In-hospital formula use deters breastfeeding

"We are a step closer to showing that giving formula in the hospital can cause problems by reducing how much women breastfeed later," says Caroline Chantry, lead author and professor of clinical pediatrics at UC Davis Medical Center. "Despite being highly motivated to breastfeed their babies, in-hospital formula use limits this important practice. Given the benefits of breastfeeding for both mother and baby, this is a public health issue."

"In-Hospital Formula Use Shortens Breastfeeding Duration" was published online in The Journal of Pediatrics today. The study only included women who intended to exclusively breastfeed their babies for at least a week, meaning they did not plan to use formula in the hospital.

While previous studies have examined the relationship between formula use and breastfeeding, some have questioned the results, wondering if mothers using formula were simply less committed to breastfeeding. To examine this objection, the UC Davis team surveyed expectant mothers to determine their intentions toward breastfeeding and then followed them closely after delivery to see how they fared.

In the study, 210 babies were exclusively breastfed in the hospital (UC Davis Medical Center), while 183 received at least some formula. Over the next two months, breastfeeding dropped dramatically in the formula group. Between the first and second month, 68 percent of the babies receiving in-hospital formula were not fully breastfed, compared to 37 percent of babies who were exclusively breastfed in the hospital. After two months, 33 percent of the formula babies were not being breastfed at all. By contrast, only 10 percent of the hospital breastfed group had stopped breastfeeding.

Perhaps most significant, in-hospital formula feeding dramatically reduced the likelihood of later fully breastfeeding as well as any breastfeeding, even after adjusting for the strength of the mothers' intention to continue these practices. Early formula use nearly doubled the risk of formula use from the first to the second month and nearly tripled the risk of ending all breastfeeding by the end of the second month.

The study also found that breastfeeding deterrence was dose dependent. In other words, the more formula given to babies during their hospital stay, the less likely the mother would continue breastfeeding. This is the first time researchers have found a relationship between in-hospital formula doses and breastfeeding behavior.

Mothers indicated a number of reasons for giving their babies formula in the hospital. Many thought they weren't producing enough milk. Some thought their babies weren't getting enough nutrition or were not latching on properly. Chantry notes that sometimes formula is medically necessary and research is needed to better understand how to minimize its negative effects on breastfeeding.

Chantry believes this research highlights the value of The Ten Steps to Successful Breastfeeding -- evidence-based guidelines to help mothers breastfeed (http://www.unicef.org/newsline/tenstps.htm). These include educating women about the benefits of breastfeeding, teaching them how to breastfeed and limiting formula use unless medically necessary.

"These results underline the importance of providing comprehensive support for women who wish to breastfeed," says Chantry. "Doctors and nurses must be trained to help, and lactation consultants must be readily available. We need to do more to help mothers overcome breastfeeding obstacles and limit formula use."

Breastfeeding exclusively -- rather than using infant formula -- is recommended for the first six months after birth by the American Academy of Pediatrics because of the risks of using formula to the health of both infants and moms.