Source of Evidence
The Influence of Spinal Cord Injury on Breastfeeding Ability and Behaviour. Holmgren, Lee, Hocaloski, Hamilton, Hellsing, Elliott, Hultling & Krassioukov 2018 (in press). Journal of Human Lactation. 22 May 2018, 34(3):556-565
Although fertility is typically not affected, little is known about the challenges faced by women with SCI both during and after, including breastfeeding (Alexander, Aisen, Alexander, & Aisen, 2017). Lactation dysfunction following disability has been noted in the literature (Charlifue, Gerhart, Menter, Whiteneck, & Scott Manley, 1992; Morton et al., 2013); however, the extent of lactation dysfunction and influence of SCI on breastfeeding ability and behaviour is not well understood Study To assess differences in breastfeeding experience and challenges, researchers in Stockholm, Sweden and Vancouver, Canada conducted a retrospective self-report study with mothers with SCI; participants were divided into two groups for analytic purposes – high-level SCI (Injury at T6 or above (n=18)) and low-level SCI (Injury below T6 (n=20)). They found three significant differences between the mothers with high-level SCI and the mothers with low-level SCI:
- Women with high-level SCI breastfed exclusively (i.e., without formula supplementation) for an average of 2.78 months, a significantly shorter period of time than the mothers than in the low-level SCI group who breastfed exclusively for an average of 6.45 months.
- More women with high-level injury (14 or 77.8%) reported insufficient milk production or ejection versus women with low-level injury (7 or 35%).
- 39% of women with high-level SCI experienced an episode of Autonomic Dysreflexia (AD) whereas none of the women in the low-level SCI group experienced an episode of AD.
Though this is the first study comparing breastfeeding in mothers with high-level or low-level SCI, there are some clinical implications we can draw from the work to date:
- Mothers with SCI are capable of breastfeeding, but there may be significant barriers or problems with: disrupted lactation, impaired milk ejection, mobility challenges and AD. Clinicians should be aware of these difficulties and considerations for high-level versus low-level SCI.
- Clinicians should be prepared to provide education and appropriate support (e.g., nursing pillows) to facilitate positioning during breastfeeding, a difficulty reported by most women in the study, regardless of their level of injury.
- There is a need for more in-depth and longitudinal research to be conducted with mothers with SCI, particularly research that addresses blood pressure, AD and SCI. Blood pressure in people with SCI is lower than their able-bodied counterparts, especially when the SCI is cervical or high thoracic (Phillips & Krassioukov, 2015). As AD is typically initiated by any stimulus below the injury level, it is possible that an infant’s suckling, breast engorgement or mastitis would be sufficient to trigger an AD episode.
The benefits of breastfeeding for the infant are well-known, but researchers have shown that mothers also experience benefits from breastfeeding including: higher levels of oxytocin, lower levels of blood pressure, lower rates of post-partum hemorrhage, and reduced maternal risk of ovarian and breast cancer (Johnston and Amico 1986; Light et al. 2000; Jonas et al. 2008; Ebina and Kashiwakura 2012; Chowdhury et al., 2015; Feng, Chen, & Shen, 2014; Horta & Victora, 2013b; Saxton, Fahy, Rolfe, Skinner, & Hastie, 2015; Victora et al., 2016 ). It would be useful to have evidence that showed if the benefits of breastfeeding for mothers with SCI outweighed the risks, particularly from a cardiovascular perspective.