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Formula Milk Supplementation on the Postnatal Ward: A Cross-Sectional Analytical Study

Brighton and Sussex Medical School, Brighton BN2 5BE, UK
Royal United Hospital, Combe Park, Bath BA1 3NG, UK
Department of Paediatrics, Imperial College Healthcare NHS Trust, London W2 1NY, UK
Department of Paediatrics, Saint-Petersburg State Paediatric Medical University, 194353 Saint-Petersburg, Russia
inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), 6010 Park Ave, West New York, NJ 07093, USA
Faculty of Pediatrics, I. M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
Author to whom correspondence should be addressed.
Authors contributed equally to this work.
Nutrients 2018, 10(5), 608;
Received: 6 April 2018 / Revised: 26 April 2018 / Accepted: 9 May 2018 / Published: 14 May 2018
(This article belongs to the Special Issue Breastfeeding and Human Lactation)
PDF [1008 KB, uploaded 14 May 2018]


Breastfeeding rates are low in the UK, where approximately one quarter of infants receive a breastmilk substitute (BMS) in the first week of life. We investigated the reasons for early BMS use in two large maternity units in the UK, in order to understand the reasons for the high rate of early BMS use in this setting. Data were collected through infant feeding records, as well as maternal and midwife surveys in 2016. During 2016, 28% of infants received a BMS supplement prior to discharge from the hospital maternity units with only 10% supplementation being clinically indicated. There was wide variation in BMS initiation rates between different midwives, which was associated with ward environment and midwife educational level. Specific management factors associated with non-clinically indicated initiation of BMS were the absence of skin-to-skin contact within an hour of delivery (p = 0.01), and no attendance at an antenatal breastfeeding discussion (p = 0.01). These findings suggest that risk of initiating a BMS during postnatal hospital stay is largely modifiable. Concordance with UNICEF Baby Friendly 10 steps, attention to specific features of the postnatal ward working environment, and the targeting of midwives and mothers with poor educational status may all lead to improved exclusive breastfeeding rates at hospital discharge. View Full-Text
Keywords: breastfeeding; attitudes; knowledge; midwifery; formula supplementation; justification of supplementation breastfeeding; attitudes; knowledge; midwifery; formula supplementation; justification of supplementation

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Biggs, K.V.; Hurrell, K.; Matthews, E.; Khaleva, E.; Munblit, D.; Boyle, R.J. Formula Milk Supplementation on the Postnatal Ward: A Cross-Sectional Analytical Study. Nutrients 2018, 10, 608.

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