I was driving through a New Forest village recently when I encountered an immense traffic jam that gridlocked the whole village. The narrow road was blocked in both directions—the cause of the pandemonium turned out to be a small newborn baby donkey the size of a Labrador dog, which was quietly having a feed from its mother in the middle of the road. The mother donkey stoically refused to budge until its baby had finished! It's only natural.
Donkeys have no alternative to breastfeeding, but in contemporary society humans do. However, to reclaim the significant benefits of breastfeeding among humans the Dutch technology company Philips published the results of a study in August (Philips, 2019) which, among other things, shows the importance of partner participation in the breastfeeding process. (Philips AVENT manufactures baby bottles, breast pumps, and other baby feeding and health accessories.)
Background
Out of necessity, human mothers have been known to breastfeed other animals such as piglets (Simoons and Baldwin, 1982), and before the invention of rubber-teated glass bottles it was not uncommon for human babies to be suckled by a goat or similar animal. Think back to ancient Rome and the story of Romulus and Remus, the founding fathers of ancient Rome, who were allegedly breastfed by a wolf.
A more modern example of animal to human breastfeeding is the use of goats to feed abandoned babies in the foundling hospitals. More generally, wet nursing was the preferred option when mothers themselves were either unable or unwilling to feed their babies (Hardyment, 2007). Wet nursing has been an occupation for many poor women in many societies since time immemorial (Obladen, 2012) and during the 19th century, when maternal death was not uncommon after the birth of a baby, wet nurses were engaged to feed orphaned children. For example, in Dickens' novel Dombey and Son the main character's wife dies shortly after giving birth to a son and he employs a wet nurse to feed the baby.
As an occupation, wet nursing remained prevalent until the invention of bottles and formula milk, because it was the safest choice when a mother was unable to feed her own infant for whatever reason. However, during the latter part of the 19th century, commercial milk products became available as an alternative to wet nursing and this led to a decline in the industry. Society began to reject the notion of wet nursing and artificial feeding began to supersede this as the best method of feeding an infant when a mother's natural milk was not available (Stevens et al, 2009).
The decline in breastfeeding, which accompanied the evolution of artificial milk for babies, was also associated with the development of several childhood illnesses, the first of which were associated with outbreaks of gastroenteritis caused by bottled milk becoming infected, especially during the summer months and the lack of refrigeration. In context, refrigerators did not become common place in the UK until after the Second World War and even as late as 1959 only 13% of homes had one (Wilson, 2011).
The use of formula milk feed has also been associated with several other childhood illnesses, for example atopy, diabetes mellitus, and childhood obesity. This has been attributed to the decline in breastfeeding from 90% in the 20th century to 42% in the 21st century. (Stevens et al, 2009)
In recent years, there has been a renewed recognition that breast milk is best for babies, with numerous campaigns focusing on the importance of breastfeeding. Health professionals now endeavour to promote breastfeeding during the antenatal period.
Factors mitigating against continued breastfeeding
A survey of mothers in the USA (Ogbuanu et al, 2009) identified several reasons why mothers choose not to feed their babies naturally, including returning to work or education, having too many household chores, embarrassment at exposing what are seen by many as sexual aspects of the body, not wanting to be tied down and, crucially, the lack of partner support.
These financial and emotional barriers to breastfeeding are not easy to overcome and can be exacerbated if health professionals themselves are not fully educated in breastfeeding strategies. In addition, the low rate of breastfeeding in the UK may be due to social pressures on mothers to get their babies to sleep through the night and insufficient support for new mothers to enable them to continue breastfeeding (Davis, 2016).
Breastfeeding report
To encourage women to breastfeed, at the beginning of every August, the World Health Organization (WHO) promotes a worldwide Breastfeeding Week (https://tinyurl.com/who-breastfeed). This year, the WHO worked closely with the United Nations Children's Fund (Unicef) to promote family-friendly policies, such as paid maternity and paternity leave, and encourage workplaces to provide private spaces where mothers can breastfeed. The WHO has reported that, among other things, breastfeeding decreases the incidence of breast cancer, potentially saving 20 000 women's lives (WHO, 2016).
