Why Mothers Should Breastfeed 1

Why Mothers Should Breastfeed Instead of Formula Feed

Caylin Corns, Jessica Woods, Jasmine Moses, Cody Wohlgemuth, John Massie

04/03/2017

NURS 3947: Nursing Research

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Abstract

This research was to look at why mothers should breastfeed their infants instead of formula

feeding. There are many benefits for the mother and infant from breastfeeding. It all starts with

the correct education and initiation of breastfeeding. This research was gathered from ten

different literature reviews. There was a large amount of evidence with initiation of

breastfeeding, importance of correct education, the benefits of breastfeeding, and disadvantages

of formula feeding. While some common problems with breastfeeding was discovered the

positive attributes outweigh the negative of formula feeding.

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Literature Review

Introduction

To address why a mother should breastfeed information was found via google scholar,

OhioLINK database, and up to date from the hospital. Ten sources were reviewed for education,

initiation, benefits, disadvantages of formula feeding and common problems with breastfeeding.

Education

According to the Centers for Disease Control and Prevention:

Breastfeeding education takes place during the prenatal and intrapartum periods of

pregnancy. The educator should be of proficiency in lactation management. The teaching

can take place in an assortment of places, such as: libraries, churches, clinical setting, and

etc.. Ultimately, the CDC wants to fulfill the goals of increasing mothers knowledge and

skills, aide the mothers in viewing breastfeeding as normal, and help acquire positive

attitudes from these mothers toward breastfeeding (CDC, 2013.).

By looking at the use of breastfeeding education, many results can come array. The amount of

teaching provided, the group receiving the education, and following through with the teachings

can lead to a variety of outcomes.

Looking farther into breastfeeding education, ninety-four breastfeeding mothers

participated in a twenty-four-week study. By participating in the study, lactation consultants and

educators made nine follow-up support telephone calls. These phone calls were checking in on

any breastfeeding problems, proposing solutions, pinpointing causes that may have inclined the

mothers verdict to initiate and remain breastfeeding, and recognizing why mothers would opt

out of breastfeeding.
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According to the study Rasheed (2000), breastfeeding is on the decline and the study

blames: knowledge deficiency, attitude of the nurses, and the practice of breastfeeding.

Shockingly the nurses were given statements with three correct statements of the failure of

lactation and none of the nurses recognized all three statements as correct. Per the study, the

three correct statements were proper latching-on, mother if not willing to breastfeed and if

breastfeeding is initiated late. This was an appalling finding of the study. If the nurses do not

have the correct knowledge about breastfeeding and formula feeding how can the nurse give the

correct information to the new mothers.

The research showed there were four reasons why the nurses did not preach breastfeeding

to the new mothers. The top reason from both qualified and non-qualified nurses, at 62% and

65% respectively, was the low salary. The other three reasons were no time, lack of knowledge,

and it is the doctors duty to teach the patient about the benefits of breastfeeding. The lack of

education given to the mothers from the nurses led the mother to formula feed. Without knowing

the benefits of the breastfeeding the mothers are shown to choose to formula feed the infant.

Another part of the study was when the nurse should tell the mother to discontinue

breastfeeding. The most common reason the nurses said to continue breastfeeding was when the

mother had a fever. If the mother has a fever, there is an obvious problem and even a possible

infection which could be transferred to the infant if breastfeeding continued. If the child is

constipated almost ever nurse said to withhold the breastfeeding which is correct.

The results from the study led to the hospitals holding classes for both qualified and non-

qualified nurses working on maternity units. Lactation management and the benefits of

breastfeeding have to be discussed to the mother. As nurses one of the most important job is to
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correctly educate the patient. This demonstrates that proper education and training of the nurses

is essential in order for the patient to receive the best care possible.

