When my friend Kate hit the tremendous milestone of exclusively breastfeeding her son for one year, she shared the following with members of our new moms Facebook group:
“I have spent 24,666.4 minutes nursing him, or 411.1066666 hours nursing him, or 17.129 days nursing him a total of 1,656 times in the last year!”
“I have pumped 795 times and gotten 3,828.8 ounces of milk during those pumping sessions.”
If the average pumping session is 13 minutes, Kate estimates she spent 10,335 minutes attached to her pump (the equivalent of 7.18 days).
In total, between nursing and pumping, Kate spent over 35,000 minutes (or 583.37 hours) providing breastmilk for her son. How does Kate know how long she spent nursing or pumping? She used an app.
In a world where the phrase “breast is best” is thrown around by public health professionals (and I should know, I am one), doctors, lactation consultants, family members, and social media users, my first thought reading Kate’s post was, “Holy (bleep), do any of these people realize the time it takes to exclusively breastfeed a baby for a whole year?!”
While Kate’s data and experience represent some serious personal determination…they also have important public health implications.
(1) Breastfeeding apps are a gold mine of public health data
Kate used an app on her phone called Baby Nursing to track her nursing and pumping, but there are tons of similar apps out there, ranging in price and features. When I asked Kate why she tracked her breastfeeding she said that a nurse told her to, “the nurse told me I needed to keep track of how long I nursed him and write it on his [paper] log. I decided that was silly and opened my phone and searched “breastfeeding” in the app store, assuming there was an app for that!”
Most product descriptions highlight how these apps can benefit the health of individual families, especially when information needs to be shared with other caregivers and their Pediatrician. However, some developers are starting to talk about the trends they see when (de-identified) data from large groups of users is collected. For example a similar app to the one Kate used, called SmallNest, tracked 2,000 babies, primarily in the U.S. and Canada, to gather data about feedings. Among other things, they found that the average number of feedings for a breastfed newborn is 16-18 times per day. According to the app’s founder, the goal of sharing these data is “to give insights back to the community so moms can learn and achieve better breastfeeding outcomes: even just knowing you’re within a normal range can be really helpful in relieving anxiety and worry.”
While sharing these data within parental communities (to support education and positive breastfeeding knowledge and norms) is very important, these data have the potential to be used more broadly for public health advocacy and policy change. Women face a number of barriers when it comes to breastfeeding and this data could help create more supportive policy, but the data from these apps hasn’t been widely studied. At present, a PubMed search for “breastfeeding” and “app” in the title or abstract only results in two peer reviewed papers. The first study follows mothers from birth to eight weeks postpartum to capture breastfeeding behavior with one of these mobile phone apps. The study did not look at time dedicated to breastfeeding long term or the public health implications of the data collected. The second study aims to develop the first evidence-based breastfeeding app for men (with the ultimate goal of increasing their knowledge and ability to provide strong social support to their partners).
I would love to see public health researchers take this to the next step. Let’s collaborate with app developers to identify much bigger datasets. Let’s follow women beyond eight weeks and see what time it really takes to meet the American Academy of Pediatrics (AAP) recommendations to exclusively breastfeed for 6 months and then continue to breastfeed to one year (even after solid foods are introduced). And let’s publish that data in peer reviewed journals so that it can be referenced and used for future research and policy decisions.
(2) Breastfeeding time data can (and should!) affect public health policy and recommendations
Kate returned to work when her son was just over six months old. As a teacher she was fortunate to have the opportunity to extend her maternity leave. However, like the majority of women in the U.S. none of her maternity leave was paid. In fact, it cost her over $3,000 to take that extra time home with her son (primarily due to paying for her health insurance coverage during leave) and that’s in addition to the lost six months salary. Luckily, Kate was one of the only teachers in her school that had a storage closet turned office in her classroom. It had no windows and no air conditioning, but it was private. She pumped during her first period prep time, fifth period lunch, and right after school before heading home. While she made it work, Kate’s pumping schedule was not without sacrifice. She tells me, “I lost the ability to get work done at school, to socialize with coworkers, and had to say I couldn’t go to meetings because of my pumping schedule.” After putting her son to bed, she would do a lot of the grading and school work that she no longer had time for during the day…and then she would pump again right before bedtime.
She says that many of her friends and colleagues weren’t as lucky as her when they returned to work, “I have many other teacher friends who gave up on pumping shortly after returning to work because they don’t have their own classroom or space and the travel time to a place to pump, the time it takes to pump, clean your pumps and store your milk was more time than they had to give.”
The design and enforcement of federal and state laws regarding breastfeeding and the workplace would benefit from analysis of data looking at how much time women dedicate to nursing and pumping. For example, employers (with some exceptions) are required to provide reasonable break time for an employee to express breast milk for her nursing child (for one year after the child’s birth) each time such employee has need to express milk. What is reasonable? What is the average length of pumping sessions for women? What causes variation in these session lengths (e.g., time between pumping sessions; mother’s supply, age of baby, etc.)? How often are women pumping during the day? How does pumping frequency change over the course of one year? With the time required to breastfeed/pump for a 12 week old baby (when many mothers return to work), what does this say about the need for longer paid maternity leave? This is just a taste of the data that could be pulled from current breastfeeding apps that are highly relevant for writing policy that helps mothers thrive (both with work and pumping) when they return to the workplace.
(3) Infant health app developers and public health researchers should work together
Public health often views itself in conflict with private industry (think about obesity prevention, smoking cessation, and medication compliance) but if infant health app developers and public health researchers join forces, we can bring these apps to a broader audience. We can also design and capture new data fields to build on our understanding of the time dedicated to breastfeeding, and the factors that support or challenge that success. For example, what if apps asked about time dedicated to cleaning pumping supplies (both at work and at home)? And who cleaned the supplies (self, partner, other)?
Kate credits her husband Peter with being a huge factor in her ability to successfully breastfeed for one year. She tells me, “First, we decided that because I had to pump it, he had to clean it.” Peter regularly cleaned her pumping supplies and would pack them for work the next day.
We know from prior research that strong partner support (by way of verbal encouragement and active involvement in breastfeeding activities) increases a mother’s feelings of confidence and capability when it comes to breastfeeding. Many other factors have been shown in the literature to facilitate or challenge breastfeeding, so it would benefit public health to have women document the most relevant factors in these apps. For example, my family used the Total Baby app and we could log in our Pediatrician appointments. Perhaps these apps could also log appointments with lactation counselors and/or breastfeeding support groups in order to capture a mother’s access to and participation with lactation support experts.
I really hope to see public health take advantage of the data potential of breastfeeding mobile apps. There is a lot of published literature focused on fitness and nutrition apps, but to date- infant feeding apps are underutilized as a public health dataset. The data offers huge potential for health advocacy, policy, and education…and can hopefully provide a definitive answer to my question for the public health and medical professionals making breastfeeding recommendations:
“Holy (bleep), do any of these people realize the time it takes to exclusively breastfeed a baby for a whole year?!”