Postpartum breastfeeding experiences among teen mothers in North Carolina: Findings from a mixed-methods study

Background: Breastfeeding rates in the U.S. are well below the Healthy People 2010 objective of 75% of mothers initiating breastfeeding, particularly among adolescents. Teens who do initiate breastfeeding tend to breastfeed for shorter durations compared to older mothers. The purpose of this mixed-methods study is to investigate breastfeeding practices, barriers and facilitators among adolescent mothers. Methods: Quantitative descriptive analyses are conducted using data from a population-based sample of 389 teens ages 13-17 giving birth to a live born infant (NC PRAMS) between 2000 and 2007. Qualitative analyses are based on in-depth interviews with 22 Black, White and Hispanic teens residing in rural and urban areas of North Carolina. Results: In quantitative analyses, slightly more than half of North Carolina teen mothers breastfed. In both the quantitative and qualitative samples, half of teens who initiated breastfeeding stopped within the first month postpartum. PRAMS data revealed common barriers to breastfeeding initiation and continuation including not liking breastfeeding, returning to school, nipple pain, and insufficient milk. Qualitative data provided context behind the quantitative findings, elucidating the barriers and facilitators to breastfeeding from the teens' perspective and enabling further exploration of racial/ethnic differences observed in the quantitative analyses. Conclusions: Prenatal breastfeeding promotion should highlight the less well-known advantages of breastfeeding to increase teens' motivation to breastfeed. The large number of adolescents weaning within the first month points to the need for more individualized follow-up after hospital discharge to address common technical challenges and to provide assistance managing the transition back to school.