In Breastfeeding vs. Formula Debate, Parent’s Intent Matters

In the debate over breast milk, a new study finds intent to breastfeed may mean healthier babies.

Experts want new parents to feel supported in their choice between formula and breastfeeding. Getty Images

Nothing about Jessica Bates’ birth experience went as planned.

Her pregnancy wasn’t an easy one. After she delivered her first child, Henry, in March of this year via an emergency cesarean, he spent days in the neonatal intensive care unit (NICU) due to a suspected infection.

As Bates, based in Washington D.C., recovered from the emergency surgery, she hadn’t produced any milk yet, so the nurses in the NICU fed Henry with formula.

Throughout her pregnancy, Bates had assumed she’d breastfeed her newborn.

However, breastfeeding proved to be a struggle, especially because Bates experienced PTSD from the emergency birth and struggled with postpartum depression.

“I was sort of in a fog… for maybe the first two months of motherhood,” Bates said. “I really struggled with pumping and breastfeeding and couldn’t latch. I wasn’t really getting him any food and I was so tired. And C-section recovery was so hard.”

For years, new parents have been told “breast is best.” But in some cases, new mothers or parents who want to do what’s best for their child face roadblocks — biologically, mentally, or physically.

And now there’s new research that simply the intent to breastfeed may be linked to better outcomes for babies.

New research published in the journal Population Health has found that a mother’s intent to breastfeed — even if she doesn’t end up actually breastfeeding — could be an important factor in her infant’s health.


One woman’s story

Despite the difficulties she had been through, for three weeks Bates attempted to breastfeed. A lactation consultant met with her in the hospital, and friends and family encouraged her to persist.

Ultimately, though, with the blessings of her pediatrician and her husband, she decided Henry would be exclusively formula-fed.

“I really felt strongly that somebody else needed to be able to feed him and that I needed to be able to sleep at night,” said the new mom.

It wasn’t a decision she made lightly. “Navigating that road originally, that was very difficult,” Bates told Healthline. “It took me a while to get there.”

When the 39-year-old finally made the “firm decision” to formula-feed, though, “I got nothing but support for it,” she said.

Her pediatrician assured her that Henry would flourish, no matter how he received his nutrition.

“Our pediatrician said to me, ‘Whatever you decide to do, I will make sure he’s fed and we will make sure he’s healthy,’” she recalled.


Study on breastfeeding intent

The study, led by researchers Jessica Su, PhD, an assistant professor at the University of Buffalo’s department of sociology, and Kerri Raissian, assistant professor at the University of Connecticut’s department of public policy, analyzed data from the 2005 Infant Feeding Practices Study II.

Designed by the U.S. Food and Drug Administration and Centers for Disease Control and Prevention, the study contains the responses of 1,008 women who answered surveys during their third trimester, as well as almost monthly during their child’s first year of life.

During their third trimester of pregnancy, 65 percent of surveyed mothers said they intended to breastfeed, while 35 percent said they didn’t. But two months after birth, those numbers had almost flip-flopped: 40 percent of mothers were breastfeeding, but 60 percent of mothers weren’t.

In other words, all the mothers who never intended to breastfeed weren’t doing it, but two months after birth, nearly 25 percent of the moms who intended to breastfeed weren’t doing it, either.

The researchers then examined data of health outcomes of all the infants in the study. What they found was that after two months, the infants of moms who intended to breastfeed but didn’t had similar health outcomes to the moms who actually did breastfeed when it came to ear infections, respiratory syncytial viruses (RSV), and the number of needed antibiotics.

In other words, the health of infants whose mothers intended to breastfeed was more like that of moms who actually did breastfeed — which the researchers say is a noteworthy finding.


Other factors that affect infant health

Breastfeeding is recommended by the American Academy of Pediatrics as the sole source of nutrition for a newborn’s first 6 months.

“Breastfeeding is definitely the best feeding practice with a newborn,” said Dr. Sourabh Verma, assistant professor in the department of pediatrics and associate medical director of the NICU at NYU Langone’s Tisch Hospital.

