Poland pioneers breastfeeding research

Up to 97 per cent of Polish women breastfeed their children. This is the highest number in Europe. Poland also conducts pioneering research on the composition of breast milk.

Only three percent of Polish women decide not to breastfeed after childbirth, while almost every second mother in other EU member states begins feeding their children with infant formula, which is less nutritious for the baby. Breastfeeding is also supported by the special legislation – the maternity care standard, adopted in 2012, is deemed a textbook model care in Europe. For several years now, breast milk banks have been in operation, and one of them – located at the Voivodship General Hospital in Toruń – conducts breast milk tests. The surprising results of these tests, presented at scientific conferences, could re-write medicine textbooks. In an interview with Poland.pl, Dr Urszula Bernatowicz-Łojko, the head of the research programme, said that breast milk is much more nutritious and calorie-rich than was previously thought.

Poland.pl: Under your supervision, the Breast Milk Bank at the Voivodship General Hospital in Toruń runs unique and pioneering work on testing the breast milk of women who breastfeed for over a year. What are your conclusions after two years of research?

Dr Urszula Bernatowicz-Łojko: The Breast Milk Bank at our hospital, established two years ago, has a special analyser, the first one in Poland, which allows for a very quick – two-three minutes long – analysis of the composition and nutritious values of the milk that is delivered to the bank. As the bank is located near the Neonatal and Neonatal Intensive Care Ward, we use it also to test the breast milk of women who pump their breast milk for their pre-term newborns. This enables the selection of nutrition for each child individually – to determine whether it requires parenteral nutrition or the so-called breast milk fortifier. To this day, we have done over 3,000 tests, which showed how nutritious breast milk is. It turns out that the levels of protein, fat, and calories is often much higher than the numbers quoted in textbooks. With the analyser at our disposal, we also decided to test the breast milk of women who been breastfeeding for over a year. I initiated the testing of breast milk of women who have been breastfeeding for over a year. I have been a breastfeeding consultant for over 20 years, and I have frequently seen concerned, sometimes crying, mothers, whose family members or medical personnel criticised them and said that they are feeding their babies with subpar food. In the past, I could only examine the baby, order biochemical blood tests, and in this way prove that the baby is healthy, well-nourished, and that is developing properly. I had no way to analyse the breast milk, so it was difficult to refute the myth of the alleged “good-for-nothing” milk of these women. Even the global literature has little or no information on the nutritious characteristics of the breast milk of mothers who have been breastfeeding for over a year.

I gather that the analyser gave you scientific arguments?

When we bought the analyser, I thought that I have a debt to pay to these mothers. This is why we made an announcement on the fanpage of our Breast Milk Bank on Facebook that we are looking for breastfeeding women who have been breastfeeding for over a year, to take part in our research project. To our surprise, we have received over 50 applications and more women are still coming. Our tests showed that the breast milk of mothers who have been breastfeeding for over a year is still very nutritious. It is not water, as many medical professionals and people from the parenting communities used to think. It is a nutrient-rich type of food, the composition of which bears a strong resemblance to the breast milk of a mother whose baby was born pre-term. Our discovery has attracted interest from all over the world. It turned out that we are one of the very few centres in the world that runs such tests.

Your research has provided other interesting conclusions.

Our samples are also tested for the presence of biologically active components. This part of the research is conducted together with scientists from the Faculty of Chemistry at the Gdańsk University of Technology. It turns out that the breast milk of mothers who have been breastfeeding for over a year contains huge amounts of very important oligosaccharides, immunoglobulin A (IgA), lysozyme, lactoferrin, some cytokines, and also long-chain essential fatty acids, which are very important for the proper development of the nervous and immune systems. It also contains live cells, such as leukocytes, which are transferred from the mother’s blood to the milk, and then to the child’s bloodstream, where they support the not yet developed immune responses. These cells do not die in the child’s stomach thanks to a fat crust; they are transported in that crust to the small intestine, and this is where they are absorbed into the bloodstream. And there is more. The scientists from the University of Western Australia proved that breast milk also contains a high number of stem cells, which are also absorbed into the child’s bloodstream. As has been proven in tests on mice, they are built in different body organs, for example in the pancreas, where they become active pancreatic cells that produce insulin, and also in the brain. The marked stem cells from the breast milk were found in the bodies of tested animals a few months after the conclusion of being fed with milk.

Today, scientists are attempting to grow stem cells in the lab.

And here we have ready-to-use stem cells, which probably serve a regeneration purpose for micro-damage that was incurred in the uterus, during labour, or in the early infant stage. This discovery proves how valuable breast milk is, and that it is difficult to replace it with modified cow milk.

