Abstract
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It is clear to all that the jury is in and all the data support the conclusion that feeding human milk to infants as compared with providing formula substitutes results in improved short- and long-term health outcomes. To date, however, there is still insufficient data to conclude to what degree the benefits are related to feeding of fresh mothers own milk (MOM) and to what degree the processes of collection, pasteurization, storing freezing, and thawing impacts on the clinical outcome.
Simply put, we cannot as yet calculate to what degree the specificity of MOM is the key factor in accounting for the protective benefits of human milk. The importance of distinguishing between MOM and donor milk for the high-risk premature infant was recently reviewed by Paula Meier in an article 1 entitled: Donor Human Milk Update: Evidence, Mechanisms, and Priorities for Research and Practice and she concluded that there is urgent need to ascertain which benefits can be attributed to which type of milk. As such, the two articles in this issue of Breastfeeding Medicine by Meng et al. 2 who studied the effect of storage of pasteurized milk and by Cortez and Soria 3 who focused on the effect of freeze drying on a variety of bioactive and nutritional factors of breast milk are more than welcome. The data from these studies hopefully will further move us along in developing a rational practical clinical protocol so we can maximize the availability and quality of human milk feedings.
Shifting gears, the subject of what are the factors that influence the mother's decision-making process to nurse, and to what degree of exclusivity, is addressed by three articles in this issue. Zhu et al. 4 focus on the issue of association of family support and exclusivity of breastfeeding, whereas Keller et al. 5 explore the impact of maternal personality factors and how they potentially impinge on the development of mother–infant attachment and the desire and/or success to breastfeed.
Most intriguing, and to a certain degree somewhat disturbing, is the report of Ukah et al. 6 who studied the relationship between adverse childhood experiences and the rates of breastfeeding initiation and exclusivity. The fact that there are long-term consequences of childhood adverse effect on adult decision-making is in itself fascinating, and confirms again the importance of one's personal psychosocial pediatric history in the decision-making process as an adult. Apparently adverse childhood experiences such as (i) spending 2 weeks or more in the hospital, (ii) having divorced parents, (iii) having parents unemployed for a long time, (iv) that something happened that scared you, (v) that you were sent away from home for doing something wrong, (vi) that there are family problems because of parents abusing alcohol or drugs, or (vii) physically abusing someone close to you impact on those functioning as an adult.
This reality clearly challenges medical personnel such as obstetricians and midwives who are involved in discussing and motivating mothers as to their ultimate decisions regarding breastfeeding, and highlights the need to delve a bit deeper into the medical and psychosocial history of mothers so as to understand their underlying thought processes. We should remember that as long ago as in 1802, William Wordsworth wrote that the “Child is father of the Man” and clearly today this is in no less a reality, especially when it comes to decisions as to relationships and attachments to next generation, let alone be it for breastfeeding or not.