Lactation has important health benefits for both babies and mothers, but new research has discovered that breastfeeding improves women’s cardiovascular health. 

Women were assessed 3 years after the birth of their babies. Those who breastfed for at least 6 months were found to have significantly lower systolic blood pressure, diastolic blood pressure, mean arterial pressure, central systolic blood pressure, and central diastolic blood pressure than those who did not. They also had a lower body mass index. 

A sub-analysis of women who had had one or more pregnancy complications – including preeclampsia, gestational diabetes or hypertension – revealed additional benefits, said senior study author Flinders University Professor Claire Roberts.

‘These women also had lower insulin and total cholesterol levels, with higher high-density lipoprotein cholesterol,’ she said.

The improvement of cardio-metabolic risk factors through breastfeeding is ‘good news’ for women with pregnancy complications, who are at increased risk of developing future cardiovascular and metabolic diseases – such as hypertension, stroke, heart disease and type 2 diabetes.

‘When women have a pregnancy complication, it foreshadows a future risk of chronic disease,’ said Prof Roberts. ‘They have the opportunity to do something about their future health by looking after themselves, including breastfeeding as long as they can.’

However, this is easier said than done. While the majority of Australian women (96%) initiate breastfeeding, only 39% of infants are exclusively breastfed by the time babies reach 3 months of age.

Women who have had a pregnancy complication may find it even more challenging to establish breastfeeding, said Dr Melinda Boss MPS, pharmacist and chief investigator of the University of Western Australia’s LactaResearch group.

‘The hormones required for lactation can be affected, for example, if women have diabetes,’ she said.

There are a variety of reasons why women are unable to breastfeed, or choose not to, including postpartum depression or initiation of medicines that are not considered safe when breastfeeding. However, pharmacists can help women identify any issues or concerns and the right support channels, so those who can and want to breastfeed are able to continue.

Helping mums through the pain

Breastfeeding improves the whole metabolic profile of women, helping to stave off prevalent non-communicable diseases such as obesity, diabetes, and some cancers, said Dr Boss.

However, some women encounter difficulties in their journey to continue breastfeeding, often without adequate support and evidence-based knowledge to steer them in the right direction. 

‘When most people don’t really know how breastfeeding works, trying to work out whether everything’s okay or if they need help can be a source of anxiety,’ she said.

For women who have opted to breastfeed, the two most common reasons for ceasing lactation are:

• pain while breastfeeding
• concerns about milk supply. 

As the most accessible healthcare professionals, pharmacists are often the first port of call for new mums struggling with breastfeeding.

‘Women go to pharmacies to buy [products] such as [nipple compresses] for moist healing when they have nipple pain,’ said Prof Roberts.

‘You could say, “oh you’re buying this product. How are you going with breastfeeding? Is there anything else I could help you with? Do you need any referrals to anyone for help?”’ 

When women experience pain during lactation, it’s a sign that something is wrong that shouldn’t be ignored, said Dr Boss. But there are several ways pharmacists can help, beginning with pain management so women can continue breastfeeding. 

‘Mums can feed babies through nipple shields, which can reduce pain and help to prevent nipple damage,’ she said. ‘However, you need to know the diameter of the nipple and add a couple of millimetres to that measurement to appropriately size the nipple shield.’

The next step is referral for an assessment with a GP to identify the source of the pain. ‘A common cause can be an infection, confirmed through a swab of the nipple and/or a breast milk culture to see if there’s microbial growth, which would respond to antibiotics,’ said Dr Boss.

Perceived insufficient milk supply

With ‘no objective tests’ to clinically determine insufficient milk supply, Dr Boss said mums often rely only on their own set of signs, including:

• time spent at the breast during breastfeeding
• feeding more frequently than normal 
• less-full breasts
• a grizzly baby.

However, these factors, while helpful, are not actually appropriate measures of milk supply.

‘When your milk supply first comes in, you produce a little bit more than the baby needs, so your breasts feel full and firm. But over time, your synthesis down-regulates to meet your baby’s needs,’ said Dr Boss. ‘It’s also a normal pattern of baby behaviour to get a bit more unsettled towards the end of the day, and engage in cluster feeding.’

The best way to screen whether babies are getting enough milk is to look at the whole picture including:

• keeping an eye on urine output (five heavily wet disposable nappies within 24 hours)
• measuring the baby’s growth trajectory
• identifying whether the baby experiences some periods of contentment.

Without appropriate guidance, mums might introduce their own strategy, such as supplementation with formula, which will down-regulate milk supply. 

‘The way we produce more milk is to remove milk, and if we’re replacing some of those feeds with something else, low supply will become an issue,’ said Dr Boss.

If mum remains concerned, a referral to a GP for a paediatric assessment to look at the baby’s growth and development could help, she said. Sometimes, a key part of the process is helping mums move on when no more can be done.

‘We know women grieve when they don’t reach their breastfeeding goals,’ she said. ‘So it’s important to acknowledge all the effort they have gone through and the incredible things they have done to get that far.’