Helping Adolescent Mothers Breastfeed
From: LEAVEN, March-April 1990, pp. 19-21
The first telephone call a Leader receives from a teenage mother asking for breastfeeding help may take her by surprise and trigger a whirlwind of questions. Can adolescents breastfeed successfully? What issues or concerns are of special interest to teen mothers? Are adolescent mothers any different from the mothers who usually call or attend Series Meetings? Will the adolescent mother feel comfortable at Group meetings? How can Leaders most effectively address the teen mother's needs? And, the ultimate question: How can La Leche League Leaders help teen mothers breastfeed?
Developmentally, adolescence is a time of struggling for self-esteem and the establishment of personal identity. Adolescents focus intensely on their own dramatically changing bodies, their behavior, and their physical appearance. Acceptance by their peers is a constant concern.
Today's teens face pressure to become sexually active long before they are emotionally ready. Teens are bombarded by role models who promote premarital sex almost everywhere they turn: on television, in books, at the movies, and in the music they listen to. At a time when adolescents need their parents to help them adjust to their ever-changing world and develop skills for coping with life, many teens are becoming pregnant and are thus thrown into being parents themselves.
Dr. Eloise Skelton-Forrest highlighted the problem in her address at La Leche League's 12th International Conference in Anaheim last summer: "When you look at all the pregnancies in the United States, ten to twenty percent of those pregnancies are teen pregnancies. There are approximately one million teen pregnancies per year. Four hundred thousand of those pregnancies end in either spontaneous or voluntary abortion, which means that approximately 600,000 teens every year give birth to their children." No wonder, then, that more and more La Leche League Leaders are called upon to help teen mothers breastfeed.
Can Adolescents Breastfeed?
"Biologically speaking, adolescents can lactate. In cultures where human milk is the primary source of infant nourishment and the onset of reproductive years begins in adolescence, mothers do, indeed, produce adequate milk. No differences in quality or quantity have been associated with maternal age," says Dr. Ruth Lawrence. She does point out, however, that adolescents need more calories, protein, niacin, and thiamin to maintain their body stores during pregnancy and lactation than adult women.
Although teen mothers are capable of breastfeeding, most do not choose to try. Fewer than eighteen percent of pregnant adolescents say that they plan to breastfeed, and, of these, even fewer actually follow through on their decision. Most teens have little, if any, knowledge about breastfeeding, and those who think they know something about it often mention common misconceptions and old wives' tales. To combat these negative forces, teens need to know about the physiological and psychological benefits of breastfeeding to both mother and baby.
Special Concerns of Teen Mothers
Often teens are apprehensive about how breastfeeding will affect their bodies. David Elkind says in his book, All Grown Up and No Place to Go: "Perhaps because of the breast fetish of American culture, aided by the Playboy centerfold, teenage girls are extraordinarily sensitive about their breast development. It is one of the most worrisome perils of puberty for girls." Teens are not only afraid that breastfeeding will change the shape and size of their breasts forever, they also fear--even more intensely than the average nursing mother--being ridiculed if they are seen breastfeeding in public.
In addition, teen mothers want to know:
How breastfeeding will affect their relationships with others:
- If they are married, what their husbands will think if they breastfeed.
- If they are not married, how breastfeeding will affect their relationships with boys.
How breastfeeding will affect their other activities:
- How to leave their baby so they can go to appointments, school, work, or out on a date. Will breastfeeding restrict them?
- How to manage the practical details of breastfeeding while going to school and/or work, such as how to express, store, and thaw breast milk for their babies while they are away.
- How to breastfeed while trying to take care of a husband and household responsibilities.
How breastfeeding will affect them physically:
- If breastfeeding will affect how soon they will return to their pre-pregnancy weight.
- If the baby will bite them while breastfeeding.
- If they can smoke cigarettes and breastfeed.
- If they can breastfeed while taking birth control pills.
How to be a mother and other general concerns:
- What to do if baby cries.
- How they can earn enough money to take care of themselves and their babies.
