- Suckling and nursing are synonyms. For other uses,
see Nursing and Suckling
Breastfeeding is the feeding of an
infant or young
child with
breast milk directly from human
breasts (i.e., via
lactation) rather than from a
baby bottle or other container. Babies have a
sucking reflex that enables them to
suck and swallow milk. Most mothers can breastfeed for six months
or more, without the addition of
infant
formula or solid food.
Human
breast milk is the healthiest form
of milk for human babies. There are few
exceptions, such as when the mother is taking certain
drugs or is infected with
tuberculosis or
HIV.
Breastfeeding promotes health, helps to prevent disease and reduces
health care and feeding costs. In both
developing and
developed countries, artificial feeding is
associated with more deaths from
diarrhea
in infants. Experts agree that breastfeeding is beneficial, but may
disagree about the length of breastfeeding that is most beneficial,
and about the risks of using artificial formulas.
Emphasizing the value of breastfeeding for both mothers and
children, the
World Health
Organization (WHO) and the
American Academy of
Pediatrics (AAP) both recommend exclusive breastfeeding for the
first six months of life and then supplemented breastfeeding for at
least one year and up to two years or more. While recognizing the
superiority of breastfeeding, regulating authorities also work to
minimize the risks of artificial feeding.
The acceptability of
breastfeeding in public varies by
culture and country. In
Western
culture, though most approve of breastfeeding, some mothers may
be reluctant to do so out of fear of public opinion.
Breast milk
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. 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
stress, bad
food habits, chronic illnesses,
smoking, and
drinking.
Benefits for the infant
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, has
found many benefits to breastfeeding for the infant. These
include:
Less necrotizing enterocolitis in premature infants
Necrotizing enterocolitis
(NEC) is an acute inflammatory disease in the intestines of
infants. Necrosis or death of intestinal tissue may follow. It is
mainly found in
premature births. In
one study of 926 preterm infants, NEC developed in 51 infants
(5.5%). The death rate from necrotizing enterocolitis was 26%. NEC
was found to be six to ten times more common in infants fed formula
exclusively, and three times more common in infants fed a mixture
of breast milk and formula, compared with exclusive breastfeeding.
In infants born at more than 30 weeks, NC was twenty times more
common in infants fed exclusively on formula. A 2007 meta-analysis
of four randomized controlled trials found "a marginally
statistically significant association" between breastfeeding and a
reduction in the risk of NEC.
Greater immune health
During breastfeeding
antibodies pass to the
baby. Breast milk contains several anti-
infective factors such as
bile salt stimulated lipase
(protecting against
amoebic infections),
lactoferrin (which binds to iron and
inhibits the growth of
intestinal
bacteria) and
immunoglobulin A
protecting against
microorganisms.
Fewer infections
Among the studies showing that breastfed infants have a lower risk
of infection than non-breastfed infants are:
- In a
1993 University of Texas Medical
Branch
study, a longer period of breastfeeding was
associated with a shorter duration of some middle ear infections
(otitis media
with effusion) in the first two years of life.
- A 1995 study of 87 infants found that breastfed babies had half
the incidence of diarrheal illness, 19% fewer cases of any otitis media infection, and 80% fewer prolonged
cases of otitis media than formula fed babies in the first twelve
months of life.
- Breastfeeding appeared to reduce symptoms of upper respiratory tract
infections in premature infants up to seven months after
release from hospital in a 2002 study of 39 infants.
- A 2004 case-control study
found that breastfeeding reduced the risk of acquiring urinary tract infections in infants
up to seven months of age, with the
protection strongest immediately after birth.
- The 2007 review for AHRQ found that breastfeeding reduced the
risk of acute otitis media, non-specific gastroenteritis, and
severe lower respiratory tract infections.
Less tendency to develop 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. However, the
key factor may be the age at which non-breastmilk is introduced
rather than duration of breastfeeding.
Atopic dermatitis, the most common form of
eczema, can be reduced through exclusive
breastfeeding beyond 12 weeks in individuals with a family history
of atopy, but when breastfeeding beyond 12 weeks is combined with
other foods incidents of eczema rise irrespective of family
history.
