The role of fathers in breastfeeding

Men can play an important role when it comes to breastfeeding. Within our monthly topic of “Nutrition”, we wanted to get to the bottom of this issue and talked to a well-known expert in this field, Professor Michael Abou-Dakn, Head of Department at the Clinic for Gynaecology and Obstetrics at the St. Joseph’s Hospital Berlin Tempelhof, Germany.

Expert Professor Michael Abou-Dakn

To what extent do men influence women’s decision to breastfeed their child and the frequency and duration of breastfeeding?
International research and our own studies have shown that both the decisions whether women are going to breastfeed or not, as well as the duration of breastfeeding are very decisively influenced by men (fathers). This is particularly true for educationally deprived strata of society, where the influence of men is even more pronounced. What’s interesting is that the partners’ attitude, negative or positive, is frequently taken over by the women themselves.
We were also able to show that expectant fathers who are only briefly informed about the advantages of breastfeeding in a course and who receive essential information on breastfeeding support, are much more supportive later on when problems arise.

Can you observe any regional differences in this regard (e.g. within Europe) and if so, which?
The studies come from different countries and show similar effects. In particular, the influence of education on the initiation and duration of breastfeeding has been proven in many studies. Unfortunately, this also applies to the motivation of women.

According to current research findings, what are fathers’ reservations about breastfeeding based on?
For the most part it is the unawareness of the negative consequences of not breastfeeding. It’s a common believe that industrial substitute products are equal to natural breast milk, which is not the case. This is simply a misjudgement, because pregnancy itself changes the volume of the breast, and breastfeeding doesn’t have a significant influence. Abroad, the financial situation is often brought to the fore. Fortunately, this is less common in Germany due to existing maternity guidelines.

How has men’s behaviour changed over time and where is it heading (e.g. since the 1950s compared to today)?
The attitude towards the uniqueness of breast milk has changed in recent years for both men and women. Overall we haven’t achieved such a significant change with our breastfeeding promotion if you take in account our goal of encouraging as many women as possible to (exclusively) breastfeed their children, even after the first 6 months. Even after the minimum of an exclusive breastfeeding period of up to 5 months recommended in Germany, no significant changes can be observed in recent decades.

Merely the attitude and the initiation of breastfeeding have improved considerably. However, most men today are more intensely involved and included in health related issues and early child care, compared to the 50s. This is probably due to the changed roles of both parents. The introduction of parental leave for fathers was also very helpful here. Because of Scandinavian research we know, that this leads to fathers feeling more deeply involved into parenting, and from own research I can affirm you, that men have an increasing interest in health related aspects during pregnancy and postpartum period. This can be used for corresponding educational work, which is already done by the German network for young families (Netzwerk Junge Familie), the European Foundation for the Care of Newborn Infants (EFCNI), and the German Federal Center for Health Education (BZgA).

To what extent can fathers encourage their partner to breastfeed and positively support her breastfeeding behaviour?
As so often, it is primarily about a positive emotional support of the partner. Pressure, no matter in which direction, is always stressful and often leads to a difficult start to breastfeeding. I am convinced that every woman can breastfeed and every child wants to be breastfed, but often the beginning is not easy and can contribute to failure. Partners who lovingly and empathetically accompany their wife are particularly helpful. This also means that women are relieved in everyday life. We were also able to show that men who are informed about breastfeeding problems and who have got to know and understood suggestions for solutions, as well as midwives or experts in breastfeeding, are helpful counsellors who can motivate their women to continue breastfeeding even in the case of initial irritations.

Special thanks to

Professor Michael Abou-Dakn
Head of Department at the Clinic for Gynaecology and Obstetrics
St. Joseph’s Hospital Berlin Tempelhof


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Lighthouse Project: Human milk is the best for infants

A guest article by Dr Margarita Tzaki, Director of the Neonatology Department / NICU at ELENA VENIZELOU hospital in Athens, Greece

The ELENA VENIZELOU hospital in Athens, Greece, was founded in 1935 from a donation for the benefit of mothers and newborn babies. It was designed to provide the best care for them, so practicing rooming-in, based on the model of a maternity hospital in Lausanne, has been the only choice ever since its opening. In 1945, the neonatal intensive care unit (NICU) opened and in 1947, the first human milk bank was established to promote breastfeeding and provide breast milk to preterm babies.

