Below are the latest studies on interventions to protect, promote and support breastfeeding.
Laid-back breastfeeding: knowledge, attitudes and practices of midwives and student midwives in Ireland
A cross-sectional descriptive survey distributed to midwives and student midwives in three maternity hospitals in Ireland and two online midwifery groups based in the Republic of Ireland, during June, July, and August 2021. Findings indicate that although there was a high level of awareness of laid-back breastfeeding among midwives and student midwives, there are challenges preventing its use in practice. Education specifically related to using LBBF in practice is required to overcome the barriers identified. A greater understanding of mothers’ and babies’ intrinsic feeding capacities may give midwives more confidence to recommend this method as a first choice, potentially leading to more successful breastfeeding establishment and maintenance.
Teleintervention’s effects on breastfeeding in low-income women in high income countries: a systematic review and meta-analysis
Many mothers in high-income countries (HIC) do not breastfeed to the World Health Organisation’s recommendation of two years. This is particularly true for low-income women (LIW). They often face additional socio-structural barriers that encourage early discontinuation and are inadequately supported by current healthcare interventions. This meta-analysis aimed to identify if teleinterventions increase ‘exclusive’ or ‘any’ breastfeeding by LIW in HIC at 1-, 3–4, and 6-months postpartum. Despite insufficient high-quality research into breastfeeding teleinterventions for LIW, results suggest teleinterventions may improve exclusive and any breastfeeding. Given breastfeeding is particularly low in LIW population from HIC, our findings are promising and require further exploration by larger, methodologically sound trials in other HIC.
Corkery-Hayward, M., Talaei, M. Teleintervention’s effects on breastfeeding in low-income women in high income countries: a systematic review and meta-analysis. Int Breastfeed J 19, 26 (2024). https://doi.org/10.1186/s13006-024-00631-2
Emotional and informational social support from health visitors and breastfeeding outcomes in the UK
Findings from this study point to the importance of health visitors providing emotional support to bolster the continuation of breastfeeding and encourage a positive subjective experience of infant feeding. The emphasis of emotional support in our results encourages increased allocation of resources and training opportunities to ensure health visitors are able to provide enhanced emotional support. Lowering health visitors caseloads to allow for personalised care is just one actionable example that may improve breastfeeding outcomes in the UK.
Exploring the reasons why mothers do not breastfeed, to inform and enable better support
This paper calls for more comprehensive and tailored antenatal breastfeeding education to refine practical breastfeeding skills necessary for successful breastfeeding establishment and maintenance. Suggestions are therefore made to train mental health practitioners on infant feeding with an aim to provide more extensive support, which may serve to disrupt the bidirectional relationship between poor mental health and poor breastfeeding outcomes. Recommendations are made, in light of these findings, to tighten workplace legislation to protect breastfeeding women.
Roberts D, Jackson L, Davie P, Zhao C, Harrold J, Fallon V, Silverio S 2023 Exploring the reasons why mothers do not breastfeed, to inform and enable better support. In Frontiers in Global women’s health. https://www.frontiersin.org/articles/10.3389/fgwh.2023.1148719/full
What will it take to increase breastfeeding?
This paper describes current evidence about the major structural challenges in place to improve breastfeeding practices, as well as the evidence‐based policies and interventions that can be effective at advancing breastfeeding on a largescale to promote, protect and support breastfeeding
Cordero, S., Perez-Escamilla, R. What will it take to increase breastfeeding? (2022). Maternal and Child Nutrition. DOI: 10.1111/mcn.13371
They can do it, you can help: Building breastfeeding skill and confidence in mother and helper
This chapter explores supporting positive breastfeeding skills in mothers.
Glover, R and Weissenger, D (2023) They can do it, you can help: Building breastfeeding skill and confidence in mother and helper. In Watson-Genna, C (2023) ed. Supporting sucking skills in breastfeeding infants Fourth edition. Jones Bartlett Publishing, Burlington
Compassion in healthcare: an updated scoping review of the literature
A previous review on compassion in healthcare (1988-2014) identified several empirical studies and their limitations. Given the large influx and the disparate nature of the topic within the healthcare literature over the past 5 years, the objective of this study was to provide an update to the original scoping review to provide a current and comprehensive map of the literature to guide future research and to identify gaps and limitations that remain unaddressed. Since the original scoping review on compassion in healthcare, while a greater number of studies incorporated patient perspectives, clinical or educational interventions appeared to be limited. More efficacious and evidence-based interventions or training programs tailored towards improving compassion for patients in healthcare is required.
Malenfant S, Jaggi P, Hayden K (2022) Compassion in healthcare: an updated scoping review of the literature. BMC Palliat care. 21(80) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9116004/
NHS England (2016) Compassion in practice: evidencing the impact.
This report demonstrates that nurses, midwives and care staff can be the primary agents of transformation but must be helped to prepare for the future – strategically setting out how we can create the right culture for change, explaining the need for change and providing the tools to achieve it. Now is the time to be proactive in progressing the strategic focus for nurses, midwives and care staff
https://www.england.nhs.uk/wp-content/uploads/2016/05/cip-yr-3.pdf
Compassion in practice—Evaluating the awareness, involvement and perceived impact of a national nursing and midwifery strategy amongst healthcare professionals in NHS Trusts in England
This paper reports findings from an evaluation of the impact of the Compassion in Practice Vision and Strategy (National Health Service England (NHSE), 2012) on nursing, midwifery and care staff. Results reveal professional anger, distress and resistance to the Compassion in Practice Vision and Strategy and a view of the programme as a top-down initiative which did not sufficiently recognise structural constraints on nurses’ ability to deliver compassionate care. We discuss the implications of our findings for global nursing.
