Why Breastfeeding is Important

Why Breastfeeding is Important

Breastfeeding is good for the baby, good for the mother, good for the family and good for society. We have plenty of evidence to show that this is true.

But before we begin describing the research, it is important to address some objections that some people have expressed about studies showing that breastfeeding is superior to formula feeding. (We will often refer to formula as artificial baby milk or artificial feeding.

That’s a more accurate description, really. The name “formula” makes it sound scientific – but it’s just an artificial substitute for the real thing, human milk.) These objections often reflect a lack of understanding about how breastfeeding actually works, as well as a bias in favour of bottle-feeding of the person making the objection. Here are some of the comments you may have read:

The studies showing breastfeeding is superior to artificial feeding are flawed and thus prove nothing.

It’s true that studies comparing breastfeeding and artificial feeding do not comply with what would be considered the “gold standard” for clinical studies: the randomized, double blind, controlled study. Good drug studies, for example are designed this way: a group of people with high blood pressure, say, who are generally similar are divided randomly into two groups. People in one group get the drug being tested, people in the other get a placebo (a pill with no active ingredients). Neither the researchers nor the participants know who is getting the real drug (that makes it “double blind”). The study subjects’ blood pressure would be measured at regular intervals and after a given period of time, the results would be analyzed and side effects noted.

In fact, these types of studies aren’t perfect either. While researchers try to make the two groups similar, for example, there may be important differences between the groups especially if the numbers are small.

Studies comparing breastfeeding and artificial feeding can’t be done this way. You cannot randomly assign new mothers to breastfeed or not. It’s even hard to define “breastfeeding” in a study. Often mothers who breastfeed only for a short time, or who breastfeed partially and give formula are included in the breastfeeding group. This tends to bias the study in favour of artificial feeding.

From multiple surveys, we know that women in industrialized countries are more likely to breastfeed if they: a) are older, b) have a higher level of education, c) are more affluent, d) are in a stable relationship with a partner who is supportive of her breastfeeding. But those who criticize breastfeeding studies for these reasons are missing the point completely. Breastfeeding is the normal, physiologic, natural way of feeding babies and young children. Formulas are only very superficially similar to breastmilk. The protein, carbohydrate and fats that are in formulas are significantly different from those in human milk, not only in quantity but also biochemically. There are also dozens of components of breastmilk that are absent from formula. And there are many undesirable components, such as high concentrations of aluminum and lead, that are present in formulas that are not present in breastmilk.

Thus you don’t have to prove that the normal, physiologic and natural is better than the artificial. You have to prove that the artificial is at least as good as the normal. What is interesting is that despite the challenges of accurately defining breastfeeding in these research studies, we still find in study after study after study that artificial feeding increases the baby’s risks of a wide range of health and developmental problems.

The antibodies in milk are not absorbed into the baby’s body. They stay in the gut and thus can protect the baby only against gut infections.

Maclean’s magazine in the January 17, 2011 issue quoted Joan B. Wolf, an assistant professor of women’s studies at Texas A&M University, as saying: “We do have very good evidence that breastmilk reduces gastrointestinal infections. The milk is ingested, goes into the baby’s gut, and antibodies from the mother’s milk fight the bacteria in the gut. What we don’t have is any evidence that those antibodies have any effect anywhere else in the body.”

This is an incredibly absurd statement that only points out her ignorance about how diseases are contracted and how breastfeeding protects against infections. First, antibodies are not the only immune components in breastmilk. There are dozens, which interact to protect the baby from bacteria, viruses and fungi. Together, these immune components coat the linings of the gut and respiratory tract with a “shield” to prevent these germs from entering the baby’s body in the first place. The majority of infections are transmitted through your respiratory tract or intestinal tract. So breastfeeding provides a much better way of protecting the baby than having to fight off the germs once they have entered the baby’s blood stream. The effectiveness of breastfeeding against a long list of infections and diseases has been conclusively shown in numerous studies. Secondly, even if it were true that “all breastfeeding does is decrease the incidence of gut infections (gastroenteritis)” that is far from a minor difference. Prof. Wolf’s comment was really rather heartless. Hundreds of babies die of gut infections in the United States every year and hundreds of thousands die around the world. But of course, breastfeeding is important in protecting against many other conditions as well.

My kids were formula fed and they’re okay.

It’s very true that most babies who are given formula will survive and grow and thrive. But this doesn’t mean it doesn’t matter.

