Australian National Breastfeeding Strategy 2010-2015

1.4 The breastfeeding continuum

Page last updated: 15 July 2010

The Australian National Breastfeeding Strategy recognises breastfeeding as occurring on a continuum or natal cycle that starts well before the birth of a baby and then progresses through several stages, including birth and the weeks and months after birth. While the concept of the continuum is widely used and accepted, there is no uniformly agreed definition. The Australian National Breastfeeding Strategy draws upon the continuum in Figure 1.1 that is based on Thornley et al. (2007).

Figure 1.1
shows continuum flow from Pre-natal to Immediate post-natal to Medium post-natal to Long post-natal then beyond 6 months
Source: Based on Thornley et al. (2007)

The needs of parents, mothers and infants will change between the stages and settings of the breastfeeding continuum. It is important that the activities and interventions that are provided to protect, promote, and support breastfeeding are evidence based and suited to the different stages of the continuum. The evidence indicates that multifaceted approaches are the most effective. The Australian National Breastfeeding Strategy sets out Australia’s breastfeeding goals and objectives for each stage of the breastfeeding continuum.

Antenatal Stage

This is the preparatory stage for breastfeeding and includes developing knowledge, commitment and support networks. The development of a commitment to breastfeeding includes viewing breastfeeding as the biological and social norm for infant and young child feeding. Attitudes are formed from childhood and can change through to parenthood. Antenatal promotion and education play a large role in informing mothers and families about breastfeeding. The extent to which a mother commits to breastfeed at this point can impact on the duration of breastfeeding (Shealy et al. 2005). The goal is to enable mothers to understand the value of breastfeeding and to breastfeed successfully by equipping them with knowledge and establishing or consolidating their support networks.

Immediate postnatal (birth to four days)

This is when mothers begin breastfeeding. Approximately 92 per cent of Australian babies are breastfed at birth (AIFS 2008). Mother and baby’s experiences in birthing services, and the feeding practices encouraged there affect the establishment of breastfeeding. Medications and procedures administered during labour can affect the baby’s behaviour at the time of birth, which can impact on the ability to breastfeed. Placing babies in skin to skin contact with their mothers immediately following birth and encouraging mothers to recognise when their babies are ready to breastfeed helps to establish the breastfeeding relationship (WHO 2009). Mothers who room-in with their babies have more opportunities to practice breastfeeding because of the infant’s proximity (Shealy et al. 2005).

Medium postnatal (four days to eight weeks)

By one week of age, the rate of full breastfeeding drops to 80 per cent. At one month only 71 per cent are fully breastfed, another 11 per cent receive a combination of breast milk and infant formula, 18 per cent receive formula only (AIFS 2008). Many mothers are reliant on their social networks after returning home from birthing services. These social networks can be highly influential in many of the decision making processes associated with raising a baby. Lay advice and support can either act as a barrier to or provide encouragement for breastfeeding (McLorg and Bryant 1995). New mothers’ preferred resource for concerns about child rearing is often other mothers (Shields 2004).

Long postnatal (eight weeks to six months and beyond)

At four months, approximately 46 per cent of Australian infants are fully breastfed, noting that at five months, this rate has dropped to 28 per cent. By six months, around the time when the Australian Dietary Guidelines recommend introducing solid foods, a total of 56 per cent are still receiving at least some breast milk and 14 per cent are fully breastfeeding (NHMRC 2003, AIFS 2008, Baxter 2008). Efforts to extend breastfeeding during the long postnatal stage include the continuation of health professional and peer support, and the creation of enabling breastfeeding friendly environments in a range of settings including workplaces, child care and public spaces, and the broader community.