Medicine is fraught with controversies. However, there is one topic upon which there is almost universal agreement: with few exceptions, breast milk is the best source of nourishment for infants. Breast milk is an impressive food. The milk produced during pregnancy and just after birth is rich in the nutrients and antibodies newborns need. By three to five days after birth, the milk is an easy-to-digest balance of the right amount of fat, sugar, water and protein to help the baby continue to grow.
The Benefits
While formula may be able to mimic the nutritional value, it can't match breast milk in protecting babies from illness, nor is it as easily digestible by the newborn's immature digestive tract. Epidemiological studies have shown that breastfed babies have fewer bouts with ear infection, respiratory infection, meningitis, diarrhea, and constipation. They also have lower risk of allergies, asthma, obesity, diabetes, childhood leukemia and sudden infant death.
The benefits to mothers are similarly impressive, with studies linking breastfeeding to lower risk for type 2 diabetes, breast cancer, ovarian cancer, hypertension, cardiovascular disease, and postpartum depression. The skin-to-skin contact with their babies causes the mother's pituitary to release oxytocin, a hormone that helps milk flow, while at the same time helping the uterus to shrink after delivery.
From a purely practical standpoint, breast milk is always available, does not have to be warmed before feeding the infant and does not require lugging around a bunch of supplies. Also, breast milk is free and breastfeeding saves the cost of formula and supplies, which can tally up to more than $1,500 a year. Breastfed babies have been shown to be sick less often, resulting in lower health care costs and fewer missed days of work for parents. The government estimates the U.S. could save $13 billion a year in medical care costs if 90 percent of new mothers breastfed exclusively for six months.
The Statistics
Nationally, three out of four mothers start out breastfeeding. In California, the statistics are better with 86.6 percent of new mothers breastfeeding their infants for some period. At six months, 53.8 percent of Californian mothers are still breastfeeding, but by one year the number drops to 31.4 percent, still better than the national average. Only 40.4 percent of mothers in California exclusively breastfeed their infants during the first three months, feeding them only breast milk and no formula or water supplements between feedings. At six months, this number is down to 17.2 percent.
Multiple health organizations, including the American Academy of Pediatrics, the American Medical Association, the American Dietetic Association, the American College of Obstetrics and Gynecology, the American Academy of Family Physicians, the American Public Health Association, the Centers for Disease Control, and the World Health Organization recommend breastfeeding for at least six months and preferably a year, and many express a preference for exclusive breastfeeding during this time. In fact, breastfeeding has become such an important public health issue that Surgeon General Regina M. Benjamin, MD, will soon be releasing a call to action to support breastfeeding that will explain steps that family members, communities, health care professionals and employers can take to make breastfeeding an easy choice for mothers.
The Barriers
There are a number of barriers that women need to overcome to be able to comfortably breastfed their infants. Historically, one of them is social. In 1984, it was still possible for mothers to be cited for breastfeeding in public. Now, nearly every state in the nation has passed legislation to protect the rights of mothers to breastfeed their children in public. California is only one of 16 states with legislation that requires employers to provide private space and time for a nursing working mother to be able to pump her milk, as long as it does not "seriously disrupt" the operations of the employer.
Additionally, nursing mothers must watch what they ingest. They need to limit their intake of fish with high mercury levels, curtail excessive alcohol and caffeine consumption, and check with their physician about any medications, including over-the-counter drugs and supplements, which may pass into the breast milk and then the baby.
Also, nursing can be very tiring. In the beginning, the infant may breastfed every two to four hours for 10 to 20 minutes on each breast. As time goes on, the frequency of feeding will decrease. Mom may be able to get some much needed rest if she pumps her milk and lets dad take a few of the feedings, especially the nighttime ones.
There are some medical barriers as well - a woman with HIV should not breastfeed, nor should a woman undergoing chemotherapy or receiving certain medications that pass into the breast milk and can harm the child. Also, some women who have had breast surgery may have difficulties with lactation.
Where to Go for Help
For mothers, there are volumes of advice available for breastfeeding, from strategies for getting the proper "latch" from the baby to the best way to hold the baby. My advice is to be patient and embrace support. While it may seem that breastfeeding should be instinctive, for many women it can be difficult, uncomfortable and frustrating at first. Before your hungry bundle of joy arrives, consider taking a breastfeeding class and making a list of resources available to you. Immediately after delivery, you can get help from the nurses available at the hospital, or from your doula or midwife. Your pediatrician can help too. In addition to lactation consultants, there is support from other mothers available online and through La Leche League. Help is as close as a phone call away through the U.S. Department of Health and Human Services' free National Breastfeeding Helpline at 1-800-994-9662.