One of the reasons people don’t recognize the importance of breastfeeding is that when a baby or child does get ill, it’s usually not attributed to the method of feeding. For example, between 75% and 83% of children will have at least one ear infection by the time they are three years old, and 46% will have three or more. Parents and doctors consider this normal. But it’s not. Breastfed babies have far fewer ear infections than those fed with formula. Ear infections cause much suffering and may have long term effects, but most parents would consider a child who has had multiple ear infections as “okay;” even if they did see it as a problem they would not likely know it was linked to how the baby was fed.

The formulas that people who are 30 or 60 years old were given are very different from those of today. When I was attending medical school, commercial formulas were available, but most people most people made their own using evaporated milk, water and corn syrup. Most of the adults who were fed these formulas as babies would say they are

“okay” (although they may have problems with overweight, heart disease, allergies, high blood pressure and other conditions that could quite likely be related to how they were fed as infants). Yet almost everyone today would agree that those homemade formulas are not as good as the formulas of today and that they were very inadequate and should not be used.

Every few years, formulas get “improved.” A recent change has been adding long chained polyunsaturated fatty acids (DHA and ARA) to the formula. This “improvement,” accompanied by a huge and shamelessly misleading campaign, is supposed to result in the baby’s being more intelligent and seeing better. Does it? We don’t know. Studies not financed by the formula companies say not. Studies financed by the formula companies give different results. But if DHA and ARA do in fact make the baby more intelligent and improve his vision, does that not mean that previously all formula-fed babies had deficient intellectual and visual development?

This has happened repeatedly over the years. In the 1970s, taurine (an amino acid present in breastmilk) was added so that babies’ vision would be better. What about before the 1970s, when babies did not get taurine? In the 1990s, nucleotides were added, which are supposed to enhance immunity (questionable). But what about the artificially fed babies before the 1990s? They didn’t get this either. So, are these additions important to the baby’s health or not? If not, we are being sold a bill of goods. If yes, the health of hundreds of millions of babies has been compromised. And we know formula is still missing many components in human milk that are important to protect and maintain the baby’s health. What new ingredients will be added in five years, ten years, twenty years that today’s formulas lack?

The latest thing is the addition of prebiotics. (Prebiotics, of course, have always been in breastmilk.) By the time you read this book is published, more “amazing” ingredients will likely be added to formulas, but it still won’t be breastmilk. ,

The real evidence: why breastfeeding is important

In some parts of the world, the use of breastmilk substitutes means many babies will not survive. While the vast majority of bottle-fed babies in North America will survive, that doesn’t mean the health problems and risks are not real and potentially serious.

Health care providers, childbirth educators and others often talk about the “advantages” of breastfeeding. But to describe the differences between breastfeeding and artificial feeding this way assumes that artificial feeding is what is normal and acceptable. The warning messages on packages of cigarettes don’t say, “Non-smokers may have lower rates of heart disease or lung cancer,” they say, “Smoking increases your risk of heart disease and lung cancer.” This perspective makes a difference in how statistics are presented. One study announced that women who were breastfed as infants had a decrease of 25% in breast cancer rates when compared to women fed formula as infants. More accurately: Women who were fed formula as infants had a 33.3% increase in breast cancer rates. Looks more significant, doesn’t it?

It is breastfeeding that is the normal way to feed a baby; there are risks to artificial feeding.

One risk: as with all manufactured items, mistakes are sometimes made in preparing or processing of formula. Formulas have had to be recalled because important ingredients have been left out, the labels were wrong, bacteria were found in the cans, etc.

This can happen with any product, but it matters more with formula. If an important ingredient is missing (as has happened in the past), the effect on the baby can be devastating. Babies have suffered brain damage and permanent developmental delays because of chloride-deficient formulas; babies have become ill with diseases such as meningitis from contaminated formulas. A recent study of several brands of formulas found that some cans contained more than four times the amount of Vitamin D listed on the label—and Vitamin D in excess is toxic. In 2003, three babies in Israel died and 10 were admitted to the hospital because the formula they drank did not contain adequate amounts of vitamin B1. In 2008, some 1200 babies in China became seriously ill because of formula contaminated with melamine.

Parents using formula have to rely on a manufacturer’s assembly line, which will inevitably produce some errors and problems. They have to hope that their baby isn’t unlucky enough to get that batch of formula, and that they notice when a particular lot number is recalled (and several lots of formula are recalled every year.)