Breastfeeding sick children in hospital: Exploring the experiences of mothers in UK paediatric wards
This qualitative interview study of UK mothers aimed to explore the challenges of breastfeeding sick infants and children on a paediatric ward or paediatric intensive care unit. From 504 eligible respondents, a sample of 30 mothers of children aged 2–36 months with various conditions and demographic backgrounds was purposively chosen, and a reflexive thematic analysis undertaken. The study identified previously unreported impacts such as complex fluid needs, iatrogenic withdrawal, neurological irritability and changes to breastfeeding behaviour. Mothers described breastfeeding as emotionally and immunologically meaningful. It also highlights areas for improvement, which may inform more nuanced paediatric breastfeeding standards and training.
Factors that influence women’s engagement with breastfeeding support: A qualitative evidence synthesis
For breastfeeding support programmes to be effective, a better understanding of contextual factors that influence women’s engagement and satisfaction with these programmes is needed. The aim of this synthesis is to suggest strategies to increase the level of satisfaction with support programmes and to better match the expectations and needs of women. Findings illustrate that the current models of breastfeeding support are dependent on a variety of contextual factors encouraging and supporting women to initiate and continue breastfeeding and highlight the relevance of providing different forms of support based on socio-cultural norms and personal backgrounds of women, especially if the support is one-on-one.
Bengough, T., Dawson, S., Cheng, H.-L., McFadden, A., Gavine, A., Rees, R., Sacks, E., & Hannes, K. (2022). Factors that influence women’s engagement with breastfeeding support: A qualitative evidence synthesis. Maternal & Child Nutrition, 18, e13405. https://doi.org/10.1111/mcn.13405
Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022
These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
Mitchell, K. et al. 2022. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeeding Medicine, Volume 17.
Predictors and impact of women’s breastfeeding self-efficacy and postnatal care in the context of a pandemic in Australia and Aotearoa New Zealand
This paper aimed to investigate predictors of breastfeeding self-efficacy, postnatal care experiences, and there subsequent impact on breastfeeding outcomes in Australia and Aotearoa New Zealand in the context of the COVID-19 pandemic. There were 1001 complete responses. Visitor restrictions impacted the woman’s early parenting experience in both positive and negative ways. Despite 94.3% of participants initiating breastfeeding, only 70% were exclusively breastfeeding at six weeks. The mean self-efficacy score was 49.98 suggesting the need for additional help, with first time mothers having a statistically significant lower score.
Sweet, L. et al. Predictors and impact of women’s breastfeeding self-efficacy and postnatal care in the context of a pandemic in Australia and Aotearoa New Zealand, Midwifery, Volume 114, 2022, 103462, ISSN 0266-6138, https://doi.org/10.1016/j.midw.2022.103462.
Support for healthy breastfeeding mothers with healthy term babies
Conclusions from this review highlighted how when ‘breastfeeding only’ support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points. For ‘breastfeeding plus’ interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face‐to‐face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits.
Gavine A, Shinwell SC, Buchanan P, Farre A, Wade A, Lynn F, Marshall J, Cumming SE, Dare S, McFadden A. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews 2022, Issue 10. Art. No.: CD001141. DOI: 10.1002/14651858.CD001141.pub6. Accessed 20 April 2023.
Mental Health Benefits of Breastfeeding: A Literature Review
This review aims to illustrate the effects that breastfeeding has on the mental health of postpartum mothers. An extensive computerized search was performed through databases of PubMed, CINAHL, and Medline. All studies conducted to determine the effects of breastfeeding on mental health were screened and included in this review. Search terms related to breastfeeding, postpartum, and mental health were used.
Tucker Z, O’Malley C (September 15, 2022) Mental Health Benefits of Breastfeeding: A Literature Review. Cureus 14(9): e29199. doi:10.7759/cureus.29199
Educational Resources and Curriculum on Lactation for Health Undergraduate Students: A Scoping Review
Breastfeeding is a fundamental component of health care, and health professionals need to be adequately prepared. As part of the system, health care professionals have the ability to influence the establishment and maintenance of breastfeeding. This scoping review explores the literature for the educational resources, methods, and curriculum used in the education of undergraduate health students related to lactation.
Overcoming Barriers to Breastfeeding
This paper provides an overview of the historic decline in breastfeeding rates and how timely initiation, exclusive breastfeeding and duration continue to lag behind global targets, resulting in approximately 600,000 child deaths and 100,000 maternal deaths annually. Many women face substantial barriers to breastfeeding, and despite public health initiatives and interventions which attempt to counter this, substantial work remains to implement fully supportive policies across multiple social sectors in order to limit the pervasive influence of breastmilk substitute marketing and achieve more equitable outcomes.
Cecília Tomori, Overcoming Barriers to Breastfeeding, Best Practice & Research Clinical Obstetrics & Gynaecology, 2022, ISSN 1521-6934, https://doi.org/10.1016/j.bpobgyn.2022.01.010.
Maternal and paternal involvement in complementary feeding in Kaduna State, Nigeria: The continuum of gender roles in urban and rural settings
Household gender roles influence infant and young child feeding behaviours and may contribute to suboptimal complementary feeding practices through inequitable household decision-making, intra-household food allocation and limited paternal support for resources and caregiving. In Igabi local government area of Kaduna State, Nigeria, the Alive & Thrive initiative implemented an intervention to improve complementary feeding practices through father engagement. Findings from their study suggest that some parents hold traditional attitudes about their roles in feeding and caring for children and that traditional gender normative roles of fathers limit their involvement in the ‘hands-on’ activities. The study also provided evidence that some parents are performing ‘non-traditional’ gender normative roles despite social disapproval.
