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Evidence-Based Nursing Online First, published on October 17, 2014 as 10.1136/eb-2014-101945
Midwifery

to examine association between supplementation and breastfeeding


Cohort study status. Models were adjusted to control for confounding variables such as
maternal demographic background, length of hospital stay and strength
Among women planning to of infant feeding intention.

exclusively breastfeed, in-hospital


Findings
formula supplementation is Two hundred and ten infants were exclusively breastfed in hospital (53%)
while 183 (47%) received formula supplements. Infants received supple-
associated with almost tripled risk of mentation for a range of reasons, the most common being perceived
breastfeeding cessation by 2 months insufcient milk supply (18%), inadequate intake (16%) and poor latch
(14%). Infants who received formula in hospital were signicantly less
10.1136/eb-2014-101945 likely to be exclusively breastfed at 3060 and 60 days. The greater
volume of formula received, the greater the risk of not breastfeeding at
30 or 60 days. Each reason for supplementation (excluding maternal
Amy Brown
medication) increased risk of non-exclusive breastfeeding.
Department of Public Health and Policy Studies, Swansea University,
Swansea, UK Commentary
Correspondence to: Dr Amy Brown, Department of Public Health and The ndings support previous research linking early formula supplemen-
Policy Studies, Swansea University, Singleton Park, Swansea SA2 8PP, tation to breastfeeding cessation3 5 6 and further highlighted a dose
UK; a.e.brown@swansea.ac.uk responsive relationship; risk of breastfeeding cessation increased as
volume of supplementation increased. Moreover, the study showed that
all reasons for supplementation increased risk of cessation (apart from
maternal medication), suggesting that formula supplementation itself
Commentary on: Chantry CJ, Dewey KG, Peerson JM, et al.
contributed to risk of breastfeeding cessation, rather than the underlying
In-hospital formula use increases early breastfeeding cessation
reason for supplementation.
among rst-time mothers intending to exclusively breastfeed.
However, the study did not consider the impact of childbirth experience.
J Pediatr 2014;164:133945. Medications during childbirth increase the risk of breastfeeding difculties
(eg, pain, poor latch, milk insufciency),4 which increase the chance of
Implications for practice and research formula supplementation.3 5 6 Moreover, difculties in breastfeeding can
Formula supplementation in hospital increases risk of breastfeeding affect maternal condence, making formula milk appear a safer option.3
cessation. The issue of formula supplementation in hospital is important.
UNICEF Baby Friendly standards advise against supplementation unless
The more formula received, the greater the risk of cessation. necessary. Formula supplementation increases risk of breastfeeding cessa-
Almost half of infants of mothers who intended to breastfeed received tion as it can lead to confusion for the infant between breast and bottle,
formula supplementation in hospital. reduce milk supply and impact negatively on maternal condence.3 5 6
The majority of women can successfully breastfeed, but support is vital.
Many reasons for which supplements were given could be solved Women may be worried that they are not producing enough milk or can
through breastfeeding support rather than supplementation. have difculties latching the infant on (which can increase risk of pain
and poor milk supply).3 However, many of these issues can be solved
Context with the right support; women need expert breastfeeding guidance and
Breastfeeding is established as benecial to infant and maternal health1 time after the birth, rather than formula supplementation. Health profes-
and the WHO recommends exclusive breastfeeding for the rst sionals must recognise the impact of supplementation on breastfeeding
6 months.2 However, levels of breastfeeding remain low. Reasons for success, and hospitals the importance of nding time for staff to support
breastfeeding cessation involve both physiological and psychosocial new mothers rather than offer formula.
factors.3 Increasing attention is being given to the impact of early factors
on breastfeeding experience, including medications during childbirth, Competing interests None.
hospital practices, such as separation of mother and infant, and formula
supplementation, which can increase risk of physical difculties.46 References
1. Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health
Methods outcomes in developed countries. Evid Rep Technol Assess (Full Rep) 2007;
The purpose of this study was to examine the relationship between (153):1186.
formula supplementation in hospital and breastfeeding duration among 2. World Health Organisation. Global strategy for infant and young child feeding.
primiparous mothers who intended to exclusively breastfeed in a US hos- 55th World Health Assembly. Geneva: WHO, 2003.
3. Thulier D, Mercer J. Variables associated with breastfeeding duration. J Obstet
pital (n=393). A longitudinal survey method was employed. Prenatally,
Gynecol Neonatal Nurs 2009;38:25968.
mothers indicated strength of infant feeding intention. Data regarding
4. Brown AE, Jordan S. Impact of birth complications on breastfeeding duration: an
birth experience, breastfeeding, formula supplementation and reasons for internet survey. J Adv Nurs 2013;69:82839.
supplementation were collected via maternal interview in hospital within 5. DiGirolamo A, Grummer-Strawn L, Fein S. Effect of maternity care practices on
24 h of birth. Follow-up phone interviews at 14, 30 and 60 days post- breastfeeding. Pediatrics 2008;122:439.
partum examined breastfeeding and formula use. A series of statistical 6. Forster DA, McLachlan HL, Lumley J. Factors associated with breastfeeding at six
analyses were performed on the data including 2 and logistic regression months postpartum in a group of Australian women. Int Breastfeed J 2006;1:18.

Evid Based Nurs Month 2014 | volume 0 | number 0 | 1


Copyright Article author (or their employer) 2014. Produced by BMJ Publishing Group Ltd (& BCS) under licence.
Downloaded from http://ebn.bmj.com/ on March 16, 2015 - Published by group.bmj.com

Among women planning to exclusively


breastfeed, in-hospital formula
supplementation is associated with almost
tripled risk of breastfeeding cessation by 2
months
Amy Brown

Evid Based Nurs published online October 17, 2014

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Topic Articles on similar topics can be found in the following collections


Collections Childhood nutrition (125)
Infant nutrition (including breastfeeding) (74)
Reproductive medicine (318)
Midwifery (37)
Pain (neurology) (295)

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