We often assume that if breastfeeding is not possible—a rare situation—formula is the second-best solution for feeding the baby. The World Health Organization (WHO), though, states that second-best would be the mother’s own milk, pumped or expressed, and fed to her baby (perhaps with a cup or tube). This is only second best because feeding at the breast enhances the development of the development of neuronal connections in the baby’s brain, the development of the baby’s jaw and facial muscles as he nurses at the breast, and the transfer of germs back and forth between the mother and the baby, which helps protect the baby against infection and allergies. Expressed milk won’t provide those important factors, or the unique, close relationship between mother and baby that is also an essential part of breastfeeding. If expressing milk is impossible, the third feeding suggestion on WHO’s list is screened donated milk. Only if that is also unavailable would artificial baby-milk feedings be used—the fourth-best solution.

One of the ways that breastfeeding is different is that the milk constantly changes. The milk a mother produces in the morning is different from the milk in the evening. The milk also changes day by day, so the milk produced for a six month old baby is not the quite the same as the milk produced for a two week old or a one year old. The milk of a mother whose baby was born prematurely is different – and more suitable for her tiny baby’s needs – than the milk of a mother whose baby was born full-term.

The milk also changes from the beginning of the feeding to the end, with generally higher levels of fat towards the end, helping to reduce the risk of obesity by helping the baby feel full and satisfied.

As the baby grows into a toddler, some immune factors which kill bacteria increase in concentration in the milk (helping to keep the toddler who puts everything in his mouth healthy!)

This does not mean, however, that milk donated from a mother breastfeeding an 12 month old is less appropriate for a 1 month old than formula. The “12 month old milk” is still closer to “1 month old milk” than formula.

There is also a “mutual relationship” in breastfeeding: when the baby fusses or shows he wants to feed, the mother’s milk begins to let down, so that breastfeeding both fills the baby’s stomach with milk and soothes him and, at the same time, relieves the pressure of milk in the mother’s breast and releases hormones that make the mother feel calmer and more loving. They reinforce those good feelings in each other.

Here’s an overview of some of the risks of artificial feeding.

Intelligence and Cognitive Development

A baby’s brain is not fully developed at birth. It continues to grow and build a network of connections between brain cells for the first three or four years. Breastmilk, because it is designed for human babies, contains all the nutrients a baby’s brain needs to reach its maximum potential.

Researchers have known from early on that children breastfed as infants scored, on average, higher on tests of intelligence and development, but researchers thought that perhaps mothers who breastfed were more motivated to do other good things to enhance learning. Or perhaps the extra holding and skin-to-skin contact involved in breastfeeding was the reason these children were brighter .

One study that tried to reduce the effect of those factors compared mothers who gave birth in two different groups of hospitals, some that had introduced policies to support breastfeeding and others that did not have these policies. A higher percentage of the mothers from the breastfeeding-supportive hospitals breastfed and the babies born in these hospitals, as a group, later scored an average of 11 points higher on tests of intelligence when compared to the babies born in the other hospitals. Incidentally, this was not a small study, but one that followed many thousand babies for several years.

A 1992 study tried to eliminate the parenting factors by looking at premature babies who were being fed through a tube in the stomach. One group was given breastmilk plus banked breastmilk if the mother was not able to express enough, the other was given breastmilk plus preterm formula if the mother was not able to express enough. When they reached school age, the children who had received only breastmilk scored an average of eight points higher on tests of intelligence. The milk itself, not extra cuddling or holding, made the difference.

Other researchers have studied babies who were breastfed for varying lengths of time, and found that intelligence scores were higher (on average) for babies who were breastfed longer.

It may be that the increased skin-to-skin contact and holding is also a factor. Mothers who are bottle-feeding usually hold their babies when they are small, but as the baby gets bigger, he may hold the bottle himself or even walk around with a bottle. Breastfeeding ensures the baby will be held skin-to-skin many times a day. This contact is undoubtedly beneficial.

Whatever the contributing factors, it’s clear that babies who are not breastfed are less likely to reach their potential when it comes to intelligence.

Diabetes

Type 1 diabetes is the type usually seen in children, and there is clearly a genetic component that makes some children vulnerable to this illness. Some studies have shown that if a baby who is genetically at risk of diabetes is not given cow’s milk or formula (made from cow’s milk) during his first year, he’s less likely to develop Type 1 diabetes. Type 2 diabetes is the kind generally seen in adults (although increasingly children are affected). Adults who were breastfed as children are also less likely to develop Type 2 diabetes, at least in part because those who are breastfed are less likely to be overweight or obese. The mother who breastfeeds is also less likely to develop Type 2 diabetes; the longer she breastfeeds, the lower her risk.

