We all know breastmilk is the optimal food for a newborn baby. It’s also very clear leading health organisations recommend babies be exclusively fed breastmilk for the first six month after birth.

Thanks to research, we know formula supplementation can have a negative impact on breastfeeding. Babies given formula in hospital – especially in the early days after birth – can affect how breastfeeding is established and how long breastfeeding continues.

To help promote breastfeeding and support new mothers, many countries have adopted the Baby-Friendly Hospital Initiative (BFHI).

The BFHI has strict guidelines about formula supplementation for breastfed babies. For hospitals to be eligible for BFHI accreditation, the exclusive breastfeeding rate on discharge from hospital must be at least 75%.

6 Factors Linked To Babies Given Formula In Hospital: Study

Recently published research discovered, however, not all babies born at BFHI accredited hospitals are exclusively breastfed.

The researchers looked at 1,530 babies born at a BFHI accredited hospital in Dunedin, New Zealand. It was found 15% of these babies were supplemented with formula during their stay in hospital following birth.

Although there might be a need for formula supplementation in some babies, due to medical problems, there’s evidence to show in many cases it is not done for clinical reasons – for example, where a baby is losing weight, or a mother is medically unable to breastfeed.

The research, published in the Journal of the College of Australian Midwives, also looked into the factors associated with formula supplementation of breastfed babies in hospital.

Here are 6 factors which can affect the chances of breastfed babies being given formula in hospital:

#1: Maternal Weight

Overweight and obesity have become significant global health problems in the last decades. Research now shows a link between women having a high BMI and reduced breastfeeding initiation and duration.

For example, an Australian study found babies born to obese mothers were 2.3 times more likely to be supplemented with formula. This is believed to be due to overweight and obese mothers experiencing a delay in their milk coming in.

The NZ study showed BMI significantly predicted whether or not formula supplementation would occur; each unit increase in BMI was associated with an increase in the chance of formula supplementation.

#2: First Time Mother

Previous research has shown babies born to first time mothers are more likely to be given formula supplementation in hospital.

The recent study of NZ babies confirmed this: being a first time mother was associated with a significant increase in formula supplementation.

#3: Use Of Pain Relief

Several studies have found a link between epidural use and increased formula supplementation. This might be because of the potential negative effect of epidurals on the breastfeeding behaviours of newborns, but further research is needed.

The recent study showed a mother receiving pain relief during labour was associated with an increase in the odds of formula supplementation in hospital.

#4: Birth Gestation And Birth Weight

The number of weeks gestation babies are born, and their birth weight, can also be risk factors for formula supplementation.

In accord with hospital policy, when babies are born late preterm (35-37 weeks) and/or weigh less than 2.5kg, they are tested for low blood sugar levels. Where the levels are below a certain threshold, this could indicate the reason for formula supplementation being given. The Academy of Breastfeeding Medicine, however, tends to recommend intravenous glucose rather than formula supplementation.

In the case of these babies, it would be expected they are likely to have higher formula supplementation rates compared with babies born full term (37 weeks and beyond) and have a weight greater than 2.5kg .

In the recent study, each week of increasing gestational age was associated with a reduction in the odds of formula supplementation by 0.67. Also, a birth weight of less than 2.5kg was significantly associated with formula supplementation.

#5: Skin-To-Skin Contact

An important step in helping to get breastfeeding off to the best start possible is immediate skin-to-skin contact between a mother and her baby at birth.

An Australian study found for every hour breastfeeding initiation was delayed there was a marked increase in breastfeeding difficulties.

It takes an average of 62 minutes for a baby to go through the nine identifiable behavioural phases to locate the breast when left in undisturbed skin-to-skin contact immediately after birth.

It has also been found allowing babies to go through all of these nine phases during skin-to-skin contact meant they were more likely to be exclusively breastfed on discharge from hospital. The longer the duration of skin to skin contact, the higher were the rates of early exclusive breastfeeding.

The recent research found a delay of greater than 91 minutes in skin-to-skin contact was associated with a significant increase in the odds of formula supplementation.

#6: Use Of Synthetic Oxytocin

Synthetic oxytocin is commonly used to induce or augment labour, to assist in the birth of the placenta, and to control bleeding after delivery.

One large study has found the use of synthetic oxytocin for controlling bleeding after delivery was associated with a 6-8 % reduction in breastfeeding at 48 hours after birth.

Another study found maternal release of oxytocin, in response to suckling on day two, was reduced among women who were exposed to synthetic oxytocin used for augmentation of labour.

The recent study found use of synthetic oxytocin was associated with 2.39 odds for formula supplementation.

Common Reasons For Formula Supplementation

In the study, the most common reasons given for formula supplementation were:

Delay in milk coming in, which was associated with: first time mothers; birth other than normal vaginal delivery; the use of pain relief during delivery; and a longer delay before skin-to-skin contact was initiated.
‘Maternal request’ for formula, which was associated with lower maternal age and a shorter duration of skin-to-skin contact.
Low blood sugar, which was associated with non-use of pain relief in the delivery, earlier gestation and lower birth-weight.
For some babies (27%), there was no recorded reason for formula supplementation.

This study provides evidence there are still many babies receiving early formula supplementation, despite leading health organisations recommending exclusive breastfeeding from birth to six months.

Although a 15% rate of formula supplementation might appear acceptable by BFHI standards, the results of this study show there is clearly a lot of room for improvement.

It’s possible many mothers with the risk factors identified in this study could receive additional education and support in the immediate period after giving birth, to help with breastfeeding initiation and success.

In some circumstances, the antenatal expression of colostrum might be appropriate. In a large number of cases, the reason for supplementation was not recorded; this also suggests there is potential for improved outcomes and better documentation.