Challenge

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

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

Donna Geddes

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 short and long term health of infants.

As a result, there have been few scientifically tested products on the market designed with mother or infant anatomy in mind and few options available to mothers who wish to continue breastfeeding when returning to work or separated from their infants.

Dr Donna Geddes, Senior Research Fellow working in the 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; and
• infant sucking dynamics.

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 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’ 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 motion to draw the milk out. As they suck they co-ordinate their breathing and swallowing to match milk flow from the breast.

In pre term 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 of their feeds.  As such, they are often delayed from hospital discharge.  These babies, as well as those whose mothers whose babies cannot suck from the breast are often offered bottle feeds.  With conventional bottle teats, these babies may experience nipple confusion when transferred to the breast meaning some mothers are unable to re-establish breastfeeding behaviours.

Participants in this research included successfully breastfeeding mothers and infants to clarify the sucking mechanism. This work led to an innovative evidence based ‘Calma feeding solution’ that uses 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.”

Donna Geddes

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 sucked.
• 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, Donna’s team are now looking to broaden their research to:

• Explore feeding solutions for mothers and babies struggling to breastfeed.
• Develop simple point of care tests for clinicians that will inform them of the health of the breast and/or the effectiveness of the baby at breastfeeding.
• Study obesity and how babies are programmed during pregnancy and in the first two years of life to set them up to have the best chance of appetite regulation and neural pathways to regulate their own intake later in life.

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 saves literally saves infant lives by providing the best nutrition and protecting from infection.  The current focus of the research explores how it 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 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 problematic breastfeeding.

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”

Donna Geddes

Whilst we know that breastfeeding is the healthiest way to feed babies, our culture around breastfeeding is quite different these days where women often have to go back to work, choose to resume their careers after they’ve had their babies, or have pre-term babies that are underdeveloped 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 the group’s basic research led to 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.”

Donna Geddes

The two Medela feeding products resulting from this research are designed to feed expressed milk in the closest way to breastfeeding to encourage normal facial, oral and skull development, and reduce the risk of malocclusion and sleep disorders.

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.

The use of the Calmita feeding solution in hospital for pre-term infants has resulted in earlier discharge.  Not only does this benefit hospitals with economic savings but more importantly it supports families in bringing their babies home earlier; which is better for the health of the baby.

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.