11.6.1: Breastfeeding

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Learning Objectives

Describe the nutritional and immunological benefits of breastfeeding for infants.
Identify maternal health benefits associated with breastfeeding.
Discuss challenges and societal factors that influence breastfeeding practices.
Compare historical and contemporary perspectives on breastfeeding and the use of formula.

Breastfeeding

Breast milk is considered the ideal diet for newborns. Colostrum, the first breast milk produced during pregnancy and just after birth, has been described as “liquid gold” (United States Department of Health and Human Services (USDHHS), 2011). It is very rich in nutrients and antibodies. Breast milk changes by the third to fifth day after birth, becoming much thinner, but containing just the right amount of fat, sugar, water, and proteins to support overall physical and neurological development. For most babies, breast milk is also easier to digest than formula. Formula-fed infants experience more diarrhea and upset stomachs. The absence of antibodies in formula often results in a higher rate of ear infections and respiratory infections. Children who are breastfed have lower rates of childhood leukemia, asthma, obesity, type 1 and 2 diabetes, and a lower risk of SIDS. The USDHHS recommends that mothers breastfeed their infants until at least 6 months of age and that breast milk be used in the diet throughout the first year or two.

A nurse helping a new mother to breastfeed — Figure $\PageIndex{1}$. A nurse helps a new mother to breastfeed. Image by the Military Health System is in the public domain.

Maternal Benefits of Breastfeeding

Several recent studies have reported that it is not just babies who benefit from breastfeeding. Breastfeeding stimulates contractions in the mother’s uterus to help it regain its normal size, and women who breastfeed are more likely to space their pregnancies further apart. Mothers who breastfeed are at lower risk of developing breast cancer (Islami et al., 2015), especially among higher-risk racial and ethnic groups (Islami et al., 2015; Redondo et al., 2012). Women who breastfeed have lower rates of ovarian cancer (Titus-Ernstoff, Rees, Terry, & Cramer, 2010), reduced risk for developing Type 2 diabetes (Schwarz et al., 2010; Gunderson, et al., 2015), and rheumatoid arthritis (Karlson, Mandl, Hankinson, & Grodstein, 2004). In most studies, these benefits have been seen in women who breastfeed longer than 6 months.

Challenges to Breastfeeding

However, most mothers who breastfeed in the United States typically stop breastfeeding at around 6-8 weeks, often to return to work outside the home (USDHHS, 2011). Mothers can continue to provide breast milk to their babies by expressing and freezing it for later use, or by being available to their infants during feeding time. However, some mothers find that after the initial encouragement they receive in the hospital to breastfeed, the outside world is less supportive of such efforts. Some workplaces support breastfeeding mothers by providing flexible schedules and welcoming infants, but many do not. In addition, not all women may be able to breastfeed. Women with HIV are routinely discouraged from breastfeeding as the infection may pass to the infant. Similarly, women who are taking certain medications or undergoing radiation treatment may be told not to breastfeed (USDHHS, 2011).

Cost of Breastfeeding

In addition to the nutritional benefits of breastfeeding, breast milk is readily available without the need for purchase. Anyone who has priced formula recently can appreciate this added incentive to breastfeeding. Prices for a year’s worth of formula and feeding supplies can cost well over $1,500 (USDHHS, 2011).

But some challenge the belief that breast milk is free. For breast milk to be completely beneficial for infants, the mother's life choices will ultimately affect the quality of the nutrition an infant receives. Let's consider the nutritional intake of the mother. Breastfeeding will limit some food and drink choices as well as necessitate an increased intake of healthier options. A simple trip down the supermarket aisles will show you that nutritious and healthier options can be more expensive than some of the cheaper, more processed options. A wide variety of vegetables and fruits must be consumed, accompanied by the right proportions and amounts of whole grains, dairy products, and healthy fat sources. Additionally, it is also encouraged for breastfeeding mothers to take vitamins regularly. That raises the question of how free breastfeeding truly is.

A Historic Look at Breastfeeding

The use of wet nurses, or lactating women hired to nurse others' infants, during the Middle Ages eventually declined, and mothers increasingly breastfed their infants in the late 1800s. In the early 20th century, breastfeeding began to experience another decline. By the 1950s, it was practiced less frequently as formula began to be viewed as superior to breast milk.

Infant at the breast of a wet nurse. Portrait by Paul Nadar.

Figure $\PageIndex{2}$. A wet nurse feeding an infant in 1856. Image is in the public domain.

In the late 1960s and 1970s, greater emphasis began to be placed on natural childbirth and breastfeeding, and the benefits of breastfeeding were more widely publicized. Gradually, rates of breastfeeding began to climb, particularly among middle-class educated mothers who received the strongest messages to breastfeed.