Allotey, D., Flax, V. L., Ipadeola, A., Kwasu, S., Bentley, M. E., Worku, B., Kalluru, K., Valle, C. G., Bose, S., & Martin, S. L. (2022). Maternal and paternal involvement in complementary feeding in Kaduna State, Nigeria: The continuum of gender roles in urban and rural settings. Maternal & Child Nutrition, e13325. https://doi.org/10.1111/mcn.13325
Typically, the most significant expansion and differentiation of the adult mammary gland occurs in response to systemic reproductive hormones during pregnancy and lactation to enable milk synthesis and secretion to sustain the offspring. However, human mammary tissue remodelling that takes place during pregnancy and lactation remains poorly understood due to the challenge of acquiring samples. This study reports a transcriptomic analysis of 110,744 viable breast cells isolated from human milk or non-lactating breast tissue, isolated from nine and seven donors respectively. Findings provide evidence to support the viability of milk-derived epithelial cells and show that they can be maintained in vitro. The study also demonstrates the power of comparing mammary cells isolated from different stages of human mammary gland maturation and illustrates the luminal lineage remodelling that occurs during lactation. These create a window into the cellular dynamics that occur during human lactation and may provide further insights on the interplay between pregnancy, lactation and breast cancer.
Twigger, AJ., Engelbrecht, L.K., Bach, K. et al. Transcriptional changes in the mammary gland during lactation revealed by single cell sequencing of cells from human milk. Nat Commun 13, 562 (2022). https://doi.org/10.1038/s41467-021-27895-0
Breastfeeding reduces mothers’ cardiovascular disease risk
A meta-analysis of international studies comprised of the health records of nearly 1.2 million women found that women who breastfed at some time in their lives were less likely to develop heart disease or stroke and had a lower risk of dying from cardiovascular disease compared to women who did not breastfeed. Over an average follow-up period of 10 years, women who breastfed at some time in their life were 14% less likely to develop coronary heart disease; 12% less likely to suffer strokes; and 17% less likely to die from cardiovascular disease. There were no notable differences in cardiovascular disease risk among women of different ages or according to the number of pregnancies.
American Heart Association. “Breastfeeding reduces mothers’ cardiovascular disease risk.” ScienceDaily. ScienceDaily, 11 January 2022. www.sciencedaily.com/releases/2022/01/220111091356.htm
Global breastfeeding scorecard 2021: protecting breastfeeding through bold national actions during the COVID-19 pandemic and beyond
The Global Breastfeeding Collective has identified seven policy priorities for countries to protect, promote and support breastfeeding in a scorecard designed to encourage and document progress on the support of breastfeeding.
World Health Organization (WHO). 2021. Global breastfeeding scorecard 2021: protecting breastfeeding through bold national actions during the COVID-19 pandemic and beyond
Women who breastfeed exhibit cognitive benefits after age 50
To determine the relationship between breastfeeding history and postmenopausal cognitive performance, cognitive domain scores were examined in relation to breastfeeding in depressed and non-depressed women, controlling for age, education and ethnicity. Women who breastfed exhibited superior performance in the domains of learning, delayed recall, executive functioning and processing speed compared to women who did not breastfeed (P-values 0.0003–0.015). These four domains remained significant in analyses limited to non-depressed and parous subsets of the cohort. Among those depressed, only executive functioning and processing speed were positively associated with breastfeeding. Breastfeeding’s biological effects and psychosocial effects, such as improved stress regulation, could exert long-term benefits for the mother’s brain, with findings suggesting that women who breastfed performed better on a series of cognitive tests in later life compared to women who did not breastfeed.
Molly Fox, Prabha Siddarth, Hanadi Ajam Oughli, Sarah A Nguyen, Michaela M Milillo, Yesenia Aguilar, Linda Ercoli, Helen Lavretsky, Women who breastfeed exhibit cognitive benefits after age 50, Evolution, Medicine, and Public Health, Volume 9, Issue 1, 2021, Pages 322–331, https://doi.org/10.1093/emph/eoab027
Testing the buffering hypothesis: Breastfeeding problems, cessation, and social support in the UK.
A series of Cox models were run on a sample of 565 UK mothers in order to assess the extent to which social support can provide a buffer from the negative impact breastfeeding problems can have on duration. Findings indicated that a wide range of support can positively – and sometimes negatively – impact the experience. For example, support for discomfort issues (e.g. blocked ducts) was significantly associated with reduced hazards of cessation, as predicted. However, support for reported milk insufficiency was assoicated with an increased hazard of cessation.
Page, A. et al. 2021. Testing the buffering hypothesis: Breastfeeding problems, cessation, and social support in the UK. Medical Research Council, Grant/Award Number: MR/P014216/1. https://doi.org/10.1002/ajhb.23621
Integrative Review of Antenatal Milk Expression and Mother-Infant Outcomes During the First 2 Weeks After Birth
This study explored the practice of antenatal milk expression (AME) and related outcomes for mother-infant dyads during the first 2 weeks after birth, using the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines to guide data extraction and reporting of 588 screened articles, of which 15 were included in the review. Conclusions found that AME may support breastfeeding by improving breastfeeding self-efficacy and milk supply and by decreasing early formula use. Synthesized literature on AME shows the safety of the practice and that infants of women who practice AME have a greater likelihood of breastfeeding exclusivity during the short term.
Juntereal NA, Spatz DL. Integrative Review of Antenatal Milk Expression and Mother-Infant Outcomes During the First 2 Weeks After Birth. J Obstet Gynecol Neonatal Nurs. 2021 Aug 14:S0884-2175(21)00124-6. doi: 10.1016/j.jogn.2021.07.003. Epub ahead of print. PMID: 34403651.
