Breastfeeding is feeding of infants or young children with breast milk from human breasts (i.e. through lactation). The sucking reflex enables babies to suck and swallow milk instinctively. WHO, UNICEF and Save the Children recommend children be breastfed within one hour of birth, exclusively breastfed for the first six months, after which WHO recommends continued breastfeeding until age two together with age-appropriate, nutritionally adequate and safe complementary foods. The American Academy of Pediatrics recommends for the U.S. that after 6 months of exclusive breastfeeding, babies should continue to breastfeed "for a year and for as long as is mutually desired by the mother and baby". Inadequate nutrition is an underlying cause of the deaths of more than 2.6 million children and over 100,000 mothers every year. Some mothers express milk to be used while their child is being cared for by others by hand or by using a breast pump.
The American Academy of Pediatrics and the American Dietetic Association promote breastfeeding as the best source of infant nutrition". Breastmilk is easy for the baby to digest, which promotes the child eating more often due to faster digestion. It may decrease risk of diabetes and celiac disease. There are also controversial benefits of decreased risk for obesity in adulthood and improved cognitive development. Benefits for the mother include: helps in uterine shrinkage, decreases risk of breast cancer, decreases depression, and decreases risk of osteoporosis. It may also be a bonding experience for mother and child, and can be less expensive than infant formula.
Breastfeeding was the rule from ancient times up to recent human history, and babies were carried with the mother and fed as required. With 18th– and 19th–century industrialization in the Western world, mothers in many urban centers began dispensing with breastfeeding due to work requirements. Breastfeeding declined significantly from 1900 to 1960 due to negative social attitudes towards the practice and the development of infant formula. From the 1960s onwards, breastfeeding has experienced a revival which continues to the 2000s, though some negative attitudes towards the practice still remain.
Health authorities consider human breast milk the healthiest diet for babies, as opposed to infant formula. Breastfeeding promotes health of both mother and infant and helps prevent disease. There is consensus that breastfeeding is beneficial and concerns about the effects of artificial formulas. Artificial feeding is associated with more deaths from diarrhea in infants in both developing and developed countries. There are a few exceptions, such as when the mother is taking certain drugs, has active untreated tuberculosis or is infected with human T-lymphotropic virus. The World Health Organization recommends that national authorities in each country decide which infant feeding practice should be promoted and supported by their maternal and child health services to best avoid HIV infection transmission from a mother to child.
- 1 Lactation
- 2 Breast milk
- 3 Methods
- 4 Ways of feeding babies
- 5 Mother's diet
- 6 Duration
- 7 Weaning
- 8 Health effects
- 8.1 For the baby
- 8.1.1 Growth
- 8.1.2 Immunity
- 8.2 For the mother
- 8.3 Concerns
- 8.1 For the baby
- 9 Financial considerations
- 10 Difficulties
- 11 Society and culture
- 12 See also
- 13 References
- 14 Further reading
- 15 External links
The hormonal endocrine control system drives milk production during pregnancy and the first few days after the birth. From the twenty-fourth week of pregnancy (the second and third trimesters), a woman's body produces hormones that stimulate the growth of the milk duct system in the breasts. Progesterone influences the growth in size of alveoli and lobes; high levels of progesterone, estrogen, prolactin, and other hormones inhibit lactation before birth; hormone levels drop after birth, triggering the onset of milk production. After birth, the hormone oxytocin contracts the smooth muscle layer of cells surrounding the alveoli to squeeze milk into the duct system. Oxytocin is also necessary for the milk ejection reflex, or let-down to occur. Let down occurs in response to the baby's suckling, though it also may be a conditioned response, e.g. to the cry of the baby. Lactation can also be induced by a combination of physical and psychological stimulation, by drugs, or by a combination of these methods.
Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast milk is made from nutrients in the mother's bloodstream and bodily stores. Breast milk has just the right amount of fat, sugar, water, and protein that is needed for a baby's growth and development. Breastfeeding triggers biochemical reactions which allows for the enzymes, hormones, growth factors and immunologic substances to help create effective defense to infectious diseases for the infant. The breastmilk also has long-chain polyunsaturated fatty acids which help with normal retinal and neural development. Because breastfeeding uses an average of 500 calories a day, it helps the mother lose weight after giving birth. The composition of breast milk changes depending on how long the baby nurses at each session, as well as on the age of the child.
The quality of a mother's breast milk may be compromised by smoking, alcoholic beverages, caffeinated drinks, marijuana, methamphetamine, heroin, and methadone. However, the American Academy of Pediatrics states that "tobacco smoking by mothers is not a contraindication to breastfeeding." In addition, the AAP states that while breastfeeding mothers "should avoid the use of alcoholic beverages", an "occasional celebratory single, small alcoholic drink is acceptable, but breastfeeding should be avoided for 2 hours after the drink."
There are many books and videos to advise mothers about breastfeeding. Lactation consultants in hospitals or private practice, and volunteer organizations of breastfeeding mothers such as La Leche League International also provide advice and support.
Early breastfeeding is associated with fewer nighttime feeding problems. A systematic review of thirty four trials found that early skin to skin contact between mother and baby improves breastfeeding outcomes, and cardio-respiratory stability and decreases infant crying.
