Breastfeeding: Good For Babies, Mothers, And The Planet
Alicia Dermer, M.D., I.B.C.L.C.
Human Milk's Nutritional Benefits
While most people are aware that human milk provides excellent nutrition, many people are unaware of breastfeeding's other health benefits for babies.
Breastfeeding and the Immune System
Babies from families with a tendency to allergic diseases particularly benefit from breastfeeding. Exclusive breastfeeding, especially if it continues for at least six months, provides protection against allergies, asthma, and eczema.
Infant Growth and Development
More and more research is showing that breastfeeding leads to optimal brain development. While there are behavioral aspects to this, the milk is important, too. One study of premature babies who were tube-fed breast milk or artificial milk, but were never breastfed directly, showed that the babies who received no breast milk had IQS 8 points lower on average than those who received breast milk. Human milk has special ingredients like DHA (docosohexaenoic acid) and AA (arachidonic acid) which contribute to brain and retinal development. And all breastfed babies tend to spend a lot of their time in the "quiet alert" state which is most conducive to learning.
Breastfeeding in Special Circumstances
There are very few reasons, particularly from the baby's point of view, to avoid breastfeeding. Most authorities recommend that USA mothers who are HIV positive not breastfeed; however, in many areas of the world breastfeeding's known benefits outweigh the small risk of transmission from breast milk. Few other medical conditions preclude breastfeeding, as there are many appropriate medications that are suitable for use in breastfeeding moms.
Breastfeeding's immunologic and developmental benefits may be particularly important for babies with medical problems such as congenital heart disease, cleft palate, Down's syndrome, etc. In cases where the baby has a problem which affects ability to suckle at the breast, expressed breast milk from mother is still the best choice. Banked human milk, the availability of which is unfortunately limited, would be the second choice. Commercial artificial baby milks are preferable to other alternatives, but far from perfect substitutes for human milk. For every "new" component that is added to commercial baby milks to make them closer to human milk, several more components of human milk are discovered.
It's not JUST the milk, either!
Breastfeeding and Women's Health
Surprise: Breastfeeding is good for mothers, too! Not only that, but it is a joyful, relaxing experience. Although breastfeeding advocates have been criticized for oversimplifying and not informing mothers of potential problems of breastfeeding, the truth of the matter is that when practiced optimally breastfeeding is an enjoyable experience, pure and simple. We must remember that many of the problems and inconveniences so commonly described in the lay literature and passed around by word of mouth as "horror stories" are due to the fact that we live in a bottle-feeding society, with little family or social support and little understanding of breastfeeding by many health care professionals. Thus, problems such as "insufficient milk syndrome," engorgement, cracked and bleeding nipples, all of which would be rare in a breastfeeding society, have become commonplace.
Physical Health Benefits for Mothers
In addition, there are many direct health benefits to breastfeeding mothers. Immediately after birth, repeated bursts of oxytocin released in response to the baby's sucking cause contraction of the uterus. This protects mothers from postpartum hemorrhage (bottle-feeding mothers get oxytocin intravenously immediately after birth, but for the next 24-48 hours during which risk of hemorrhage is highest, they're on their own). Continued exclusive nursing (i.e., breastfeeding without added bottles of formula or solids) tends to delay the return of ovulation and menstruation. In fact, the lactational amenorrhea method (LAM) is a well-studied method of child spacing which is 99% effective in preventing pregnancy in the first six months as long as exclusive nursing is practiced. For mothers who don't practice exclusive breastfeeding, there is still some relative protection; and most contraceptives including barrier methods, IUD's and even progesterone-only hormonal contraceptives such as the "mini-pill" or injectable "depo" progesterone, are all compatible with breastfeeding. So there's no need to stop breastfeeding in order to use effective birth control.
In addition to the child-spacing advantage, the delayed menses also decrease the mother's iron losses. When combined with improved iron absorption from the gut, the net effect (despite some iron use for breastmilk production) is decreased risk of iron deficiency anemia.
Another well-documented benefit of breastfeeding is more rapid and sustained weight loss. Milk production uses up 200-500 calories a day. To burn off an equivalent number of calories, a bottle-feeding mother would need to swim 30 laps or ride a bicycle for over an hour. In our opinion, breastfeeding is definitely easier! Mothers who have had gestational diabetes benefit particularly from the efficient use of calories during breastfeeding, since a return to optimal weight may prevent subsequent development of diabetes. Furthermore, diabetic mothers who breastfeed tend to need less insulin or medication for their diabetes.
The prolonged suppression of ovulatory cycles appears to be associated with significant long-term health advantages as well. Mothers who breastfeed for at least 6 months throughout their lifetime have a decreased risk of breast cancer, and similar reduced rates have been shown for ovarian and uterine cancers. Even being breastfed has been associated with decreased risk of breast cancer, over and above the fact that women who were breastfed themselves are more likely to breastfeed their own children.
For some time, there was concern about calcium loss during lactation and potential for osteoporosis. In fact, some literature actually lists breastfeeding as a risk factor for osteoporosis. Current medical literature demonstrates that not only is the loss in bone density during breastfeeding temporary, reverting to normal after weaning, but that bones may actually be stronger after prolonged breastfeeding. Far from a risk factor for osteoporosis, breastfeeding may actually protect against it.
The impact of breastfeeding on other women's illnesses needs further study. One example is the connection between breastfeeding and cholesterol levels. Breastfeeding mothers tend to have high total cholesterol levels, made up largely of the HDL ("good") fraction. This may prove to decrease the risk of coronary artery disease.