Understanding the Racialized Breastfeeding Experiences Among Black Millennials
Results from a qualitative study on racial disparities in breastfeeding rates found a difference in the treatment of black millennial mothers due to institutional racism and challenges to motherhood. Major themes which emerged from the study include black experiences, hopes for the community, and the desire to succeed in breastfeeding in order to change the narrative about past generations
Yasmeen I. Lee and Stephanie Baker.Breastfeeding Medicine.Jun 2021.481-486.http://doi.org/10.1089/bfm.2020.0305
Breasts and the city: an urban ethnography of infant feeding in public spaces within Cardiff, United Kingdom
This study identified the various barriers and facilitators in supporting infant feeding in public spaces in Cardiff, UK, including high streets, cafes and transport. Findings call for urgent change in urban city centres and public transport if countries are to meet their aims of increasing breastfeeding rates.
Grant, A. Breasts and the city: an urban ethnography of infant feeding in public spaces within Cardiff, United Kingdom. Int Breastfeed J 16, 37 (2021). https://doi.org/10.1186/s13006-021-00384-2
Achieving Breastfeeding Equity and Justice in Black Communities: Past, Present, and Future
A US-based analysis of initiatives which have increased rates of breastfeeding among black women found that systemic and structural barriers, including racism and inequitable access to lactation resources, continue to be major causes of disparities in black communities. Increasing breastfeeding rates is vital to supporting a public health strategy which aims to reduce maternal and infant mortality.
Ifeyinwa V. Asiodu, Kimarie Bugg, and Aunchalee E.L. Palmquist.Breastfeeding Medicine.Jun 2021.447-451.http://doi.org/10.1089/bfm.2020.031
Promoting equity in breastfeeding through peer counseling: the US Breastfeeding Heritage and Pride program
This study uses the Community Energy Balance Framework – an equity-oriented, multi-level framework for fostering healthy lifestyles – to examine the impact of a US-based breastfeeding support programme for predominately low-income minority mothers titled the Breastfeeding Heritage and Pride Program (BHP). Conclusions indicate that BHP highlights the importance of community-engaged formative research for informing breastfeeding programme design and provides an evidence-based example of a programme model that offers a continuum of breastfeeding support, considers cultural-contextual influences on breastfeeding and social determinants of health, and incorporates continuous quality improvement.
Rhodes, E.C., Damio, G., LaPlant, H.W. et al. Promoting equity in breastfeeding through peer counseling: the US Breastfeeding Heritage and Pride program. Int J Equity Health 20, 128 (2021). https://doi.org/10.1186/s12939-021-01408-3
Factors associated with longitudinal changes in B-vitamin and choline concentrations of human milk
One hundred women were assessed in a prospective birth cohort in order to observe associations between maternal factors, B-vitamin and choline concentrations in early milk, as well as the trajectories of these vitamins during lactation. Findings indicated that changes in B-vitamin and choline concentrations in human milk over time may be associated with the early concentrations of these micronutrients in milk, maternal prepregnancy BMI, dietary intake, and gestational age at delivery.
Mônica A Batalha, Ana L L Ferreira, Nathalia C Freitas-Costa, Amanda C C Figueiredo, Thais R B Carrilho, Setareh Shahab-Ferdows, Daniela Hampel, Lindsay H Allen, Rafael Pérez-Escamilla, Gilberto Kac, Factors associated with longitudinal changes in B-vitamin and choline concentrations of human milk, The American Journal of Clinical Nutrition, 2021;nqab191, https://doi.org/10.1093/ajcn/nqab191
Breastfeeding promotes early neonatal regulatory T-cell expansion and immune tolerance of non-inherited maternal antigens
Research led by the University of Birmingham and Birmingham Women’s and Children’s NHS Foundation Trust has revealed new insight into the biological mechanisms of the long-term positive health effects of breastfeeding in preventing disorders of the immune system in later life, with data showing that exposure of the neonate to maternal cells through breastfeeding acts to drive the maturation of Tregs and ‘tolerizes’ the neonate towards non-inherited maternal antigens.
The association between breastfeeding duration and subsequent domain-specific cognitive performance in a diverse sample of 9–10-year-olds is examined in this study. Results found a strong association between breastfeeding duration and General Ability scores, with the greatest effect stemming from those who were breastfed for more than 12 months. Findings support current public health policies which recommend that women breastfeed children through at least age 1 or as long as desired. A report on this research can be found here.
Lopez, D. et al. Breastfeeding Duration Is Associated With Domain-Specific Improvements in Cognitive Performance in 9–10-Year-Old Children. Frontiers in Public Health. Volume 9. (2021). DOI=10.3389/fpubh.2021.657422
New partnership pledges clear and consistent evidence-based guidance on medicines for pregnant and breastfeeding women
A major new initiative to ensure pregnant and breastfeeding women can make informed decisions about their healthcare was announced today by health minister Nadine Dorries. The Safer Medicines in Pregnancy and Breastfeeding Consortium brings together 16 leading organisations under a common pledge to meet the information needs of pregnant and breastfeeding women and healthcare professionals, through accessible, clear and consistent advice. The partnership spans the NHS, regulators, and leading third sector and charitable organisations. Together, this group will develop a long-term programme of work to improve information provision on medicines for women who are thinking about becoming pregnant, are pregnant, or are breastfeeding.
Read more on the GOV.UK website.
