What are the best practices for weaning a toddler from breastfeeding, and what role can health-care providers play in helping nursing mothers to do so? That is what Diane Spatz and Addie Cunniff of the University of Pennsylvania set out to learn by speaking with mothers who had breastfed their infants beyond the first 12 months, what is considered “extended breastfeeding” in the United States.

From speaking with four participants from varying backgrounds, the researchers learned several key points, which they published in the March/April issue of the American Journal of Maternal Child Nursing.

First, every woman experiences breastfeeding differently and elects to stop for a variety of reasons; sometimes her process and motives change daily. Second, the amount that fertility, particularly in relation to the first postpartum menstrual cycle, came up surprised the researchers. Finally, normalizing extended breastfeeding, particularly among health-care practitioners, could reframe a conversation that sometimes makes women feel stigmatized for their choices around this parenting practice.

“Very few women breastfeed long-term in the United States,” said Spatz, a perinatal nursing and nutrition professor in Penn’s School of Nursing and lactation program director at the Children’s Hospital of Philadelphia. Therefore, “it’s one of these areas that just kind of gets ignored because there are not a lot of people doing it.”

The project came about when Cunniff, then one of Spatz’s students in the School of Nursing and now a neonatal intensive care nurse at Pennsylvania Hospital, began asking questions about what research on weaning had already been done. After some digging, she and Spatz realized it was almost non-existent, so Spatz suggested they conduct their own.

Through connections to the Pennsylvania Resource Organization for Lactation Consultants and the non-profit Breastfeeding Resource Center, the pair found a quartet of women willing to speak about their victories and struggles breastfeeding their infants beyond a year.

“The moms were really excited to share their experiences because no one had talked to them about this before,” Spatz said.

One mother was a 37-year-old woman who worked full-time from home, another a 32-year-old stay-at-home mom. The final two, a 36-year-old woman and a 37-year-old mother of two boys, both worked full time outside of the house. Each had individual ideas about the commitment she wanted to make to breastfeeding but all had gone beyond an initial 12-month period.

When you talk to moms who do breastfeed beyond a year, a lot of times you don’t see a person weaning one single way. It can shift based on the day.”

From hour-long in-person interviews, Spatz and Cunniff concluded that all four opted for slightly different weaning practices.

“When you look at what is out there, basically people talk about mother-led weaning, child-led weaning or a combination of both,” Spatz said. “When you talk to moms who do breastfeed beyond a year, a lot of times you don’t see a person weaning one single way. It can shift based on the day."

Other themes that emerged from the interview data included: attachment, co-sleeping, maternal health and discomfort, family planning and online support communities.

All of this told Spatz that more research on weaning is needed, particularly related to fertility issues.

“For some of the women, the motivation to wean was really because they wanted to have another baby. People don’t think about breastfeeding as being birth control, but it can be,” Spatz said. “Every mom is different. Some moms who breastfeed have a return to menstruation within three months.”

She said it’s important to educate both mothers and health-care providers about breastfeeding beyond year one, to normalize the practice, something that’s already true around the world.

Previous research found that globally, up to three years is the average breastfeeding duration. “It’s OK if a baby breastfeeds for more than a year. There’s nothing wrong with that,” Spatz said. “The baby is going to wean. Babies don’t go off to school breastfeeding. They all stop.” 

Long term, Spatz said she would like to create a space where women can be resources for each other, particularly given the twists and turns that often accompany navigating breastfeeding. For now, she and Cunniff will put into practice in the nursing-care setting what they’ve learned, to help their patients make better-informed decisions.

Spatz and Cunniff received no financial support for this research.