Initiation of Breastfeeding

In the United States, the goals for Healthy People 2020 include the initiation of

breastfeeding in 82 percent of newborns, and any continued breastfeeding in 61 percent of six-

month-old infants (Schanler, R., Potak D., 2016). The initiation of breastfeeding is an important

part of obtaining the beneficial attachment of baby to mother and yields many other benefits for

baby and for the mother. Breastfeeding is the optimal feeding for infants to six months of age. It

is important to initiate breastfeeding in the first hour of the newborns life where colostrum

provides vital nutrients to the baby. Lactation consultants often come and observe and even

guide the first feeding between mother and baby. Newborns should be fed breast milk unless

there is a medical problem preventing it. Babies should be encouraged to breastfeed by placing

them on the mothers chest, encouraging breastfeeding on command, and maintaining contact

with each other as much as possible.

According to The American Academy of Pediatrics (VOLUME 115, ISSUE 2, 2005),

human milk is superior to all other methods of infant feeding, with more beneficial outcomes in

growth, health, development, and several other outcomes in baby. Breastfed infants all have

better immune systems and improved developmental outcomes. Not only is the initiation of

breastfeeding important for baby but it benefits mother as well. It decreases postpartum bleeding

and increases uterine contractions allowing the uterine involution to be more rapid. Menstrual

blood loss decreases and most mothers have an early return to pre-pregnancy weight. Lactating

can decrease the risk of breast cancer, ovarian cancer, and osteoporosis in the postmenopausal

period.
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In addition to specific health advantages for infants and mothers, economic, family, and

environmental benefits have been described. These benefits include the potential for

decreased annual health care costs of $3.6 billion in the United States; decreased costs for

public health programs such as the Special Supplemental Nutrition Program for Women,

Infants, and Children (WIC); decreased parental employee absenteeism and associated

loss of family income; more time for attention to siblings and other family matters as a

result of decreased infant illness; decreased environmental burden for disposal of formula

cans and bottles; and decreased energy demands for production and transport of artificial

feeding products (AAP, 2005, VOLUME 115 / ISSUE 2).

Initiating breastfeeding comes with many parts to it, involving the mechanisms of

breastfeeding such as positioning the infant, latch-on, and transfer of milk. Positioning is

important so that mother and baby are comfortably positioned. Infants should be positioned

toward the mothers body so that the mouth is near the nipple with the neck slightly extended

and the head, hips, and shoulders aligned. Latching on is also an important part of initiating

breastfeeding for baby, the lips must form a tight seal around the nipple to allow efficient milk

removal. It is important to hold the breast in one hand and allow for the infant to grasp the entire

nipple. Schanler (2016) states that an adequate latch-on includes an angle of about 120 degrees,

the lower lip turned outward, the chin and nose close to the breast, and full cheeks.

An efficient milk transfer involves coordination of sucking and swallowing. Audible

swallowing is usually a sign of successful milk transfer in most infants. However, the only

reliable way to assess infant intake is by comparing the weight before and after feeding and

keeping track of total infant growth over time. If the infant does not adequately stimulate the

breast, it is difficult to maintain the milk supply. Disorganized sucking may lead to poor infant
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growth. Signs of disorganized sucking include early release of the breast, spilling of milk from

the mouth during feeding, coughing, or gagging. (Schanler R., Potak D., 2016).

Benefits of Breastfeeding

According to Infant Benefits of Breastfeeding by Richard J Schanler, MD, there are so

many benefits that come with breastfeeding rather than formula-feeding. Breastfeeding plays a

huge role in numerous factors of an infants well-being including his or her gastrointestinal

system, host defense, weight, visual function, and psychological development (Schanler 2016).

Components exist in breastmilk that improve the gastrointestinal systems ability to grow and

mobilize contents (Schanler 2016). These components work by stimulating and protecting the

gastrointestinal system (Schanler 2016). Cortisol, growth factors similar to insulin, thyroid

hormone, and insulin are hormones found in breastmilk that stimulate the growth of the

gastrointestinal system and mucosal performance (Schanler 2016). White blood cells play the

biggest role in fighting infections and breastmilk contains white blood cells which then get

passed on to the infant. A huge majority, about ninety percent, of the white blood cells in

breastmilk are neutrophils and macrophages (Schanler 2016). The destruction of infectious cells

through phagocytosis is done with the help from neutrophils and macrophages, which is how

breastmilk contributes to the ability to fight infections in infants. Not only does the presence of

white blood cells help to protect the infant from infections, but the presence of antibodies in

breastmilk does so as well. An example of an infection that newborns are potentially at risk for

developing is gastroenteritis. Gastroenteritis can occur in episodes and symptoms include severe

vomiting and diarrhea that may lead to hospitalization (Schanler 2016). Symptoms of

gastroenteritis can last for forty-eight hours or more (Schanler 2016). If a mother chooses to
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breastfeed rather than bottle-feed, she can reduce her infants risk for gastroenteritis during the

first thirteen weeks after birth (Schanler 2016).