SIDS

SIDS stands for Sudden Infant Death Syndrome—situations in which a baby dies for no apparent reason, usually while asleep. This used to be called crib death or cot death. No cause has been discovered, and there are probably several factors involved. (For example, doctors are now recommending that babies sleep on their backs to reduce the incidence of SIDS.) Researchers have found that feeding a baby with formula doubles the risk of the baby dying from SIDS.

Overweight and obesity

Several recent studies found that artificially fed babies are much more likely to be overweight or obese as children and teens. Why? There are many possible reasons. Breastfed babies are able to control the amount of milk they take in at each feeding; mothers feeding with bottles often urge the baby to finish the bottle. Human milk increases in fat content throughout the feeding, so the baby feels full and stops when ready. A recent study showed that the bottle may be part of the problem, even if there is breastmilk in it. Here is a direct quote from the researcher: “Infants who are bottle-fed in early infancy are more likely to empty the bottle or cup in late infancy than those who are fed directly at the breast”. And another quote from this article “Bottle feeding, regardless of the type of milk, is distinct from feeding at the breast in its effect on infants’ self-regulation of milk intake.”

Bottle feeding may “prime” the baby to want more. A baby who is bottle fed in the first few days drinks a lot more than the baby who is breastfeeding. As at least one study showed, the more weight a baby gains in the first week of life, the more likely that child will be overweight as an adult.

Exclusively breastfed babies actually take less milk than we previously thought. An exclusively breastfed well gaining five month old is taking about the same amount of milk as a one month old even though the five month old weighs twice as much as the one month

old. A five month old formula-fed baby will usually drink twice as much as he did a one month.

Breastmilk also contains compounds such as leptin and ghrelin which, together act to control appetite. Formulas do not contain these factors.

There is a relationship between the amount of protein a baby takes and the risk of overweight and type 2 diabetes later in life. The amount of protein a formula fed baby takes in during the first six months of life far exceeds that consumed by the exclusively breastfed baby. Not only does the formula fed baby take in more, but he also absorbs more. Again, let me emphasize that this is not a good thing and can result in an increased risk of disease later in life. More is not necessarily better.

Another factor: breastfeeding babies are exposed to various tastes through their mother’s milk; formula fed babies get the same bland taste at every meal. Researchers have found that breastfed babies more readily eat a variety of vegetables and fruits when they start solid foods, if their mothers have been eating these foods during the time they were breastfeeding, compared to formula fed babies who prefer sweet, starchy and bland foods. This early acceptance of nutritious foods gives the breastfed baby a head start on healthy eating.

Respiratory Illnesses

Feeding a baby with formula is a risk factor for developing asthma (which has increased dramatically in recent years). Babies fed formula instead of breastmilk are also at a higher risk of other respiratory illnesses, including respiratory syncytial virus (RSV) and pneumonia. They also take longer to recover from these illnesses than do breastfed babies.

Meningitis

Meningitis is an inflammation of the brain which can be caused by viruses or bacteria and the bacterial form can be fatal if not treated in time. Babies who are not breastfed are much more likely to become ill with this disease.

Ear Infections

Formula-feeding has been repeatedly shown to be a risk factor in developing otitis media (ear infection). Ear infections are often very painful for the baby, and can lead to further complications, the most common of which is fluid remaining in the ear after the infection has been treated, affecting the baby’s hearing and speech development. Spread of the infection to adjoining areas to the ear and even to the brain, with very serious consequences also occurs, though, happily, not very commonly these days.

Childhood Cancer

At least three studies have found that formula-feeding increases the risk of developing cancer during childhood. The child who is breastfed or was breastfed has a more mature immune system and it is known that at least a few cancers are caused for facilitated by viral infections. A more mature immune system is likely to help defend the baby against these

viruses. Furthermore, breastmilk contains a compound called α-lactalbumin which is transformed in the baby’s stomach to human lactalbumin made lethal to tumour cells (HAMLET) which causes tumour cells to “commit suicide” (apoptosis)

Gastrointestinal Infections and Diseases

It seems logical that the baby’s gastrointestinal system would be affected by the choice of food. Formula significantly increases the baby’s risk of diarrhea caused by various infections, and babies who are fed artificially also take longer to recover, partly because they often are taken off their formula feedings and given only clear fluids while they are sick, so

they get virtually no nutrition. A breastfed baby can and should continue breastfeeding and receiving high-quality nutrition plus antibodies and other immune factors to kill off the germs that are causing the illness. Diarrhea can be very serious in a young baby.