More easily aroused from sleep
Breastfed babies have better arousal from sleep at 2–3 months. This
coincides with the peak incidence of
sudden infant death
syndrome.
Higher intelligence
Studies examining whether breastfeeding in infants is associated
with
higher intelligence later in life
include:
- Horwood, Darlow and Mogridge (2001) tested the intelligence quotient (IQ) scores of
280 low birthweight children at seven or
eight years of age. Those who were breastfed for more than eight
months had verbal IQ scores 6 points higher (which was significantly higher) than
comparable children breastfed for less time. They concluded "These
findings add to a growing body of evidence to suggest that breast
milk feeding may have small long term benefits for child cognitive
development."
- A 2005 study using data on 2,734 sibling pairs from the
National
Longitudinal Study of Adolescent Health "provide[d] persuasive
evidence of a causal connection between breastfeeding and
intelligence."
- In 2006, Der and colleagues, having performed a prospective cohort study, sibling
pairs analysis, and meta-analysis,
concluded that "Breast feeding has little or no effect on
intelligence in children." The researchers found that "Most of the
observed association between breast feeding and cognitive
development is the result of confounding
by maternal intelligence."
- The 2007 review for the AHRQ found "no relationship between
breastfeeding in term infants and cognitive performance."
- The 2007 review for the WHO concluded "Subjects who were
breastfed experienced... higher performance in intelligence
tests."
- Two initial cohort studies
published in 2007 suggest babies with a specific version of the
FADS2 gene demonstrated an IQ averaging 7
points higher if breastfed, compared with babies with a less common
version of the gene who showed no improvement when breastfed. FADS2
affects the metabolism of polyunsaturated fatty acids found in
human breast milk, such as docosahexaenoic acid and arachidonic
acid, which are known to be linked to early brain development. The
researchers were quoted as saying "Our findings support the idea
that the nutritional content of breast milk accounts for the
differences seen in human IQ. But it's not a simple all-or-none
connection: it depends to some extent on the genetic makeup of each
infant." The researchers wrote "further investigation to replicate
and explain this specific gene–environment interaction is
warranted."
- In
"the largest randomized trial ever conducted in the area of human
lactation," between 1996 and 1997 maternity hospitals and polyclinics in Belarus
were
randomized to receive or not receive breastfeeding promotion
modeled on the Baby
Friendly Hospital Initiative. Of 13,889 infants born at
these hospitals and polyclinics and followed up in 2002-2005, those
who had been born in hospitals and polyclinics receiving
breastfeeding promotion had IQs that were 2.9-7.5 points higher
(which was significantly higher). Since (among other reasons) a
randomized trial should control for maternal IQ, the authors
concluded in a 2008 paper that the data "provide strong evidence
that prolonged and exclusive breastfeeding improves children's
cognitive development."
Diabetes
Infants exclusively breastfed have less chance of developing
diabetes mellitus type 1
than peers with a shorter duration of breastfeeding and an earlier
exposure to cow milk and solid foods. Breastfeeding also appears to
protect against
diabetes
mellitus type 2, at least in part due to its effects on the
child's weight.
Obesity
Breastfeeding appears to reduce the risk of extreme
obesity in children aged 39 to 42 months. The
protective effect of breastfeeding against obesity is consistent,
though small, across many studies, and appears to increase with the
duration of breastfeeding.
Other long term health effects
In one study, breastfeeding did not appear to offer protection
against
allergies. However, another study
showed breastfeeding to have lowered the risk of
asthma, protect against allergies, and provide
improved protection for babies against respiratory and intestinal
infections.
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 life-long
protection.
An initial
study at the University of Wisconsin
found that women who were breast fed in infancy may
have a lower risk of developing breast
cancer than those who were not breast fed.
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. Although a 2001
study suggested that adults who had been breastfed as infants had
lower arterial distensibility than adults who had not been
breastfed as infants, the 2007 review for the WHO concluded that
breastfed infants "experienced lower mean blood pressure" later in
life. Nevertheless, the 2007 review for the AHRQ found that "the
relationship between breastfeeding and cardiovascular diseases was
unclear".