To coincide with Breastfeeding Week Philips (2019) published a report into breastfeeding based on a worldwide survey into fathers' support and involvement in the activity. The Philips AVENT report reveals that women who receive support from a partner are more likely to initiate breastfeeding and will continue to do so for longer.
The role of the father in contemporary society has changed considerably over the past decades. Men are now more willing to take an active role in the process of child rearing and more likely to be present at the birth of their child. In a study of fathers involved in the breastfeeding process, Rempel and Rempel (2011) found that a primary fathering role was to develop knowledge about breastfeeding and then use this knowledge to help their partners by expressing value to the act of breastfeeding and to share house work and child care.
Fathers should be assisted by health professionals to recognise their own unique position in supporting breastfeeding within the family, not least their nurturing role and the promotion of father–infant bonding. Supporting the breastfeeding process is beneficial for the father–infant relationship and has longlasting benefits that the baby will carry into later life. Furthermore, Flacking et al (2010) showed that an enabling of an increased involvement from fathers during the infants' first year of life, including paid paternity leave, may have beneficial effects on breastfeeding up to 6 months of age.
The Philips report also reveals that, although breastfeeding naturally remains the role of the mother, women need support from their wider network of family and friends, including fathers. Unsurprisingly, the study findings show that most of the new mothers surveyed would like their partners to be involved in every aspect of looking after their newborn baby, with 65% saying they wanted their partners to help prepare a bottle feed and nearly as many wanted help with night feeding. Of the fathers surveyed, 81% said they wanted to help in the process and were involved with comforting and checking on the infant's welfare.
However, the findings also show that fathers were underrepresented in some aspects of child rearing: fewer than 50% were involved in cleaning breast pumps and feeding bottles, and only 41% took the time to research how to feed a baby. Hence, 76% of the mothers surveyed said that more information is needed on how partners can support their breastfeeding journey.
Fathers have been named as a recommended target in promoting breastfeeding because there is evidence to suggest that educating fathers on the benefits of breastfeeding can double the likelihood of babies being exclusively breastfed for the first 6 months, which the WHO and Unicef recommend (Mahesh et al, 2018).
Discussion
The health benefits of breastfeeding for both mother and baby are well known, but the Philips report shows that breastfeeding rates around the world are falling, leading to fewer women continuing to breastfeed for the optimum WHO recommended period of 6 months. Philips makes the case that one way of stemming the reduction in breastfeeding among women is to provide better support for breastfeeding mothers. This is especially true among women constrained by time, which Philips suggests can be mitigated by more focused help from partners.
The report shows that women who receive support from a partner are more likely to initiate and continue breastfeeding for longer and that father involvement promotes father–infant bonding, which has several benefits for the child, including reducing cognitive delay and promoting weight gain in the preterm infant. It is in the best interests of the child if breastfeeding is continued for the minimum period of 6 months and all agencies support efforts to enable mothers to do so. Unicef 's Baby Friendly Initiative (https://www.unicef.org.uk/babyfriendly), which promotes breastfeeding, is already embedded within many UK maternity and neonatal units.
In a review of the health benefits of breastfeeding, Grummer-Strawn and Rollins (2015) discussed a range of advantages for the children, not least a lower risk of obesity and asthma. Breastfeeding also has benefits for the mother, including a lower risk of breast cancer, type 2 diabetes and postpartum depression.
Conclusion
The Philips report reaffirms that breast milk is the optimum source of nutrition for newborn babies. Breast milk provides more favourable health outcomes for the infant and mother, which are not solely limited to growth-related, immunological and economic benefits. If the role of fathers can be enhanced throughout the breastfeeding period it may result in women feeding their babies for longer, thus meeting the 6-month optimum recommended breastfeeding period.