Breastfed babies are also much less likely to become constipated. It is extremely rare for an exclusively breastfed baby to have hard bowel movements. Their bowel movements are usually very loose, even if infrequent. Formula is much more likely to cause constipation and painful bowel movements, a problem that can become chronic and difficult to resolve.

Constipation means hard bowel movements, not necessarily infrequent bowel movements. Exclusively breastfed babies, after the four to six weeks of life, may actually have bowel movements only every few days and even less frequently. If they are breastfeeding well and gaining weight well and content, it is not a concern. Incidentally, I am aware of two healthy exclusively breastfed babies who had, on one occasion, no bowel movements for 31 days and another exclusively breastfed baby who had no bowel movements for 32 days. All three were perfectly healthy, not constipated and growing well.

Effectiveness of Vaccines

Artificial feeding reduces the effectiveness of vaccinations by diminishing the baby’s response and production of the necessary antibodies. Breastfed babies have a normal response to vaccinations, and produce more antibodies. Some think that breastfed babies will have less response to vaccines given by mouth such as the rotavirus. This is incorrect.

Development of Jaw and Facial Muscles

Anyone who has carefully observed a baby suck on a bottle and compared it to the way a baby suckles at the breast knows that these are two very different techniques, and naturally the development of the muscles, jaw and tongue will be different. Some people claim they

can recognize a breastfed baby on sight, just by looking for the rounded, well-developed cheeks! Children who were artificially fed as babies are more likely to need orthodontic work, and to have related problems such as snoring and sleep apnea. Long-term breastfeeding, in particular, seems to promote the development of a well-shaped jaw and straight teeth.

Death

Babies in developing countries are much more likely to die if they are not breastfed. We tend to think that with good medical care, that’s not an issue. It is. A US study found that babies who are not breastfed are significantly more likely to die, from all causes, in the first year.

Mental Health

Recent studies have found that children and adults who were not breastfed as infants are more likely to have depression, anxiety, alcoholism, ADHD, and schizophrenia. In their teen years, children who were not breastfed are more likely to have serious behaviour problems.

Child Abuse

Researchers looked at children who were in situations considered to be at high risk for child abuse, and found that those who were formula fed were at greater risk of being abused by their mothers than those who were breastfed. Perhaps mothers who were more likely to abuse their babies are less likely to breastfeed. However, breastfeeding may also help mothers fall in love with their babies.

Post-Partum Depression

Breastfeeding can protect mothers from post-partum depression, and can also protect babies from possible harmful effects of post-partum depression when it does happen. Researchers have found that when bottle-feeding mothers are depressed, their babies’ brains don’t develop normally. The mothers talk and interact with the babies less because of the depression. But when babies are breastfed, even though their mothers are depressed, their brains continue to develop normally, and the mothers talk and interact with them in more positive ways.

Unfortunately, some researchers in post-partum depression have taken it as a given that if a mother sleeps better she will less likely be depressed. A study is going on at this moment where mothers are separated from their babies during the night and formula fed during the night so the mothers can sleep – almost a sure fire method of making breastfeeding fail.

Necrotizing enterocolitis

Necrotizing enterocolitis is a very serious condition usually seen in premature babies; formula is a major risk factor.

Beyond infancy

The risks of being formula-fed continue as baby grows up. Young adults who were fed formula as babies are more likely to have high blood pressure and high cholesterol, and to be overweight and be insulin resistant (a risk factor for type 2 diabetes). Other studies have directly linked formula feeding to heart disease in later life. Crohns disease, colitis and irritable bowel syndrome are also much more common in adults who were fed formula as babies; so are multiple sclerosis and arthritis.

Researcher David Newburg commented that he used to think of human milk as providing the best nutrition for babies, but as he continued his research he realized that its protective

role against acute infections in infancy and chronic illnesses in adulthood was probably even

more important. He’s not the only one:

Human milk is not simply a food but rather a complex, human infant support system. From the abstract of a

research article by Michelle G. Brenner and E. Stephen Buescher.