Benefits for mothers
Breastfeeding is a cost effective way of feeding an infant, and
provides the best nourishment for a child at a small nutrient cost
to the mother. Frequent and exclusive breastfeeding can delay 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.
Bonding
Breastfeeding helps to strengthen the
maternal bond. The hormones released during
breastfeeding 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 expressed breast milk. The various
breast pumps available for sale and rent help
working mothers to feed their babies breast milk for as long as
they want. To be successful, the mother must produce and store
enough milk to feed the child for the time she is away, and the
feeding caregiver must be comfortable in handling breast
milk.
Hormone release
Breastfeeding releases
oxytocin and
prolactin, hormones that relax the mother
and make her feel more nurturing toward her baby. 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. Some
women experience
orgasm during breastfeeding
due to the release of oxytocin.
Weight loss
As the fat accumulated during pregnancy is used to produce milk,
extended breastfeeding—at least 6 months—can help mothers lose
weight. However, weight loss is highly variable among lactating
women; monitoring the diet and increasing the amount/intensity of
exercise are more reliable ways of losing weight. The 2007 review
for the AHRQ found "The effect of breastfeeding in mothers on
return-to-pre-pregnancy weight was negligible, and the effect of
breastfeeding on postpartum weight loss was unclear."
Natural postpartum infertility
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 a
greater than 98% effectiveness during the first six months after
birth if specific nursing behaviors are followed. It is possible
for some women to ovulate within two months after birth while fully
breastfeeding.
Long-term health effects
For breastfeeding women, long-term health benefits include:
- Less risk of breast cancer, ovarian
cancer, and endometrial
cancer.
- A 2009 study indicates long duration of lactation (at least 24
months) is associated with a reduced risk of heart disease.
- Although the 2007 review for the AHRQ found "no relationship
between a history of lactation and the risk of osteoporosis", mothers who breastfeed longer
than eight months benefit from bone re-mineralisation.
- Breastfeeding diabetic mothers require
less insulin.
- Reduced risk of post-partum bleeding.
- According to a Malmö
University study published in 2009, women who breast fed for a
longer duration have a lower risk for contracting rheumatoid arthritis than women who
breast fed for a shorter duration or who had never breast fed.
Organisational endorsements
World Health Organization
The WHO recommends exclusive breastfeeding for the first six months
of life, after which "infants shouldreceive nutritionally adequate
and safe complementary foods while breastfeeding continues for up
to two years of age or beyond."
American Academy of Pediatrics
The AAP recommends exclusive breastfeeding for the first six months
of life. Furthermore, "breastfeeding should be continued for at
least the first year of life and beyond for as long as mutually
desired by mother and child."
Breastfeeding difficulties
While breastfeeding is a natural human activity, difficulties are
not uncommon. Putting the baby to the breast as soon as possible
after the birth helps to avoid many problems. The AAP breastfeeding
policy says: "Delay weighing, measuring, bathing, needle-sticks,
and eye prophylaxis until after the first feeding is completed."
Many breastfeeding difficulties can be resolved with proper
hospital procedures, properly trained midwives, doctors and
hospital staff, and lactation consultants. 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. Rarely, a mother may
not be able to produce breastmilk because of a prolactin
deficiency. This may be caused by Sheehan's syndrome, an uncommon
result of a sudden drop in blood pressure during childbirth
typically due to hemorrhaging. In developed countries, many working
mothers do not breast feed their children due to work pressures.
For example, a mother may need to schedule for frequent pumping
breaks, and find a clean, private and quiet place at work for
pumping. These inconveniences may cause mothers to give up on
breast feeding and use infant formula instead.
