Breastfeeding and antenatal screening. Dr Stuart Prosser audio 24 June 2025

Dr Stuart Prosser, a Perth GP-obstetrician, has developed an antenatal screening tool in collaboration with the Geddes Hartmann Human Lactation Research Group at The University of Western Australia. Please note: there were technical problems with Dr Prosser's presentation, and the audio has an echo at times. It nevertheless contains important information about antenatal screening.

Dr Prosser and Dr Perrella's important retrospective July 2025 study examined matched antenatal lactation risk screening data and infant feeding method at 6 to 8 weeks postpartum in a cohort of 296 Australian women who gave birth at term gestation. The authors conclude: "Nonmodifiable lactation risk factors may be identified in half of pregnant women. Previously identified risks of Gestational Diabetes Mellitis and increased body mass index are compounded when they coexist, posing significant risks to early full breastfeeding outcomes. Antenatal identification of lactation risk factors offers opportunities to proactively educate and support women at risk to optimize breastfeeding and subsequent maternal and child health outcomes."

I have uploaded the Antenatal Screening Tool that Dr Sharon Perrella and Dr Prosser used to establish risk in their 2025 study for those studying the NDC Lactation Fellowship. This tool makes a good prompt for a clinician who is taking the woman's history antenatally, with a view to ascertaining risk and the kind of support she requires to optimise breastfeeding post-birth. I note the 2023 NDC Breastfeeding History Tool which is found in the NDC Resource Hub, takes the same history using Possums language and approaches.

I have the view, despite the importance of this research, that Dr Prosser's tool is not suitable for handing out to mothers, because women are asked to report, by ticking the relevant box, if

• They have 'Breast hypoplasia'

• Their nipples are 'Large', 'Short', or 'Flat'.

Unfortunately, I believe that requiring a pregnant woman to self-identify according to these categories prior to birth could impact negatively on her breastfeeding outcomes, because such labelling impacts upon her relationship with her body and her confidence that she can breastfeed. This has not yet been investigated as a research question. For example, I regularly see women who've been told that their breastfeeding problems are caused by the shape of their nipple, which makes them feel disempowered (and anatomically flawed) because they can't change this, when the actual underlying problem relating to fit and hold has not been skilfully addressed.

Recommended resources

The shape of a woman's breasts and nipple-areolar complex (her macroscopic anatomy) is located on a glorious spectrum of normal anatomic trait variation, including during lactation

Do certain (macroscopic) maternal anatomic variations cause breastfeeding difficulties?

Insufficient glandular tissue and mammary hypoplasia

Reference

Cummins L, Meedya S, Wilson V. Factors that positively influence in-hospital exclusive breastfeeding among women with gestational diabetes: an integrative review. Women and Birth. 2022;18:S1871-5192(1821)00040-00048.

Perrella SL, Prosser SA, Vlaskovsky P, Geddes DT. Prevalence of antenatally identifed lactation risk factors and risk of not fully breastfeeding at 6 to8 weeks postpartum. Journal of Midwifery and Women's Health. 2025:doi:10.1111/jmwh.70006.