Risks of Formula Feeding to the Mother

Breastfeeding is not only important to the health of the baby and child and the adult that child will become, but also important for the mother’s health as well. Breastfeeding helps new mothers to recover from giving birth by encouraging the uterus to contract normally and reducing the amount of blood loss.

It also reduces the risk of developing breast cancer, cancer of the uterus, and cancer of the of the uterus). The more months a mother breastfeeds, the lower the risk.

Breastfeeding reduces the risk of developing osteoporosis. Although your body transfers calcium to the baby in the milk and the mother loses bone mass during breastfeeding, once the baby weans, bone mass increases and may rebound to higher levels than at the baby’s birth.

Iron deficiency in young women is almost epidemic despite the fact that we have iron rich foods readily available. A mother who breastfeeds a toddler will get back her period, on average, 14 months after the birth of the baby (some later, some earlier). The mother who does not breastfeed at all will usually get her period back by three months after birth. Those 11 extra menstrual periods add up to the equivalent of one unit of blood lost, significantly increasing the risk of anemia.

When a mother does not breastfeed, her risk of overweight and obesity in later life increases. Breastfeeding helps women lose any extra weight gained during pregnancy. The mother who did not breastfeed is at greater risk of developing diabetes type 2 and metabolic

syndrome, a combination of insulin resistance, abnormal lipid profile, high blood pressure and overweight leading to a very high risk of heart attack and stroke.

Are all these risks of formula feeding proven?

It is very difficult to prove beyond a shadow of a doubt that breastfeeding protects against child abuse or obesity, for example. Other factors are also involved. And no study is perfect. The accumulation of research adds up to a clear message: breastfeeding is the normal way to feed a baby and artificial feeding has many risks.

The Convenience and Ease of Breastfeeding

The topic of the first meeting in the standard La Leche League series of four meetings is Advantages of Breastfeeding. (Yes, they should probably change it to Risks of Artificial

Feeding.) What’s interesting is that when mothers get talking at the meetings, they rarely discuss the research. Most mothers talk about the emotional side of breastfeeding and how it makes mothering a baby, toddler or young child easier and more enjoyable.

They like the convenience: the milk is always ready, always at the right temperature. It takes just a second to lift up a shirt or undo a button and offer the breast to the baby. They find breastfeeding easy when traveling to places where it might be hard to store formula or find a place to heat it. They love being able to just roll over in bed and feed the baby when he fusses with hunger in the night. And they appreciate not having to spend time preparing or cleaning bottles because it means extra time with the baby.

At first, mothers are focused on the mechanics of getting the baby to latch on properly and figuring out how much he is eating. But once those techniques are mastered, some of the other important aspects of breastfeeding become apparent.

Breastfeeding is a great comfort to a baby who has been hurt or scared or upset for some other reason. It soothes a baby who has to be given a vaccination, and calms a baby who has been startled or stressed.

When studies came out showing that sugar water decreased the pain a newborn felt when having blood taken, giving sugar water was adopted with relish by the medical community. When it was shown that breastfeeding the baby works even better, doctors ignored it! We even see breastfed babies given sugar water instead of the breast. Some have even suggested that it’s not a good idea to give the baby the breast during or after a painful procedure because we don’t want the baby to associate breastfeeding with the pain. Does that make sense? Who would suggest that caressing the baby during a painful procedure is not a good idea because the baby would then associate caressing with the pain?

Being at the breast reminds the baby of being in the womb: “Ah, yes, there’s that familiar heartbeat, and that voice I’ve always heard, and that familiar smell, and I’m warm and comfortable,” and makes the transition to the outside world a little easier.

Mothers also talk about how breastfeeding forces them to slow down in a busy world.

You can’t prop up a breast and leave the baby to eat while you finish washing the dishes.

Breastfeeding guarantees that you and baby will be skin to skin, relaxing together, several times a day. And those restful feeding times can help you recover from pregnancy and birth.

The mothers love the smell of the breastfed baby, that clean smell that doesn’t come from any soap or talcum powder. Even the baby’s bowel movements don’t smell unpleasant—they give off a faint yeasty odour. Mothers talk about how breastfeeding tunes them in to their baby’s signals. Mothers tell stories about how they couldn’t consciously

recognize their baby’s crying, but their breasts did, and started to leak milk at the sound of his voice. They talk about how often they wake up just a minute or so before the baby does. Some tell stories about how they knew their baby was ill because of a small change in the way he suckled or behaved at the breast.

