Traditional vs. baby-led breastfeeding

“Giving babies regular, short feeds may benefit them and their mothers more than the popular ‘baby-led’ method”, reports The Daily Telegra ph today. That’s according to a study that found regular feeds of up to 10 minutes on each breast led to increased weight gain.

BBC News also covers the study of 63 breastfeeding mothers in Bradford. Half of them were told to use one breast to feed their baby, as and when it wanted being fed, and to only use the other breast if the baby was still hungry. The other half were advised to follow a routine of using each breast for a maximum of 10 minutes at a time, and to feed their baby about every three hours during the day, and on demand at night. The researchers found that babies in the second group were breastfed for longer, and gained more weight from birth to six-to-eight weeks.

These reports are based on a relatively small study, and may not be representative of what might be seen in a larger group of women, or in women from other areas of the country with different backgrounds. However, the study does give some reassurance to mothers that if they find that baby-led breastfeeding does not suit them, or if their baby is not growing as well as it should, that they can try the traditional breastfeeding method as an alternative.

Where did the story come from?

Dr Anne Walshaw and colleagues from hospitals in Bradford and Liverpool carried out the research in conjunction with the University of Bradford. The study received no specific funding. It was published in the peer-reviewed medical journal Archives of Disease in Childhood.

What kind of scientific study was this?

In this cohort (group) study, the researchers compared the effect of traditional breastfeeding to ‘baby-led’ breastfeeding on how much weight the baby gained, and looked at the relationship between weight gain and how long the baby breast fed (no bottle feeding).

Advice to mothers on the best method to breastfeed their babies has changed a number of times over the years. Before 1988 it was recommended that both breasts should be used for up to 10 minutes at a time with regular feeds every three hours during the day, and on demand at night. This advice was changed later the same year, when a study suggested that using this approach could lead to ‘‘overfeeding’’ the babies, lactose intolerance and poor growth. The new advice was that mothers should use baby-led breastfeeding, where the baby is fed on demand from one breast until it stops feeding of its own accord (between 45 to 60 minutes on each breast). The baby is then offered the second breast only if it shows signs of hunger.

However, following the introduction of this method at the researchers’ general practice, there was some concern that weight gain in babies actually suffered. In 1998, this resulted in a decision within the general practice to return to advising mothers to use traditional breastfeeding methods. The researchers then decided to look at routinely collected data from a group that received the baby-led breastfeeding advice, and compared it to a group that were advised to use traditional breastfeeding, to see if there were differences in weight gain.

The researchers identified all the babies born in their general practice area in West Yorkshire between November 1995 and January 2000. They included all babies who were breastfeeding at a health visitor’s routine first visit 10 to 14 days after the birth. Babies who were having difficulty latching onto the breast or had medical conditions likely to affect weight gain or breastfeeding were excluded.

For all babies in the study, mothers were advised to use baby-led breastfeeding for the first 10 days after the birth. After this, mothers were given different advice according to whether their baby was born before October 31 1997 (group one) or after February 1 1998 (group two). There were 32 babies in group one, whose mothers were advised to use baby-led breastfeeding by the health visitor, and 31 babies in group two, whose mothers were advised to change to traditional breast feeding.

Babies were weighed at the first health visit, and weekly for eight weeks, after which mothers could attend a drop-in clinic fortnightly. Data on the baby’s weight gain, and other health data for both mother and baby were routinely collected and recorded and then analysed retrospectively for group one and prospectively for group two.

Mothers were also sent a questionnaire at 16 to 20 months about their baby’s breastfeeding, feed length, frequency, whether both breasts were used, and how long the baby had been exclusively breastfed. The researchers compared maternal and pregnancy characteristics between groups one and two to see if the groups were similar, and then compared baby weight gain, how long the baby had been exclusively breastfed, and other outcomes between the groups.

What were the results of the study?

The researchers found that the groups were similar in the characteristics of the mothers and babies, such as how long the babies had been carried in the womb (gestational age), how many other children the mothers had, and the birth weight of the babies.

Babies whose mothers had been advised to use baby-led feeding were more likely to use one breast at each feed, and to breastfeed for longer than 10 minutes on the first breast than the traditional breastfeeding group.

It was found that babies whose mothers were advised to use traditional breastfeeding were exclusively breastfed for longer than babies whose mothers were advised to use baby-led breastfeeding, and also gained more weight at six-to-eight weeks.

What interpretations did the researchers draw from these results?

The researchers concluded that traditional breastfeeding advice increases the length of time a baby is exclusively breastfed compared with baby-led breastfeeding advice, and leads to improved baby weight gain.

What does the NHS Knowledge Service make of this study?

This study does suggest benefits from advising women to use traditional methods of breastfeeding. However, there are some limitations:

• The study is relatively small, and information was not available for all babies for all outcomes. For example, information on weight gain at six to eight weeks was only available for 86% of babies.
• As the mothers and babies were not randomly assigned to the groups, they may have differed in characteristics that might affect baby breastfeeding and growth. Although the researchers compared the groups for some key characteristics, and found the groups to be similar, this does not exclude the possibility that there were differences in other important characteristics that were not assessed. Examples include the mother’s attitude to breastfeeding, or how much support she received from healthcare professionals.
• The study was carried out in one location only. These results may not be representative of what might be seen in women from other areas.
• Data was collected retrospectively for babies whose mothers were given advice to use baby-led breastfeeding, therefore the reliability of these measures may not be as good as those taken prospectively in the traditional breastfeeding group.
• The two groups of babies were born in different time periods, therefore practices other than breastfeeding may have changed over this period, and this may have affected results.

Different breastfeeding methods may suit different mothers and their babies, and these findings may give some reassurance to mothers that if they find baby-led breastfeeding does not suit them, or if their baby is not growing as well as it should, that they can try the traditional breastfeeding method.

Sir Muir Gray adds...

Single studies are not reliable and this important question needs a systematic review of all the studies of this subject.