Why is Early Initiation of Breastfeeding Important?

Early Initiation of Breastfeeding: The Best Start for Every Newborn

The World Health Organization (WHO) recommends that a baby initiates breastfeeding within the first hour of birth to lower the risk of death and disease and make them more likely to continue breastfeeding.

Initiation of breastfeeding in the first hour takes advantage of the hormonal changes that occur immediately after delivery; in particular, the high levels of prolactin and oxytocin. When a baby suckles at the breast, sensory impulses pass from the nipple to the brain. In response, the anterior lobe of the pituitary gland secretes prolactin and the posterior lobe secretes oxytocin.

Prolactin’s Role – Primary Function is to Make Milk

During pregnancy, prolactin stimulates the growth and development of mammary tissues in preparation for milk production. However, the high levels of progesterone during pregnancy inhibit the release of milk. Once both the baby and placenta are delivered, there is a drastic decrease in progesterone and a significant increase in prolactin. Prolactin levels are further elevated by the sucking stimulus.  This surge of prolactin helps to drive production of high milk volumes. When a mom has early, effective, and frequent sucking stimulation to the nipple, increased prolactin levels at this opportune time help drive milk production that is sufficient to meet the long-term volumes required for exclusive breastfeeding.

Prolactin levels decrease over time, so taking advantage of these high prolactin levels immediately after delivery is critical to long-term milk production.

Prolactin, driven by the sucking stimulus, is highest about 30 minutes after the beginning of the feed, so its most important effect is to make milk for the next feed. During the first few weeks, the more a baby suckles and stimulates the nipple, the more prolactin is produced and then more milk is produced.

Oxytocin's Role - Primary Function is to Release Milk

Oxytocin makes the myoepithelial cells around the alveoli contract. This makes the milk, which has collected in the alveoli, flow to and then fill the ducts.

The oxytocin reflex is often referred to as ‘letdown’ and is driven by a mother thinking of her baby, smelling her baby, hearing her baby cry, anticipating the next feed, and the sucking stimulus – to name a few. This is one reason why it is so important to keep mother and baby together immediately after delivery and as much as possible after that.

Oftentimes when a baby is breastfeeding, a mother will notice uterine contracting. This is normal and is caused by the same type of smooth muscle cell contraction that is happening in the breast when suckling is induced.

In a systematic review, studies noted a correlation between oxytocin levels and milk yield, and milk yield correlated with the number of breastfeeding-induced oxytocin pulses during early breastfeeding.

Proven Benefits of Breastfeeding and Updated AAP Recommendations

Hand expression can always be used in conjunction with sucking, but should never be used as an alternative to an effective breastfeeding baby or a pump.  Suction helps drive prolactin surges. Hand expression only provides compression; not suction.  Through advances in research that have helped us to better understand breast anatomy and evaluation of an infant’s sucking pattern through ultrasonography, milk removal depends more on the baby’s ability to create a vacuum (suction) between the tongue and the soft palate, rather than the movement (or stripping) of the tongue itself.

Taking advantage of the hormone shifts immediately after delivery by allowing a baby to breastfeed early and frequently contributes to the overall long-term breast milk production that allows a mother to exclusively breastfeed for the first six months, as recommended by the American Academy of Pediatrics (AAP).

 In July 2022, the AAP published updated breastfeeding policy recommendations which include:

• Breastfeeding exclusively until six months of age and then continued breastfeeding for up to two years of age and beyond (previously 1 year).
• Birth hospitals or centers implement maternity care practices that improve breastfeeding initiation, duration, and exclusivity for all mothers and infants no matter their race, ethnicity or gender.
• Health benefits from breastfeeding are significant and can be viewed as a long-term investment not only in a child’s development, but also in the mother to reduce the incidence of chronic conditions and cancer, and to public health as a whole.

Repeated exposure to oxytocin with each episode of breastfeeding contributes to the lifelong benefits of breastfeeding for mother and baby, and it may even counteract some negative consequences of medical interventions. Research shows long-term maternal benefits for different types of cardiovascular disease, including myocardial infarction, stroke, hypertension, diabetes type 2, breast cancer, ovarian cancer, and endometrial cancer to name a few. Longer duration of breastfeeding shows increased effectiveness against these diseases.

Medela has recently released two simple videos (one for the parent and one for the clinician) that help to understand the importance of initiation.  Please take a moment to review these and share with your patients as you see appropriate.

• Helping Moms Initiate Breast Milk Production
• Initiating Breast Milk Production

Thank you for all you are doing to improve the lives of all mothers and babies!

References

1. https://www.who.int/health-topics/breastfeeding#tab=tab_2
2. Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: World Health Organization; 2009. SESSION 2, The physiological basis of breastfeeding. Available from: https://www.ncbi.nlm.nih.gov/books/NBK148970/
3. Uvnäs­Moberg K, Ekström-Bergström A, Buckley S, Massarotti C, Pajalic Z, Luegmair K, et al. (2020) Maternal plasma levels of oxytocin during breastfeeding—A systematic review. PLoS ONE 15(8): e0235806. https://doi.org/10.1371/journal.pone.0235806
4. D.T. Geddes et al. Tongue movement and intra-oral vacuum in breastfeeding infants. The Journal of Early Human Development (2008) 84, 471–477
5. Elad D. et al. Biomechanics of milk extraction during breast-feeding. Proceedings of the National Academy of Sciences of the United States of America 2014, 111(14): 5230-5235
6. Moberg K, Prime D. (2013) Oxytocin effects in mothers and infants during breastfeeding. Infant 9(6): 201-206.
7. Meek JY, Noble L. Technical Report: Breastfeeding and the Use of Human Milk. Pediatrics. 2022;000(0):e2022057989
8. Joan Younger Meek, Lawrence Noble, Section on  Breastfeeding; Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics July 2022; 150 (1): e2022057988. 10.1542/peds.2022-057988