Parents are now bombarded with adverts for taking cord blood, which can be used to obtain stem cells.

But, as opposed to cells in breast milk, these cells are more mature, and more specialised, which makes their biological value for regeneration purposes slightly lower. It also means that the risk of the cells transforming into cancerous cells is higher, if the given person is genetically prone to cancer. The stem cells in the breast milk are lesser less developed and do not pose such risk.

The Breast Milk Bank at the Voivodship General Hospital in Toruń is one of four breast milk banks that have been established in Poland over the past three years. Where did breast milk come from before?

For a couple of years Poland had no milk banks at all, even though milk banks appeared in our country soon after the first one in the world was opened in Vienna. This initiative was strongly promoted in the inter-war period and after the war; new milk banks were established in many cities in Poland, and women who had too much milk donated it to infants carried to term or children a few months old, e.g. children from orphanages, who had no chance of being breastfed, which resulted in them being more frequently and seriously ill. At the end of the 1990s, boosted by medical progress, we learnt that certain micro-organisms might also be carried in breast milk, and the milk banks were shut down. The last one was closed at the Polish Mother’s Memorial Hospital in Łódź at the end of the century. And so, for a few years, children in Poland, in particular sick infants or pre-term babies, who could not be breastfed, were given only modified milk formulas based on cow milk.

What changed?

An initiative of a dozen or so mothers from Poland took action. They started to ask questions and demand answers, they wanted to know whether cow milk is the only milk they could use to feed their babies with. Women with hyperlactation, wishing to donate milk, called orphanages, hospitals, and nurseries, and heard that Sanepid (Poland’s Food Health and Safety Agency) will never agree to it. In the old milk banks, the milk was collected in one container and given to different children. At the beginning of the 21st century, concerns were raised about giving the baby milk of one mother, sometimes the baby’s own mother. At the moment, the majority of modern breast milk banks offer a selection of donating women who meet the specified criteria, serological tests are performed, and then their milk is subjected to microbiological tests, followed by pasteurisation according to Holder at 62.5 degrees for 30 minutes. Such thermal processing eradicates the majority of potentially dangerous pathogens.

Is pasteurisation currently performed in modern Polish breast milk banks as well?

Yes, but in order for the first bank of this kind to be opened, in 2012, it had to be preceded by the Association for the Breast Milk Bank, later transformed into the Breast Milk Bank Foundation. The Foundation is headed by Dr Aleksandra Wesołowska, a biologist by education, and also one of the mothers – the initiators of the project to reactivate breast milk banks in Poland. The mothers invited a number of medical professionals to work together on this very important initiative – including those specialising in providing care to the youngest children, that is neonatologists, e.g. professor Maria Katarzyna Borszewska-Kornacka and myself. And so now Poland has four Breast Milk Banks, and a few more will be launched soon, most of them in cooperation with the Breast Milk Bank Foundation.

Close to 100 per cent of women in Poland breastfeed after childbirth. What is the reason for this high result?

This 95-97 per cent is the result of the growing appreciation for the value of breastfeeding and the breast milk itself for the health of the infant, which is a result of the efforts of the work of both medical professionals and also bottom-up initiatives. The benefits of breastfeeding are being discovered and promoted by the parents themselves. There are many blogs which propagate the nutrition and emotional value of feeding babies this way. Breastfeeding also enjoys the support of good legislation, such as the maternity care standard, approved in 2012, which is the subject of envy of parents and medical personnel from many countries, including EU member states. The maternity care standard, issued as an ordinance of the Minister of Health, devotes a lot of its content to breastfeeding – assistance of medical personnel in effective breastfeeding and in stimulating milk production since the first moments of a child’s life. In the Autumn of 2015, another ordinance of the Minister of Health was signed, this time concerning the maternity care standard in the event of specific complications or pregnancy failures. The document reads that allowing the woman to breastfeed the infant is a proper procedure, including in the event of the pregnancy, labour, and the puerperium period with complications. We also have an early milk production stimulation programme for neonatology and maternity centres (3rd level), edited by the National Neonatology Consultant – this document offers a very detailed description of the role of breast milk for a pre-term infant or for an infant born to term, but requiring specialist neonatal care. For example, it mentions that natural breastfeeding should be allowed at the birthing room. The infant should leave that room with at least one drop of colostrum (first milk) in its mouth, because it is proven that it significantly decreases the risk of infection and improves the prognosis. Milk production should be stimulated as soon as possible, in the case of mothers who cannot hug their babies or feed them. The important thing to do now is to put these documents into practice in Polish hospitals. This will surely improve the quality of care in the case of the youngest patients.

Interview by Karolina Kowalska