- How to cope with staying home to take care of a baby while all their friends are going out on dates.
- How they can care for the baby who is born prematurely.
How Leaders Can Help Pregnant Adolescents
Jacquelyn Griggs, a Leader from Texas, was herself pregnant at the age of sixteen and also has helped two pregnant teens in her own family. She advises Leaders not to be afraid to suggest that teen mothers breastfeed. She cautions, however, that while teens need a lot of information and support to breastfeed, Leaders need to be careful not to overwhelm them with information. It is the Leader's own enthusiasm for breastfeeding that has the greatest impact on the teen mother.
Some Leaders are asked to work closely with a group of adolescent mothers by conducting breastfeeding classes at schools, clinics, or homes for unwed mothers. But the most common contact Leaders have with teen mothers is an occasional phone call asking for breastfeeding information.
As with all helping calls, a Leader's primary responsibility to the mother is to help the mother make her own decisions. It is important to treat the adolescent mother like any other mother. Treat her with respect. Listen carefully to her questions and provide her with information and support so that she can make informed decisions. And, perhaps most importantly, be sure not to talk down to her or treat her like a child.
While some teen mothers call with specific questions about breastfeeding, others are simply reaching out for support from anyone they can find who will help them. They may not even know whether they want to breastfeed. This type of call challenges a Leader to engage teen mothers in conversation and provide information that will help them decide what is best for them and their babies.
Leaders need to be especially careful to avoid judgmental language when teens call for breastfeeding information. Teens are usually bombarded with advice by family members, friends, or school and clinic personnel who have already told them that they are "too young to be a mother." So teens are sometimes defensive by the time they have reached the stage in their pregnancy when they are considering how they will feed their baby. In this case, Leaders need to be advocates for both mother and baby.
Leaders also need to recognize that many teen mothers lack family support. The mother's parents are often consumed with worry about their child having a child of her own. They may not be able to imagine their child breastfeeding. In this case, Leaders might suggest talking with both the teen mother and her parents to help the teen mother receive as much breastfeeding support as possible after the baby is born.
If the teen mother is married or has a boyfriend, he may not want her to breastfeed. Adolescent males are often just as confused about breasts and their development as their female counterparts. The teen mother's partner may worry about what his friends will say if his wife or girlfriend breastfeeds and may wonder about his own response as well. Leaders can help teen mothers learn to breastfeed discreetly so that she and the baby's father will be comfortable about nursing in front of others.
Many teen mothers are not married, therefore Leaders should be sensitive about using the word "husband" unless the mother says that she is married. Instead, Leaders can talk about the value of the support that the "baby's father" can offer.
Most teens face extreme financial hardships, hardly having enough money to take care of themselves, much less their babies. Teen mothers may not be able to pay for breastfeeding books or LLL information sheets. And many teens do not have their own cars, making it difficult to get to and from League meetings without a ride.
Leaders also can suggest to the pregnant teen that she "try" breastfeeding for a few days or weeks. This may encourage mothers to breastfeed who might otherwise never even start. Unless a teen mother brings up how long she plans to nurse, Leaders might want to avoid discussing long-term commitments to breastfeeding.
Pregnant adolescents become parents before they have an opportunity to fulfill their own needs to be nurtured by their parents. Often they do not know how to be parents because their training in how to nurture is incomplete. Leaders can be especially helpful to these mothers by being willing to talk about parenting skills and being open and honest with teens. As Djamillah Samad, a Leader from New York, says, teen mothers "need and want someone who can laugh and cry with them. Never judge. Teen mothers need our candor and our expressions of failure when things have gone wrong in our lives. They need someone who can really listen."
Emphasize Breastfeeding's Advantages
It is also helpful for Leaders to emphasize the benefits of breastfeeding, especially the advantages to mother. Because she is concerned about returning to her pre-pregnancy size, a teen mother needs to know that breastfeeding right after birth causes the uterus to contract and reduces the flow of blood, helping to prevent hemorrhage. Tell her that breastfeeding helps the uterus get back into shape more quickly than it would if she were not nursing. She might also appreciate knowing that breastfeeding mothers have been found to lose weight faster without restricting calories.