In 2011, researchers did MRIs of mothers’ brains while the mothers listened to their own babies crying. They found that the breastfeeding mothers had more response in the parts of the brain related to caregiving behaviour and empathy, compared to mothers who were feeding their babies formula. These differences were apparent at one, three and four months after birth and correlated with more sensitive caregiving behaviours in the breastfeeding mothers.

Breastfeeding helps mothers learn to understand their babies’ sometimes subtle cues.

One mother was nursing her baby while chatting with a public health nurse, and, at one point moved the baby to the other breast. The nurse stopped what she was saying and asked, “Why did you change breasts?” The mother, surprised, said, “He was finished that side, and he wanted the other one.” The nurse insisted that she hadn’t seen any signals from the baby. Experienced nursing mothers can tend to other children, prepare meals, talk with friends and still be aware of the baby’s suckling so that they know when to adjust the baby’s latch, when to change breasts, and when the feeding is over.

Mothers talk about the sheer pleasure of being skin to skin with their baby, and of seeing him drift off to sleep at the breast with a trickle of milk running down his chin. As the baby gets older, he’ll begin to play at the breast, letting go to smile, patting the mother’s cheek or investigating her dental work, making happy noises as he nurses. These are all part of the joy of parenting.

“Taking a little one to nurse, watching him grow to manhood, that’s what love is.”

Carol Shields, The Stone Diaries

Mothers who work outside the home talk about how much they appreciate that bond.

It’s hard to leave your baby in someone else’s care, but being able to put the baby to the breast at the end of the day can re-establish the connection, and be relaxing for both mother and baby. These mothers like having something special between them and their babies— something the babysitter can’t do.

These experiences are difficult to measure in a scientific way, but they are very real to mothers, and they are important considerations in deciding to breastfeed.

Yes, It’s Worth Solving the Problems

Twenty to 30 years ago, almost any difficulty encountered by a breastfeeding mother had one “solution”: wean the baby. Sore nipples? Stop breastfeeding. Breast infection?

Wean immediately. Baby isn’t gaining weight well? Give him formula. Easy and straightforward for the doctor giving out the advice, but often devastating to the mother who really wanted to breastfeed. Many mothers have told me that they said nothing to the doctor and cried only once they left the doctor’s office. The doctors often believe “The mother was asking permission to stop breastfeeding” and feel they did the right thing. I disagree. The doctor should have helped the mother with the problem and if he couldn’t, he should have referred her to someone who could. When a mother goes to the doctor with a breastfeeding problem she wishes to resolve she is not asking for permission to quit. She is asking for help, and if the doctor did not make an attempt to help her or find help for her, the doctor has failed her.

In the past, if the baby was premature or smaller than average in size, even if born full-term, the mother was usually advised not to even try breastfeeding, because suckling would be too hard for the baby, and breastmilk wouldn’t have enough calories to help him gain weight. If a baby was bigger than average, mothers were often told that their breastmilk wouldn’t be enough to sustain him, and that giving formula would be better. If either baby or mother had any health issues, breastfeeding would be stopped.

Mothers today are more likely to be aware of the benefits and importance of breastfeeding, but many still have difficulty getting the help they need to make breastfeeding work.

Mothers’ Stories

Lesley

Lesley’s labour was induced a week before her due date because her blood pressure was high. After a short but intense labour, her daughter was born weighing just over seven pounds (3.2 kg). The baby seemed very sleepy, and Lesley wasn’t able to get her to breastfeed right away. When Lesley went home a day later, the baby had nursed a couple of times but not well, and Lesley’s nipples were getting sore. By the time the baby was three days old, Lesley’s nipples were unbearably painful, and the engorgement made it even harder to get the baby on the breast. Her doctor recommended supplementing with a bottle of formula after each feeding, and suggested she take painkillers.

Dissatisfied, Lesley called the public health department, and a nurse made a home visit.

Her advice: “Put the baby on a bottle. This isn’t working.” Lesley wanted to breastfeed, not wean. She looked online and found information about the importance of getting a good

latch, but it took several more calls before she found someone who could help her get the baby correctly latched on. Her sore nipples healed.

Lesley was well aware of the reasons breastfeeding her baby was important, but she needed more than that—she needed some practical help.

Breastfeeding and Guilt

One reason that the many significant differences between breastfeeding and formula-feeding have been downplayed is that people are concerned about making mothers who do not breastfeed feel guilty.