According to a study performed by the Centers for Disease Control and Prevention,

breastfeeding contributes to a lower risk of a child becoming overweight among non-Hispanic

white children if that child was breastfed during his or her first six to twelve weeks of life versus

never getting breastfed at all (Schanler 2016). Visual function is likely to be better in a breastfed

infant than in a formula-fed infant and this is due to the presence of docosahexaenoic acid in

human milk (Schanler 2016). Docosahexaenoic acid is found in the brain, red blood cell

membranes, and retinas of the eyes which is why the presence of this acid contributes to the

visual function of an infant (Schanler 2016). Lastly, psychological development is affected by

stress reduction found in breastfed infants. Oxytocin and Prolactin are lactation hormones that

cause a positive effect on an infants connection with his or her mother, meaning maternal-infant

bonding becomes stronger (Schanler 2016). This stronger bonding experience between the infant

and the mother cause stress reduction in the infant.

According to The Risks of Not Breastfeeding for Mothers and Infants by Alison Stuebe,

MD, MSc, breastfeeding plays a huge role in preventing respiratory complications and SIDS in

infants. Based off of a meta-analysis of seven studies of full-term infants with no complications,

Bachrach and associates found that a 3.6-fold increased risk for lower respiratory tract infections,

like pneumonia for example, was found in infants who were formula-fed rather than breastfed

(Stuebe 2009). This study also concluded that infants who were entirely breastfed for greater

than four months did not face this high risk for lower respiratory tract infections (Stuebe 2009).

Studies suggest that if a mother chooses to formula-feed rather than breastfeed, there is a 1.6-2.1-

fold increased risk for SIDS (Stuebe 2009). It is recommended that not only should mothers of
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infants be encouraged to have their babies sleeping alone, on his or her back, in the crib, but

mothers should also be encouraged to breastfeed rather than formula-feed to decrease the infants

risk for SIDS (Stuebe 2009).

Disadvantages of Formula Feeding

The original use of formula was designed for infants with difficulties in proper breast-feeding

(Palmer, 2003). In regards to the overall health of infants, studies have shown that there are

many disputes with the use of formula mixed with or without breastmilk when compared to

breastfeeding. The first six months of an infants life is very critical in relation to health; there-

fore, many research studies look at disputes during the infants first couple of months of life

(Mohsen, H., Vahid, M., & Hossein-Kargar, J., 2016). Various inquiries have noted that the use

of breastfeeding resulted in children who had lower rates of hospitalization, gastrointestinal

infections, diarrhea, allergies, and other possible diseases (Mohsen, H., Vahid, M., & Hossein-

Kargar, J., 2016). With research, there are numerous explanations for the difference in health of

breast-fed and formula-fed infants.

One of the more obvious explanations was the discovery of human milk including

hormones, growth factors, immunoglobulins, cytokines, enzymes and more. All of these

encompassing components of human milk not only help with infant growth, but passive defenses

as well. Therefore, the composition nutrients added to formula can be beneficial to infants, but

have been found to still not compensate for the natural bene- fits that are found in human milk

(Huerou-Luron, I., Blat, S., & Boudry, G., 2010).

Although there are many stances on whether a mother should breastfeed or formula-feed

her child, the mothers own stance could be persuaded based on the health professional. The

health care provider could be lacking in support, providing unsuitable lactation consulting,
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lacking in knowledge, and/or showing a biased attitude (Chabrol, H., Walburg, V., Teissedre, F.,

Armitage, J., & Santrisse, K., 2004). This scenario could be a reason a mother would decide to

bottle-feed without being aware of the disadvantages, such as the finding that American babies

chance of death doubles when on a formula diet (Palmer, 2003). This scenario could also relate

back to the importance of proper teaching and education because the mother needs to be

informed of the pros and cons of all choices to be made.

