Background
Breastfeeding is one of the most key aspects of post-partum care. Mothers are generally encouraged to breastfeed and many express desire to do so. However, despite recommendations, many introduce formula partially or fully in the first months or even weeks of an infant’s life. Formula is an FDA approved product that mimics human milk and has many of similar nutrients, but is unable to match all the natural elements that breastmilk may include. Due to social pressures, breastfeeding is a point of contention, therefore even with identified benefits there has been a continuous discussion regarding the efficacy of formula as a potential replacement for breastfeeding.
Selection of the topic
The topic is undoubtedly interesting, and it pivots into my personal interest in neonatal and post-partum care. Anecdotal data indicating that millennial mothers are choosing formula more, particularly due to reasons of convenience, is concerning. Although the subject has been studied excessively, modern evidence could provide new insights on the issue. In turn, it will guide decision-making in clinical healthcare and patient guidance to ensure mothers are making the right choices for themselves and their infants.
PICOT Question
The PICOT question highlights the fundamentals of the investigation. The population are breastfeeding mothers, that is intentional, not ‘new’ mothers. That is because if a mother is unable to breastfeed for some medical reason, it is evident that formula will be necessary for the survival of the infant. Here, the investigation focuses on choice. The use of breast milk is the intervention because even thought it is the recommended standard, it is ultimately the action that health professionals want to take. Obviously, the comparison being to formula. Outcomes are general focused on infant health and development with an impact that breastfeeding has. Finally, the time is 6 months, because that is the recommended time period for exclusive breastfeeding post-partum.
Evidence
It is important to note that every major U.S. and global, both private and public, health organizations or agencies have continuously emphasized the importance of breastfeeding as the primary source of infant feeding. Breastfeeding is known to aid in establishing a stronger immune system which benefits both the mother and the infant, decreasing incidence and severity of a wide range of infections such as respiratory or GI tract. Breast milk contains vital antibodies, which have the unique capacity to stimulate the infant’s immune system and offer passive protection until it is safe to administer vaccinations. Formula cannot do this in any capacity, and only offers the nutritional elements (also arguably not as rich compared to breast milk) but not the health benefits.
As a result of protection against infections and other health conditions, mortality has been generally lower in breastfed infants. Important to note, that researchers generally emphasize the difficulty of comparison because so many other factors come into play both in the context of the breastfeeding issue and overall infant health. However, associations have been found to reduce risks of allergies, asthma, diabetes, and even obesity.
Breastmilk is also generally more easily digestible by infants due to their digestive system and components of the human milk that cannot be recreated in formula. Neurodevelopmental elements as well as the emotional concept of skin-to-skin contact are other benefits. Overall, it is strongly recommended to engage in exclusive breastfeeding for at least 6 months prior to introducing formula or other foods.
As part of the evidence, it is important to consider not only the start of breastfeeding when the mother is in the hospital, but the continuation of it. While most mothers express desire to fully breastfeed, they stop it early, at around 4 months, with only half the mothers feeding their infants at all by 6 months, with a significant portion switching partially or fully to formula. This is due to personal factors such as pain, poor body image, convenience, as well as social pressures or lack of a support system, including in healthcare. Therefore, it is necessary to provide a system of support and education, both for mothers and the general public on continuous benefits of breastfeeding until 6 months at the very least.
Integration into Practice
Evidence should be integrated into practice through post-partum counseling offered by physicians, nurses, or midwives. Evidence continues to demonstrate overwhelming support for exclusive breastfeeding, without formula in the first six months of the infant’s life. Staff play a critical role in educating and advising mothers on the best course of action. It is vital to present all the benefits and information in a manner which is understandable to the patients.
Nevertheless, it should be understood that breastfeeding is a highly sensitive issue from all kinds of perspectives, social, cultural, psychological, individual health. Western society both pushes mothers to breastfeed, making it an association of good motherhood, but at the same time shames them in many ways. Staff have to weigh these considerations and provide support for mothers. As mentioned, formula feeding may be often used unnecessarily and early, due to convenience or poor experiences with breastfeeding. Experienced staff can guide mothers in dealing with these issues, i.e. if an infant has trouble latching which is often distraught to mothers, there are techniques that can be tried before resorting to formula. Providers should not pressure mothers to breastfeed but give them the information and tools to make their own decision.
Evaluation
While evaluation may be difficult to gauge with this type of intervention, particularly because ethics do not allow for double blind studies giving infants formulas. Therefore, evaluation of effectiveness will have to rely on observation and statistics. It is important for staff to keep track of the effectiveness of the intervention and counseling to identify if any changes have to be made in the process or if something is not being received well by the mothers. The key objective is to provide accurate information and recommendations so that the mothers choose the best evidence-based practice from a clinical standpoint.
Conclusion
Evidence demonstrates that breastmilk has significant benefits over the use of formula. There is general intent among Western mothers to breastfeed but various factors ranging from physiological to psychological and socio-cultural create barriers. Formula is not inherently bad, but it can cause complications with breastfeeding and should not be used unnecessarily, especially in the first months. Health professionals should counsel and encourage mothers towards exclusive breastfeeding, providing the guidance to navigate individual or social support issues they may face.
References
Brown, A. (2018). Breastfeeding as a public health responsibility: A review of the evidence. Journal of Human Nutrition and Dietetics: The Official Journal of the British Dietetic Association, 30(6), 759–770.
Feldman-Winter, L., & Kellams, A. (2020). In-hospital formula feeding and breastfeeding duration. Pediatrics, 146(1), e20201221.
Hanawalt, Z. H. (2019). Millennial moms choose formular feeding for convenience. Parents.
Holcomb, J. (2017). Resisting guilt: Mothers’ breastfeeding intentions and formula use. Sociological Focus, 50(4), 361–374. Web.
McCoy, M. B., & Heggie, P. (2020). In-hospital formula feeding and breastfeeding duration. Pediatrics, 146(1), e20192946.
U.S. Food & Drug Administration. (2018). Questions & answers for consumers concerning infant formula.
Wagner, C. L. (2021). Counseling the breastfeeding mother. Medscape. Web.