From dyad to triad: a survey on fathers’ knowledge and attitudes toward breastfeeding
This cross-sectional study explores paternal knowledge and attitudes toward breastfeeding and the possible associations with breastfeeding rates at discharge. A total of 200 fathers of healthy term neonates were asked upon discharge to rate their degree of agreement to 12 items on a 5-point Likert scale, which was analysed using univariate binary logistic regression analysis to verify if the total score was predictive of exclusive breastfeeding at discharge. By quantifying fathers’ knowledge and overall attitudes toward breastfeeding, this study underlines the importance of including fathers in the promotion of breastfeeding. Findings showed that fathers displayed a solid knowledge of maternal (87%) and neonatal (98%) benefits of breastfeeding, skin-to-skin (99.5%), rooming-in (79%), and responsive feeding (67.5%); conversely, only 51% knew about the recommended use of pacifiers.
Crippa, B.L., Consales, A., Morniroli, D. et al. From dyad to triad: a survey on fathers’ knowledge and attitudes toward breastfeeding. Eur J Pediatr (2021). https://doi.org/10.1007/s00431-021-04034-x
Antiviral Properties of Human Milk
Human milk antibodies have been found in over 80% of milk samples from women infected with COVID-19. This review identifies the specific antiviral properties of human milk and describes how maternal support of infants through lactation is protective beyond the production of maternal antibodies. The researches highlight the need for greater understanding of the complexity of human milk and how this could be used to enhance public health.
Wedekind, Sophie I.S.; Shenker, Natalie S. 2021. “Antiviral Properties of Human Milk” Microorganisms 9, no. 4: 715. https://doi.org/10.3390/microorganisms9040715
Breastfeeding research improves lives and advances health, but faces conflicts
This article discusses the importance of breastfeeding and the responsibility of various stakeholders including governments and non-profit organisations, researchers, companies and advocacy groups to actively discredit unfounded claims, rumours and misinformation surrounding breastfeeding. The authors also discuss the impact of the pandemic on breastmilk research and sharing of information.
Azad, M., et al. Breastfeeding research improves lives and advances health, but faces conflicts (2021.)
Tandem Breastfeeding: A Descriptive Analysis of the Nutritional Value of Milk When Feeding a Younger and Older Child
This study examined the breastmilk of 13 tandem breastfeeding women after weaning and conducted an analysis of the fat, protein, carbohydrate and energy energy content using MIRIS. Findings concluded that higher fat content, energy value and total protein concentration were found in tandem breastfeeding mothers’ milk during tandem breastfeeding, as opposed to after weaning the older child. The macronutrients of the breastmilk changes after weaning, taking into account the nutritional requirements of the younger child. Findings also concluded that the milk of nursing mothers in tandem did not show diurnal variability in individual components. The authors suggest an adaptive role of human milk to nutrient requirements of newborn and older children.
Sinkiewicz-Darol E, Bernatowicz-Łojko U, Łubiech K, Adamczyk I, Twarużek M, Baranowska B, Skowron K, Spatz DL. Tandem Breastfeeding: A Descriptive Analysis of the Nutritional Value of Milk When Feeding a Younger and Older Child. Nutrients. 2021; 13(1):277. https://doi.org/10.3390/nu13010277
Typologies of postnatal support and breastfeeding at two months in the UK
This study explores the typologies of postnatal support for mothers in the UK using retrospective data from an online survey (data collection period December 2017 – February 2018). Three distinct typologies of postnatal support were identified: 1) Extensive support, where mothers received support from a wide range of supporters including partners, maternal grandmothers, friends and health professionals, but mothers were the only ones to feed the infant; 2) Family support, where mothers received support from partners and maternal grandmothers, including with infant feeding, but less likely to receive support from health professionals; and 3) Low support, where mothers primarily received support from partners. Findings highlight the complexities of family support and its potential impact on breastfeeding, as well as the significance of professional support.
Emmott, E. et a. 2020. Typologies of postnatal support and breastfeeding at two months in the UK, Social Science & Medicine, Volume 246, 2020, 112791, ISSN 0277-9536, https://doi.org/10.1016/j.socscimed.2020.112791.
Partner behaviours improving breastfeeding outcomes: An integrative review
This study aims to determine what specific supportive behaviours of a breastfeeding woman’s partner increase breastfeeding initiation, exclusivity, and duration rates in Western-culture settings by applying a Population-Interest-Context framework-based search strategy to the Cumulative Index to Nursing Allied Health Literature Plus with full-text, Web of Science, Scopus, and PubMed databases, limited to primary research published January 2008–December 2018 in English conducted in Western-culture settings. Results were mixed regarding behaviours affecting exclusivity and duration; however, responsiveness was found to ameliorate otherwise generally negative effects of knowledge, help, and encouragement on these outcomes.
Eirwyn L. Davidson, Richard L. Ollerton, Partner behaviours improving breastfeeding outcomes: An integrative review, Women and Birth, Volume 33, Issue 1, 2020, Pages e15-e23, ISSN 1871-5192, https://doi.org/10.1016/j.wombi.2019.05.010.
Longitudinal effects of breast feeding on parent-reported child behaviour
This study analysed 11 148 children, their parents and teachers to examine the longitudinal effect of breast feeding on parent-reported behaviour in children aged 3-14 by mapping the effect of breastfeeding duration on parent-reported child behaviour longitudinally, using latent growth curve modelling and on teacher-reported child behaviour using multiple regression analyses. Breastfeeding duration was assessed through parent interviews when the child was 9 months old. Children’s behavioural development was measured using parent-reported Strengths and Difficulties Questionnaires (SDQ) at 3, 5, 7, 11 and 14 years and teacher-reported SDQs at 7 and 11 years. The study found that breastfeeding was associated with fewer parent-reported behavioural difficulties at all ages even after adjusting for potential confounders.
Speyer LG, Hall HA, Ushakova A, Murray AL, Luciano M, Auyeung B. Longitudinal effects of breast feeding on parent-reported child behaviour. Arch Dis Child. 2020 Nov 9:archdischild-2020-319038. doi: 10.1136/archdischild-2020-319038. Epub ahead of print. PMID: 33168523.