Time and place for breastfeeding
Feeding a baby "on demand" (sometimes referred to as "on cue"), means feeding when the baby shows signs of hunger. Newborn babies usually express demand for feeding every 1 to 3 hours per 24 hours (resulting in 8-12 times in 24 hours) for the first two to four weeks.
"Experienced breastfeeding mothers learn that the sucking patterns and needs of babies vary. While some infants' sucking needs are met primarily during feedings, other babies may need additional sucking at the breast soon after a feeding even though they are not really hungry. Babies may also nurse when they are lonely, frightened or in pain."
"Comforting and meeting sucking needs at the breast is nature's original design. Pacifiers (dummies, soothers) are a substitute for the mother when she cannot be available. Other reasons to pacify a baby primarily at the breast include superior oral-facial development, prolonged lactational amenorrhea, avoidance of nipple confusion, and stimulation of an adequate milk supply to ensure higher rates of breastfeeding success."
Most US states now have laws that allow a mother to breastfeed her baby anywhere she is allowed to be. In hospitals, rooming-in care permits the baby to stay with the mother and improves the ease of breastfeeding. Some commercial establishments provide breastfeeding rooms, although laws generally specify that mothers may breastfeed anywhere, without requiring them to go to a special area.
In 2014, newly elected Pope Francis drew world-wide commentary when he encouraged mothers to breastfeed in church if their babies were hungry. During a special papal baptism Pope Francis said that mothers "should not stand on ceremony" if their children were hungry. "If they are hungry, mothers, feed them, without thinking twice," he said, smiling. "Because they are the most important people here."
Latching on, feeding, and positioning
Correct positioning and technique for latching on are necessary to prevent nipple soreness and allow the baby to obtain enough milk. The "rooting reflex" is the baby's natural tendency to turn towards the breast with the mouth open wide; mothers sometimes make use of this by gently stroking the baby's cheek or lips with their nipple to induce the baby to move into position for a breastfeeding session, then quickly moving the baby onto the breast while its mouth is wide open. To prevent nipple soreness and allow the baby to get enough milk, a large part of the breast and areola need to enter the baby's mouth. Failure to latch on is one of the main reasons for ineffective feeding and can lead to infant health concerns.
There are different ways to position the baby that make it easier for him/her to latch on properly. Each baby may prefer different positions. One position to hold the baby is known as the football hold with his/her legs next to the mother's side with the baby facing the mother. Another hold is the cradle hold or the cross-body hold. With the cradle hold, the mother supports the baby's head in the crook of her arm. The cross-over hold is similar to the cradle hold; however, the baby's head is supported with the opposite hand instead of resting in the crook of the mother's arm. The reclining position is another position in which to nurse a baby. The reclining position allows the mother to lay back in a reclining position or on her side with the baby laying next to her while nursing.[unreliable medical source?]
Duration of each session
During the newborn period, most breastfeeding sessions will take from 20 to 45 minutes. After the finishing of a breast, the mother may offer the other breast.
Ways of feeding babies
Exclusive breastfeeding is defined as "an infant's consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk, and no foods) except for vitamins, minerals, and medications." National and international guidelines recommend that all infants be breastfed exclusively for the first six months of life. Breastfeeding may continue with the addition of appropriate foods, for two years or more. Exclusive breastfeeding has dramatically reduced infant deaths in developing countries by reducing diarrhea and infectious diseases. It has also been shown to reduce HIV transmission from mother to child, compared to mixed feeding.
While it can be hard to measure how much food a breastfed baby consumes, babies normally feed to meet their own requirements. Babies that fail to eat enough may exhibit symptoms of failure to thrive.
The La Leche League says that their most often asked question is, "How can I tell if my baby is getting enough milk?" They advise that for the first few days while the baby is receiving mostly colostrum only one or two wet diapers per day is normal. Once the mother's milk comes in, usually on the third or fourth day, the baby should begin to have 6-8 wet cloth diapers (5-6 wet disposable diapers) per day. In addition, most young babies will have at least two to five bowel movements every 24 hours for the first several months.
The La Leache League gives the following additional signs that indicate a baby is receiving enough milk:
- The baby nurses frequently averaging at least 8-12 feedings per 24-hour period.
- The baby is allowed to determine the length of the feeding, which may be 10 to 20 minutes per breast or longer.
- Baby's swallowing sounds are audible as he is breastfeeding.
- The baby should gain at least 4-7 ounces per week after the fourth day of life.
- The baby will be alert and active, appear healthy, have good color, firm skin, and will be growing in length and head circumference.
Expressing breast milk
When direct breastfeeding is not possible, a mother can express (artificially remove and store) her milk. With manual massage or by using a breast pump, a woman can express her milk and store it. It can be stored in freezer storage bags and containers made specifically for breastmilk, a supplemental nursing system, or a bottle ready for use. Breast milk may be kept at room temperature for up to six hours, refrigerated for up to eight days or frozen for up to six to twelve months. Research suggests that the antioxidant activity in expressed breast milk decreases over time but it still remains at higher levels than in infant formula.
Expressing breast milk can maintain a mother's milk supply when she and her child are apart. If a sick baby is unable to feed, expressed milk can be fed through a nasogastric tube.
Expressed milk can also be used when a mother is having trouble breastfeeding. Hand expression of breast milk, together with manual massage while pumping has been shown to maximize a mother's milk supply.
