Giving Formula May Improve Breastfeeding Rates??

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Yesterday the Huffington Post published an article entitled “The Case for Rethinking Breastfeeding Goals: Six Months of exclusive nursing is out of reach for many moms.  Is it time for a change?”  This headline alone suggests one thing: there is a case for rethinking the goal of exclusive nursing for the first six months.  Interestingly enough, nothing in the article itself actually suggests this..  

The piece is filled with impassioned stories from three women who struggled to breastfeed for one reason or another.  The first is a woman who had an emergency c-section and a baby with tongue tie.  The second was a woman who had breastfeeding challenges since her baby spent a night in the NICU early on.  The third woman had trouble keeping up her milk supply after going back to work.  In each of these situations the women felt guilty about their decisions to give their babies one bottle of formula per day. 

In addition to these women’s stories the piece looks at some of the research that has been done.  The article highlights many of the organizations that suggest exclusively breastfeeding for the first six months including the AAP, WHO and the promotion of this by the US Surgeon General.  It also mentions the advantages of breastfeeding: it helps diarrhea in areas where contaminated food and water are common, it helps decrease the “risk of respiratory tract infection, reduced risk of Sudden Infant Death Syndrome and even drop in the risk of Type 1 dialetes” and it has potential benefits for moms including “decreased postpartum blood loss and even a drop in subsequent breast cancer risk”.  Thanks to groups like La Leche League, “more lactation consultants now who can help women address their breastfeeding challenges than there were just a decade ago”.  

What does this article say about exclusive nursing for the first six months?

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The article says two things about exclusive breastfeeding.  The first is that there is “no need to change the existing guidance on exclusive breastfeeding”.  The article mentions one article and one individual who clearly make this statement: the 2016 review of studies and Alison Stuebe, “a maternal-fetal medicine physician and medical director of lactation services at University of North Carolina Health Care”.  

The second thing that this article says about exclusive breastfeeding is what Stuebe goes on to say repeatedly, “The real problem […] is not the core recommendation that all women should exclusively breastfeed for the first six months; it is how that recommendation is communicated to mothers and what is done to actually support them.”  In general the WHO and UNICEF “have said there’s not one single country that sufficiently supports breastfeeding mothers through measures like paid parental leave, workplace protections for moms who pump and access to breastfeeding help”.  In fact, our country is one of the worst, “America has the dubious distinction of being the only developed nation in the world without a paid leave for new moms or dads”.  Not only is our paid leave abysmal but we also have “bottle culture” where breastfeeding is looked at as “shameful or sexual.” 

The article ends with a quote from Stuebe that makes a very important point, “I think our biggest work now is how do we eliminate those barriers to help them be successful, and ultimately support them in whatever feeding choices they end up making.  You know, we don’t have to play the blame game.”  We need to continue efforts to improve knowledge of breastfeeding and improve our understanding of ways to troubleshoot breastfeeding issues: including troubleshooting what to do when a mother doesn’t produce enough milk to exclusively breastfeed or how to support the issues of the three women’s stories in this article.  We can’t rely on the “online stores and mom blogs” that peddle breastfeeding teas and cookies.  Instead we need to rely on organizations like La Leche League with properly trained IBCLCs (International Board Certified Lactation Consultants) that can fix issues while still helping lead us towards greater numbers of exclusively breastfed children. 

Flaherman’s study

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There’s one more piece that I haven’t mentioned yet: Flaherman’s study.  The article says “In 2013, Flaherman published a very small study that suggested giving some newborns a little bit of formula early on may improve their breastfeeding rates at three months and decrease the likelihood of them being fed formula months later”.  So all three women who told their stories in this article are justified by giving their babies one bottle of formula a day, right?  Unfortunately none of these three women’s stories are proven effective by Flaherman’s study.  What does Flaherman’s study actually say?  

Flaherman’s study was conducted on infants at UCSF and Lucille Packard who had lost between 5 and 10% of their birth weight before 36 hours of age, had not received formula or water, did not require greater care than a level 1 nursery, their mothers gave consent and were at least 18 years old.  This study found that for these infants, “supplementation with small volumes of formula in a structured manner [syringe feeding 10 mL of extensively hydrolyzed formula after each breastfeeding until mature milk production began] may benefit exclusive breastfeeding at 1 week and 3 months.  Further research is needed to confirm this in a larger and more diverse population, and to determine whether any such reduction in total formula use is associated with improved health outcomes.”

Unless the babies meet the criteria that Flaherman used for their study, were in the population that Flaherman studied, and are syringe fed (not bottle fed) a particular type of formula.  The results of this study do not apply to them and more research is needed.  There are other researchers who did subsequent studies based on Flaherman’s findings but none have found that giving any newborns formula early on (given by any method) may improve these rates.