Breastfeeding

Breastfeeding

Also known as nursing, the practice of providing an infant or toddler with nutrition from mother's milk via direct sucking on the breast.

Breastfeeding has nutritional, immunological, and developmental benefits for the child, as well as physiological and emotional benefits for the mother. Breast milk is a unique combination of fats, sugars, minerals, proteins, vitamins, and enzymes that lowers an infant's risk of infections, including diarrheal and urinary tract infections and pneumonia. It has been shown to lower infant susceptibility to atopic diseases, diabetes, the herpes simplex virus, lymphomas, Crohn's disease, and gastrointestinal problems. Breastfed babies have higher IQs than their bottle-fed counterparts. Women who

Country Percent of mothers who
  start breastfeeding continue breastfeeding for 6 months or longer
Source: Baby Milk Action, Cambridge, England; Center for Breastfeeding Information, Schaumburg, Illinois, as quoted in Parenting (April 1997).
Sweden 98 53
Norway 98 50
Poland 93 10
Canada 80 24
Netherlands 68 25
Britain 63 21
United States 57 20

breastfeed recover from childbirth more quickly, return to pre-pregnancy weight sooner, and are better able to space their natural born children due to the suppression of ovulation during lactation. The act of breastfeeding is relaxing for the mother since the hormone prolactin, which is a relaxant, is released when the infant nurses. Women who breastfeed are also less likely to develop pre-menopausal breast cancer.

In the United States, very few mothers breastfed their babies from the 1950s to the early 1970s. During the 1970s the natural health movement caused an increase in the number of mothers who breastfed, from 20% in 1970 to 62% in 1982. That figure declined until the early 1990s, when only about half of U.S. mothers breastfed their babies, and only 20% were breastfeeding after six months. Since the late 1980s, both the World Health Organization and UNICEF have been recommending breastfeeding for at least two years. As seen in the accompanying table, this contrasts significantly with practices in European countries.

Currently, all major U.S. organizations promoting children's health agree that breastfeeding provides the best nourishment for the infant. In 1992 the American Academy of Pediatrics issued a statement recommending breastfeeding infants through the first year. During the mid-1990s the U.S. Department of Health and Human Services was working to increase post-partum breastfeeding to 75% and breastfeeding after six months to 50%. To help promote breastfeeding, some states, including California and Florida, have passed laws allowing breastfeeding in public.

The primary deterrents to breastfeeding are infant formula promotion by the media and through hospital samples, and physician, health care provider, and patient misinformation about the benefits of breastfeeding. A national survey found that 25% of physicians did not know the superior nutritive value of breast milk, and 33% were unaware of the immunological benefits of breastfeeding. In individual cases, a new mother's reluctance to breastfeed may derive from the fact that she may not have been taught to breastfeed by her own mother, who had children in an era when breastfeeding was unpopular. While it is a natural practice, breastfeeding is not an instinctive skill, and both mother and infant need to learn how to nurse properly. If breastfeeding is unsuccessful, the baby becomes frustrated and the mother anxious, which worsens the condition. Many mothers give up, thinking they have insufficient milk, a condition that is extremely rare. Most breastfeeding problems involve the frequency and/or efficiency of feedings. A professional lactation consultant can provide advice for mothers who are planning to breastfeed or who are having problems with breastfeeding.

Elements of feeding

Two hormones control breastfeeding: prolactin, which causes the production of milk in the breasts, and oxytocin, which causes the milk ejection or let-down reflex that squirts milk out of the breast. Stimulation of the nipple by the baby's sucking causes the release of both hormones. Breastfeeding should begin as soon as possible after birth, preferably within an hour. For the first three to five days, the breasts will not emit milk but colostrum, a thick yellowish fluid high in protein.

Initially, the baby will suck rapidly at the outer end of the nipple. This causes the release of oxytocin and a tingling sensation in the nipple before the milk is ejected. The nipple will elongate and harden, allowing the baby to "latch-on," or pull the rest of the nipple and the entire aureola (the pink or brown area surrounding the nipple) into the mouth against the baby's palate. The baby will then initiate the slower suck-and-swallow rhythm that constitutes nutritive sucking, or milk intake. In addition to the child's active and noisy sucking, signs that the let-down reflex is working are milk dripping from the other breast and uterine contractions.

Feeding sessions should be approximately 20-30 minutes long, with 8 to 10 minutes on the first breast, a change of activity to keep the baby awake, and then 10-I 5 minutes on the other breast. Feedings should occur about every three hours during the day and every four hours at night during the first six months, equaling 8-12 feedings per 24 hours. The baby should generally be fed on demand, though not more often than every two hours. After a breastfeeding pattern is established, the mother's milk will flow whenever it is about time for a feeding, or when she hears a baby crying.

There are three common breastfeeding positions. Alternating between positions ensures that all milk is drained from the breasts. In the traditional position the mother sits in a comfortable chair with the baby in one arm, the baby's head in the crook of her arm and buttocks in her hand. In the football hold position the mother sits on a sofa or bed with the baby lying next to her, tucked under her arm as in holding a football. In the lying down position mother and baby lie face to face, with one arm under the mother's head and her other arm holding the breast.