But this concern about guilt is, in reality, just a ploy. It allows health professionals not to feel guilty for their lack of knowledge about breastfeeding and their inability to help women overcome difficulties with breastfeeding (many of which could be prevented in the first place). This argument also allows formula companies and health professionals to pass out formula company literature and free samples of formula to pregnant women without any guilt pangs, even though it has been clearly demonstrated that this literature and the “free” samples decrease the frequency and duration of breastfeeding. (Nothing is free. The companies are repaid many times over for these “free” gifts.) Many mothers trust the formula company brochures and decide to try the free samples. The formula brochures stress the “benefits” of “giving the father a chance to feed the baby” or promise their formula makes babies sleep better. Using the free samples is often the first step on the downward slope to complete weaning from the breast. There are often deliberate attempts to make the two methods of feeding seem equivalent; for example, one brochure had a list of “pros and cons” for breastfeeding and formula. Amazingly, there were the same number of “pros” and the same number of “cons” for both types of feeding. The “pros” for

breastfeeding included “baby’s bowel movements smell better”, a minor benefit that is easily cancelled out by one of the pros for formula; “father can feed baby too.” The lists are only equal because dozens of significant reasons to breastfeed are ignored.

This is not how health professionals discuss other health decisions. If a pregnant woman went to her physician and admitted she smoked a pack of cigarettes a day, or admitted to drinking a couple of beers every day, wouldn’t she be made to feel guilty about endangering her baby? What if she told her physician that she was feeding her week-old baby homogenized milk? Her doctor would practically have a fit, and would have no trouble making the mother feel guilty about using plain cow’s milk. He’d pressure her to use formula. He wouldn’t pressure her to breastfeed, of course, because he wouldn’t want to make her feel guilty about not breastfeeding. Why is there such indulgence for formula? Formula companies have succeeded in convincing most of the world that formula-feeding is just about as good as breastfeeding, and that it is no big deal if babies are not breastfed. Formula company marketing actually implies that formula is better than breastfeeding, which is reassuring for the many health professionals who themselves or their spouses did not breastfeed..

While formula is theoretically more appropriate for a newborn baby than cow’s milk, there are no long-term clinical studies showing any difference between feeding the baby whole cow’s milk and formula. Not one. Sixty years ago, many babies, especially if they grew up on farms, were fed straight whole milk from the cow. The differences between cow’s milk and formula are much smaller than the differences between formula and breastmilk. Many studies show how much better off the breastfed child is, and almost every day there are new studies.

So how should breastfeeding be supported? All pregnant women and their families need to know the risks of formula-feeding. It does matter how the baby is fed. Mothers should get the best support available to start breastfeeding once the baby arrives. This support is critical. It’s unfair to tell women breastfeeding will be good for their babies, and then not help them succeed. If mothers get accurate information about the risks of formula-feeding, plus support and help, and still decide to formula-feed, they will have made an informed decision. If mothers get good help with breastfeeding but still find it is not for them, they can decide to switch to bottle-feeding, if they choose. It is not difficult to go from breastfeeding to bottle-feeding. On the other hand if they start bottle-feeding, it’s harder to switch.

Indeed, it can be impossible if the baby has been on the bottle for more than a few weeks.

While You’re Pregnant

You can begin to prepare for breastfeeding while you are pregnant, not by “toughening up your nipples” as mothers were at one time advised to do, but by planning ahead. Some ideas:

Attend at least one meeting of a breastfeeding support group like La Leche League while you are pregnant. You will get to see babies breastfeeding, and meet people who can help you once the baby arrives.

Check out the website to see videos of babies breastfeeding so you will know how to tell if your baby is drinking well.

If you will be giving birth in a hospital, ask about the hospital policies and tell your doctor or midwife that you want to keep your baby with you from birth on, unless there is a medical issue that requires separation. Arrange to have a doula with you

during your labour and birth. A doula can help you avoid unnecessary interventions

during labour and you are more likely to breastfeed successfully.

Plan with your caregivers how you will get breastfeeding underway if you need a caesarean birth, have a premature baby or if baby is ill. Arrange for support and practical help after the birth so you can focus on breastfeeding.

Questions?

First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.

To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.

Breastfeeding and Medication, 2009©
Written and revised (under other names) by Jack Newman, MD, FRCPC, 1995-2005©
Revised Jack Newman MD, FRCPC, IBCLC and Edith Kernerman, IBCLC, 2008, 2009©

All of our information sheets may be copied and distributed without further permission on the condition that it is not used in ANY context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions.

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