The Continuum of Breastfeeding Care


I often think about continuums. They are everywhere with many of us falling somewhere in the middle most of the time. There are two breastfeeding continuums that come to mind. First, the desire to breastfeed. For some this is strong and it is going to happen regardless of even the toughest of circumstances in whatever form possible: exclusive breastfeeding, partial breastfeeding, prolonged pumping with some eventual latching, or exclusive pumping, each defining their own success. For others, there is aversion that can be attributable to various life experiences, marketing forces, or simply an indifference to this part of our biology. And then, there are those in between where perhaps many of the 60% of women who report stopping breastfeeding before meeting personal goals find themselves.

Second, is the continuum of modern breastfeeding support. La Leche League International established this over 60 years ago when artificial milk was growing into the billion dollar industry of today instead of remaining a “formula” reserved for circumstances in which human milk is unavailable. Breastfeeding support has been evolving ever since and now includes three complementary levels: clinical, educator, and peer.

The clinical level consists of the International Board Certified Lactation Consultant (IBCLC), required to complete extensive prerequisites and pass a comprehensive examination before applying skills to assess and treat common to clinically complex breastfeeding challenges. The educator level includes Certified Lactation Counselors (CLC) and Breastfeeding Educators (CBE) among others, required to take at least a week-long training course and pass the training organization testing before providing breastfeeding support and education. The peer level requires personal experience as found with WIC peer counselors and La Leche League leaders who complete a peer guided credentialing process before providing community support. Peer remains a most important level as it is within the community, has sustained us through millennia in some form and is ongoing for those aware of and consistently able to access it.

Many parents attend peer La Leche League meetings to get trusted breastfeeding support. Some go upon encouragement from family or friends. Others find meetings through personal searching, identify with the philosophy and eventually become leaders. I was the latter. It was the start of a journey that continues years later as I navigate through the healthcare system working as an IBCLC and advocate for equitable access to and insurance coverage for IBCLC care. With a background in physical therapy, I have always been fascinated with how the human body is designed to move. It made sense to me to pursue natural birth and to breastfeed. I had a lot to learn, but with biology and developmental knowledge, I had some foundation.

Many people very reasonably rely on physicians to guide them through this time. An expecting parent’s familiarity with the continuum of breastfeeding support and care is likely minimal without personal connection. So, what kind of breastfeeding knowledge is cultured in medical school and other healthcare related degree programs to ensure informed feeding choices? Are healthcare providers aware of the continuum of breastfeeding care?

I increasingly wondered over years of leading La Leche League meetings as I heard many parents express concern about medical advice to feed on a schedule, sleep train, or give more formula for weight gain. It was always amazing to see a relaxed expression with reassurance that the wants and needs of an infant are the same, feeding responsively is biologically normal, and more specialized care with a lactation consultant is an option. This became part of my motivation to transition my career to one that focuses on breastfeeding and development. What I have discovered is that education about breastfeeding, although a pillar of health and development, is minimal during medical school, and in other healthcare professional degree programs, including physical therapy. Those that do know more have usually pursued it on their own. And, even with the knowledge, time to provide information and help is often limited.

Thus, a third breastfeeding continuum I think about is knowledge within the medical community. In my experience, some have advanced ability to help solve complex breastfeeding problems; others at least know it is the best way to nourish a new human and the importance of referral to the appropriate level of support; while others think it has benefits but alternatives are similar. A 2014 study confirms some of my experience revealing that while physicians reported their breastfeeding education is sufficient women reported a lack of breastfeeding information from their physicians.

The good news is that each continuum seems to be shifting to better align with our biology and what truly promotes lifelong wellness: recognition of breastfeeding as an extension of pregnancy and birthing, requiring just as much or more specialized care. There are now many other community groups to foster informed feeding choices, a global Baby Friendly Hospital Initiative, professional associations including International and United States Lactation Consultant Associations, and state and federal advocacy groups to help improve public policy. Organizations that raise awareness of breastfeeding disparity among African American families are transforming healthcare equity and job opportunity.  The Human Milk Banking Association of North America helps distribute thousands of gallons of human milk to hospitals and others to ensure as much is given to human babies as possible, especially among the most vulnerable infants requiring neonatal intensive care. The Academy of Breastfeeding Medicine now exists with 35 evidence based protocols for physician and professional reference. The Affordable Care Act set provisions in 2013 for professional prenatal and postnatal lactation care to be fully covered by insurance for the duration of breastfeeding. And, in 2018 the American Academy of Pediatrics developed a comprehensive action plan that includes recommendations for addressing gaps in breastfeeding training and education for physicians.

While the desire to breastfeed will continue to vary, and breastfeeding care gradually grows to be standard within a healthcare system catching up with human lactation science, awareness of continuums can help families be assertive as they learn how to nourish new life. Hopefully the continuums continue to align for better knowledge, access and equity throughout our communities and healthcare system.

As we like to say at Nurture Columbus, seek support early and often! Doing so can help you find your way along the breastfeeding continuum of care, and understand what will best empower you to achieve your goals to whatever degree possible. After all, any amount of breastfeeding and/or breastmilk can optimize lifelong health and opportunity!


Reasons for Earlier Than Desired Cessation of Breastfeeding Erika C. Odom, Ruowei Li, Kelley S. Scanlon, Cria G. Perrine, Laurence Grummer-Strawn Pediatrics Mar 2013, 131 (3) e726-e732; DOI: 10.1542/peds.2012​

Borra C, Iacovou M, Sevilla A (2015) New evidence on breastfeeding and postpartum depression: the importance of understanding women’s intentions. Matern Child Health J 19:897–907

The United States Lactation Consultant Association, “Who’s Who in Breastfeeding Support?”

J. M. Stolzer and Syed Afzal Hossain, “Breastfeeding Education: A Physician and Patient Assessment,” Child Development Research, vol. 2014, Article ID 413053, 6 pages, 2014. doi:10.1155/2014/413053

About the author: Allyson Wessells is a physical therapist and International Board Certified Lactation Consultant (IBCLC) with Nurture Columbus, in Columbus, Ohio.  As a PT and IBCLC, she focuses on optimizing nourishment and growth for lifelong health. Other services include presentations emphasizing the interdependence of breastfeeding and infant development as a foundation for preventative healthcare.


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