Metabolomic and Metataxonomic Fingerprinting of Human Milk Suggests Compositional Stability over a Natural Term of Breastfeeding to 24 Months
This study uses rapid evaporative ionisation mass spectrometry (REIMS) for metabolic fingerprinting and 16S rRNA gene metataxonomics for microbiome composition analysis. Milk expression volumes were significantly lower beyond 24 months of lactation, but there were no corresponding changes in bacterial load, composition, or whole-scale metabolomic fingerprint. Some individual metabolite features (~14%) showed altered abundances in nursling age groups above 24 months. Neither milk expression method nor nursling sex affected metabolite and metataxonomic fingerprints. Self-reported lifestyle factors, including diet and physical traits, had minimal impact on metabolite and metataxonomic fingerprints. Findings suggest remarkable consistency in human milk composition over natural-term lactation.
Shenker, N., Perdones-Montero, A., et al. (2020). Metabolomic and Metataxonomic Fingerprinting of Human Milk Suggests Compositional Stability over a Natural Term of Breastfeeding to 24 Months. Nutrients 2020, 12(11), 3450; https://doi.org/10.3390/nu12113450
Designing a model of breastfeeding support in Australia: An appreciate inquiry approach
This qualitative study used an appreciate inquiry approach to co-design a model of peer and professional breastfeeding support in the metropolitan area of New South Wales, Australia. Thirty mothers, health professional and peer supporters participated in a two-part study, the results of which led to a solution-focused attitude among participants and a commitment to improving breastfeeding support.
Burnes, E., Triandafilidis, Z., et al. (2020). Designing a model of breastfeeding support in Australia: An appreciate inquiry approach
Breastfeeding and Climate Change: Overlapping Vulnerabilities and Integrating Responses
This article explores how climate change and breastfeeding disruption are both rooted in a global economic system that undervalues the environment and women’s reproductive labour. A recognition of the relationship between breastfeeding and climate change highlights opportunities to unite breastfeeding and climate change advocacy movements and responses to both problems.
Zadkovic, S., Lombardo, N., et al (2002). Breastfeeding and Climate Change: Overlapping Vulnerabilities and Integrating Responses. https://doi.org/10.1177/0890334420920223
Anaesthesia and sedation in breastfeeding women 2020
This new consensus document has been produced by the Association of Anaesthetists and informed by the Unicef UK Baby Friendly Initiative and endorsed by the RCM and RCOG. The authors discuss how breastfeeding mothers who require anaesthesia or sedation can sometimes receive inconsistent information from health professionals regarding the passage of drugs into breastmilk, which can potentially result in the interruption of feeding, discarding of breastmilk or early cessation of breastfeeding. Based on the evidence, the authors note that breastfeeding is acceptable to continue after anaesthesia and should be supported as soon as the woman is alert and able to breastfeed, and that breastmilk should not be discarded. This document reviews the pharmacokinetics of drugs commonly used during anaesthesia so that professionals can undertake a risk‐benefit discussion with the woman and provides guidance on the development of local policies for staff.
Mitchell, J., Jones, W., et al. (2020). Guideline on anaesthesia and sedation in breastfeeding women 2020. DOI: 10.1111/anae.15179
Lactation improves pancreatic β cell mass and function through serotonin production
This article explores the metabolic burden, weight gain and insulin resistance put on women due to pregnancy, and the long-term effects that lactation can have for women. Results suggest that serotonin mediates the long-term beneficial effects of lactation on female metabolic health by increasing β cell proliferation and reducing oxidative stress in β cells.
Moon, J., Hyengseok, K., et al. (2020). Lactation improves pancreatic β cell mass and function through serotonin production. DOI: 10.1126/scitranslmed.aay0455
Breastfeeding and Prevention of Overweight in Children
An advocacy brief for the Global Breastfeeding Collective, a partnership of 20 international agencies jointly led by the World Health Organization (WHO) and Unicef, was released in March 2020 with the aim of increasing support for policies and programmes that help breastfeeding mothers and babies. The report evidences the short- and long-term benefits of breastfeeding for both low- and middle-income countries, detailing the significant impact early breastfeeding can have upon a child’s later years in terms of healthy diet and obesity prevention. Nearly 100,000 cases of childhood obesity could be avoided each year by breastfeeding in line with global recommendations.
WHO/HEP/NFS/20.1 © World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) March 2020
The cost of not breastfeeding: global results from a new tool
This new tool is designed to help policy-makers and advocates have information on the estimated human and economic costs of not breastfeeding at the country, regional and global levels. The analysis looks at several factors attributed to not breastfeeding according to global recommendations from WHO and UNICEF, including childhood deaths from diarrhoea and pneumonia, childhood obesity and maternal breast and ovarian cancers. Aggregating all the costs, the researchers estimate the total global economic losses to be US$341.3 billion, or 0.70% of global gross national income. They note that the estimates are likely to be conservative since economic costs of increased household caregiving time (mainly borne by women), and treatment costs related to other diseases attributable to not breastfeeding according to recommendations are not included in the analysis.
Walters, D, Phan, LTH, & Mathisen, R, (2019). The cost of not breastfeeding: global results from a new tool, Health Policy and Planning, doi.org/10.1093/heapol/czz050
Perspective: Should Exclusive Breastfeeding Still Be Recommended for 6 Months?
This review explored evidence behind a range of concerns about the World Health Organization (WHO) recommendation of exclusive breastfeeding for six months. Considering the concerns around risk of iron deficiency, food allergies and undernutrition, the review found no evidence to support changes to the current recommendations.