"Exclusively expressing", "exclusively pumping", and "EPing" are terms for a mother who feeds her baby exclusively her breastmilk while not physically breastfeeding. This may arise because her baby is unable or unwilling to latch on to the breast. With good pumping habits, particularly in the first 12 weeks when the milk supply is being established, it is possible to produce enough milk to feed the baby for as long as the mother wishes.
It is generally advised to delay using a bottle to feed expressed breast milk until the baby is 4–6 weeks old and is good at sucking directly from the breast. As sucking from a bottle takes less effort, babies can lose their desire to suck from the breast. This is called nursing strike or nipple confusion. To avoid this when feeding expressed breast milk (EBM) before 4–6 weeks of age, it is recommended that breast milk be given by other means such as feeding spoons or feeding cups. Also, EBM should be given by someone other than the breastfeeding mother (or wet nurse), so that the baby can learn to associate direct feeding with the mother (or wet nurse) and associate bottle feeding with other people.
With the improvements in breast pumps, many women are able to return to work while exclusively feeding their infants breast milk because of their ability to express milk at work. Women can also leave their infants in the care of others for vacation or other extended trips, while maintaining a supply of breast milk. This can be very convenient to the mother.
Some women donate their expressed breast milk (EBM) to others, either directly or through a milk bank. Though historically the use of wet nurses was common, some women dislike the idea of feeding their own child with another woman's milk; others appreciate being able to give their baby the benefits of breast milk. Feeding expressed breast milk—either from donors or the baby's own mother—is the feeding method of choice for premature babies. The transmission of some viral diseases through breastfeeding can be prevented by expressing breast milk and subjecting it to Holder pasteurisation.
Predominant or mixed breastfeeding means feeding breast milk along with infant formula, baby food and even water, depending on the age of the child. Babies feed differently with artificial nipples than from a breast. With the breast, the infant's tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth; with an artificial nipple, an infant must suck harder and the milk may come in more rapidly. Therefore, mixing breastfeeding and bottle-feeding (or using a pacifier) before the baby is used to feeding from its mother can result in the infant preferring the bottle to the breast. Some mothers supplement feed with a small syringe or flexible cup to reduce the risk of artificial nipple preference.
It used to be common worldwide, and still is in some developing nations such as those found in Africa, for more than one woman to breastfeed a child. Shared breastfeeding has now been found to be a risk factor for HIV infection in infants. A woman who is engaged to breastfeed another's baby is known as a wet nurse. Shared breastfeeding can sometimes incur negative reactions in the Anglosphere; American feminist activist Jennifer Baumgardner has written about her experiences in New York with this issue.
Feeding two children at the same time who are not twins or multiples is called tandem nursing. As the appetite and feeding habits of each baby may not be the same, this could mean feeding each according to their own individual needs and can also include breastfeeding them together, one on each breast.
In cases of triplets or more, it is a challenge for a mother to organize feeding around the appetites of all the babies. Breasts can respond to the demand and produce large quantities of milk; mothers have been able to breastfeed triplets successfully.
Tandem nursing occurs when a woman has a baby while breastfeeding an older child. During the late stages of pregnancy, the milk will change to colostrum, while some children will continue to feed even with this change, others may wean due to the change in taste or drop in supply. Breastfeeding a child while being pregnant with another may also be considered a form of tandem feeding for the nursing mother, as she also provides nutrition for two.
Re-lactation is the process of restarting breastfeeding after it has been stopped. In developing countries, mothers may start breastfeeding after a normal weaning process as part of an oral rehydration treatment for diarrhea. In developed countries, re-lactation is commonly done because early medical problems have been resolved, or because a mother changed her mind about breastfeeding. Re-lactation is most easily accomplished with a very young newborn or with a baby that was previously breastfeeding; if the baby was bottle-fed for the first six months, then the baby may refuse to suckle. If the mother has recently stopped breastfeeding, then she is more likely to be able to re-establish her milk supply, and more likely to have an adequate supply. Although some women successfully re-lactate after interruptions of several months, success is highest if the interruption has only been a few days or weeks long.
Induced lactation, also called adoptive lactation, is the process of starting breastfeeding in a woman who did not give birth. This usually requires the adoptive mother to take hormones and other drugs to stimulate breast development and promote milk production. In some cultures, breastfeeding an adoptive child creates milk kinship.
Techniques to promote re-lactation and induced lactation both use frequent attempts to breastfeed, extensive skin-to-skin contact with the baby, and frequent, long sessions of pumping to express breastmilk. Suckling may be encouraged with a tube filled with infant formula, so that the baby associates suckling at the breast with food. Milk-producing drugs, such as domperidone, may also be given. All of these techniques require a significant commitment of time and energy on the part of the mother over a period of weeks or months. Success is likely, but not guaranteed. However, even when lactation is established, the supply may not be large enough to breastfeed exclusively. A supportive social environment improves the likelihood of success.
Extended breastfeeding usually means breastfeeding after the age of 12 or 24 months, depending on the source. In Western countries such as the United States, Canada, and Great Britain, extended breastfeeding is relatively uncommon. For example, in the United States overall, only 22.4% of babies are breastfed until at least 12 months. By contrast, in India, mothers commonly breastfeed their children until 2 to 3 years of age.