Don't forget the resources close to home: husband or partner, family and close friends. Juggling all the responsibilities that come with a new baby can be challenging, and don't hesitate to ask for extra help and support until you establish a routine.
Breastfeeding is among the best measures that can be taken to ensure a newborn's future health and nutritional well-being. While it is ultimately the personal choice of a mother, as a community we should do what we can to make the choice an easy one. Wouldn't it be nice if virtually every child could say: "Thanks for the mammaries"?
"For Release: Monday, November 8, 2010 12:01 am (ET)
BREASTFEEDING MOMS DON’T GET LESS OR WORSE SLEEP THAN MOMS WHO USE FORMULA, STUDY FINDS
Breastfed infants are reported to awaken more often and to sleep less. But does that mean breastfeeding mothers get less sleep, too? Not necessarily, according to the study, “Infant Feeding Methods and Maternal Sleep and Daytime Functioning,” in the December issue of Pediatrics (published online Nov. 8). For the study, 80 mothers kept daily sleep diaries and wore devices that measured nighttime sleep. Researchers found no difference in objective or subjective total sleep time or sleep quality between mothers who were exclusively breastfeeding, exclusively formula feeding or using a combination of the two. Nor were there differences on measures of daytime sleepiness or fatigue. Study authors conclude that women should be told that choosing to formula feed may not mean they’ll sleep better. "
Also, new babies need to feed during the night, it's biologically normal. If someone else is feeding baby, then breasts are either not being used (lowers supply), or mom is up anyway pumping. And nighttime is when prolactin levels and milk supply both tend to be highest.
Given the recent REACH trials showint the decrease in cardiovascular events in diabetics on 'metformin',do you ahve any advice on whether I should satar it on my overweight,but non diabetic patients?
Thanks in advance
I just want to point out since you mention state laws, that as of March 2010 the FLSA was amended to require most employers to offer employees breaks for breastfeeding and a private place with an outlet that is not a bathroom, to pump. They, however, do not require that employees be paid for these breaks, though some states cover that.
I'm a breastfeeding counsellor and tutor in the UK, and the majority of women who contact me are struggling with breastfeeding in some way. They have read or heard or otherwise absorbed a message of restricting breastfeeding - rather like the way Dr B. says they should. 'Feeding two to four hourly' may be ok for some mothers and babies, but it can be disastrous for others (see Susan Burger's comments); timing '10 to 20 minutes on each breast' ditto.
Western cultures tend not to encourage the 'easy' way to breastfeed which is simply for mothers and babies to be physically close much of the time when the baby is young, with responsive, 'ad lib' breastfeeding day and night - plus some initial monitoring of breastfeeding effectiveness in the early days to ensure the baby is transferring milk well (birth interventions and experiences can affect this). Instead, we've come up with rules and schedules and routines and timings and tiresome lists of things you can't eat or drink, as well as places you can and can't do it....making the whole thing into a Big Deal, and even an obligation or some sort of penance! No wonder some women decide it's not for them.
Laurence
laurencegirard@fas.harvard.edu
When you weigh the benefits to the baby of having either 1) a reasonably contented mother, but no breastmilk or 2) a mother who forces herself to breastfeed but is too miserably depressed to interact with baby, I think the former wins out. Yes, there should be support for women who want to breastfeed, but none of this emotional coercion that turns even hardcore breastfeeding advocates like me right off. Also, I'm fortunate in that my husband supports us financially so I don't have to work, but for women who work it's really a little much to ask them to come home at the end of a tiring day (made longer, one presumes, by frequent breast pumping breaks and a sleepless night) and, on top of all the other demands of parenting - laundry, groceries, household upkeep, maybe some parent-child interactions and yes, even some personal time - cook a nutritionally balanced meal is a BIT MUCH. I agree that nutrition is really important (and meals don't have to be all that fancy when you're strapped for time - microwave steamed frozen veggies are simple to prepare, with whole grain store-bought pasta and cheese) but it's all too easy to pass airy judgment on exhausted moms when you're not one of them. And one presumes at least some of these children have fathers, so let's hear a bit more about their role in providing nutritious home cooked meals to their offspring.
I think the main take away should be that you need to look to the baby first & for most & that there is no one size fits all for a nursing dyad.
I do like the use of the word barriers in the article because breastfeeding moms are up against far too many. Even with the best information & intentions the barriers become overwhelming to some moms. Every mom has a right to accurate information & the right to the support she needs to make her choice work.