References
Why breast milk matters
Abstract
Midwives understand the benefits of breastfeeding, both for the infant and mother. However, the biochemical and physiological reasons for the superiority of breast milk are less widely known. This is, in part, because of the extraordinary complexity of breast milk's composition. Its key components include nucleotides, which benefit gut and immune development, human milk oligosaccharides, which promote an optimal gut biome, lipids in the milk fat globule membrane, which promote gut health and brain development, immunoglobulins, which modulate the infant's immune system, and an optimum protein content, which is high in the first 2 weeks after birth but decreases thereafter. A greater awareness and understanding of the mechanisms behind the benefits of breastfeeding could help midwives to have informed discussions with parents and potentially contribute to improving the UK's breastfeeding rates. Growing understanding of breast milk's unique composition may also help infant formula manufacturers drive innovation and improve the formulation of their products.
Midwives are trained to offer all new mothers support in making informed choices on how to feed their baby. This support is based on robust evidence that breastfeeding offers the most complete form of nutrition during the first 6 months of life. Expert opinions from the World Health Organization (2023) to the public health bodies responsible for England, Scotland and Wales recommend exclusive breastfeeding for the first 6 months of life and that breastfeeding should continue for at least the first year (The Scientific Advisory Committee on Nutrition, 2018; Welsh Government, 2019; Public Health Scotland, 2020).
However, in the UK, breastfeeding rates fall short of this ideal. Current data suggest that around 72% of babies born in the UK are breastfed within 48 hours of birth, but only 1% are exclusively breastfed until 6 months (McAndrew and Thompson, 2012; Nuffield Trust, 2022). This low breastfeeding initiation and high drop off rate is despite 30 years of best practice guidance, as advised by UNICEF's (2013) baby friendly initiative, introduced to the UK's health services in 1994. There is evidence that the initiative has increased very early breastfeeding rates in the UK (birth to 7 days), but this increase is not sustained at 1 month (Fallon et al, 2019). Thus, current breastfeeding rates fall short of the recommendations.
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