Some pollutants and other ingredients in the mother's food and drink are passed to the baby through the breast milk, including mercury (found in many fish), alcohol, caffeine, and bisphenol A.
The World Health Organization recommends exclusive breastfeeding for the baby's first 6 months of life, and continued breastfeeding complemented with appropriate foods up to two years old and beyond. The US Centers for Disease Control and Prevention (CDC) recommends exclusive breastfeeding till six months of age. A 2012 Cochrane review found that infants exclusively breastfed for six months had less gastrointestinal infection-related morbidity than did infants who were exclusively breastfed for three to four months, and then partially breastfed afterward.
Weaning is the process of introducing the infant to other food and reducing the supply of breast milk. The infant is fully weaned when he no longer receives any breast milk. Most mammals stop producing the enzyme lactase at the end of weaning, and become lactose intolerant. Figures vary, but worldwide, humans lose about 75 to 95 percent of birth lactase levels by early childhood, and there is a continuous decline in lactase during the course of a lifetime. However, the prevalence varies widely among ethnic backgrounds. Estimates range from 2 to 5 percent in persons from Northern Europe to nearly 100 percent in adult Asians and American Indians. Blacks and Ashkenazi Jews have prevalences of 60 to 80 percent, and Latinos have a prevalence of 50 to 80 percent.
In humans, the psychological factors involved in the weaning process are crucial for both mother and infant as issues of closeness and separation are very prominent during this stage.
In the past bromocriptine was in some countries frequently used to reduce the engorgement experienced by many women during weaning. This is now done only in exceptional cases as it causes frequent side effects, offers very little advantage over non-medical management and the possibility of serious side effects can not be ruled out. Other medications such as cabergoline, lisuride or birth control pills may occasionally be used as lactation suppressants.
For the baby
Scientific research, such as the studies summarized in a 2007 review for the U.S. Agency for Healthcare Research and Quality (AHRQ) and a 2007 review for the WHO, have found numerous benefits of breastfeeding for the infant. According to the American Academy of Pediatrics, research shows that breast feeding provides advantages with regard to general health, growth, and development. Infants who are not breastfed are at a significantly increased risk for a large number of acute and chronic diseases including lower respiratory infection, ear infections, bacteremia, bacterial meningitis, botulism, urinary tract infection, and necrotizing enterocolitis. Breastfeeding may protect against sudden infant death syndrome, insulin-dependent diabetes mellitus, Crohn's disease, ulcerative colitis, lymphoma, allergic diseases, digestive diseases, and a possible enhancement of cognitive development.
The average breastfed baby doubles its birth weight in 5 to 6 months. By one year, a typical breastfed baby will weigh about 2½ times its birth weight. At one year, breastfed babies tend to be leaner than formula-fed babies, which is healthier, especially in the long-run.
Comparing weight gain of breastfed to formula-fed infants, the Davis Area Research on Lactation, Infant Nutrition and Growth (DARLING) study reported that the groups had similar weight gain during the first 3 months, began to drop below the median beginning at 6 to 8 months, and were significantly lower than that of the formula-fed group between 6 and 18 months. Length gain and head circumference values were similar between groups, suggesting that breast-fed babies are leaner.
During breastfeeding, approximately 0.25-0.5 grams per day of secretory IgA antibodies pass to the baby via the milk. This is one of the most important features of colostrum, the breast milk created for newborns. The main target for these antibodies are probably microorganisms in the baby's intestine. There is some uptake of IgA to the rest of the body, but this amount is relatively small. Also, breast milk contains several anti-infective factors such as bile salt stimulated lipase (protecting against amoebic infections) and lactoferrin (which binds to iron and inhibits the growth of intestinal bacteria).
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Maternal vaccination while breastfeeding
In a review article published in the journal Pediatrics, data from 2001 to 2012 were analyzed to discern any safety issue for mothers being vaccinated while breastfeeding. The American Academy of Pediatrics (AAP) concludes that it is safe for women to receive almost all vaccines while nursing their infants. The study further found that the protected immunity of the mother obtained by vaccination against tetanus, diphtheria, whooping cough and influenza can pass on to the baby, and that breastfeeding can reduce fever rate after infant immunization. Exceptions are smallpox and yellow fever vaccines which increase the risk of infants developing vaccinia and encephalitis. In all other cases AAP recommends women continue breastfeeding after vaccination.
Infants exclusively breastfed have less chance of developing diabetes mellitus type 1 than those with a shorter duration of breastfeeding and an earlier exposure to cow milk and solid foods. Breastfed infants also appear to have a lower likelihood of developing diabetes mellitus type 2 later in life.
The protective effect of breastfeeding against obesity is consistent, though small, across many studies. A 2013 longitudinal study reported less obesity at ages two and four among breastfed infants who were not fed solid foods until after at least four months old.
Allergic diseases (atopy)
In children who are at risk for developing allergic diseases (defined as at least one parent or sibling having atopy), atopic syndrome can be prevented or delayed through exclusive breastfeeding for four months, though these benefits may not be present after four months of age.
Necrotizing enterocolitis in premature infants
A 2007 meta-analysis of four randomized controlled trials found "a marginally statistically significant association" between breastfeeding and a reduction in the risk of Necrotizing enterocolitis (NEC).