HIV infection
As breastfeeding can transmit
HIV from mother to
child, UNAIDS recommends avoidance of all breastfeeding where
formula feeding is acceptable, feasible, affordable and safe. The
qualifications are important. Some constituents of breast milk may
protect from infection. High levels of certain
polyunsaturated fatty acids in
breast milk (including eicosadienoic,
arachidonic and
gamma-linolenic acids) are associated
with a reduced risk of child infection when nursed by HIV-positive
mothers. Arachidonic acid and gamma-linolenic acid may also reduce
viral shedding of the HIV virus in
breast milk. Due to this, in underdeveloped nations infant
mortality rates are lower when HIV-positive mothers breastfeed
their newborns than when they use infant formula. However,
differences in infant mortality rates have not been reported in
better resourced areas. Treating infants prophylactically with
lamivudine (3TC) can help to decrease the
transmission of HIV from mother to child by breastfeeding. If free
or subsidized formula is given to HIV-infected mothers,
recommendations have been made to minimize the drawbacks such as
possible disclosure of the mother's HIV status.
Infant weight gain
Breastfed infants generally gain weight according to the following
guidelines:
- 0–4 months: 170 grams per week†
- 4–6 months: 113–142 grams per week
- 6–12 months: 57–113 grams per week
- † It is acceptable for some babies to gain
113–142 grams (4–5 ounces) per week. This average is
taken from the lowest weight, not the birth weight.
The average breastfed baby doubles its birth weight in 5–6 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
bottle fed babies. By two years, differences in weight gain and
growth between breastfed and formula-fed babies are no longer
evident.
Methods and considerations
There are many books and videos to advise mothers about
breastfeeding.
Lactation
consultants in hospitals or private practice, and volunteer
organisations of breastfeeding mothers such as
La Leche League International
also provide advice and support.
Early breastfeeding
In the half hour after birth, the baby's suckling reflex is
strongest, and the baby is more alert, so it is the ideal time to
start breastfeeding. Early breast-feeding is associated with fewer
nighttime feeding problems.
Time and place for breastfeeding
Breastfeeding at least every two to three hours helps to maintain
milk production. For most women, eight breastfeeding or pumping
sessions every 24 hours keeps their milk production high. Newborn
babies may feed more often than this: 10 to 12 breastfeeding
sessions every 24 hours is common, and some may even feed 18 times
a day. Feeding a baby "on demand" (sometimes referred to as "on
cue"), means feeding when the baby shows signs of
hunger; feeding this way rather than by the clock
helps to maintain milk production and ensure the baby's needs for
milk and comfort are being met. However, it may be important to
recognize whether a baby is truly hungry, as breastfeeding too
frequently may mean the child receives a disproportionately high
amount of foremilk, and not enough hindmilk.
"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 can't 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."
rith
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.
Latching on, feeding and positioning
Correct positioning and technique for latching on can 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 in
order to induce the baby to move into position for a breastfeeding
session, then quickly moving baby onto the breast while baby's
mouth is wide open. In order 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. To help the baby
latch on well, tickle the baby's top lip with
the nipple, wait until the baby's mouth opens wide, then bring the
baby up towards the nipple quickly, so that the baby has a mouthful
of nipple and
areola. The nipple should be at
the back of the baby's throat, with the baby's tongue lying flat in
its mouth.
Inverted or flat nipples
can be massaged so that the baby will have more to latch onto.
Resist the temptation to move towards the baby, as this can lead to
poor attachment.
Pain in the nipple or breast is linked to incorrect breastfeeding
techniques. Failure to latch on is one of the main reasons for
ineffective feeding and can lead to infant health concerns. A 2006
study found that inadequate parental education, incorrect
breastfeeding techniques, or both were associated with higher rates
of preventable hospital admissions in newborns.
The baby may pull away from the nipple after a few minutes or after
a much longer period of time. Normal feeds at the breast can last a
few sucks (newborns), from 10 to 20 minutes or even longer (on
demand). Sometimes, after the finishing of a breast, the mother may
offer the other breast.
While most women breastfeed their child in the
cradling position, there are many ways to hold
the feeding baby. It depends on the mother and child's comfort and
the feeding preference of the baby. Some babies prefer one breast
to the other, but the mother should offer both breasts at every
nursing with her newborn.
When tandem breastfeeding, the mother is unable to move the baby
from one breast to another and comfort can be more of an issue. As
tandem breastfeeding brings extra strain to the arms, especially as
the babies grow, many mothers of twins recommend the use of more
supporting pillows.
Exclusive breastfeeding
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.
