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Breastfeeding Versus Bottle feeding

As part of their role, a midwife needs to deal with the subject of breastfeeding versus bottlefeeding. It is a big ethical issue for a midwife but ultimately the decision of whether to breast or bottle feed is that of the individual mother. Midwives have to be aware of the World Health Organisations (WHO) guidance to mothers when they are giving advice on infant feeding- WHO (2010) state that exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. The issue of breastfeeding versus bottle-feeding has been greatly debated by scientists, doctors and parents since infant formula was invented in 1915. To compare and contrast the two feeding options this essay will look at the effects of each method on infant nutrition and development, and will highlight the importance of informed choice when deciding to breastfeed or bottlefeed a newborn baby.

Prentice, A. (1996) states that breast milk contains all of the nutrients needed by the newborn baby during the first weeks of life. These include the metabolic fuels (fat, protein, carbohydrate), water, and the raw materials for tissue growth and development, such as fatty acids, amino acids, minerals, vitamins, and trace elements. A team of researchers from the University of Minnesota Cancer Centre revealed in a study published in the Journal of the National Cancer Institute (1999) that infants that breastfed for at least one month had a 21% lower risk of developing leukaemia and those who breastfed for at least 6 months or longer have up to a 30 percent lower risk of developing leukaemia than bottle fed babies. The World Health Organisation (2010) states that early breastfeeding initiation reduces neonatal mortallity by 22%. Breastfeeding also protects against many other diseases and infections all of which incur costs to the NHS and distress to families. For example, bottle fed babies are twice as likely as a breastfed baby to suffer from respiratory infections. 49,000 babies were hospitalised with respiratory infections in 1992. Baby Milk Action (2010) reveals that gastro-enteritis is up to 10 times more common among bottle-fed babies. The hospitalisation of one infant with gastro-enteritis costs the NHS between £500 and £1000. Department of Health statistics reveal that 11,554 babies were hospitalised with gastro-enteritis in the UK in 1992. This cost the NHS approximately £12 million. Cases of gastro-enteritis treated by GPs cost the NHS a further £6 million. Breastfed babies are rarely hospitalised for gastro-enteritis. The probiotics found naturally in breast milk are special nutrients that encourage the growth of friendly bacteria in the digestive system and contribute to greater immune health. Along with having higher protection from several forms of disease and infections breastfed infants have less tendency to develop alergies, have increased protection from SIDS, higher intelligence, reduced risk of diabetes and obesity.

Obvious benefits of breastfeeding for the mother include weight loss, the natural delay of the return of fertility by suppressing ovulation and increased bonding between mother and child. Long-term health benefits include, reduced risk of breast cancer, ovarian cancer, and endometrial cancer. The American Journal of Obstretics and Gynecology (2009) did a study which indicated that lactation for at least 24 months is associated with a 23% lower risk of coronary heart disease. Melton III L et al (1993) reveal that mothers who breastfeed longer than eight months benefit from bone re-mineralisation. Breastfeeding diabetic mothers are thought to require less insulin. Breastfeeding reduces the risk of post-partum bleeding and according to a Malmö University, Pikwer M, Bergström U, Nilsson JA, et al (2009), women who breast fed for a longer duration have a lower risk for contracting rheumatoid arthritis. Aptimal (2010) say that breastfeeding stimulates the release of a hormone called oxytocin. When your baby first begins suckling,  this prompts your milk to start flowing at the same time as contracting your uterus. The contractions protect you against postpartum haemorrhage and help your uterus return to its normal size. Oxytocin also has a positive effect on your emotions. Known as the love hormone, it makes you feel relaxed and content while feeding your baby, making it a comforting experience for you both.

Infant formula is an artificial feed made to use along side or instead of breast milk as the sole source of nutrition for a baby. The most commonly used infant formulas contain purified cow's milk; whey and casein as a protein source, a blend of vegetable oils as a fat source, lactose as a carbohydrate source, a vitamin-mineral mix, and other ingredients depending on the manufacturer.  

The American Academy of Paediatrics (2010) state there are a few conditions under which breastfeeding may not be in the best interest of the infant. Breastfeeding is contra-indicated in infants with classic galactosemia, mothers who have active untreated tuberculosis disease or are human T-cell lymphotropic virus type I–or II–positive; mothers who are receiving diagnostic or therapeutic radioactive isotopes or have had exposure to radioactive materials (for as long as there is radioactivity in the milk); mothers who are receiving anti-metabolites or chemotherapeutic agents or a small number of other medications until they clear the milk; mothers who are using drugs of abuse; and mothers who have herpes simplex lesions on a breast. It has been suggested that ‘true’ milk insufficiency occurs in as little as 1- 2% of women. In the above cases and when the mother is absent through mortality or is unable to breastfeed due to employment commitment or just chooses not to breastfeed, artificial or formula feeding is invaluable. NHS (2010) state the advantages of bottle-feeding include that they may sleep for longer between feeds. If you bottle feed your baby, you can ask someone else to feed your baby, such as your partner, or a family member, if you need to take a break. Bottle feeding enables a parent to bond and a sense of closeness to develop between the baby and parent. Formula milk has added vitamin K.