Other long-term health effects
A review of the association between breastfeeding and celiac disease (CD) concluded that breast feeding while introducing gluten to the diet reduced the risk of CD. The study was unable to determine if breastfeeding merely delayed symptoms or offered lifelong protection.
Breastfeeding may decrease the risk of cardiovascular disease in later life, as indicated by lower cholesterol and C-reactive protein levels in adult women who had been breastfed as infants. A 2007 review for the WHO concluded that breastfed infants "experienced lower mean blood pressure" later in life. A 2007 review for the AHRQ found that "there is an association between a history of breastfeeding during infancy and a small reduction in adult blood pressure, but the clinical or public health implication of this finding is unclear".
In a paper selected by UNICEF as the “Breastfeeding Paper of the Month” in July 1998, it was suggested that breastfed babies have a better chance of good dental health than artificially fed infants because of the effects of breastfeeding on the development of the oral cavity and airway. It was thought that with fewer malocclusions, breastfed children may have a reduced need for orthodontic intervention. The report also suggested that children with the proper development of a well rounded, "U-shaped" dental arch, which is found more commonly in breastfed children, may have fewer problems with snoring and sleep apnea in later life.
Connection to intelligence
It is unclear whether breastfeeding infants improves their intelligence later in life. Several studies have found no relationship after controlling for confounding factors like maternal intelligence (smarter mothers are more likely to breastfeed their babies). However, other studies have concluded that breastfeeding is associated with increased cognitive development in childhood, although the cause may be the increased mother–child interaction rather than the breastmilk itself.
For the mother
Breastfeeding is a cost-effective way of feeding an infant, providing nourishment for a child at a small cost to the mother. Frequent and exclusive breastfeeding usually delays the return of fertility through lactational amenorrhea, though breastfeeding is an imperfect means of birth control. During breastfeeding beneficial hormones are released into the mother's body and the maternal bond can be strengthened. Breastfeeding is possible throughout pregnancy, but generally milk production will be reduced at some point. Children who are not breastfed are almost six times more likely to die by the age of one month than children who receive at least some breastmilk.
According to some authorities, there is a growing body of evidence that suggests that early skin-to-skin contact (also called kangaroo care) of mother and baby stimulates breast feeding behavior in the baby. Newborn infants who are immediately placed on their mother’s skin have a natural instinct to latch on to the breast and start nursing, typically within one hour of being born. It is thought that immediate skin-to-skin contact provides a form of imprinting that makes subsequent feeding significantly easier. The World Health Organization reports that in addition to more successful breastfeeding, skin-to-skin contact between a mother and her newborn baby immediately after delivery also reduces crying, improves mother to infant interaction, and keeps baby warm. According to studies quoted by UNICEF, babies have been observed to naturally follow a unique process which leads to a first breastfeed. Initially after birth the baby will cry as they take their first breaths. Shortly after, it will relax and begin to make small movements of the arms, shoulders and head. The baby will crawl towards the breast and begin to feed. After feeding, it is normal for a baby to remain attached to the breast while it rests. This is sometimes confused for the baby not being hungry, however it is a normal thing for the baby to do after finding their food source. Providing that there are no interruptions, all babies are said to follow this process and it is suggested that trying to rush the process or interruptions such as removing the baby to weigh him/her is counter-productive and may lead to problems at subsequent breastfeeds.
Hormones released during breastfeeding help to strengthen the maternal bond. Teaching partners how to manage common difficulties is associated with higher breastfeeding rates. Support for a mother while breastfeeding can assist in familial bonds and help build a paternal bond between father and child.
If the mother is away, an alternative caregiver may be able to feed the baby with breast milk expressed with a breast pump.
Breastfeeding releases oxytocin and prolactin, hormones that relax the mother and make her feel more nurturing toward her baby. This hormone release can help to enable sleep even where a mother may otherwise be having difficulty sleeping. Breastfeeding soon after giving birth increases the mother's oxytocin levels, making her uterus contract more quickly and reducing bleeding. Pitocin, a synthetic hormone used to make the uterus contract during and after labour, is structurally modelled on oxytocin. Syntocinon, another synthetic oxytocic, is commonly used in Australia and the UK rather than Pitocin.
It is unclear whether breastfeeding causes mothers to lose weight after giving birth.
The recent recognition on the influence of postpartum weight retention (PPWR) on later chronic diseases has brought a surge in data analysis. In fact, the proportion of US women who gain weight excessively during pregnancy is growing. In 2005, 20.6% gained 18.2 kg (40 lb), the upper limit recommended by the Institute of Medicine. Recommended weight gains during pregnancy vary according to maternal baseline characteristics. The Institute of Medicine has established guidelines where women who are underweight (BMI less than 18.5) are encouraged to gain 13 to 18 kg; women who are at normal weight (BMI 18.5-24.9) are encouraged to gain 11–16 kg; those who are overweight (BMI 25-29.9) are suggested to gain 7–11 kg; and those who are obese I (BMI 30-34.9) are recommended to gain 5–9 kg. These recommendations are variable and are meant to inform an obstetrician in caring for a pregnant woman. Extreme gains in visceral fat can put women at higher risk of cardiovascular and glycemic disorders later in life.
