Breastfeeding
Introduction
Before 1900, most mothers breastfed their infants. Breastfeeding rates declined
sharply worldwide after 1920, when evaporated cow’s milk and infant
formula became widely available. These were promoted as being more
convenient for mothers and more nutritious than human milk. Breastfeeding
rates began rising again in the late 1950s and early 1960s
BENEFITS OF BREASTFEEDING
Benefits for Infant Benefits for Mother
• Perfect food for infant
• Guarantees safe, fresh milk
• Enhances immune system
• Protects against infectious and noninfectious diseases
• Protects against food allergies and intolerances
• Decreases risk of diarrhea and respiratory infections
• Promotes correct development of jaw, teeth, and speech patterns
• Decreases risk of childhood obesity
• Increases cognitive function
• Increases bonding with mother
• Promotes faster shrinking of the uterus
• Promotes less postpartum bleeding
• Promotes faster return to pre-pregnancy weight
• Eliminates the need for preparing and mixing formula
• Saves money not spent on formula
• Decreases risk of breast and ovarian cancer
• Increases bonding with infant
• Enhances self-esteem in the maternal role
• Delays the menstrual cycle
Breastfeeding, or lactation, is, in fact, the ideal method of feeding and
nurturing infants. Most health organizations recommend infants be exclusively
breastfed during the first four to six months of life, but ideally
through the first year. Premature infants also benefit from their mothers’
milk. In developing countries, breastfeeding up to age two, with appropriate
supplementary solid foods, maintains good nutritional status and prevents
diarrhea
Benefits of Breastfeeding
Human milk contains the right balance of nutrients for human growth and
development. It is low in total protein and high in carbohydrates, making
it more digestible and less stressful on the immature kidneys. In addition,
each mammal produces milk that is nutritionally and immunologically tailored
for its young. In rare cases, such as galactosemia and phenylketonuria,
some infants cannot metabolize human milk or other milk products. A significant
benefit of human milk is that it contains many immunologic agents
that protect the infant against bacteria, viruses, and parasites. Breastfeeding
also provides many benefits for the mother
Human milk contains the right balance of nutrients for human growth anddevelopment. It is low in total protein and high in carbohydrates, makingit more digestible and less stressful on the immature kidneys. In addition,each mammal produces milk that is nutritionally and immunologically tailoredfor its young. In rare cases, such as galactosemia and phenylketonuria,some infants cannot metabolize human milk or other milk products. A significantbenefit of human milk is that it contains many immunologic agentsthat protect the infant against bacteria, viruses, and parasites. Breastfeedingalso provides many benefits for the mother
Breastfeeding Trends
Despite the many benefits of breastfeeding, only 64 percent of mothers in
the United States initiate breastfeeding, with 29 percent still breastfeeding
six months after birth. The U.S. goals for 2000 were to increase to 75 percent
the proportion of women who initiate breastfeeding, and to increase
to 50 percent the proportion of women who breastfeed for five to six months.
In the United States, ethnic minorities are less likely to breastfeed than their
white counterparts.
Based on a 2001 report by the World Health Organization (WHO), 35
percent of infants worldwide are exclusively breastfed (no other food or drink,
not even water) for the first four months of life. Rates are very low in a number
of African countries, especially Nigeria, Central African Republic, and
Niger. Some countries, such as Benin, Mali, Zambia, and Zimbabwe have
had small increases, due mainly to breastfeeding campaigns, baby-friendly
hospitals, and the commitment of trained breastfeeding counselors. In Southeast
Asia, the exclusive breastfeeding rate, though low, has increased. Breastfeeding
rates are also low in many European countries, especially France,
Italy, Netherlands, Spain, Switzerland, and the United Kingdom. Sweden,
however, has a rate of 98 percent, the highest level in the world.
An increase in breastfeeding could save the lives of millions of children
a year worldwide. However, the aggressive marketing campaigns by infant
formula companies and the promotion of infant formula by health professionals
combine to discourage breastfeeding. Other factors that determine
:whether a woman will breastfeed include
• The father’s preference for a specific feeding method
• Whether the mother was breastfed as an infant
• Social support
• Whether relatives and/or friends breastfeed
• Whether the mother gets help with household chores
• The mother’s need to work
• Hospital policies
Physiology of Breastfeeding
During pregnancy, the body increases its production of a hormone called
prolactin, which stimulates the breast to make milk. Suckling by the infant
stimulates the release of prolactin. The size of the breasts is not a factor in
milk production. Oxytocin, another hormone, allows the breast tissue to “let
down” or release milk from the milk ducts to the nipples.
Colostrum, the first milk produced, has all the nutrients a newborn infant
needs. It also contains many substances to protect against infections. The body
produces colostrum for several days until the “mature milk” comes in. Mature
milk adjusts to the baby’s needs for the rest of the time the infant is breastfed.
Nutritional Needs of the Mother
Milk production requires about 800 calories a day. The Recommended
Dietary Allowances for calories during breastfeeding is 500 more calories
a day than is required by a nonpregnant woman. Nutritional requirements
do not change significantly from pregnancy, with the exception of decreases
in folate and iron, and increases in vitamin A, vitamin C, niacin, and zinc.
The diet can be the same as during pregnancy, plus an additional glass of
milk. Women who are on medication should check with their physicians,
since most drugs are absorbed in breast milk.
Weaning
The decision to wean should be based on the desires and needs of the mother
and child. Weaning should be gradual. Women returning to work can pump
and store their milk for later use. Solid foods should be given based on the
age and developmental stage of the child. In some countries, many toddlers
become malnourished because they are given too many high carbohydrate
foods, such as cassava, potatoes, and other root vegetables, too early. These
foods are filling, but they are low in protein and other nutrients essential
for growth and development.
Breast Implants and Breast Reduction
Many women with breast implants breastfeed successfully, though it is not
known whether the health of the infant is affected by breast implants.
Women who have had a breast reduction may not be able to breastfeed,
since the surgical procedure removes glandular tissue and realigns the
nipple.
Who Should Not Breastfeed?
Women with HIV/AIDS, hepatitis, cancer, and other conditions where the
immune system may be compromised should not breastfeed. A case-bycase
assessment should be made with women exposed to certain environmental
toxins and those who use illicit drugs.
Policies and Recommendations
A woman’s ability to breastfeed for the optimal recommended time depends
on the support she receives from her family, health care providers, and the
workplace. Health care institutions should adopt policies and initiatives that
include
• A written breastfeeding policy
• A breastfeeding education program
• Rooming-in of mother and child
• Breastfeeding on demand
• Limited use of pacifiers, water, and formula
With the increased number of women in the workforce, employers can
do a lot to support and encourage breastfeeding, such as providing adequate
breaks; flexible hours; job sharing; part-time work; refrigerators for storage
of breast milk; and on-site child care.
A public health campaign can greatly increase the initiation and duration
of breastfeeding. These campaigns should target all social groups, including
men, future parents, grandparents, health care providers, and
employers. In addition, culturally appropriate programs and materials should