Exclusively breastfed infants feed anywhere from 6 to 14 times a
day. Newborns consume from 30 to 90 ml (1 to 3 US fluid ounces).
After the age of four weeks, babies consume about 120ml (4 US fluid
ounces) per feed. Each baby is different, but as it grows the
amount will increase. It is important to recognize the baby's
hunger signs. It is assumed that the baby knows how much milk it
needs and it is therefore advised that the baby should dictate the
number, frequency, and length of each feed. The supply of milk from
the breast is determined by the number and length of these feeds or
the amount of milk expressed. The
birth
weight of the baby may affect its feeding habits, and mothers
may be influenced by what they perceive its requirements to be. For
example, a baby born small for gestational age may lead a mother to
believe that her child needs to feed more than if it larger; they
should, however, go by the demands of the baby rather than what
they feel is necessary.
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. If necessary, it is
possible to estimate feeding from wet and soiled nappies (diapers):
8 wet cloth or 5–6 wet disposable, and 2–5 soiled per 24 hours
suggests an acceptable amount of input for newborns older than 5–6
days old. After 2–3 months, stool frequency is a less accurate
measure of adequate input as some normal infants may go up to 10
days between stools. Babies can also be weighed before and after
feeds.
Expressing breast milk
Manual breast pump
When direct breastfeeding is not possible, a mother can
express (artificially remove and store) her milk. With
manual massage or using a
breast pump, a
woman can express her milk and keep it in freezer storage bags, a
supplemental nursing
system, or a
bottle ready for use.
Breast milk may be kept at
room
temperature for up to ten hours, refrigerated for up to eight
days or frozen for up to four to six 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, such as when a newborn causes grazing and bruising.
If an older baby bites the nipple, the mother's reaction - a jump
and a cry of pain - is usually enough to discourage the child from
biting again.
"Exclusively expressing", "exclusively pumping" and "EPing" are
terms for a mother who feeds her baby exclusively on 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. Kellymom has a page of
links relating to exclusive pumping.
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.
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.
Mixed feeding
Expressed breast milk (EBM) or infant formula can be fed to an
infant by bottle
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 teats 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 teat, an infant will 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. Orthodontic teats,
which are generally slightly longer, are closer to the nipple. Some
mothers supplement feed with a small syringe or flexible cup to
reduce the risk of artificial nipple preference.
Tandem breastfeeding
Feeding two children at the same time is called
tandem
breastfeeding The most common reason for tandem breastfeeding
is the birth of
twins, although women with
closely spaced children can and do continue to nurse the older as
well as the younger. 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. While breasts can respond to the demand and produce
large quantities of milk, it is common for women to use
alternatives. However, some mothers have been able to breastfeed
triplets successfully.
Tandem breastfeeding may also occur when a woman has a baby while
breastfeeding an older child. During the late stages of pregnancy
the milk will change to colostrum, and some older nurslings will
continue to feed even with this change, while others may wean due
to the change in taste or drop in supply. Feeding a child while
being pregnant with another can also be considered a form of tandem
feeding for the nursing mother, as she also provides the nutrition
for two.
Extended breastfeeding
Breastfeeding past two years is called "full term breastfeeding" or
extended breastfeeding or "sustained breastfeeding" by
supporters and those outside the U.S. Supporters of extended
breastfeeding believe that all the benefits of human milk,
nutritional, immunological and emotional, continue for as long as a
child nurses. Often the older child will nurse infrequently or
sporadically as a way of bonding with the mother.
Shared breastfeeding
It used to be common worldwide, and still is in
developing nations such as those in
Africa, for more than one woman to breastfeed
a child. Shared breastfeeding is a risk factor for
HIV infection in infants. A woman who is engaged to
breastfeed another's baby is known as a
wet
nurse.
Islam has
codified the
relationship between this woman and the infants she nurses, and
also between the infants when they grow up, so that milk siblings
are considered as blood siblings and
cannot
marry (
mahram).
Shared breastfeeding can incur strong
negative reactions in the Anglosphere;
American feminist activist Jennifer
Baumgardner has written about her experiences in New York
with this
issue.