He cites the reduction of ear, gut, and respiratory infections as two of the main benefits for infants. Breast milk contains antibodies that help an infant fight viruses and bacteria. Breastfeeding is also linked to a lower risk for sudden infant death syndrome (SIDS), both after 1 month and 1 year of an infant’s life.

Breastfeeding has numerous benefits to the mother as well, including better uterine contractions, less bleeding issues after delivery, losing pregnancy weight earlier, and a decreased risk of ovarian and breast cancer, Verma says.

Breastfeeding is “not only impacting a newborn who’s going to be a meaningful citizen of the country and contributing in so many ways, but also the mother, who is a big part of the society, and her own health,” Verma told Healthline.

Even while acknowledging the nutritional benefits of breast milk, experts say more understanding of the full scope of infant health is needed.

“Beyond any doubt, breast milk is the best milk,” Verma said. “But what we really need to understand is what are the other factors that play a role in an infant’s nutrition and health.”

Verma was intrigued at the findings of a mother’s intention to breastfeed, and said it may reflect “the mother’s understanding of various other things, such as the infant’s nutrition, her own nutrition, [and] her own health, which could make an infant’s health better.”

Indeed, Su explained, “it may not be breast milk alone that is leading to better health outcomes for these infants.”

For one thing, the participants in the Infant Feeding Practices Study II were primarily white, married, and had a college education. All these factors could influence a mother’s decisions during pregnancy as well as once the infant is born. Therefore, the researchers suggest, crediting breast milk alone may be obscuring the full picture.

“It’s not clear whether the better health outcomes for breastfed kids are due to the properties of breast milk or due to a lot of these other advantages,” Su said.

‘No one was going to be able to tell our kids apart eventually’

Su and Raissian became interested in looking more closely at the data in the Infant Feeding Practices Study II due to their own life experiences as mothers.

They had known each other since graduate school. When they became parents, they fed their infants in different ways. Su says private conversations about the stigma and shame around formula-feeding led them to turn their attention to the topic as researchers.

“One of us was able to successfully breastfeed, and one of us was not,” Su told Healthline. Both of their children are healthy. So, they thought as researchers, “let’s then examine this, because that might mean that there’s more effective ways of improving infant health besides just telling [parents] to breastfeed,” she said.

“We’re not saying don’t breastfeed. I think that’s great if that’s working for people,” Su continued. “But I also think it’s important that we don’t vilify formula as some poison when there’s just no evidence that it’s really disadvantaging kids. It’s almost like making good the enemy of perfect.”

One thing both experts and the researchers agreed upon were that mothers need to be supported in their decisions, no matter which choice they make.

“What I feel is all the hospitals and all the information now is guilt, guilt, guilt, guilt, [that] something’s wrong with you if you don’t breastfeed,” said Sara-Chana Silverstein, a board-certified lactation and breastfeeding consultant and doula based in Brooklyn.

As a lactation consultant for 25 years, Silverstein is adamant that new mothers and their healthcare providers need more education about what to expect from breastfeeding and all the different factors that go into it.

In particular, many women aren’t taught that the size and shape of nipples can impact breastfeeding. They think they’re “failing,” so to speak, when in fact they need different adaptive techniques.

New moms need to be taught the correct way to breastfeed with their nipples and develop “a plan that works around the individual person,” Silverstein said.

“My philosophy is forget the guilt. Educate, educate, educate, [and] stand by their side,” she said.

Verma would also like to see less guilt heaped upon new moms.

“There is a very big need of making sure that the mother doesn’t feel guilty about [formula-feeding],” he said. “She [shouldn’t feel] that she is taking her own infant’s nutrition, the best part of nutrition, and giving her some substitute.”

The medical establishment needs to ensure new mothers are informed that “her exercise and her own nutrition, her own sleep and rest” are extremely important, and that “we can provide nutrition” no matter how her child is fed, Verma says.

He says supporting postpartum mothers will go an enormous way toward her, and her infant’s, well-being.

“We should help these mothers, who, by all means, are doing work like Superwoman,” he said.

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