Emphasize that breastfeeding establishes a strong emotional bond between baby and mother. Breastfeeding gives the teen mother something she can do for her baby that no one else can. This may be especially important to her because many teen mothers worry that the baby's grandmother or baby-sitter will usurp them in their role as the baby's mother.
Leaders also can mention the economics of breastfeeding. Because most teen mothers have low incomes, they would appreciate knowing that breastfeeding saves them not only the cost of formula, but also doctor bills and medications, since breastfed babies have fewer illnesses.
Leaders might also mention that teen mothers would miss less school and/or work to care for a sick baby if they breastfeed.
Finding Local Resources for Teen Parents
Pregnant teens need to know about the various support programs available within their communities. Leaders can compile this list themselves or suggest that the teen mother check into her local resources.
- high schools--to find out which schools offer parenting classes and have on-site child-care programs or allow teen mothers to bring their newborns to classes with them;
- hospitals and clinics--to learn which ones provide prenatal and postpartum services to adolescent mothers;
- doctors and midwives--to find out if they work with adolescent mothers;
- in the U.S., the local branch of the U.S. Department of Health and Human Services and the WIC offices--to see what services they offer teen parents.
- in other countries, public health departments or clinics may provide services for teen parents.
Having a list of names and telephone numbers at hand enables Leaders to provide teens with a wealth of information and support. When gathering this information, Leaders may want to go the extra mile and encourage each school, hospital, clinic, and other organization to provide services for teen parents.
Teen Mothers at Series Meetings
Teen mothers rarely attend LLL Series Meetings, but when they do, there are ways Leaders can help them feel more comfortable. Lou Boyes, a Leader from Florida, suggests that Leaders "talk with (the teen mother) before the meeting, show her the Group Library, and introduce her to a mother who has attended meetings regularly so she will have someone to sit with. Explain during the meeting that a support person (doula) is important for every mother and that the doula can be a relative or a friend."
Leaders can help teen mothers at meetings by making sure the discussion includes mothering skills, such as ways to calm a crying or fussy baby. It can also be helpful to mention that most babies have fussy periods and to offer reassurance that meeting a baby's needs will not "spoil" him.
Also, it is important to include a demonstration of positioning and discreet nursing, because these issues are of paramount importance to teens. Leaders might ask the mothers in the Group to share how they resolved their own concerns and mixed feelings about nursing when others are around.
Jacquelyn Griggs suggests that Leaders be sure not to single out the teen mother during the discussion portion of the meeting. Teens want to be treated like any other mother at the meeting.
Special Breastfeeding Meetings for Teen Mothers
When a Leader is asked to work closely with teen mothers, perhaps the first thing she should do is to evaluate her own feelings about helping teens. While any Leader can offer information and support on an occasional basis, those who work regularly with teens need to be sure they can meet their special needs. One way a Leader can become more comfortable working with teens is to learn as much as possible about adolescent development and the experience of teens in different cultures, suggests Phyllis Maloney, a Leader from New York.
Some Leaders with experience in helping teen mothers have offered special teen mother meetings. These meetings usually feature the same format and basic information as regular LLL Series Meetings, but emphasize teen mothers' special concerns. For example, at Meeting No. 2, "Baby Arrives: The Family and the Breastfed Baby," the discussion may focus on how to involve the baby's father or a new boyfriend with the breastfed baby or how to breastfeed while the mother attends school or goes to work. Another possible topic is how to gain support of the baby's grandparents.
These special meetings are often purposely kept short, because teens are used to sitting in school classes lasting about fifty minutes and their attention tends to wander after that. Most Leaders suggest keeping meeting length to about an hour but offering meetings more often than once a month. Another suggestion is to keep meetings informal by using open discussions, offering ample opportunity for questions and answers, and the time for the mothers to talk about themselves. Since adolescence is a time of intense personal focus, meetings should be a place where teens can feel comfortable expressing their concerns and feelings about becoming a parent and breastfeeding their baby.
