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Breastfeeding

The World Health Organization (WHO) strongly recommends exclusive breastfeeding for the first six months of life. Most women are able to breastfeed.

Breastfeeding should be promoted in a sensitive manner, and information given about the benefits to both mother and baby, evidence for which is well-established, as it is for the risks of not breastfeeding. (UNICEF) Babies who breastfeed are at lower risk of:

  • Gastroenteritis
  • Respiratory infections and asthma
  • Sudden infant death syndrome
  • Obesity
  • Type 1 & 2 diabetes
  • Allergies and food intolerance (e.g. lactose intolerance)

Benefits to mothers

  • The longer mothers breastfeed, the greater their protection against breast and ovarian cancer, and hip fractures in later life.
  • Recent evidence has demonstrated an association between prolonged breastfeeding and postmenopausal risk factors for cardiovascular (CV) disease.
  • The World Cancer Research Fund includes breastfeeding as one of 10 recommendations to reduce the risk of some cancers.

These illnesses all represent the greatest threats to women's health across all ages. Evidence also suggests that breastfeeding has a positive impact on mother-baby relationships, conducive to the baby's health emotional, social and physical development.

 

In the UK, the initial breastfeeding rate is 81 per cent, according to the five-yearly Infant Feeding Survey, 2010. (The survey scheduled for 2015 was cancelled). Key findings of the survey were:

  • The initial breastfeeding rate increased from 76 per cent in 2005 to 81 per cent in 2010. This includes all babies who were put to the breast at all, even if this was on one occasion only, and also includes giving expressed breastmilk.
  • The highest incidences of breastfeeding were found among mothers aged 30 or over (87 per cent), those from minority ethnic groups (97 per cent for Chinese or other ethnic group, 96 per cent for Black and 95 per cent for Asian ethnic group), those who left education aged over 18 (91 per cent), those in managerial and professional occupations (90 per cent) and those living in the least deprived areas (89 per cent).
  • The prevalence of breastfeeding fell from 81 per cent at birth to 69 per cent at one week, and to 55 per cent at six weeks. At six months, just over a third of mothers (34 per cent) were still breastfeeding.
  • Mothers continued to breastfeed for longer in 2010 than was the case in 2005. The gap in breastfeeding levels at birth between 2005 and 2010 was five percentage points (76 per cent in 2005 compared with 81 per cent in 2010) and by six months the gap became nine percentage points (25 per cent in 2005 compared to 34 per cent in 2010). This suggests that policy developments to improve support and information provided to mothers to encourage them to continue breastfeeding may have had an impact.
  • Across the UK, 69 per cent of mothers were exclusively breastfeeding at birth in 2010. At one week, less than half of all mothers (46 per cent) were exclusively breastfeeding, while this had fallen to around a quarter (23 per cent) by six weeks. By six months, levels of exclusive breastfeeding had decreased to one per cent, indicating that very few mothers were following the UK health departments' recommendation that babies should be exclusively breastfed until around the age of six months.
  • There has been an increase in the prevalence of exclusive breastfeeding at birth (from 65 per cent in 2005 to 69 per cent in 2010), but there has been little change thereafter up until six weeks. However, the fall-out rate in later months was lower in 2010 than 2005. For example, at three months, 17 per cent of mothers were still breastfeeding exclusively (up from 13 per cent in 2005) and at four months, 12 per cent were still breastfeeding exclusively (up from 7 per cent in 2005).

Breast feeding rates in the US are similar to those in the UK.

 

The UNICEF UK Baby Friendly Initiative standards recommend healthcare professionals to: 1. Support pregnant women to recognise the importance of breastfeeding and early relationships for the health and well-being of their baby. 2. Support all mothers and babies to initiate a close relationship and feeding soon after birth. 3. Enable mothers to get breastfeeding off to a good start. 4. Support mothers to make informed decisions regarding the introduction of food or fluids other than breastmilk. 5. Support parents to have a close and loving relationship with their baby.

Early feeding contributes to the success of breastfeeding. The first feed should be supervised by the midwife. It should proceed without pain and baby allowed to terminate the feed spontaneously.

Certain pre-existing conditions, most notably HIV, are a contra-indication to breastfeeding due to the risk of vertical transmission of the infection from the mother to the baby.

See also, Lactation

The Practising Midwife featured articles

Infant feeding 1. Anatomy and physiology 2012; 15(9): 38 - 41 Author: Joyce Marshall

Infant feeding 3. Skills to support infant feeding 2012; 15(11): 43- 46 Author: Joyce Marshall

Breastfeeding and relationship building: turning evidence into practice 2014; 18(2): 29 - 31 Author: Francesca Entwistle

Further reading/Resources

Bartick M, Reinhold A. (2010) The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics,125(5), e1048-56. http://www.ncbi.nlm.nih.gov/pubmed/20368314

Health & Social Care Information Centre (2012). Infant Feeding Survey - UK, 2010. Available at: http://www.hscic.gov.uk/article/2021/Website-Search?productid=9569&q=infant+feeding+survey&sort=Relevance&size=10&page=1&area=both

UNICEF. Health benefits of breastfeeding. http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/Health-benefits/

UNICEF UK (2012) Guide to the Baby Friendly Initiative standards. http://www.unicef.org.uk/Documents/Baby_Friendly/Guidance/Baby_Friendly_guidance_2012.pdf Patient. Infant feeding (professional reference). http://patient.info/doctor/infant-feeding

Information/Resources for patients

Newson L. (2013) Breast feeding (information for patients). http://patient.info/health/breast-feeding

BFN - The Breastfeeding Network. www.breastfeedingnetwork.org.uk

La Leche League GB. www.laleche.org.uk National Childbirth Trust www.nct.org.uk

NHS Choices. Pregnancy and baby guide. http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/pregnancy-and-baby-care.aspx

 

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