Historical photo (c) ELENA VENIZELOU hospital

Medical literature from the early 1980’s and the tradition in hospital were the driving forces to feed preterm babies, from 1990, with fresh human milk from their mothers or pasteurised donor milk from mothers who had given birth in the hospital and who voluntarily donated their excess milk. Neonatologists and midwives from the neonatal intensive care unit and human milk bank supported women in breastfeeding. Through these years, it has become evident that providing human milk in the NICU is very rewarding for mothers and infants because they tolerate human milk feeding very well, reach full feeding quickly and we rarely see cases of necrotizing enterocolitis (NEC). In a group of extremely preterm babies under 27+0 weeks of gestational age that we studied from 2001 to 2012, among 222 babies with mGA* 25+1 and BW (birth weight) 795+168, the survival rate was 47.5% and the NEC rate was only 2.15%.

Breastfeeding supports the bonding process (c) ELENA VENIZELOU hospital

Although resources are limited in the hospital, through continuous education of health care personnel in the field of breastfeeding, its promotion in the well-baby nursery (a Baby-Friendly Hospital (BFH) since 2011) and in the NICU make a difference in the bonding process and in the early and long-term outcome. From 2015, doctors and nurses were educated in family-centred developmental care and from 2016, we implemented the FINE (Family and Infant Neurodevelopmental Education) programme in our practice in the NICU. This new approach resulted in happy babies and parents. It was really impressive to see that, after the implementation of practices that increase the contact with the parents, like Kangaroo care, extremely and low birth weight infants latched on to the nipple and were breastfed from 30-31 weeks corrected age. They were also discharged home at 36 weeks corrected age when parents knew their babies cues and were ready to take them home.

We really need a change in attitude, education and only very limited resources to promote breastfeeding in the NICU and to improve early and long term outcomes of the “graduates” of our intensive care units as well as the well-being of their families.

*mGA: mean value of birth weight according to the reference

View more (website HELENA VENIZELOU hospital)

Special thanks
Dr Margarita Tzaki
Director, Neonatology Department / NICU
ELENA VENIZELOU hospital in Athens, Greece


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Breastfeeding during vaccinations reduces pain

Essential, but painful: needles are used for babies’ early childhood vaccinations and medical care during childhood illnesses. They cause distress for the babies and often also for their parents and caregivers, and can result in future anxiety and fear about needles. Researchers around Harrison et al. examined if breastfeeding reduces vaccination pain in babies aged 1 to 12 months. The results were published in the Cochrane Database for Systematic Review

Painful procedure - blood samplingIn an intervention review in February 2016, the Canadian scientists searched the medical literature for studies of randomised controlled trials (RCTs) examining the effectiveness of breastfeeding babies beyond the neonatal period up to one year of life during the use of needles. They compared the effectiveness of breastfeeding in reducing pain (as scored by crying time and pain scores), to parental holding, skin- to-skin contact, babies lying flat, the giving of water or sweet solutions, placebo, other interventions, and to no intervention. For the data collection and analysis, they searched several scientific databases and identified 10 studies with a total of 1066 infants aged 28 days postnatal to 12 months. All studies examined if breastfeeding reduced pain during vaccinations. 

The results showed that breastfeeding reduced crying in young babies having vaccinations compared to no treatment, oral water, and other interventions such as cuddling, oral glucose, topical anaesthetic, massage, and vapocoolant spray (“cold spray”). On average, breastfed babies cried for 38 seconds less than babies who were not breastfed and pain scores were significantly lower. There was no evidence that breastfeeding had an effect on physiological responses, such as heart rate. No studies reported on any harm while breastfeeding healthy babies during vaccinations (based on low-quality evidence).

No studies included in this review involved populations of hospitalised infants undergoing skin-breaking procedures. Because the studies only evaluated the effects of breastfeeding during vaccination, more evidence is needed to learn if breastfeeding helps older babies in hospital during blood work or procedures such as the insertion of drips. 

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