How can I address and manage maternal anxiety related to breastfeeding difficulties?

Addressing and managing maternal anxiety related to breastfeeding difficulties involves a combination of assessment, support, and appropriate mental health interventions.

First, a practitioner skilled in breastfeeding support should assess the breastfeeding process to identify and address any concerns. This includes asking about the mother's concerns, feeding frequency and duration, baby's sucking and swallowing, baby's contentment after feeds, baby's waking patterns, weight gain or loss, number of wet and dirty nappies, and the condition of the mother's breasts and nipples. Observing feeds within the first 24 hours and at least once more within the first week is recommended to identify difficulties early ².

If concerns persist, further actions include observing additional feeds, adjusting positioning and attachment, providing expressed milk, referring to lactation consultants or peer support, and assessing for tongue-tie ².

Supporting the mother’s mental health is crucial. For maternal anxiety, consider psychological interventions such as cognitive behavioural therapy (CBT) or facilitated self-help using CBT-based materials with support over several sessions ¹.

Encourage breastfeeding unless contraindicated by specific medications, but support the mother’s choice of feeding method that best suits her and her family ¹.

Where anxiety is moderate or severe, or if psychological interventions alone are insufficient, consider referral to specialist perinatal mental health services for further assessment and treatment, which may include medication with careful risk-benefit analysis and monitoring ¹.

Throughout, provide empathetic support, address any mother–baby relationship concerns, and ensure continuity of care through clear referral pathways and multidisciplinary collaboration ¹.