The authors argue that: the risk of iron deficiency can be significantly reduced if delayed cord clamping is performed in all newborns; there is no population-level evidence suggesting an increased risk of food allergies with exclusive breastfeeding for six months; milk volume is not directly diminished by mild to moderate maternal undernutrition, and; reports of insufficient milk volume globally are likely to be the result of lack of access to timely lactation counselling and social support rather than primary biological reasons. They highlight the importance of careful monitoring of newborns, and the introduction of complementary foods at around six months, taking infant developmental readiness into account.
Pérez-Escamilla, R, Buccini, GS, Segura-Pérez, S, & Piwoz, E, (2019). Perspective: Should Exclusive Breastfeeding Still Be Recommended for 6 Months? Advances in Nutrition, doi.org/10.1093/advances/nmz039
Perinatal breastfeeding interventions including fathers/partners: A systematic review of the literature
This literature review highlights the value of including fathers/partners in interventions to support breastfeeding. Researchers analysed studies of partner-inclusive educational and psychosocial interventions, and found that such interventions all improved at least one breastfeeding outcome, including duration or exclusivity up to 24 weeks postpartum. They concluded that the inclusion of fathers/partners in breastfeeding interventions improves breastfeeding initiation, duration, and exclusivity rates. Interventions that include face-to-face information delivery, are designed in a culturally appropriate manner, and provide information on how partners can support breastfeeding are more likely to have a beneficial effect. Research is warranted to examine the underlying intervention mechanisms.
Abbass-Dick, J, Brown, H, Jackson, K, et al (2019). Perinatal breastfeeding interventions including fathers/partners: A systematic review of the literature, Midwifery, doi.org/10.1016/j.midw.2019.04.001
Breastfeeding outcomes among early-term and full-term infants
This study of mother-infant pairs in Hong Kong explored whether early-term birth (37 to <39 weeks) had an impact on any and exclusive breastfeeding duration among healthy normal weight infants. Researchers found no significant difference in breastfeeding duration between full and early-term infants, suggesting that in the absence of neonatal complications, early-term birth itself may not lead to reduced breastfeeding duration.
Heidi Sze Lok Fan, Janet Yuen Ha Wong, Daniel Yee Tak Fong et al (2019). Breastfeeding outcomes among early-term and full-term infants, Midwifery, doi.org/10.1016/j.midw.2019.01.005
The effect of labor medications on normal newborn behavior in the first hour after birth: A prospective cohort study
This video study sought to determine the effects of common intrapartum medications on the instinctive behavior of healthy newborns during the first hour after birth through a prospective cohort study. Researchers found that intrapartum exposure to the drugs fentanyl and synthetic oxytocin (synOT) is associated with altered newborn infant behavior, including suckling, while in skin-to-skin contact with mother during the first hour after birth. For example, babies exposed to both fentanyl and synOT were significantly less likely to begin suckling than babies in the control cohort with no exposure to fentanyl or synOT, babies exposed to fentanyl without synOT or babies exposed to synOT without fentanyl. Author Karin Cadwell spoke on this subject at our 2018 Annual Conference; find out more.
Brimdyr, K, Cadwell, K, Widström, A, et al (2019). The effect of labor medications on normal newborn behavior in the first hour after birth: A prospective cohort study, Early Human Development, doi.org/10.1016/j.earlhumdev.2019.03.019
Older research
- Development and pretesting of “Becoming Breastfeeding Friendly”: Empowering governments for global scaling up of breastfeeding programmes
Hromi-Fiedler, A, dos Santos Buccini, G, Bauermann Gubert, M, et al (2018). Development and pretesting of “Becoming Breastfeeding Friendly”: Empowering governments for global scaling up of breastfeeding programmes. Maternal & Child Nutrition, doi/10.1111/mcn.12659
- Breastfeeding practices in the United Kingdom: Is the neighbourhood context important?
Peregrino, A, Watt, G, et al, (2018). Breastfeeding practices in the United Kingdom: Is the neighbourhood context important? Maternal & Child Nutrition, doi.org/10.1111/mcn.12626
- Using 24-hour weight as reference for weight loss calculation reduces supplementation and promotes exclusive breastfeeding in infants born by cesarean section
Deng, X, & McLaren, M, (2018). Using 24-hour weight as reference for weight loss calculation reduces supplementation and promotes exclusive breastfeeding in infants born by cesarean section. Breastfeeding Medicine, doi: 10.1089/bfm.2017.0124
Unicef and WHO, (2018). Capture the Moment, https://www.unicef.org/publications/index_102949.html
- Breastfeeding: A mother’s gift for every child
Unicef, (2018). Breastfeeding: A mother’s gift for every child, https://www.unicef.org/publications/index_102824.html
- Cost-effectiveness and Return on Investment (ROI) of interventions associated with the Best Start in Life
Public Health England, (2018). Cost-effectiveness and Return on Investment (ROI) of interventions associated with the Best Start in Life
- Intrapartum Administration of Synthetic Oxytocin and Downstream Effects on Breastfeeding: Elucidating Physiologic Pathways
Cadwell, K, & Brimdyr, K, (2017). Intrapartum Administration of Synthetic Oxytocin and Downstream Effects on Breastfeeding: Elucidating Physiologic Pathways, Annals of Nursing Research and Practice, Vol. 2, Iss. 3.
