The World Health Organisation (WHO) (2001) recommends that from birth to six months of age, all babies should be exclusively breastfed, as it is unequalled with any other form of nutrition and has health benefits for the mother. The Scientific Advisory Committee on Nutrition (SACN) (2017) endorses these guidelines, with key messages from scientific reviews that it is possible for avoidance of tooth decay, potentially avoid allergy risks and ensures appropriate growth and development of the infant. In addition, we know that mothers experience normal weight gain during pregnancy (Institute of Medicine and National Research Council 2007) and that given the increased requirements to breastfeed (SACN 2011), it can help support a healthy weight. Incidence of breastfeeding for those crucial first six months are increasing globally but the numbers have remained below the target in the UK since 2005, according to the Infant Nutrition Survey 2010 report (2012).
Advantages
The advantages (WHO 2013) are fewer infections, higher IQ, good oral development, lower cholesterol and lowers the risk of Crohn’s in adulthood. Having breast milk can decrease risk of obesity, atopy and sudden infant death. Breastfeeding supports bonding with the mother, the milk has optimum composition for baby’s growth which also contains immunoglobulins which can improve baby’s immunity (Infant feeding survey 2010).
The milk composition is lower in protein compared to that of cow’s milk and formula which makes this gentle on the baby’s kidneys (Ballard and Marrow 2013). The stages of the milk changes from colostrum at 2-4 days to a more liquid type at 3-7 (WHO 2013). During feeding two types of milk are produced; hindmilk and foremilk which ensures adequate hydration initially, then satiety with increased fats. Therefore, the production and composition of the milk is adaptive to the baby’s needs.
Hormones are produced when making human milk, such as prolactin, which induces the next feed and acts as a contraception by stopping ovulation. Oxytocin is another hormone which is produced when breastfeeding, which helps the uterus to contract, prevents anaemia and bleeding (Ballard and Marrow 2013).
Breastfeeding is readily available, convenient and can reduce health care costs for long term due to the protective benefits against breast, ovarian and cervical cancers (WHO 2003). In developing countries breastfeeding not only has health benefits but it can be cheaper, hygienic and can be economical for the environment versus sourcing formula feed. The contraceptive benefits might be also helpful when other contraception is not available.
The Main Problems
Babies can be born with a cleft lip making it difficult for them to latch on and require specialist equipment. The supportive equipment might not be readily available which may sway mothers to use formula straight away.
Inborn errors of metabolism are rare but would be a contraindication. Babies are unable to digest parts of the milk or require a special low protein feed to avoid toxic effect. Other examples of contraindication in breastfeeding are drug toxicity and HIV risk, through transfer to the baby from breastfeeding. This is most prevalent in developing countries such as Africa (WHO 2001).
Younger mothers, in lower educated jobs and low socioeconomic status were less likely to breastfeed according the Infant Feeding Survey 2010. However, this survey explained that despite these statistics, 75% of mothers who didn’t breastfeed were able to name a benefit of breastfeeding spontaneously and 83% of them said they knew there are benefits.
Latching on can take practice and when babies are struggling to achieve this, it can be stressful and painful. Leading to mastitis, can be a reason to choose formula feeding (Radzyminski and Callister, 2016). Due to the different types of milk produced during feeding, it is essential for full drainage of the breast before starting feeding on the next. This can be mean mental and physical exhaustion for the mother. Formula can be measured, and since the human milk is quickly digested, formula can increase satiety and reducing times to feed (Radzyminski and Callister, 2016). The Infant feeding Survey (2010) it states that four out of five women who were struggling, were receiving support in hospital, medical centres and once they arrived home.
Summary of the findings
Evidence shows breastmilk is deemed perfect for an infant’s growth and development, supporting the recommendations by WHO experts. These benefits are seen in the short and long term for both mother and child (WHO 2013). The guidelines for exclusive breastfeeding for six months are crucial in health promotion. Surveys have found that there is support and health promotion for mothers from healthcare, and a good working knowledge of the benefits.
In the UK by six months of age, breastfeeding had dropped to 34% showing a decline in compliance with these guidelines. Contraindications are rare, linking reasons to this are low. Factors influencing this choice are qualitative such as pain, sleep deprivation, lacking family support and socioeconomic implications. Statistics suggest mental health support, education for breastfeeding and infant positioning, could all be improved.
Conclusion
In conclusion, there is a strong evidence base for breastfeeding for the baby’s development, function and for later in life, even with the main problems that can be encountered. Despite the guidelines, incidence of breastfeeding exclusively for six months is globally low. These recommendations set a standard which a mother might not be able to meet, leaving feelings of guilt and psychological distress when it is not possible for them emotionally to continue. Especially in circumstances when they have poor emotional support.
There is still a stigma to breastfeed in public, with lack of facilities making it less convenient than formula. Formula can support an exhausted mother, who could share the feeding with their family. There are gaps in our knowledge regarding exactly why the recommendations are not being met. It is also unclear how effective guidance and support is for mothers.
Further qualitative studies could explore social, psychological aspects and impacts on maternal mental health. These studies may give us further information to explore why many mothers understand the benefits of breastfeeding but still do not engage in this. Maintenance, exhaustion and concerns regarding social development and attachment of a child, could be factors to explore. From this, the healthcare industry can address these factors in future, to help mothers reach the global health recommendations.
References
1. Ballard O, & Morrow A.L. (2013) Human Milk Composition: Nutrients and Bioactive Factors. Pediatric Clinics of North America, 60(1), 49–74. Available from: http://doi.org/10.1016/j.pcl.2012.10.002 [accessed: 16/2/19]
2. Health and Social Care Information Centre, IFF Research (2012) Infant Feeding Survey 2010 summary. [online] available from: https://files.digital.nhs.uk/publicationimport/pub08xxx/pub08694/ifs-uk-2010-sum.pdf [accessed 15/2/19]
3. Institute of Medicine and National Research Council (2007) Weight Gain During Pregnancy: Reexamining the Guidelines. [online] available from: https://www.ncbi.nlm.nih.gov/books/NBK32813/pdf/Bookshelf_NBK32813.pdf [accessed 12/2/19]
4. Radzyminski, S and Callister, L.C (2016) Mother’s Beliefs, Attitudes, and Decision Making Related to Infant Feeding Choices. The Journal of Peritenal Education, 25 (1), 18–28. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4719110/ [accessed 16/2/19]
5. Scientific Advisory Committee on Nutrition (2011) The influence of maternal, fetal and child nutrition on the development of chronic disease in later life. [online] Available from: http://www.sacn.gov.uk/pdfs/sacn_early_nutrition_final_report_20_6_11.pdf [Accessed 12/2/19]
6. Scientific Advisory Committee on Nutrition (2017) Draft Feeding in the First Year of Life Report. [online] available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/629221/Feeding_in_the_first_year_of_life_draft_report.pdf [Assessed 24/2/19]
7. World Health Organisation (WHO) (2001) Global strategy on infant and young child feeding. [online] available from: http://apps.who.int/gb/archive/pdf_files/WHA55/ea5515.pdf?ua=1 [Accessed 14/2/19]
8. World Health Organisation (WHO) (2013) The long-term effects of breastfeeding: A systematic review. [online] available from: http://apps.who.int/iris/bitstream/10665/79198/1/9789241505307_eng.pdf [Accessed 10/2/19]