Important that nurses help women find ways to bond with their infants when breast-feeding is not possible

Sep 20 2004

New mothers with fibromyalgia (FM) face multiple barriers to breast-feeding their babies, according to a study published recently in the American Journal of Maternal/Child Nursing.

For the study, “Breast-feeding in Chronic Illness—The Voices of Women with Fibromyalgia,” Karen M. Schaefer, D.N.Sc., R.N., assistant professor of nursing at Temple University’s College of Health Professions, analyzed the written stories and tape-recorded interviews of nine mothers with FM, ranging in age from 26 to 36. All had given birth to at least one child before being diagnosed with FM, a chronic disorder characterized by widespread pain and fatigue. Because there is no cure, patients often undergo physical therapy, counseling and medication to alleviate their symptoms. Commonly prescribed medications include antidepressants, ibuprofen and morphine.

Women living with this condition are faced with a difficult decision once they decide to have children: to breast-feed or bottle-feed. Many of Schaefer’s subjects viewed breast-feeding as part of being “a perfect mother ” and breast-feeding as a critical time for mother and child to bond. But since the drugs used to control FM symptoms may be harmful to newborns, these women must either forgo their medication usage or give up their dreams of nursing their children.

“Because breast-feeding is a stationary activity, they would become stiff, sore and along with increased fatigue would often be unable to resume normal activities as quickly as they thought they should have been able to do,” said Schaefer.

Also common among the women was the sense that their milk supply was not enough to nourish their babies. One woman indicated that her breasts never fully engorged, while others turned to drugs like oxytocin to increase their milk supply.

Problems not directly related to FM, but that nonetheless increased pain, like sore nipples caused by candida or thrush (when a yeast infection spreads to the baby’s mouth) also made breast-feeding unbearable. Though the women often tried to relieve their pain naturally, most were forced to return to their doctors and their medication regimens.

Because breast-feeding is such a valuable and healthy means of nutrition, Schaefer suggests that healthcare providers learn more about FM when advising breast-feeding mothers with the condition. Before discouraging a mother’s nursing efforts, providers should first explore non-prescription methods for reducing discomfort and pain.

If such attempts to ease the mother’s discomfort fail, however, Schaefer recommends that nurses refer women with FM to a lactation consultant with experience in dealing with breast-feeding challenges and postpartum fatigue. A more proactive approach is to consult with a lactation specialist while pregnant to begin the process of planning for successful breast-feeding. Interventions like music therapy might help the mothers relax and reduce discomfort during breast-feeding. It is also important that nurses help women find ways to bond with their infants when breast-feeding is not possible, and reassure them that their infants will get adequate nutrition through bottle feeding.

Schaefer’s research focuses on women with chronic illness (fibromyalgia, lupus, ovarian cancer) and diversity in nursing.