported that health professionals were supportive of breastfeeding up to a certain point, but seemed to disapprove when breastfeeding continued past infancy, feeling that this no longer gave enough benefit to outweigh the impact on medication choices.
The Breastfeeding Network has a useful page discussing parents' views on breastfeeding with a disability - an important point being that bottle feeding can be more difficult than breastfeeding with some physical disabilities, so breastfeeding may be empowering. Breastfeeding reduces postpartum flares for some conditions, and mothers may want to breastfeed specifically to reduce the likelihood of their child experiencing the same condition in the future.
Here is another useful page with practical advice for parents with disabilities. If mothers/parents cannot, or do not want to, breastfeed/chestfeed because of their disability they may find this website helpful, looking at feelings around feeding babies. For example some people with autoimmune rheumatic disease reported significant guilt when they stopped breastfeeding.
Note this publication on breastfeeding while on dialysis, which doesn't find evidence of significant risks to the infant and recommends that parents should aim to breastfeed after dialysis sessions rather than before.
Mothers and parents with neurodiverse diagnoses such as autism and ADHD may experience specific challenges with breastfeeding/chestfeeding. Systematic review has identified difficulties with accessing antenatal and postnatal services because of poor understanding of the needs of Autistic people, stigma and discrimination; increased distress in the postnatal period because of the impact of interrupted routines and loss of control; and sensory challenges in the experience of breastfeeding/chestfeeding or expressing milk. Positives such as a high level of preparation and motivation to breastfeed/chestfeed were also identified. This is a padlet for professionals working with parents in the perinatal period that explores how to best support Autistic parents - it was designed to maximise and amplify the voice of autistic people.