Another disadvantage of formula feeding in an infant is the decreases ventilation for the

baby. According to the study Taki (2009), showed that the infant will continue to suck when

milk is being dispensed from the breast or the bottle. With a bottle the milk will continue to be

flow as long as there is formula inside the bottle. With bottle feeding it is important to be giving

the correct amount of formula. The infants were shown to be consuming more than they are

capable to while being bottle fed. With the consistent milk from the bottle it is very important to

educate the mother to give breaks while feeding.

Some mothers may be concerned that the newborn will not gain enough weight if she

breasts feeds. There was a very small difference in breastfeeding and bottle feeding. In both

cases the newborn gained a lot of weight at 6 months of age. For newborns that were breastfeed

the average amount weight gained was 7,790 grams while the bottle feed newborns had an

average of 7,986 grams. There is less than a 200-gram difference, but the bottle feed newborn

will not get all the benefits as the breastfeed newborn will.

Majority of the topics that were studied had very similar results. Total feeding time and

total length of resting time in one feeding had similar results. Total rest time for first month

newborns have the largest difference. Breastfeeding had a rest time of 230 seconds while the

bottle-feeding newborns only had an average of 50 seconds. This could lead to an issue with
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decreased ventilation to the infant. With the large rest time while breastfeeding there is a lower

chance the infant will be hypoxic. Total number of sucks per feeding decreased in the six-month

mark in breast fed infants, because their suck was stronger and got more milk with each suck.

The opposite happened in infants that were bottle fed. As the infant matured the suck became

weaker.

Common Problems with Breastfeeding

There are a multitude of common problems with breastfeeding seen in both the mother

and the infant. One of the most common reasons for early cessation is inadequate milk intake;

usually due to either insufficient milk production or failure of the infant to extract the milk.

Inadequate milk production can usually be correlated to some type of condition or congenital

defect such as insufficient breast development during pregnancy in which the glandular tissue is

not able to develop because of a previous breast surgery. This is commonly seen with breast

reduction procedures in which the lactation in severely impaired. There is also an endocrine

disorder called prolactinoma. Prolactinoma is a benign tumor in the pituitary gland that produces

the hormone prolactin (Behbahan, 2008). Prolactin is important to pregnant breastfeeding

woman because it stimulates the breast to produce milk. If stimulation is lacking, then the

production of milk needed to adequately feed the infant will also be lacking. Nipple conditions

such as sore nipples can also impede a proper feeding. Some common medications that can also

decrease milk production are: Pseudoephedrine (Sudafed), Diuretics such as furosemide or

Antihistamines (Benadryl) used in high doses (Behbahan, 2008). As mentioned before hormones

come into play with breast-feeding, especially those affecting the pituitary.

After reviewing what conditions the mother can have, it is necessary to examine what

causes the infant to have inadequate milk intake. A common problem, especially in third world
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countries, is malformations with the infants lip and palate, including cleft lip and/or palate.

Basically, what happens here is the opening in the palate makes it impossible for the baby to seal

off his mouth and make the suction needed to extract milk from the breast. The baby could also

just have some type of sucking or swallowing disorder. Perhaps the infant failed to meet their

developmental milestones. This is most commonly caused by hypoxia at birth, which is basically

lack of oxygen; especially to the brain at birth (Behbahan, 2008). When this occurs, the infant

presents with neuromotor delay. Finally, the infant may simply be premature and not developed

well enough in life to be able to properly breast-feed. To improve and increase milk production

and transfer, it could be as simple as technique. Therefore, direct observation of breastfeeding is

recommended. Some common positions used are the cradle position in which the mother is

sitting. If she is feeding from the left breast, the mothers left forearm support the infants head

and body. She can then use her free hand to guide her breast to the infants mouth.

Another position for a mother to breast feed is the football position. To feed from the

right breast, the infants body and legs are under the mothers right arm and the head is supported

by the mothers right hand. Much like a person would hold a football in their right arm. Again,

the free arm is used to guide the breast to the infants mouth.

