How Metacognition Can Impact Breastfeeding Success

Lactation Consultant (IBCLC) Sarah Siebold discusses how principles of metacognition can help breastfeeding feel more sustainable, especially during difficult moments.

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“I knew it would be hard, but I didn’t know it would be this hard,” say many new moms I meet in lactation consults. They share myth-like horror stories about bleeding nipples and mastitis (one woman I met said her OB coined her case “raging mastitis,” which sounded more like a band name than a legitimate diagnosis and terrified the poor mother into weaning abruptly.) 

Like any new skill, learning to breastfeed can be challenging. But the overwhelming consensus is that breastfeeding is an insurmountable feat.  According to Healthy People 2020, an initiative to increase overall health and wellness in the United States, only 1 in 4 infants is exclusively breastfed at 6 months and just 36.2% are breastfed in any capacity by their first birthdays. Lack of national paid family leave and discrimation against mothers in the workplace, heavy marketing of artificial breastmilk substitutes to especially vulnerable populations, and historical and cultural dynamics that cast breastfeeding in a complicated light — these are looming societal forces to blame, and we can’t erase them overnight.

But individually, there is something each of us can do before our little ones are born to persevere. We can practice thinking about thinking. 

The term “metacognition” refers to the process by which we think, make meaning, and learn. It’s the birds-eye view of how our thoughts influence our actions. I’m writing this and seeing myself from above: hunched back over keyboard, matcha latte to my diagonal right. “I’m thinking about my sore back” I say to myself, “and what to do to feel more comfortable.” Immediately I straighten my spine and bring my shoulders down. By thinking about what this thought would do, I solve my problem. 

When it comes to breastfeeding, lactation consultants help prevent and/or navigate existing problems. We’re the nursing parent’s “breast friend,” and we’re here to help you make informed decisions about infant feeding. And though you can call on us almost always, we’re not available at 3am when you’re futzing with a nipple shield in the dark, or your 16-day-old has cluster fed for 4+ hours and you don’t know which way is up. What if applying principles of metacognition kept you from throwing in the breastfeeding towel and acting on impulse? Took the edge off of the hardship? Changed your perception from “breastfeeding is an insurmountable feat” to “breastfeeding feels really hard right now?”


Here are 5 metacognitive steps to persevering, even through the most trying breastfeeding moments:


  1. Think about thinking: As if you don’t have all of the other things to think about during pregnancy, carve out space to think about your thinking in concrete ways. I deliberately do this at checkered moments during my day. Like this morning, when I thought about making a matcha latte and then thought about what it was that led me to that thought in the first place. I wanted that matcha because I’m an exhausted parent of two. It’s a very grounding moment with oneself, and practicing it during pregnancy will give you a leg up when postpartum haziness strikes.
  2. Ask yourself open-ended questions: These are questions that allow for reflection. During difficult breastfeeding moments, like when you worry that your baby is not getting enough milk at breast despite her frequent wet and stool diapers, ask, “Why do my thoughts go to that place? Can you tell me more about that?” Answer yourself honestly and openly. Maybe the fear comes from a slow weight-gaining older child, or from a parent who always told you to eat more than you felt comfortable eating. Don’t worry about what your answers may mean; focus only on your conversation with yourself. 
  3. Aim for judgement-free: Instead of, “Ugh, I’m insane for constantly thinking about baby’s weight gain,” try, “I keep having thoughts about my baby’s weight gain, and it’s making me anxious.” You’re observing the thought without criticizing it, or yourself for thinking it. Most importantly, you’re allowing the feeling to surface and exercising a new muscle — the metacognition muscle. 
  4. Focus on the process: Growing up, my mom advised against making big decisions in especially trying moments. My “fight or flight” impulse was always to leave the tense moment for fear that it meant something was wrong. It makes sense to want to leave fear, discomfort, and worry behind; but oftentimes we’re perfectly safe during moments that feel but aren’t actually catastrophic. If your goal is to breastfeed for a year but on day 2 you wonder how you could possibly keep going when it already feels so hard, try to see yourself from above. Envision the moment itself and the little moments of the day about to unfold. The rest can wait.
  5. Think of solutions: You’re in the thick of it and feel another plugged duct forming. Your breast is tender to the touch, you’ve just gone back to work, you’ve reached your emotional bandwidth. But you want to keep breastfeeding. So you begin to think about how the metacognition work you’ve been doing has changed your understanding of self. You label the feelings associated with this experience — “I feel depleted, I hate the way this feels physically, I don’t know how many more obstacles I can take” — and you watch the feelings float by. This gives you space to realize that you have many options available to you: you can connect with a local lactation consultant; find a breastfeeding support group or La Leche League meeting; phone a friend who has had recurring plugged ducts; write an email to your partner about how horrible your day has been.


I offer these tools not as a mental health professional, but as a lactation consultant, anxious mother of two, and fellow breastfeeder who has been in these hard places more times than I can count. If you’ve decided that breastfeeding isn’t for you, know  that your decision is yours and that you know what’s best for you and your family. But if you want to keep breastfeeding — because you CAN do this — see yourself from above, acknowledge your feelings about your current experience without worrying about what they mean, and keep on keeping on. You’ve got this.


Interviews, stories, and guides on contain information that is general in nature and should not replace professional medical advice, diagnosis or treatment. If you have a medical condition or concern or plan on trying a new diet, supplement or workout, it’s best to first consult with your physician or a qualified health professional.


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