Natural postpartum infertility
Breastfeeding may delay the return to fertility for some women by suppressing ovulation. A breastfeeding woman may not ovulate, or have regular periods, during the entire lactation period. The period in which ovulation is absent differs for each woman. This lactational amenorrhea has been used as an imperfect form of natural contraception, with greater than 98% effectiveness during the first six months after birth if specific nursing behaviors are followed.
Long-term health effects
For breastfeeding women, long-term health benefits include:
Infants that are otherwise healthy will only benefit from breastfeeding, as there are "no known disadvantages" of breastfeeding for children. There are however a number of cases where extra precautions should be taken or breastfeeding be avoided entirely, including certain infectious diseases, use of certain medications or drugs. In other cases it may not be feasible for the mother to continue breastfeeding for longer periods or at all.
The central concern about breastfeeding with HIV is whether or not it places the child at risk of becoming infected. Varying factors, such as the viral load in the mother’s milk, contribute to the difficulty in creating breastfeeding recommendations for HIV-positive mothers.
Taking medication while breastfeeding
In a review article published in the journal Pediatrics, data from 2001 to 2012 were analyzed to discern any safety issue for mothers taking prescription drugs while breastfeeding. The American Academy of Pediatrics (AAP) advises that mothers can take most prescription drugs but should avoid certain painkillers, psychiatric drugs and herbal supplements. The health benefits of mother taking drugs and breastfeeding should be weighed against the risk of drug exposure to the infant. The report recommends consulting the NIH database 'LactMed' on the most up-to-date information on drugs and breastfeeding.
Breastfeeding is widely accepted as being cheaper than any of the alternatives, but it is not free of cost. The mother generally must eat more food than she would if she were not lactating. In the US, the extra money spent on food (about US$13 each week) is usually about half as much money as the family would have spent buying infant formula.
The time she spends breastfeeding represents an opportunity cost, as she must spend hours each day breastfeeding instead of engaging in other activities, such as paid work or home production (such as growing food for her family to eat). Whether it is economically more advantageous for an individual mother to spend her time breastfeeding or engaging in paid work depends on how much income she loses as a result. In general, the higher the mother's earning power, the less likely she is to save money by breastfeeding.
Breastfeeding reduces health care costs and the cost of caring for sick babies. Parents of breastfed babies are less likely miss work and lose income because their babies are sick.
The AAP breastfeeding policy says: "Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed." There are some situations in which breastfeeding may be harmful to the infant, including infection with HIV and acute poisoning by environmental contaminants such as lead. The Institute of Medicine has reported that breast surgery, including breast implants or breast reduction surgery, reduces the chances that a woman will have sufficient milk to breast feed. Research shows that women whose pregnancies are unintended are less likely to breast feed their babies.
The majority of mothers intend to breastfeed when their baby is born. There are many things that happen that disrupt or intervene in this plan. Here are just a few of the barriers that women face when attempting to breastfeed.
- Birth procedures – routine separation of the baby from the mother, delayed breastfeeding initiation, vigorous routine suctioning, medications and mode of delivery all interfere with breastfeeding. A "substantial" number of hospital and facilities implemented procedures and policies that were not evidenced based and that were known to interfere with lactation.
- Knowledge and social support
- Personal – breastfeeding is the biologic norm but in absence of watching others nurse their babies (i.e., a behavioral history of breastfeeding), it is a lost behavior. Classes, books and personal counseling (professional or lay) can be beneficial. Some women do not want to breastfeed because they fear that breastfeeding will negatively impact the look of their breasts, although medical evidence attributes "drooping" or "sagging" of the breasts to pregnancy, aging, and smoking habits. Jae Ireland reports “the idea that breastfeeding causes saggier, smaller breasts is a myth, as proven by a 2008 study published in the Aesthetic Surgery Journal. The study found that while breastfeeding had no effect on a woman's breasts, other factors did contribute to sagginess, such as a mother's advanced age, her number of pregnancies and whether or not she smoked. All three factors can result in altered breasts, but breastfeeding was not identified as a marker for a change in overall breast appearance.”
- Partner – Partners also lack basic breastfeeding knowledge and are typically unsure of their role in breastfeeding.
- Practitioner – Physicians and nurses have surprisingly little training in lactation and lactation support. One of the main action items in The Surgeon General’s Call to Action to Support Breastfeeding is to help educate practitioners about breastfeeding and breastfeeding issues. Research has reported women look to primary care providers for breastfeeding information and support but it is a need that often goes unmet.
- Workforce – Returning to work is the most common cited reason for discontinuing breastfeeding. Maternity leave in the US varies widely despite the Family Medical Leave Act (FMLA), which provides most mothers up to 12 weeks leave. Many mothers are forced to take unpaid time off from their job and the majority do not use FMLA for the full twelve weeks. Fathers are also allowed to use FMLA for the birth or adoption of the child. Maternity leave varies widely by state. Save the Children recently examined maternity leave laws, the right to nursing breaks at work, and several other indicators to create a ranking of 36 industrialized countries measuring which ones have the most – and the least – supportive policies for women who want to breastfeed. Norway topped the scorecard and the United States came in last.
- Poor latch - Pain caused from mis-positioning the baby on the breast or a tongue-tie in the infant can cause pain in the mother and therefore discourage her from breastfeeding. These problems are generally easy to correct (by re-positioning or clipping the tongue-tie).
