The theme of World Breastfeeding Week in 2024 is “closing the gap,” with a focus on providing support for all. Part of that support involves having the appropriate information, and a pair of new studies from the Yale School of Medicine aims to do just that.
In one, people who used pumps provided human milk to their children for an average of 21 weeks longer than those who did not. In another, researchers indicated that human milk was better for infants’ intestinal development than formula.
Let’s stop there for a second. The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) are among the health organizations that suggest providing human milk to a child for at least two years (and beyond if mutually desired).
However, meeting those marks can be challenging for various reasons, including lack of societal and systemic support (see: No paid leave in this country, and that’s just the tip of the iceberg.) So, we’re saying it here—and we’ll say it again: You are not a bad parent if you are scrolling through this thinking, “But wait, I formula fed.”
“I encourage all [parents] to breastfeed and/or pump to provide breast milk for their babies and to give themselves grace if they can’t provide human milk exclusively for their baby,” says Jenelle Ferry, MD, a board-certified neonatologist and director of feeding, nutrition and infant development at Pediatrix Medical Group. “We are fortunate to have safe alternatives with formula. Breast milk definitely has benefits that can’t be replicated by formula, and formula will still ensure that a baby gets appropriate nutrition to grow and thrive.”
And by the way?
“I think it’s also important for [parents] to realize that any amount of breast milk they’re able to provide, including in combination with formula, provides benefits to their baby—it doesn’t have to be all or none,” Dr. Ferry says.
In other words, there are various ways to feed a baby, and it’s OK to go with what works for you. Part of informed support is having the correct information so that you can make a decision you feel comfortable with.
That being said, we discussed this new research with the studies’ authors and had pediatricians and feeding experts share actionable tips for new parents hoping to provide exclusive or some human milk for their babies.
- Spectra S1 Plus Electric Breast Pump
This double electric breast pump is a top choice for moms looking to efficiently express milk. It’s portable, quiet, and has a rechargeable battery, making it ideal for both home and on-the-go use. Spectra S1 Plus Electric Breast Pump - Lansinoh Breastmilk Storage Bags
These pre-sterilized, BPA-free bags are perfect for storing and freezing breast milk. They have a double zipper seal to prevent leaks and are designed to lay flat for easy storage. Lansinoh Breastmilk Storage Bags - Medela Harmony Manual Breast Pump
A lightweight, portable, and affordable option for moms who need a manual pump for occasional use. It’s easy to use and mimics the natural sucking rhythm of a baby. Medela Harmony Manual Breast Pump - Haakaa Silicone Breast Pump
This simple, one-piece silicone pump is perfect for catching let-down milk on one side while nursing on the other. It’s easy to clean, portable, and doesn’t require any electricity or batteries. Haakaa Silicone Breast Pump - Earth Mama Organic Nipple Butter
An excellent organic option for soothing sore nipples. Made with natural ingredients, it’s safe for both mom and baby, and doesn’t need to be washed off before nursing. Earth Mama Organic Nipple Butter
These products can be found on Amazon and could greatly support parents in their breastfeeding journey.
Pumping and Lactation Duration
Deanna Nardella, MD, and her team work in pediatric primary care clinics and neonatal intensive care units. She noticed a key problem.
“We often care for families who are unable to access the breastfeeding support they need when they need it most,” Dr. Nardella explains. “We see this lead to physical and mental struggles for parents and, ultimately, unmet personal infant feeding goals.”
Dr. Nardella and her fellow authors anecdotally noticed an uptick in families pumping when the Patient Protection and Affordable Care Act mandated insurance coverage for pumps in 2012, giving more families access to the tool for removing milk when a dyad is separated.
“Despite the observed increase in pump use over the last decade, little is understood about how pump use actually impacts breastfeeding outcomes,” Dr. Nardella says. “We set out to better understand the relationship between pump use and breastfeeding duration.”
Using data from the Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System, the researchers examined a sample of nearly 20,000 U.S. lactating people from 2016-21. They assessed the prevalence of pump use and how long the people provided human milk to their children.
Dr. Nardella says the researchers found that:
- More than 91% of them used a pump to extract milk.
- Women who reported using a pump at any point lactated for five months (21 weeks) longer than those who didn’t.
- Pump use was linked to a 37% lower risk of lactation cessation on average, with non-Hispanic Black and Native American—who have the lowest lactating rates in the country—people experiencing the most significant benefits.
The study has some limitations, including a lack of specifics on the type of pump parents were using (Single or double? Electric or manual?) Dr. Nardella also says the link between lactation duration and pump use is indirect.
“We cannot infer that this relationship is causal, meaning that pump use directly causes longer breastfeeding durations,” Dr. Nardella says.
Still, the results don’t surprise outside experts.
