Human milk expression as a sole or ancillary strategy for infant feeding: a qualitative study

Abstract

In the United States, a significant proportion of human milk (HM) is now fed to infants from bottles. This mode of infant feeding is rarely measured or described in research studies or monitored by national surveillance systems. Consequently, little is known about expressed-HM feeding as an infant feeding strategy. Our objective was to understand how mothers use HM expression and expressed-HM feeding as a sole strategy or in combination with at-the-breast feeding to feed HM to their infants. We conducted semi-structured interviews with 41 mothers with experience of HM expression and infants under three years of age. Data were analysed using a grounded theory approach for sub-themes related to the pre-selected major themes of maternal HM production and infant HM consumption. Within the major theme of maternal HM production, sub-themes related to maternal over-production of HM. Many mothers produced more HM than their infant was consuming and stored it in the freezer. This enabled some infants to consume HM weeks or months after it was expressed. Within the major theme of infant HM consumption, the most salient sub-theme related to HM-feeding strategies. Four basic HM-feeding strategies emerged, ranging from predominant at-the-breast feeding to exclusive expressed-HM feeding. The HM-feeding strategies and trajectories highlighted by this study are complex, and most mothers fed HM both at-the-breast and from a bottle-information that is not collected by the current national breastfeeding survey questions. To understand health outcomes associated with expressed-HM feeding, new terminology may be needed.

Awareness and prevalence of human milk sharing and selling in the United States

“…This study included 41 mothers from four counties in upstate New York, United States, and ethical approval was obtained from Cornell University's Institutional Review Board. More detailed methods have been previously published (O'Sullivan, Geraghty, & Rasmussen, ; O'Sullivan et al, ).…”

Comparing Alternative Breast Milk Feeding Questions to U.S. Breastfeeding Surveillance Questions

“…The other feeding behaviors of public health interest that we explored, about which no national data are collected, suggest a possible need for revision of the current national breastfeeding surveillance questions. Based on formative qualitative data, 19 we predicted that some infants would continue consuming breast milk after their mothers had stopped producing breast milk. Although this occurred, most mothers of infants who continued to consume expressed breast milk after their mother had stopped lactating provided answers to the NIS questions that reflected their own duration of lactation, which underestimates the infant's duration of breast milk consumption.…”

“…15,16 Thus, the dichotomous classification of infants as breastfed or bottle-fed, with bottle-fed signifying the feeding of infant formula, is no longer completely accu-rate, and the meaning of the word breastfeeding has become unclear. [17][18][19][20] The national breastfeeding surveillance tool in the United States, the National Immunization Survey (NIS), has been used to monitor and report breastfeeding prevalence since 2001. 21 However, the NIS questions ask only about infant breast milk consumption, regardless of whether breast milk was consumed at the mother's breast or from a bottle.…”

“…12,22 This is problematic because maternal breast milk production and infant breast milk consumption are no longer synchronous behaviors. 19 It is important to understand and recognize the complexity of breast milk feeding practices because recently published data associated infant expressed breast milk consumption with higher infant growth velocity during the first year of life, 5,6,11 higher risk of wheezing and coughing, 7 increased risk of otitis media, 9 lower satiety responsiveness in children, 4 and less desirable children's eating behavior at 6 years of age 8 when compared with feeding directly at the breast. It is possible that other outcomes differ by infant breast milk consumption mode, but that they remain to be studied.…”

A pilot study on nutrients, antimicrobial proteins, and bacteria in commerce‐free models for exchanging expressed human milk in the USA

“…Despite warnings from the AAP and FDA, there is growing evidence of active milk sharing communities in the United States, often facilitated by the Internet (Palmquist & Doehler, ; Perrin et al, ; Reyes‐Foster et al, ). Recent research suggests that lactating women in the United States are generally aware of the concept of peer milk sharing and many are receptive to it (Keim et al, ; O'Sullivan, Geraghty, & Rasmussen, ; O'Sullivan, Geraghty, & Rasmussen, ; Perrin et al, ). Additionally, there are case reports of undisclosed use of peer‐shared milk in paediatric inpatient settings (Barbas, Sussman‐Karten, Kamin, & Huh, ).…”