Are there any known harmful effects of breastfeeding on women's health? A couple of studies have demonstrated an increased risk of rheumatoid arthritis flare-ups and increased severity of arthritis in nursing mothers. Whether it is breastfeeding or some other confounding factor which causes this increase remains to be determined.
Psychosocial Issues in Breastfeeding and Women's Health
Another common psychological issue after birth is postpartum depression(PPD). The role of breastfeeding in this area is not clear, with some studies showing increased rates of PPD among breastfeeding mothers, others lower rates. The cause of PPD is unknown, and is probably due to a number of factors, including hormonal changes and lack of support in the new overwhelming role of motherhood. For some depressed mothers, their breastfeeding relationship takes on special importance. Sometimes, when antidepressant medications are deemed necessary, doctors are concerned about prescribing them for a breastfeeding mother. Antidepressants have been studied, and some have been demonstrated not to get to the baby or cause any symptoms. The small potential risk of the medication to the baby has to be weighed against the potential emotional devastation to an already depressed mother of having to wean her baby, as well as the known detrimental effects on infant emotional development when mother suffers from persistent depression.
Let's consider the situation of mothers who need to return to work. Is it worth it to breastfeed at all? Is it necessary to wean the baby when returning to work? Is pumping and storing mother's milk worth the effort? The answer to these questions is: yes, no and definitely. Even if a mother needs to return to work within weeks and will be unable to pump while at work, the baby benefits from the colostrum and early milk and mother gets the experience of the closeness and bonding. On return to work, a breastfeeding mother has three options: continue to breastfeed exclusively by nursing while at home and pumping her milk while at work; continue to nurse while at home and feed formula while at work; wean completely to formula. Clearly, any amount of continued breastfeeding would be preferable to weaning. Studies have shown that babies in day care whose mothers provide their milk have the fewest days out of day care and their mothers have the fewest missed days from work, while those who were breastfed and got some formula were sick more often. The mothers of completely formula-fed babies had the most days out of work to care for their sick babies.
Although pumping and storing may sound daunting and time-consuming, most mothers whose employers give breastfeeding support find that they work into an easy routine, and the work of pumping is worth it for the peace of mind of a healthier child and the continued bonding from breastfeeding on returning home. Increasing numbers of companies, in response to studies showing economic benefits, are instituting policies supportive of continued breastfeeding for their employees. Additionally, the cost of renting or even purchasing a pump is much lower than the cost of formula.
Breastfeeding and Fathers
Breastfeeding and The Environment
Despite this, the media and some environmental groups tend to play up issues of environmental contaminants in mother's milk. In fact, except in situations of toxic spills or occupational exposure to hazardous levels, breastfeeding has caused no ill effects in babies. To the contrary, studies comparing breastfed and bottle-fed babies in the same environment have shown better development and less cancer in the breastfed babies.
Furthermore, despite concerns about PCBs in breastmilk potentially producing infertility in the offspring, the major burden of PCBs gets to babies during pregnancy. (Note: cows get exposed to PCBs, too, so artificial milks are not necessarily "pure," either.) A lesser known and less publicized issue is the fact that soy formulas contain phytoestrogens, which may have just as serious long-term effects. Rather than calling for women to avoid breastfeeding, the call needs to be to continue to clean up the environment to safeguard everyone's health. Breastfeeding will contribute to this clean-up effort.
Breastfeeding in a society where bottle-feeding is the norm clearly requires a significant commitment, especially when relatives and friends do not support breastfeeding. However, women making the decision about infant feeding should know that breastfeeding is clearly more than a lifestyle choice: it is a significant health decision with life-long consequences. And, speaking from personal experience, it's also fun!
Editor's note: Alicia Dermer, M.D., I.B.C.L.C. is Clinical Assistant Professor in the Department of Family Medicine at the University of Medicine and Dentistry of New Jersey -- Robert Wood Johnson Medical School. She is board certified in Family Practice.
As part of her interest in wellness and health promotion, Dr. Dermer has developed a special interest in the area of breastfeeding education and promotion. She is active in educating health care professionals, especially fellow physicians, in lactation. She is collaborating on the development of a curriculum for her medical school. In 1995, she successfully passed the certifying examination of the International Board of Lactation Consultant Examiners. She has published medical journal articles on lactation, and lectures extensively on the subject. She may be contacted at: Alicia Dermer, MD, IBCLC, 69 County Road 516, Old Bridge, New Jersey 08857 USA, Telephone: (908) 254-1515; FAX: (908)651-0774, e-mail: email@example.com
Anne Montgomery, M.D. is a board certified family physician, and Clinical Assistant Professor in the department of Family Practice at the University of Washington. She teaches family practice residents and medical students at the St. Peter Hospital Family Practice residency. She is a fellow of the American Academy of Family Physicians, a member of the Academy of Breastfeeding Medicine, and a supporting member of the International Lactation Consultants Association. She is active in birth and breastfeeding advocacy, and lectures frequently on these subjects.
She was in private practice for 5 years in Minnesota, after graduating from Mayo Medical School, and completing her residency in family practice at St. John's Unit of the University of Minnesota Community Hospital's family practice training program. Dr. Montgomery is married to Charles Nordstrom, and the mother of Ian Montgomery Nordstrom, a breastfed baby who is now 6 years old.
She may be contacted at: Anne Montgomery, M.D., St. Peter Hospital Family Practice Residency, 525 Lilly Road NE, Olympia, Washington USA 98506, telephone: (360) 493-4040, e-mail: firstname.lastname@example.org
© February 1, 1997, Joel R. Cooper, All rights reserved