Earlier this month, the New York Times reported that the Trump administration had pushed to block a resolution backing breastfeeding at a United Nations health assembly. Experts Paula P. Meier, PhD, RN, Tricia J. Johnson, PhD, and Aloka L. Patel, MD, explain why — and how — Rush promotes breastfeeding.
In recent days, considerable attention has been given to whether the United States optimally promotes and protects breastfeeding, using criteria defined by the World Health Organization.
From a global health perspective, breastfeeding is an early-life intervention that unequivocally enhances health and reduces societal costs, so its promotion and protection should be a national priority for allocation of health care resources. Not unlike immunizations, exclusive breastfeeding for the first six months of life and partial breastfeeding thereafter represent early foundational health behaviors that translate into lifetime health care savings for the infant, mother and society as a whole.
These health care savings result from a significantly lower risk of infections, allergy and asthma, childhood cancers, and later-onset noncommunicable chronic diseases such as overweight and obesity, hypertension and type II diabetes in recipient term infants.
For premature infants, the Rush Human Milk Research Team has demonstrated a relationship between higher doses of mothers’ own milk and a reduction in the risk and associated costs of late-onset sepsis, necrotizing enterocolitis and bronchopulmonary dysplasia.
Lower costs, healthier infants
In the neonatal intensive care unit (NICU), these cost savings approach tens of thousands of dollars for each affected very low birthweight infant, and the complications themselves predispose these infants to chronic health and neurodevelopmental problems.
Our NICU research team has also shown that higher doses of mothers’ own milk during the NICU hospitalization predict higher neurodevelopmental scores for very low birthweight infants at 20 months of age, corrected for prematurity. For mothers, breastfeeding or providing pumped milk “resets” the mother’s pregnancy-induced hyperlipidemia — an abnormally high concentration of fats or lipids in the blood — insulin resistance and deposition of visceral fat, as well as reshaping mammary milk-producing cells post-breastfeeding, thereby reducing the risk of breast cancer.
For society in general, early-life health interventions such as breastfeeding provide the biggest return on investment because the benefits accrue over a much longer time horizon than programs that target older ages. Reducing the incidence and severity of infant morbidities can thereby reduce the need for expensive medical and educational services later in life, with multiple cost implications for the health care system and families.
Why do various interest groups still question the benefits of breastfeeding?
A fundamental problem with all “benefits of breastfeeding” studies is the fact that researchers cannot randomly assign feeding method and type. In other words, investigators cannot tell mothers that they will be “assigned by chance” to breastfeed or to formula feed, and throughout the world, the mothers who choose to breastfeed are characterized by higher incomes and healthier overall lifestyles that also influence the research outcome.
Oftentimes, the lay literature covers only these population-based cohort studies, replete with their inherent self-selection biases for mode of feeding, leading readers to conclude that the studies do not PROVE that breastfeeding is a healthier alternative than formula feeding.
However, the human milk basic science literature is replete with a myriad of studies that identify which components or combinations of components in breast milk actually convey the protection. For example, we know that mothers’ own breast milk (not pasteurized donor milk) bacteria colonize the recipient infant’s intestinal tract with one-of-a-kind healthy bacteria that work alongside infant intestinal cells to program immunomodulation, with lifelong implications for infection risk, autoimmune disorders, allergy and asthma and inflammatory-based morbidities.
Thus, the underlying mechanistic science of human milk provides layers and layers of explanation as to WHY the population-based cohort studies reveal the “benefits” of breastfeeding.
What is the guiding philosophy at Rush about promoting and protecting breastfeeding?
At Rush, the overarching philosophy of breastfeeding and lactation care is one of providing families with as much evidence as possible so that they can make the individualized feeding choice that is right for their infants. However, in many circles it is the provision of evidence that is at the core of the debate about “breastfeeding promotion efforts.” This is because both special interests (especially companies that manufacture formulas) and well-meaning individuals argue that sharing the facts about the superiority of breastfeeding make mothers feel guilty and coerced. This is not a new argument because as a society, we experienced it with smoking cessation efforts, parent education about car seat safety and other public health initiatives.
As a Baby-Friendly hospital, Rush has implemented best practices to facilitate breastfeeding, including evidence-based promotion language, breastfeeding (or pumping if the infant is admitted immediately to the neonatal intensive care unit) in the delivery room, rooming-in (mother and infant not separated) during the maternity hospitalization, access to lactation consultants and other knowledgeable experts, and a weekly support group for mothers and their healthy discharged infants as well as a group specific to NICU lactation issues.
The Rush NICU is home to the world-renowned Rush Mothers’ Milk Club program, in which mothers receive direct NICU-specific lactation care from certified breastfeeding peer counselors, all of whom were parents of former Rush NICU infants. In the NICU, where 98 percent of infants receive their own mothers’ pumped breast milk, new mothers and infants also participate as subjects in a variety of human milk research projects that are funded by NIH, the Agency for Healthcare Research and Quality, foundations and private individuals. These multiple studies have a common overall objective: identification and removal of barriers to high-dose, long-exposure mothers’ own milk.
Paula P. Meier, PhD, RN, Tricia J. Johnson, PhD, and Aloka L. Patel, MD, are members of the International Society for Research in Human Milk and Lactation, a group of global investigators who study all facets of breastfeeding and human milk science. Meier is a past president of the society, and Patel is a past member of its executive committee.