Rubber teats or pacifiers should not be used within the first few weeks to ensure the baby does not confuse it with the mother's nipple. Initially, babies swallow very little air, and burping is usually not required. (Breastfed babies generally swallow less air than bottle-fed ones.) If burping is necessary, it should be done before switching breasts.

It is normal for a breastfed baby to lose 10% of his birth weight during the first two weeks of life. Thereafter, the baby should gain about an ounce per day, or between one-half and two ounces per day. Signs of adequate nutrition are frequent wet diapers (minimum 6 diapers per day) and loose, yellowish stools. Infrequent urination and dark green stools indicate inadequate intake of milk, and the baby should be taken to the doctor.

If the mother's milk is not expressed, her breasts will become engorged and lactation will stop, even if sucking is still occurring. Milk production can be maintained during breastfeeding problems by artificial expression of the milk using a manual, battery-powered, or electric pump immediately after feedings. The expressed milk will keep the baby healthy and happy while adjustments are being made. Instead of a bottle, a feeding tube or small medicine cup should be used for any supplements so that the baby does not experience problems returning to the breast. (Bottles encourage a passive, not active type of sucking as breastfeeding requires.)

The physician should be contacted whenever the baby is not feeding adequately, sleeps longer than four to five hours per night without feeding during the first two to three weeks, has fewer than six wet diapers per day, has a pale, blue, or yellow complexion, or has a temperature higher than 100.5°F (38°C).

Milk storage

Working mothers with infants under four months should breastfeed as much as possible during off hours, and artificially express milk during the day on a simulated feeding schedule. Studies show these increase production of prolactin, which is necessary for continued milk production. After four months pumping will only need to be done about twice a day. Milk should be pumped and stored under sanitary conditions. Pumping directly into the storage container lessens the chance of contamination. Freshly pumped breast milk will last for several hours at room temperature, and may be kept in a refrigerator for up to 72 hours. Milk may also be stored in a regular freezer for six months or in a deep freezer for 12 months.

Drugs

While every substance the mother ingests will determine the composition of breast milk, many over-the-counter drugs taken in small amounts will not harm the breastfeeding baby. The newer forms of antidepressants, such as Prozac and Zoloft, have been found to have no adverse effects over a 12-month period on the breastfeeding baby. Because older types of antidepressants, such as MAO inhibitors, have many side effects on the patient, they may be expected to have adverse effects on a breastfeeding baby. The advantages and disadvantages of taking a particular prescription drug must be weighed against any potential adverse effects on the child. A life-supporting drug may have such a negative effect that breastfeeding is not advised. Ingestion of illegal drugs while breastfeeding endangers the child's health and can lead to the baby's death.

BREASTFEEDING PROBLEMS

The most common problems are caused by poor latching-on, poor milk let-down, and ineffective sucking-and-swallowing.

Latching-On. If the nipple is flat or inverted the baby may not be able to grasp and pull the entire aureola into the mouth. Repositioning is essential until the baby latches on. The football hold is a good position for women with flat nipples. Plastic breast shells can be worn for several hours daily to correct this problem. Nipple shields (Mexican hats) should not be used, as they reduce stimulation to the nipple.

Let-Down. The most common barrier to let-down is the mother's anxiety. Breastfeeding should be done in a relaxing environment. The mother can listen to music and rock, sing to, or stroke the baby. Family support for the practice of breastfeeding and reassurance that the mother and baby will eventually master the process are very important to the success of a new breastfeeder. Sometimes a synthetic form of the hormone oxytocin in the form of a nasal spray will be prescribed by the doctor for temporary failure of let-down.

Ineffective Suck-and-Swallow. If the baby is sucking but not holding the entire aureola inside the mouth and flat against the palate, or is sucking but not swallowing, he or she is not taking in milk. If the baby has not successfully received milk from the breast, he or she may have adjusted to the lack of milk and is only using the breast as a pacifier. It is not recommended to allow a habit of non-nutritive sucking to develop. The baby who sucks while sleeping should be kept awake at the breast by rubbing the head or hands, scratching the soles of the feet, or removing a layer of clothing.

Books

Dana, N., and A. Price. Successful Breastfeeding: A Practical Guide for Nursing Mothers. New York: Meadowbrook, 1985.

Division of Maternal and Child Health. Surgeon General's Workshop on Breastfeeding and Human Lactation. Washington, DC: Bureau of Health Care Delivery and Assistance, 1991.

Eiger, M. S., and S. W. Olds. The Complete Book of Breastfeeding, rev. ed. New York: Bantam, 1985.

Eisenberg, A., et al. What to Expect the First Year. New York: Workman Pub., 1989.

Huggins, K. The Nursing Mother's Companion, rev. ed. Boston: Harvard Common, 1990.

La Leche League International Staff, eds. The Womanly Art of Breastfeeding: Thirty-Fifth Anniversary Edition. New York: NAL-Dutton, 1991.

Organizations

International Childbirth Education Association
Address: Box 20048
Minneapolis, MN 55420
Telephone: (612) 854-8660

International Lactation Consultant Association (ILCA)
Address: 200 N. Michigan Avenue, Suite 300
Chicago, IL 60601
Telephone: (312) 541-1710

La Leche League International
Address: Box 1209, 9616 Minneapolis Avenue
Franklin Park, IL 60131
Telephone: toll-free (800) LA LECHE