Bowatte G, Tham R, Allen KJ Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatrica. 2015; 104:(467)85-95

Bronsky J, Campoy C, Embleton N Palm oil and beta-palmitate in infant formula: a position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr.. 2019; 68:742-760

Cosgrove M. Nucleotides. Nutrition. 1998; 14:(10)748-751

Czosnykowska-Łukacka M, Lis-Kuberka J, Królak-Olejnik B, Orczyk-Pawiłowicz M. Changes in human milk immunoglobulin profile during prolonged lactation. Front Pediatr.. 2020; 8

European Food Safety Authority. Scientific opinion on the substantiation of a health claim related to DHA and contribution to normal brain development pursuant to article 14 of regulation (EC) no 1924/2006. 2014. (accessed 9 August 2023)

Fallon VM, Harrold JA, Chisholm A. The impact of the UK baby friendly initiative on maternal and infant health outcomes: a mixed-methods systematic review. Matern Child Nutr.. 2019; 15:(3)

Gavine A, Shinwell SC, Buchanan P Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev.. 2022; 10

Grummer-Strawn LM, Rollins N. Summarising the health effects of breastfeeding. Acta Paediatr.. 2015; 104:(467)S467:1-2

Hernell O, Domellöf M, Grip T, Lönnerdal B, Timby N. Physiological effects of feeding infants and young children formula supplemented with milk fat globule membranes. Nestle Nutr Inst Workshop Ser.. 2019; 90:35-42

Hodgkinson A, Wall C, Wang W, Szeto IM, Ye W, Day L. Nucleotides: an updated review of their concentration in breast milk. Nutr Res.. 2022; 99:13-24

Luan NN, Wu QJ, Gong TT, Vogtmann E, Wang YL, Lin B. Breastfeeding and ovarian cancer risk: a meta-analysis of epidemiologic studies. Am J Clin Nutr.. 2013; 98:(4)1020-1031

Martin C, Ling PR, Blackburn G. Review of infant feeding: key features of breast milk and infant formula. Nutrients. 2016; 8:(5)

Infant feeding survey 2010. 2012. (accessed 31 July 2023)

Mennella JA, Daniels LM, Reiter AR. Learning to like vegetables during breastfeeding: a randomized clinical trial of lactating mothers and infants. Am J Clin Nutr.. 2017; 106:(1)67-76

Nieto-Ruiz A, García-Santos JA, Verdejo-Román J Infant formula supplemented with milk fat globule membrane, long-chain polyunsaturated fatty acids, and synbiotics is associated with neurocognitive function and brain structure of healthy children aged 6 years: the COGNIS Study. Front Nutr.. 2022; 9

What proportion of mothers in England start and continue to breastfeed?. 2022. (accessed 31 July 2023)

Pokhrel S, Quigley MA, Fox-Rushby J Potential economic impacts from improving breastfeeding rates in the UK. Arch Dis Child. 2015; 100:(4)334-340

Public Health Scotland. Infant feeding. 2020. (accessed 31 July 2023)

Singhal A. Early life origins of obesity and related complications. Indian J Pediatr.. 2018; 85:(6)472-477

Teoh OH, Lin TP, Abrahamse-Berkeveld M An infant formula with large, milk phospholipid-coated lipid droplets supports adequate growth and is well-tolerated in healthy, term asian infants: a randomized, controlled double-blind clinical trial. Nutrients. 2022; 14:(3)

The Scientific Advisory Committee on Nutrition. Feeding in the first year of life: SACN report. 2018. (accessed 31 July 2023)

UNICEF. The UNICEF UK baby friendly initiative. 2013. (accessed 31 July 2023)

Vandenplas Y, Zakharova I, Dmitrieva Y. Oligosaccharides in infant formula: more evidence to validate the role of prebiotics. Br J Nutr.. 2015; 113:(9)1339-1344

Vandenplas Y, Carnielli VP, Ksiazyk J Factors affecting early-life intestinal microbiota development. Nutrition. 2020; 78

Ventura AK. Associations between breastfeeding and maternal responsiveness: a systematic review of the literature. Adv Nutr.. 2017; 8:(3)495-510

Victora CG, Bahl R, Barros AJD Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016; 387:(10017)475-490

Wang L, Mu S, Xu X Effects of dietary nucleotide supplementation on growth in infants: a meta-analysis of randomized controlled trials. Eur J Nutr.. 2019; 58:1213-1221

Welsh Government. All Wales breastfeeding five year action plan. 2019. (accessed 31 July 2023)

Wiciński M, Sawicka E, Gębalski J, Kubiak K, Malinowski B. Human milk oligosaccharides: health benefits, potential applications in infant formulas, and pharmacology. Nutrients. 2020; 12:(1)

World Health Organization. Breastfeeding. 2023. (accessed 31 July 2023)

Yu VY. The role of dietary nucleotides in neonatal and infant nutrition. Singapore Med J.. 1998; 39:(4)145-150

Zhang Z, Wang Y, Li Y Effects of Sn-2-palmitate-enriched formula feeding on infants' growth, stool characteristics, stool fatty acid soap contents and bone mineral content: a systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr.. 2022; 1-11

Why breast milk matters

02 October 2023
Volume 31 · Issue 10


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.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month