Direct vs. Expressed Breast Milk Feeding: Relation to Duration of Breastfeeding

Abstract

Background: Studies examining direct vs. expressed breast milk feeding are scarce. We explored the predictors of mode of breastfeeding and its association with breastfeeding duration in a multi-ethnic Asian population. Methods: We included 541 breastfeeding mother—infant pairs from the Growing Up in Singapore Toward healthy Outcomes cohort. Mode of breastfeeding (feeding directly at the breast, expressed breast milk (EBM) feeding only, or mixed feeding (a combination of the former 2 modes)) was ascertained at three months postpartum. Ordinal logistic regression analyses identified predictors of breast milk expression. Cox regression models examined the association between mode of breastfeeding and duration of any and of full breastfeeding. Results: Maternal factors independently associated with a greater likelihood of breast milk expression instead of direct breastfeeding were Chinese (vs. Indian) ethnicity, (adjusted odds ratio, 95% CI; 3.41, 1.97–5.91), tertiary education (vs. secondary education or lower) (2.22, 1.22–4.04), primiparity (1.54, 1.04–2.26) and employment during pregnancy (2.53, 1.60–4.02). Relative to those who fed their infants directly at the breast, mothers who fed their infants EBM only had a higher likelihood of early weaning among all mothers who were breastfeeding (adjusted hazard ratio, 95% CI; 2.20, 1.61–3.02), and among those who were fully breastfeeding (2.39, 1.05–5.41). Mothers who practiced mixed feeding, however, were not at higher risk of earlier termination of any or of full breastfeeding. Conclusions: Mothers who fed their infants EBM exclusively, but not those who practiced mixed feeding, were at a higher risk of terminating breastfeeding earlier than those who fed their infants directly at the breast. More education and support are required for women who feed their infants EBM only.

Breastfeeding progression in late preterm infants from birth to one month

“…The rationales for this choice were based on the fact that breastfeeding at the breast is the norm in Iceland, where national data show a 98% initiation rate of term infants (Directorate of Health, 2012). The other reason was that previous studies have shown that mothers that exclusively express breast milk do so for a shorter time compared with mothers that exclusively feed their infant at the breast (Forster et al, ; Pang et al, ; Pinchevski‐Kadir et al, ). It has also been reported that mothers that combine breastfeeding at the breast and formula feeding have a shorter breastfeeding duration than mothers that exclusively breastfeed at the breast (Holmes, Auinger, & Howard, ).…”

Nutrients or nursing? Understanding how breast milk feeding affects child cognition

“…Any breast milk feeding refers to an infant receiving breast milk (either directly at the breast or fed expressed breast milk), with or without non-human milk and/or solids. At 3 months, breastfeeding mothers were asked how their infants were fed breast milk (at the breast, bottle only, and breast + bottle) [26]. Bottle only includes infants who received only breast milk expressed from the breast (either manually or via a pump) by bottle, cup or spoon (very few were fed by cup or spoon).…”

A Comparison of Breastfeeding Experiences between Mothers Spending the Traditional Chinese Confinement Period in a Confinement Centre or at Home

“…With a growing body of evidence that feeding expressed breast milk might be different from feeding at the breast, this is an important finding. Studies have found that there is higher risk of asthma (17)and childhood obesity (18)(19)(20)with expressed breast milk feeding compared to direct breastfeeding. There are also concerns that only feeding expressed breastmilk could result in shorter duration of breastfeeding (20).In our study,expressed breastfeeding in the first month of life did not make any difference to our 6-month breastfeeding rates, but our study was not designed to answer this question.…”