Weaning
Weaning is the process of introducing the infant to other food and
reducing the supply of breast milk. The infant is fully weaned when
it no longer receives any breast milk. Most mammals stop producing
the
enzyme lactase at
the end of weaning, and become
lactose intolerant. Most humans have a
mutation that allows the production of lactase throughout life and
so can drink milk - usually cow or goat milk - well beyond
infancy.
In the past,
bromocriptine was
sometimes used to reduce the
engorgement experienced by many women
during weaning. However, it was discovered that when used for this
purpose, this medication posed serious health risks to women such
as
stroke and
seizures, and the
U.S. Food and Drug
Administration withdrew this indication for the drug in
1994.
History of breastfeeding
For hundreds of thousands of years, humans, like all other mammals,
fed their young milk. Before the twentieth century, alternatives to
breastfeeding were rare. Attempts in 15th century Europe to use cow
or goat milk were not very positive. 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.
True commercial
infant formulas
appeared on the market in the mid 19th Century but their use did
not become widespread until after
WWII.
As the superior qualities of breast milk became better-established
in medical literature, breastfeeding rates have increased and
countries have enacted measures to protect the rights of infants
and mothers to breastfeed.
Sociological factors with breastfeeding
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.
- Race and culture Singh et al. also found that
African American women are less likely than white women of similar
socioeconomic status to breastfeed and Hispanic women are more
likely to breastfeed. The Center of Disease Control used
information from the National Immunization Survey to determine the
proportion of Caucasian and African American children that were
ever breast fed. They found that 71.5% of Caucasians had breastfed
their child while only 50.1% of African Americans had. At six
months of age this fell to 53.9% of Caucasian mothers and 43.2% of
African American mothers who were still breastfeeding.
- Income Deborah L. Dee's research found that
women and children who qualify for
WIC, Special Supplemental Nutrition Program for Women, Infants,
and Children were among those who were least likely to initiate
breastfeeding. Income level can also contribute to women
discontinuing breastfeeding early. More highly educated women are
more likely to have access to information regarding difficulties
with breastfeeding, allowing them to continue breastfeeding through
difficulty rather than weaning early. Women in higher status jobs
are more likely to have access to a lactation room and suffer less social stigma
from having to breastfeed or express breastmilk at work. In
addition, women who are unable to take an extended leave from work
following the birth of their child are less likely to continue
breastfeeding when they return to work.
- Other factors Other factors they found to have
an effect on breastfeeding are “household composition,
metropolitan/non-metropolitan residence, parental education,
household income or poverty status, neighborhood safety, familial
support, maternal physical activity, and household smoking
status.”
Breastfeeding in public
Role of Marketing
Controversy has arisen over the marketing of
breast milk vs.
formula; particularly how it affects the
education of mothers in
third world
counties and their comprehension (or lack thereof) of the
health benefits of breastfeeding. The most famous example being the
Nestlé boycott, which arose in
the 1970's 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.
See also
References
- Dewey KG, Heinig MJ, Nommwen LA. Maternal weight-loss patterns
during the menstrual cycle. Am J Clin Nutr 1993;58: 162-166
- Widstrom AM, Wahlberg V, Matthiesen AS, Eneroth P, Uvnas-Moberg
K, Werner S, et al. Short-term effects of early suckling and touch
of the nipple on maternal behavior. Early Hum Dev 1990;
21:153-63.
- Renfrew MJ, Lang S. Early versus delayed initiation of
breastfeeding. In: The Cochrane Library [on CD-ROM]. Oxford: Update
Software;1998.
- Natural Birth and Baby Care.com
- http://www.drpaul.com/breastfeeding/colostrum.html
- [1]
- Australian Breastfeeding Association: Breastfeeding triplets, quads and higher
- Association of Radical Midwives: Breastfeeding triplets
- Guardian Unlimited: Not your mother's milk
- Jennifer Baumgardner, Breast Friends, Babble, 2007
- http://www.aafp.org/afp/20020501/1845.html
AAFP.org
- [2] Infant Feeding Action Coalition
Canada
- Milking it Joanna Moorhead, The Guardian, May
15 2007
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