- Return on investment of public health interventions: A systematic review
Masters, R, Anwar, E, et al, (2017). Return on investment of public health interventions: a systematic review, J Epidemiol Community Health, doi:10.1136/jech-2016-208141
- A realist review of one‐to‐one breastfeeding peer support experiments conducted in developed country settings
Trickey, H, et al (2017) A realist review of one‐to‐one breastfeeding peer support experiments conducted in developed country settings. Maternal and Child Nutrition, https://doi.org/10.1111/mcn.12559
- New research finds that financial incentives may increase breastfeeding rates
Relton, C, et al (2017) Effect of Financial Incentives on Breastfeeding: A Cluster Randomized Clinical Trial. JAMA Pediatrics, doi:10.1001/jamapediatrics.2017.4523
- Development and Evaluation of a Lactation Rotation for a Pediatric Residency Program
Albert, JB, Heinrichs-Breen, J. & Belmonte, F.W. (2017). Development and Evaluation of a Lactation Rotation for a Pediatric Residency Program. Journal of Human Lactation, doi/abs/10.1177/0890334416679381
- An Online Calculator to Estimate the Impact of Changes in Breastfeeding Rates on Population Health and Costs
Stuebe, A, et al (2017), An Online Calculator to Estimate the Impact of Changes in Breastfeeding Rates on Population Health and Costs. Breastfeeding Medicine, https://doi.org/10.1089/bfm.2017.0083
- Breastfeeding as a public health responsibility: a review of the evidence
Brown, A, (2017), Breastfeeding as a public health responsibility: a review of the evidence. Journal of Human Nutrition & Dietetics, DOI: 10.1111/jhn.12496
- A Comparison of Factors Associated with Cessation of Exclusive Breastfeeding at 3 and 6 Months
Fernández-Cañadas, AM (2017), A Comparison of Factors Associated with Cessation of Exclusive Breastfeeding at 3 and 6 Months. Breastfeeding Medicine, https://doi.org/10.1089/bfm.2017.0045
- Availability of breastfeeding peer support in the United Kingdom: A cross-sectional study
Grant, A, et al (2017), Availability of breastfeeding peer support in the United Kingdom: A cross-sectional study. Maternal & Child Nutrition, DOI: 10.1111/mcn.12476
- ‘People try and police your behaviour’: the impact of surveillance on mothers and grandmothers’ perceptions and experiences of infant feeding
Grant, A, et al (2017), ‘People try and police your behaviour’: the impact of surveillance on mothers and grandmothers’ perceptions and experiences of infant feeding, Policy Press, doi.org/10.1332/204674317X14888886530223
- Prevalence and determinants of cessation of exclusive breastfeeding in the early postnatal period in Sydney, Australia
Ogbo, F.A. et al (2017) Prevalence and determinants of cessation of exclusive breastfeeding in the early postnatal period in Sydney, Australia. International Breastfeeding Journal, doi: 10.1186/s13006-017-0110-4
- Breastfeeding in South Gloucestershire: Mothers’ early experiences of infant feeding
Dowling, S. et al (2017) Breastfeeding in South Gloucestershire: Mothers’ early experiences of infant feeding. Project Report. University of the West of England and South Gloucestershire Council.
- Cochrane Library Special Collection: Enabling breastfeeding for mothers and babies
http://www.cochranelibrary.com/app/content/special-collections/article/?doi=10.1002/14651858.10100214651858
- NIHR themed review: Better Beginnings – improving health for pregnancy
https://discover.dc.nihr.ac.uk/portal/article/4000308/better-beginnings-improving-health-for-pregnancy
- Breastfeeding knowledge and duration
Wallenborn, J, et al (2017), Knowledge of Breastfeeding Recommendations and Breastfeeding Duration: A Survival Analysis on Infant Feeding Practices II, Breastfeeding Medicine, doi:10.1089/bfm.2016.0170
- World Breastfeeding Trends Initiative (WBTi) UK Report 2016
WBTI Report 2016
- Determinants of breastfeeding initiation and cessation among employed mothers
Dagher, R, et al (2016), Determinants of breastfeeding initiation and cessation among employed mothers: a prospective cohort study, BMC Pregnancy and Childbirth, DOI: 10.1186/s12884-016-0965-1
- Factors associated with infant feeding choices in the adolescent population
Godbout, J, et al (2016), Factors Associated with Infant Feeding Choices in the Adolescent Population, Journal of Human Lactation, doi: 10.1177/0890334416662629
- What do women really want? Lessons for breastfeeding promotion and education
Brown, A, (2016), What Do Women Really Want? Lessons for Breastfeeding Promotion and Education. Breastfeeding Medicine, doi:10.1089/bfm.2015.0175
- The influence of grandmothers on breastfeeding rates: a systematic review
Negin, J, et al (2016), The influence of grandmothers on breastfeeding rates: a systematic review. BMC Pregnancy and Childbirth, DOI: 10.1186/s12884-016-0880-5
- Evaluation of the effectiveness of school-based breastfeeding education
Glaser, D.B. (2016) An Evaluation of the Effectiveness of School-Based Breastfeeding Education. Journal of Human Lactation. doi: 10.1177/0890334415595040.
- The impact of a prenatal education video on rates of breastfeeding
Kellams, A.L. et al (2016) The Impact of a Prenatal Education Video on Rates of Breastfeeding Initiation and Exclusivity during the Newborn Hospital Stay in a Low-income Population. Journal of Human Lactation, doi: 10.1177/0890334415599402.
- Strengthening the human rights framework to protect breastfeeding: a focus on CEDAW
Galtry, J. (2015). Strengthening the human rights framework to protect breastfeeding: a focus on CEDAW. International Breastfeeding Journal.
- Breastfeeding among adolescent mothers: a systematic review of interventions from high-income countries
Sipsma, H.L. et al (2015). Breastfeeding among adolescent mothers: A systematic review of interventions from high-income countries. Journal of human lactation. vol. 31 no. 2 pp. 221-229
- Interventions to improve breastfeeding outcomes
Sinha, B. et al (2015). Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 114-134.