Breastfeeding—A Public Health Issue,Not Just a Matter of Choice

Abstract

Congratulations to the Section on Breastfeeding of the American Academy of Pediatrics (AAP) on the release of the policy statement “Breastfeeding and the Use of Human Milk.”¹ This statement first appeared in 2005 but by AAP policy must be reviewed every 5 years. While the basic information has not changed, it is important to note the stronger language used. It clearly states exclusive breastfeeding for 6 months, no waffling. The recommendation to continue to a year while adding solid foods is firmly stated, as is the suggestion that breastfeeding continues as long as mother and baby wish. The documentation is even stronger because research data continue to appear confirming the tremendous value of human milk. The major change, therefore, is in the bibliography, which includes dozens of new scientific reports. These data, for instance, emphasize the relationship with sudden infant death syndrome (SIDS), demonstrating the reduced incidence of SIDS in breastfed infants. The list of benefits is great, including protection against ear infections, obesity, and cardiovascular disease, to mention a few. The facts are not new, only stronger.

The most dramatic message is that the AAP states that breastfeeding is about public health and not just lifestyle. That is to say breastfeeding is a public health issue for all and not just a personal choice for the mother.

Although these are the words of the AAP, the impact is not limited to the 50 states. The 2005 policy was the most frequently downloaded policy of the AAP. It has served as vital evidence and support for breastfeeding programs around the world. This document will help the Academy of Breastfeeding Medicine move forward and carry out its mission to promote, protect, and support breastfeeding worldwide.

The authors of this important policy actually are ABM's President, Arthur Eidelman, and Richard Schanler, an ABM founder and Past President. All the members of the Executive Committee of the Section on Breastfeeding of the AAP are ABM members.

While we celebrate this affirmation of breastfeeding in this policy based on the world literature, we bring some new explorations to print in this issue of the journal. The first two articles explore clinical issues of breastfeeding initiation. Crenshaw et al.² have used a video-ethnographic intervention to improve skin-to-skin care and associated breastfeeding rates. Skin-to-skin contact for premature infants in the neonatal intensive care unit (NICU) is explored by Lee et al.,³ who have investigated the barriers as well as the opportunities in this complicated environment of the NICU.

Another important issue as we encourage the use of donor milk for fragile infants is the actual process of milk expression. Three of the articles in this issue address the dynamics of milk expression, beginning with the report by Prime et al.⁴ Comparison of maternal milk expression methods is described by Slusher et al.⁵ Their results demonstrate the productivity of manual expression, which is comparable to the electric double pump in this study. Every mother should be trained to manually express her milk before leaving the hospital. The impact of milk expression was studied by Geraghty et al.⁶ They followed up a group of mothers from birth who donated to the local milk bank and found that early milk expression in the first month did not influence the length of total breastfeeding.

The intricate evaluation of milk expression was undertaken by Prime et al.⁴ in the Hartmann laboratory in Australia. These investigators studied the impact of pumping on milk flow and time duration and observed that long expression sessions are not necessarily better and that longer intervals between pumping were apt to reduce volume. These studies are important because the effort to increase the supply of donor milk to meet the demand has been intensified and milk banks are seeking more donors.

The editors encourage our readers to share their opinions and private observations in the journal with a letter to the editor.

References

Section on Breastfeeding of the American Academy of Pediatrics (AAP). Breastfeeding and the use of human milk. Pediatrics, 2012; 129:e827–e841.

Crenshaw

, Cadwell

, Brimdyr

et al. Use of a video-ethnographic intervention (PRECESS immersion method) to improve skin-to-skin care and breastfeeding rates. Breastfeed Med, 2012; 7:69–78.

Lee

, Martin-Anderson

, Dudley

. Clinician perspectives on barriers to and opportunities for skin-to-skin contact for premature infants in neonatal intensive care units. Breastfeed Med, 2012; 7:79–84.

Prime

, Kent

, Hepworth

et al. Dynamics of milk removal during simultaneous breast expression in women. Breastfeed Med, 2012; 7:100–106.

Slusher

, Slusher

, Keating

et al. Comparison of maternal milk (breastmilk) expression methods in an African nursery. Breastfeed Med, 2012; 7:107–111.

Geraghty

, Davidson

, Tabangin

et al. Predictors of breastmilk expression by 1 month postpartum and influence on breastmilk feeding duration. Breastfeed Med, 2012; 7:112–117.