See table- comparison of breast milk with infant formula (DoH, 1994: 55; Inch, 1996a: 82-83; MIDIRS/ NHS Centre for Reviews and Dissemination, 1999; Statutory instrument 77, 1995)

Values (per 100ml)

Mature breast milk

Infant formula

Effect in formula milk

Energy

70 kcal

(293 kJ)

60- 65 kcal

(250-315 kJ)

Protein (g)

1.3

1.2-1.95

Elevated blood urea and amino acid levels result in higher renal solute load and subsequent increased metabolic stress. Can provoke antigenic responses in those prone to asthma and eczema. Can also trigger IDDM

Fat (g)

4.2

2.1-4.3

Limited number of fatty acids. May compromise optimal brain growth and development of the CNS

Carbohydrate (g)

Lactose

7

4.6-9.1

Energy requirements less efficiently met. Higher pH- greater risk of invasion from bacteria e.g. Escheriachia coli

Whey proteins

Alpha-lactalbumin

Beta-lactoglobulins

Lactoferrin

Imminoglobins

Lysozyme

Present (70%)

Absent

Present

Present, mainly IgA

Present

Bovine (20%)

Present

Trace

Trace

Trace

Casein

Micelle structure

Forms soft curd (30%)

Forms hard curd

(80%)

Remains in stomach longer and requires high expenditure of energy to digest. May cause an intestinal obstruction

Essential amino acids

Cystine : metionine ratio

1.3:1

0.7:1

Higher amino-acid levels may reduce health effects

Lipids

Cholesterol

16mg

Absent

Essential fatty acids

Linoleic : alpha- linolenic

Ratio

Docosahexaenoic acid and arachidonic acid

9.1:1

Present

10.5:1

Added

Minerals

Calcium : phosphorus ratio

Zinc : copper ratio

Sodium (mg)

Potassium (mg)

Chloride (mg)

Calcium (mg)

Iron (mg)

2.3:1

7.6:1

15

60

43

35

76

1.5:1

10.0:1

13-39

39-94

32.5-81

19.5

325-975

Calcium less efficiently absorbed

May disturb copper of iron absorbtion

Only 10% of iron in formulae is absorbed

Vitamins

A (Mg)

B6 (Mg)

B12 (Mg)

Total folate (Mg)

Thiamin (Mg)

Riboflavin (Mg)

Niacin (Mg)

C (Mg)

D (Mg)

E (Mg)

K (Mg)

60

6

0.01

5.0

16

30

620

3.8

0.01

0.35

0.21

29-117

22.8

0.07

2.6

265

39

163

5.2

0.65-1.63

>0.33

2.6

All added

Digestive enzymes e.g. bile salt simulated lipase- to complete fat digestion

Present

Absent

Anti- infective factors

Secretory IgA

White cells

Antibacterial e.g. lactoperocidase

Glycoproteins

Antiviral e.g.

Ribonuclease

Oligosaccharides

Antiparasitic e.g.

Lipid (free)

Present

(varied amounts)

Present

Present (varied amounts)

Present (varied amounts)

Present (varied amounts)

Absent

Absent

Absent

Absent

Absent

Higher incidence of infection e.g. gastroenteritis, respiratory infection, otitis media, UTI, NEC, IDDM, atopic disease- asthma, eczema

Higher incidence of infection

Higher incidence of infection

Higher incidence of infection

Growth factors

Present

Absent

The benefits of breast milk have been hailed for centuries yet according to Unicef (2005) only 35 per cent of UK babies are being exclusively breastfed at one week, 21 per cent at six weeks, 7 per cent at four months and 3 per cent at five months. Breastfeeding rates in the UK are among the lowest in Europe and this is thought to be because mothers are uneducated to the importance of breastfeeding and its many benefits and to the risks of bottlefeeding. The international Formula Council (2010) state that the infant formula industry, recognizing the importance of human milk and breastfeeding and fully acknowledging breastfeeding as the preferred feeding practice for babies, is committed to providing the highest quality alternatives possible.

In summary research and statistics prove that formula fed babies suffer from higher rates of gastroenteritis, ear infections, certain cancers, diabetes, heart disease, life threatening sleep apnoea in adulthood. Other risks of bottle feeding currently being researched include childhood lymphomas, inflammatory bowel disease, multiple sclerosis, dental occlusions, autoimmune thyroid disease, coeliac disease, kawaasaki disease, lower IQ, risk of sudden death syndrome and obesity. Mothers of formula fed babies suffer higher rates of breast cancer.

In conclusion breast feeding versus bottle feeding is a big ethical issue for a midwife as evidence proves that breastfeeding is the best, safest and healthiest method of feeding a newborn yet if a mother choses to bottlefeed, apart from informing the mother of the facts and statistics and even though bottle feeding is thought to cost the NHS billions every year through the hospilitisation of sick formula fed babies there is very little a midwife can do but pass over a bottle of formula milk.


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