Inviting the baby's father and/or the teen mother's parents to the meeting is a good idea. Djamillah Samad asks teen mothers to bring their best friend with them to their breastfeeding meetings. They call the mother's best friend the baby's "godmother" or new aunt. Djamillah "trains and helps both young women in all the aspects and benefits of breastfeeding." Djamillah says that the "godmother" supports the breastfeeding mother and is encouraged to call the Leader for help when the mother is too embarrassed to call.
Djamillah also suggests inviting other teens who have breastfed to attend the meetings. "Teens understand peer pressure, but they have been exposed primarily to tales of negative peer pressure. I've tried to turn this around and use positive examples of teen-to-teen influence," she says. When other breastfeeding teens are not available to attend meetings, it is important to have a mother who is not a teen bring her baby to the meeting to model breastfeeding techniques and the loving care LLL philosophy offers.
Even though special meetings for teen mothers may only be an hour long, nutritious snacks are a must. Healthy foods set the stage for a discussion about the value of eating well while pregnant and breastfeeding.
Special breastfeeding meetings for teen mothers can provide them with a sense of belonging. In the latter stages of their pregnancies, as well as after their babies are born, teen mothers find themselves more and more out of step with their peers. They have responsibilities and demands placed on them that do not allow them to participate fully in the social activities they are accustomed to. At special teen breastfeeding meetings, teen mothers can get to know other young mothers who share their experiences.
These meetings also can give Leaders ongoing contact with teen mothers after their babies are born. As Jeanne Fisher, a Leader from Texas, says, "Attention derived from the birth of the baby wears off after a few months, and the mother usually decreases attention toward her baby proportionally." At meetings, Leaders and other teen mothers can continue to support the new mother, increasing her chances of continuing to breastfeed and meeting her baby's needs in other ways.
One Group's Experience
After Andrea Laurence and Beverly Morgan, Leaders from California, became interested in helping teen mothers breastfeed, they contacted a local home for unwed mothers to see if the home would hostess a special LLL meeting for its teen mothers. In January 1989, the Santa Clara Valley Group, which has a special emphasis on teens and young parents, was formed. Andrea and Beverly say that their Group functions much like other Groups, with a few exceptions. Their meetings are held twice a month to provide mothers the frequent contact they need to build and maintain support, the baby's father or the mother's boyfriend can attend the meetings, and the Evaluation Meetings are open to Leaders and Leader Applicants only.
Andrea and Beverly say that at each meeting there are a few mothers "who strongly resist the idea of breastfeeding." This is "because the home for unmarried girls that hosted our first series makes the LLL meetings for young and teen mothers a requirement for all those who live there. Having girls there who do not plan to breastfeed can be an advantage, as they provide opportunities to [discuss] negative comments about breastfeeding or to dispel misinformation. To our surprise, most of the teens want to breastfeed their babies, many for a year or more."
Andrea and Beverly add that "funding for the Group presented us with an additional challenge. Normally, the bulk of Group funds is provided by memberships and Group sales. Our Group attendees are typically on limited budgets with few opportunities to earn a discretionary income." These Leaders are considering asking businesses or individuals to sponsor their mothers' memberships. Their Area and other Groups in their Chapter donated books and information sheets, enabling them to have a library and to give information sheets at no cost to the teen mothers.
Leaders Have Much to Offer
LLL Leaders can help teen mothers breastfeed. Nancy Schweers says, "Teenage breastfeeding has the potential to reinforce positively the desire to love and bond [with their babies] that many teens do not have. The nurturing that we offer in LLL is a beautiful gift for mother and baby."
Lawrence, Ruth A. "The Lactating Adolescent," Fifteenth Round Table, Ross Laboratories, 1984, pp. 32-42.
Joffe, Alain and Radius, Susan M. "Breast versus bottle: correlates of adolescent mothers' infant-feeding practices." Pediatrics 1978; 79: 689.