Challenge

Breastfeeding is the most natural and beneficial form of nutrition for all newborn however when babies are born preterm, or when the mother has a very low milk supply, breastfeeding can be difficult and alternative methods of feeding breast milk are essential for the infant to gain the benefits of human milk.

Breastfeeding is everybody’s business.  It is a universal, critical part of our physiology and our evolution.

Dr Donna Geddes, UWA

Until now, few interventions have rivalled breastfeeding in promoting the health of a mother and infant. Historically, our knowledge of the lactating breast has come from diagrams drawn in the 1840’s by Sir Astley Paston Cooper. Since then, very little basic research has been carried out on the lactating breast or on breastfeeding despite it being associated with improvements in both the immediate health of the infant and long-term health into childhood and adulthood.

As a result, there are few scientifically founded products on the market designed with the mother or infant anatomy in mind resulting in few evidenced based options available to mothers who wish to continue breastfeeding when returning to work or if separated from their infants.

Dr Donna Geddes, Principal Research Fellow leading the Geddes Hartmann Human Lactation Group at the UWA School of Molecular Sciences began her research into this little understood area in 1997 in an effort to understand the basic mechanisms of human lactation.

Using ultrasound imaging, her research examined:

• breast anatomy
• milk ejection;
• infant sucking dynamics;
• infant stomach emptying; and
• infant body composition.

Whilst ultrasound is used extensively in pregnancy, to look at the foetus and to look at the abnormal breast, it had never been used to study the normal, lactating breast.

Dr Geddes and her team conducted research and together with Medela AG the major funding sponsor, have commercialised three innovative products.  These products provide practical, evidence-based ways to help women with breastfeeding problems as well as provide support to clinicians to enhance breastfeeding and improve the health of the babies they care for.

Solution

Dr Geddes ultrasound studies showed that the anatomy of the human lactating breast did not store the majority of milk close to the nipple for the baby to ‘strip’ or squeeze out as once thought. Instead, a baby first creates a vacuum, and draws the nipple into its mouth. As the mother lets-down, the baby then sucks in a cyclic manner to draw milk out of the breast. The baby uses a parallel tongue action to draw the milk out allowing the nipple to expand and milk to flow. As they suck they co-ordinate their breathing and swallowing to match milk flow from the breast.

In preterm infants, their immaturity prevents them being able to attach well to the breast and create enough suction to remove milk thus they are unable to suck all their feeds. As such, this often delays their discharge from hospital to home. These babies, as well as those whose babies cannot suck from the breast are often offered bottle feeds. With conventional bottle teats, these babies may develop an alternative sucking action, different to feeding at the breast, and may become confused when transferred to the breast meaning some mothers are unable to re-establish breastfeeding.

To clarify the sucking mechanism participants in this research included successfully breastfeeding mothers and infants. This work led to an innovative evidence based ‘Calma feeding solution’ that requires the baby to use a similar action to breastfeeding, potentially allowing the baby to move between the breast and the bottle in a smooth fashion.

“Women are well educated and know that breastfeeding is really good for their babies in both the short and long term and that breastfeeding programs babies for better health later in life.”

Dr Donna Geddes, UWA

Three products were prototyped, developed and commercialised by Medela.

Two features developed out of the research have been incorporated into all of Medela’s feeding solutions:

• to ensure the infant can only remove milk from the teat when it sucks
• to mimic the parallel suction movement of the tongue during breastfeeding. Medela Calma feeding solutions have a graduated thickness, reducing the ability to compress the teat while sucking.

Following from this success, Dr Geddes team are now looking to broaden their research to:

• Further improve milk removal by the baby and the breast pump.
• Develop simple point of care tests for clinicians that will inform them of the health of the breast, milk production and/or the effectiveness of the baby at breastfeeding.
• Clarify the mechanisms by which breastfeeding enhances the baby’s growth and development in both long and short term.

Impact Pathway

The business of breastfeeding is a universal practice and touches families globally.

This research encompassing human anatomy, milk removal from the breast, infant feeding and nutrition has increased the understanding of the importance of breastfeeding; contributing to supporting a practice that literally saves infant lives by providing the best nutrition and protection from infection. The current focus of the research builds upon this knowledge to explore how human milk programmes infants for health later in life.

The new knowledge regarding the anatomy of the lactating human breast has informed the underpinning clinical management of breastfeeding, which has changed as a result of this research.

In the past, women who experienced difficulty with breastfeeding had few options if things didn’t go well. With few specialists in human lactation, this research has brought breastfeeding into the 21st century by the development of an evidence base for both treatment and breastfeeding support products. The research has led to a greater understanding of how breastfed babies remove milk and has shed light on issues associated with breastfeeding problems.

In improving breastfeeding rates and convenience for women, this research is helping to improve the nutrition and health benefits for infants globally in both the short and long term.

If we can give mothers the most effective and comfortable means of expressing their milk when necessary, and provide them the best way to feed expressed milk to their baby to enhance facial development and promote breastfeeding, then I think we are doing a good job with the research.”

Dr Donna Geddes, UWA

Whilst we know that breastfeeding is the healthiest way to feed babies, our culture around breastfeeding is quite different these days, many women still struggle to breastfed, have to go back to work and choose to resume their careers after they’ve had their babies, or have preterm or vulnerable babies that are unable to suck at the breast and cannot feed effectively.

Mothers now have research backed choices to help them to provide breast milk for their baby and continue breastfeeding.

Medela’s belief in and support of the UWA group’s basic research linked nicely with the Swiss company opening an Australian subsidiary in Melbourne in 2000 to facilitate the sale of products to Australian and New Zealand markets.

In addition, Medela have developed education programs based on the research, designed to empower mothers and clinicians in breastfeeding techniques. The novel ultrasound techniques are published online and include tips and videos making the research more accessible.

“Ultrasound provides a window of opportunity for scientists and industry.”

Dr Donna Geddes, UWA

The two Medela feeding products resulting from this research are designed to feed expressed milk in the closest way to breastfeeding to encourage normal tongue movement, nipple positioning and the use of intraoral vacuum to remove milk and the coordination of sucking, swallowing, breathing and pausing.

The development of these evidence-based products has placed this research-based company in the enviable position of being a global player in breastfeeding products and medical vacuum technology. It has created a higher benchmark for others in the support of breastfeeding women.

Dr Geddes and her team maintain a close relationship with Medela and they continue to generously support the research conducted by her team ensuring this research continues to contribute knowledge for the benefit of families and practitioners globally. In addition, a number of UWA graduates have been offered the opportunity to work with Medela and students in the group have been exposed to industry best practices.