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"?