Society and culture
In the Egyptian, Greek and Roman empires, women usually fed only their own children. However, breastfeeding began to be seen as something too common to be done by royalty, and wet nurses were employed to breastfeed the children of the royal families. This extended over time, particularly in western Europe, where noble women often made use of wet nurses. But lower class women breastfed their infants and used a wet nurse only if they were unable to feed their own infant. Attempts were made in 15th-century Europe to use cow or goat milk, but these attempts were not successful. In the 18th century, flour or cereal mixed with broth were introduced as substitutes for breastfeeding, but this did not have a favorable outcome either.
During the early 1900s breastfeeding started to be viewed negatively by Western societies, especially in Canada and the USA. These societies considered it a low class and uncultured practice, viewing it with a certain degree of disgust. This coincided with the appearance of improved infant formulas in the mid 19th century and its increased use, which accelerated after World War II. From the 1960s onwards, breastfeeding experienced a revival which continues to the 2000s, though negative attitudes towards the practice were still entrenched up to 1990s.
The World Health Organization (WHO) states, "Breast milk is the ideal food for the healthy growth and development of infants; breastfeeding is also an integral part of the reproductive process with important implications for the health of mothers.", and together with UNICEF recommend exclusive breastfeeding for the first six months of life, after which the WHO's guidelines recommend "continue[d] frequent, on-demand breastfeeding until two years of age or beyond." Similar recommendations hold for both developed and developing countries, and focus on preventing gastrointestinal infections as well as providing optimal conditions for maintaining the child's normal weight and cognitive development. Save the Children also endorses breastfeeding saying, "Six months of exclusive breastfeeding increases a child’s chance of survival at least six-fold."
The European Commission supports breastfeeding to ensure "optimal growth, development and health." They state that "Low rates and early cessation of breastfeeding have important adverse health and social implications for women, children, the community and the environment, [resulting] in greater expenditure on national health care provision, and [increased] inequalities in health.
American Academy of Pediatrics also supports exclusive breastfeeding for the first six months of life and assert "breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child." According to the CDC, "The success rate among mothers who want to breastfeed can be greatly improved through active support from their families, friends, communities, clinicians, health care leaders, employers, and policymakers. Given the importance of breastfeeding for the health and well-being of mothers and children, it is critical that we take action across the country to support breastfeeding."
The UK-based National Health Service has related recommendations and advises exclusive breastfeeding for around the first six months, stating, "Any amount of breastfeeding has a positive effect. The longer you breastfeed, the longer the protection lasts and the greater the benefits." In a joint statement of Health Canada, Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada to provide recommendations for parents and caregivers, they advise, "Breastfeeding - exclusively for the first six months, and sustained for up to two years or longer with appropriate complementary feeding - is important for the nutrition, immunologic protection, growth, and development of infants and toddlers." The Australian Department of Health states, "Breastfeeding provides babies with the best start in life and is a key contributor to infant health. Australia’s dietary guidelines recommend exclusive breastfeeding of infants until six months of age, with the introduction of solid foods at around six months and continued breastfeeding until the age of 12 months – and beyond, if both mother and infant wish."
Researchers have found several social factors that correlate with differences in initiation, frequency, and duration of breastfeeding practices of mothers. Race, ethnic differences and socioeconomic status and other factors have been shown to affect a mother's choice whether or not to breastfeed, and how long she breastfeeds her child. A recent study found that on average, women in the U.S. who breastfed their infants had higher levels of education, were older, and were more likely to be white. The reasons for the persistently lower rates of breastfeeding among African American women are not well understood, but employment may play a role. African American women tend to return to work earlier after childbirth than white women, and they are more likely to work in environments that do not support breastfeeding. Although research has shown that returning to work is associated with early discontinuation of breastfeeding, a supportive work environment may make a difference in whether mothers are able to continue breastfeeding.
Breastfeeding in public
Breastfeeding in public is forbidden in some jurisdictions, not addressed by law in others, and a granted legal right in public and the workplace in yet others. Where it is a legal right, some mothers may nevertheless be reluctant to breastfeed, and some people may object to the practice.
There have been incidents of owners of premises, or people present, objecting to or forbidding breastfeeding. In some cases the mothers have left; in others, where a law guaranteeing the right to breastfeed has been broken, there has been legal action. Sometimes a company has apologised after the fact. Recently, when these incidents have occurred, breastfeeding mothers have protested by organizing a "nurse-in" or a breastfeeding flash-mob, where groups of nursing mothers have gathered at the offending premise and all nursed their babies simultaneously.
In 2006, the editors of US Babytalk magazine received many complaints from readers after the cover of the August issue depicted a baby nursing at a bare breast. Even though the model's nipple was not shown, readers—many of them mothers—wrote that the image was "gross". In a follow-up poll, one-quarter of 4,000 readers who responded thought the cover was negative. Babytalk editor Susan Kane commented, "There's a huge puritanical streak in Americans." In a 2004 survey conducted by the American Dietetic Association, 43% of the 3,719 respondents believed women ought to have the right to breast-feed in public.
In some public places and workplaces, rooms for mothers to nurse in private have been designated.