Today, women receive consultation from lactation specialists before being discharged from the hospital to ensure they are informed about the benefits of breastfeeding and given support and encouragement to help their infants become accustomed to taking the breast. This does not always happen immediately, and first-time mothers, especially, can become upset or discouraged. In this case, lactation specialists and nursing staff can encourage the mother to keep trying until the baby and mother are comfortable with the feeding. ³³

Alternatives to Breastfeeding

There are many reasons that mothers struggle to breastfeed or should not breastfeed, including: low milk supply, previous breast surgeries, illicit drug use, medications, infectious disease, and inverted nipples. Other mothers choose not to breastfeed. Some reasons for this include a lack of personal comfort with nursing, the time commitment required for nursing, an inadequate or unhealthy diet, and a desire for more convenience and flexibility in terms of who and when an infant can be fed. For these mothers and infants, formula is available. Besides breast milk, infant formula is the only other milk product that the medical community considers nutritionally acceptable for infants under one year of age (as opposed to cow's milk, goat's milk, or follow-on formula). It can be used in addition to breastfeeding (as a supplement) or as an alternative to breast milk.

The most commonly used infant formulas contain purified cow's milk whey and casein as protein sources, a blend of vegetable oils as a fat source, lactose as a carbohydrate source, a vitamin-mineral mix, and other ingredients, depending on the manufacturer. In addition, there are infant formulas which use soybeans as a protein source in place of cow's milk (mostly in the United States and Great Britain) and formulas which use protein hydrolysed into its component amino acids for infants who are allergic to other proteins.³⁴

Figure $\PageIndex{3}$. A father bottle-feeding his infant. Image by Ilya Haykinson is licensed under CC BY-SA 2.0.

One early argument in favor of promoting breastfeeding was that it fosters bonding and healthy emotional development in infants. However, this does not seem to be the case. Breastfed and bottle-fed infants adjust equally well emotionally (Ferguson & Woodward, 1999). This is good news for mothers who may be unable to breastfeed for a variety of reasons and for fathers who might feel left out.

References, Contributors and Attributions

33. Children’s Development by Ana R. Leon is licensed under CC BY 4.0

34. Infant Formula by Wikipedia is licensed under CC BY-SA 3.0

Fergusson, D. M., & Woodward, L. J. (1999). Breast feeding and later psychosocial adjustment. Paediatric and Perinatal Epidemiology, 13(2), 144–157. https://doi.org/10.1046/j.1365-3016.1999.00161.x

Gunderson, E. P., Hurston, S. R., Ning, X., Lo, J. C., Crites, Y., Walton, D., Mahabamunuge, J., & Jacobs, D. R. (2015). Lactation and progression to type 2 diabetes mellitus after gestational diabetes mellitus: A prospective cohort study. Annals of Internal Medicine, 163(12), 889–898. https://doi.org/10.7326/M15-0807

Islami, F., Liu, Y., Jemal, A., Zhou, J., Weiderpass, E., Colditz, G., Boffetta, P., & Weiss, M. (2015). Breastfeeding and breast cancer risk by receptor status—a systematic review and meta-analysis. Annals of Oncology, 26(12), 2398–2407. https://doi.org/10.1093/annonc/mdv379

Karlson, E. W., Mandl, L. A., Hankinson, S. E., & Grodstein, F. (2004). Do breast-feeding and other reproductive factors influence future risk of rheumatoid arthritis? Results from the Nurses' Health Study. Arthritis & Rheumatism, 50(11), 3458–3467. https://doi.org/10.1002/art.20553

Redondo, C. M., Gago-Domínguez, M., Ponte, S. M., Castelo, M. E., Jiang, X., & Castelao, J. E. (2012). Breastfeeding, parity, and breast cancer subtypes in a Spanish cohort. PLOS ONE, 7(7), e40543. https://doi.org/10.1371/journal.pone.0040543

Schwarz, E. B., Ray, R. M., Stuebe, A. M., Allison, M. A., Ness, R. B., Freiberg, M. S., & Cauley, J. A. (2010). Duration of lactation and risk factors for maternal cardiovascular disease. Obstetrics & Gynecology, 115(1), 41–48. https://doi.org/10.1097/AOG.0b013e3181c2944a

Titus-Ernstoff, L., Rees, C., Terry, K. L., & Cramer, D. W. (2010). Breastfeeding the last born child and risk of ovarian cancer. Cancer Causes & Control, 21(2), 201–207. https://doi.org/10.1007/s10552-009-9450-0

U.S. Department of Health and Human Services. (2011). The Surgeon General's Call to Action to Support Breastfeeding. U.S. Department of Health and Human Services, Office of the Surgeon General. Retrieved from: https://www.hhs.gov/sites/default/fi...ce=chatgpt.com

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A Historic Look at Breastfeeding