An additional common intervention, one that a mother could use with a premature infant

is the use of a breast pump or a manual hand expression; which is basically massaging the breast

from the outer areas of the breast toward the nipple. Both of these techniques increase milk

stimulation therefore enhancing milk production. Galactagogues is a substance also used to

promote lactation in humans. The most commonly used galactagogues medications are

metoclopramide and domperidone, which are both dopamine receptor antagonists.

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Unfortunately, studies suggest limited efficacy of galactagogues in increasing milk

production. In small randomized trials of metoclopramide given to mothers of term or preterm

infants at a dose of 10mg every eight hours, there was no difference in the amount of milk

production between mothers who received metoclopramide compared with mothers who

received placebo (Behbahan, 2008). Plus just like any medication these medications have side

effects that affect each mother differently.

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References

Blat, S., Boudry, G., & Huerou-Luron, I. (2010). Breast- v. formula-feeding: impacts on the

digestive tract and immediate and long-term health effects. Retrieved March 31, 2017.

Centers for Disease Control and Prevention. Strategies to Prevent Obesity and Other Chronic

Diseases: e CDC Guide to Strategies to Support Breastfeeding Mothers and Babies.

Atlanta: U.S. Department of Health and Human Services; 2013.

Chabrol, H., Walburg, V., Teissedre, F., Armitage, J., & Santrisse, K. (2004). Influence of

mother's perceptions on the choice to breastfeed or bottle-feed: perceptions and feeding

choice. 22(3), 189-198. Retrieved March 31, 2017.

Hojat, M., Mogarab, V., & Jahromi, H. (2016). The study of growth differences of infants less

than 6 months which have used breast milk and infant formula along with breast milk.

Interna-tional Journal of Pharmaceutical Research & Allied Sciences, 108-119. Retrieved

March 31, 2017.

JPMA. (n.d.). Decline in Breast Feeding, Who is to be blamed? A Study of Knowledge, Attitude

and Practice of Breast Feeding amongst Nurses. Retrieved February 20, 2017, from

http://www.jpma.org.pk/PdfDownload/2888.pdf

J. S., MD. (2016, October 28). Common problems of breastfeeding and weaning. Retrieved

February 15, 2017, from http://www.uptodate.com/contents/common-problems-of-

breastfeeding-and-

weaning?source=search_result&search=common%2Bproblems%2Bof%2Bbreastfeeding

%2Band%2Bweaning&selectedTitle=1~150

N.P. Breastfeeding and the Use of Human Milk. (2005). Pediatrics, 115(2). Retrieved March,

2017, from pediatrics.aappublications.org.

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Palmer, L. (2003). The Deadly Influence of Formula in America, Part 1. Part (1), 1-1. Retrieved

March 31, 2017.

Schanler, R. J., MD, & Potak, D. C., RN, BSN, IBCLC. (2016). Initiation of Breastfeeding. 1-5.

Retrieved March, 2017, from www.uptodate.com/contents/initiationofbreastfeeding.

Schanler, R. J. (2016). Infant benefits of breastfeeding. Retrieved from

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding

Scott, JA and Colin, WB. Breastfeeding: reasons for starting, reasons for stopping and problems

along the way. Breastfeeding Review, Vol. 10, No. 2, 2002 Jul: 13-9. Retrieved February

11, 2017, from

http://search.informit.com.au/documentSummary;dn=441496288795946;res=IELHEA

Stuebe, A. (2009). The Risks of Not Breastfeeding for Mothers and Infants. Retrieved from

https://www.umanitoba.ca/faculties/health_sciences/medicine/units/obstetrics_gynecolog

y/media/The_risks_of_not_breastfeeding_for_mothers_and_infants.pdf

Taki, M., Mizuno, K., Murase, M., Nishida, Y., Itabashi, K., & Mukai, Y. (2009, October 15).

Maturational changes in the feeding behaviour of infants a comparison between breast

feeding and bottlefeeding. Retrieved March 31, 2017, from

http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2009.01498.x/full
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