Negative perception of breastfeeding in social settings has led some women to feel discomfort when breastfeeding in public. Even though many women are educated about the health benefits of breastfeeding, less than 25% choose to breastfeed their children. Western society tends to think of breasts in sexual terms instead of for their main biological purpose, to bring nourishment to infants. The sexualized image of breasts has led many to have an adverse reaction to breastfeeding because people do not like to associate feeding an infant with sexual pleasure. The consequences of Western culture’s sexualization of breasts has led women feeling embarrassed to breast feed in public, and instead, in private settings. Limitations on places in which women can breastfeed, as well as negative cultural connotations with breastfeeding may play a role in the amount of time a woman will breastfeed. The end result is often that the woman may give up breastfeeding and switch to a bottle. Society has related showing one's breast as sexual, and rejects breastfeeding in public for the most part. Before bottles and formula were invented, wet nursing used to be the typical replacement if a mother could not breastfeed her own child. In the 1800s however, wet nursing was looked down upon and formula feeding was a sign of wealth and status.
Maternal guilt and shame
Research has shown that maternal guilt and shame is often associated with how a mother feeds their infant. This guilt and shame is a result of the inability to achieve the idealized notion of what it means to be a good mother. Mothers of both bottle and breast fed babies often feel shame and/or guilt for different reasons. Mothers who bottle feed their infants may feel that they are failures at breastfeeding. On the other hand, mothers who breastfeed may feel exposed when breastfeeding in public places because of sexual connotations associated with breasts. They may also fear ridicule from emotional responses to an exposed breast. Some may see breastfeeding as, “indecent, disgusting, animalistic, sexual, and even possibly a perverse act.” In response to scrutiny concerning public breastfeeding, advocates use nurse-ins to show others that there should be no shame in breastfeeding in public. However some advocates don’t fight the shame a woman can feel when she cannot breastfeed and must bottle-feed her baby. Shame should not be used as a tool to advocate breastfeeding, rather women should be able to individually define what a good mother is. Rather than focusing on the choice a woman has made on whether or not to breastfeed, it is suggested that there be a redirection with the emphasis of providing women with education on the benefits of breastfeeding as well as problem solving skills for women who may find it difficult.
Mobility to breast milk
The cultural context of Western society, does not always seem to advocate for breastfeeding in public. According to one study published in the Journal of American Dietetic Association, over half of the people who voted believed that women should not be allowed to breastfeed in public. This study confirms previous studies that indicate that Americans do not want to see breasts in public places. Thus the stigma associated with breastfeeding in public can guide parents to seek an alternative to breastfeeding, even though it may not be as healthy for the child. There used to be only two options for feeding infants: breastfeeding or formula. With the introduction of formula as a scientifically proven way of nourishing infants, many people chose to feed their child formula over breast milk. Formula was popular for the convenience it offered by opening care opportunities to others. When examining the invention of formula from a bio cultural perspective, one might also see the invention of formula as a way in which western culture adapted to negative cultural perceptions of breastfeeding in public. In response to negativism against breastfeeding, the La Leche League began a breastfeeding advocacy movement that aimed to educate the public about the short and long term benefits of breastfeeding for both mother and child. With the introduction of the breast pump came a “third option,” that offered the benefits of mobility associated with formula feeding and the health benefits of breastfeeding. This allowed care relationships to extend across further distances without compromising the health benefits of breast milk.
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International board certified lactation consultants (IBCLCs) may be a source of assistance for breastfeeding mothers. IBCLCs are health care professionals certified in lactation management. They work with mothers to solve breastfeeding problems and educate families and health care professionals about the benefits of breastfeeding. Research shows that rates of exclusive breastfeeding and of any breastfeeding are higher among women who have had babies in hospitals with IBCLCs on staff.
Marketing of infant formula
Controversy has arisen over the marketing of breast milk vs. formula; particularly how it affects the education of mothers in third world countries and their comprehension (or lack thereof) of the health benefits of breastfeeding. The most famous example, the Nestlé boycott, arose in the 1970s and continues to be supported by high-profile stars and international groups to this day.
In 1981, the World Health Assembly (WHA) adopted Resolution WHA34.22 which includes the International Code of Marketing of Breast-milk Substitutes. Subsequently, the Innocenti Declaration was made by WHO and UNICEF policy-makers in August 1990 to protect, promote, and support breastfeeding.
Commercial infant formula costs more than low-income families can afford to pay.
A 2013 Save the Children report states regarding formula companies giving free samples: "If new mothers are given free samples to feed to their babies it can start a vicious circle that undermines their own ability to breastfeed. An infant satiated with formula may demand less breast milk, so the mother produces less, and that can result in her losing confidence in her ability to breastfeed."
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|Wikimedia Commons has media related to Breastfeeding.|
|Look up breastfeeding in Wiktionary, the free dictionary.|
- Breastfeeding at DMOZ
- Human Milk Secretion: An Overview US National Institute of Health
- Breastfeeding Resources La Leche League International
- Breast-Feeding Content Resources WHO reports on Breast Feeding
- Health risks of not breastfeeding US Department of Health & Human Services
- The World Alliance for Breastfeeding Action (WABA) is a global network of individuals & organisations concerned with the protection, promotion & support of breastfeeding worldwide.
- Breastfeeding: NHS Choices
- Center for Disease Control and Prevention Breastfeeding CDC
- LactMed, a database of the safety of drugs to which breastfeeding mothers may be exposed, by the U.S. National Library of Medicine