“In an ideal world, the infant and parent would remain together feeding early and often in these weeks to facilitate that process, but many factors cause separation or cessation of direct at-the-breast feeding in the early weeks,” says Demi Lucas, IBCLC and Clinical Manager at The Lactation Network, a network of insurance-covered lactation consultations.
These include:
- Return to work/school (“Many birthing parents in America do return to work quite early compared to other countries with higher breastfeeding rates and longer maternity leaves,” Lucas says.)
- Difficulty with latching or painful
- NICU stays
- Poor support
“When that disruption or cessation occurs, pumps can play a role in increasing the breastfeeding duration as compared to a parent who runs into these issues and doesn’t have a breast pump,” Lucas says.
Find Support in Choosing and Using a Pump
Dr. Nardella hopes the study will foster more awareness of and policy efforts designed to help parents who pump to help promote “equitable breastfeeding outcomes.”
More awareness could lead to more people seeking a pump, such as through their insurance company. There are many on the market.
“A double electric hospital-grade pump is going to be the most efficient pump for most women,” Dr. Ferry says. “This allows you to pump both breasts at the same time. Most insurances now cover the cost of a good pump, as do WIC programs. If you’re waiting for the delivery of a pump or only need one for a short time, most hospitals with a maternal delivery service also rent pumps.”
To maximize output, Dr. Ferry says a good baseline is removing milk via pump any time the baby eats (through a bottle), though some people may need more frequent sessions.
“Pumping and/or feeding six to 10 times a day is important for continued milk production,” Dr. Ferry says. “If you’re unsure of how to best use your pump or have difficulty with flange fit, your local lactation consultant can be an important resource.”
Human Milk and Digestion
Get ready, people who love science—this study design is pretty cool.
“We made mini-guts (organoids) from human small intestinal tissue and grew them in their regular media or media supplemented with breast milk, donor milk, standard formula, or partially hydrolyzed formula,” says Dr. Liza Konnikova, MD, PhD, a corresponding author for Yale School of Medicine’s study on digestive health.
From there, the researchers measured the “health” of the mini-guts based on factors like:
- Size
- Growth rate
- Bud formation
- Cells found within the mini-guts
“We found that human milk supplementation resulted in more proliferative, larger mini-guts and stimulated factors needed for immune protection of the intestine,” Dr. Konnikova says. “Breast milk additionally stimulated a specific subtype of an intestinal cell, the enteroendocrine cells, that make hormones needed for motility and metabolic function of the intestine. Conversely, supplementation with formula resulted in less developed organoids, a decrease in factors needed for growth, and upregulation of inflammatory factors.”
Again, there were limitations.
“We utilized parental milk from a single source, and there could be some individual variability in how human milk affects intestinal health,” Dr. Konnikova says. “Additionally, there is variability between organoid lines developed from different human samples.”
However, Dr. Konnikova says the results were consistent. The sample size was only males, and she says future studies to evaluate female tissues could assess for sex-specific differences.
Still, outside experts say the research supports previous studies and thoughts on human milk’s positive effect on gut health.
“Human milk contains a variety of bioactive components, such as growth factors, hormones, and antibodies, which promote the growth and differentiation of intestinal cells,” says Daniel Ganjian, MD, FAAP, a board-certified pediatrician at Providence Saint John’s Health Center. “These components help in developing a healthy gut microbiome and enhancing the immune system.”
How To Find Lactation Support
Nursing can be hard. Quick personal story: If you told me 2.5 years ago that my now-toddler and I would be going strong, I would’ve laughed rather loudly to keep from crying. But here we are with no regrets or end in sight.
Support can be hard to find, but it’s important. Lucas actually suggests people interested in giving lactation a go reach out during their pregnancies.
“When a breastfeeding parent is struggling with nursing and/or pumping, they need to know who they can trust and turn to—that is the role of the IBCLC,” Lucas says.
It can be helpful to have their number on hand if you run into issues or even set up an appointment when you get home from the hospital or birthing center (they can even meet you there).
Whether you took this step or not, don’t be scared to continue to reach out for ongoing support. Dr. Ferry says your pediatrician can also help you find groups and International Board Certified Lactation Consultants (IBCLCs) if they aren’t certified themselves. Peer-to-peer assistance can help you feel less alone.
“Even experienced breastfeeders can struggle, as each baby is unique, and your body continues to change,” Dr. Ferry says. “Changes in latch holds, diet and hydration, feeding/pumping frequency, pump type, and flange size are just some examples of what your physician or lactation consultant might recommend.”
And if it doesn’t work out? As promised, here it is again, this time from a board-certified pediatrician.
“The decision to use formula is often made during a vulnerable time, and it’s important to prioritize the well-being of both the baby and the parent,” says Dr. Ganjian. “Being informed and supported is what truly matters. Formula feeding can be a healthy and viable option, and no one should feel guilty for making the best choice for their family.”