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breastfeed

  (brĕst'fēd') pronunciation
or breast-feed
v., -fed (-fĕd'), -feed·ing, -feeds.

v.tr.

To feed (a baby) mother's milk from the breast; suckle.

v.intr.

To breastfeed a baby.


 
 
Food and Fitness: breast-feeding

Breast milk is the perfect food for a newborn baby. It contains a balanced mixture of carbohydrates, fats, and proteins, with adequate amounts of vitamins (except vitamin D) and minerals. During the first two weeks, breast milk is called colostrum or early milk. It contains substances (e.g. immunoglobulins, lactoferrin, and lysozyme) that provide some immunity from infection. Breast-feeding lowers the incidence of food allergies in infants, especially those from families with a history of hypersensitivity.

A study of 926 babies born before the normal 40 week term of pregnancy, found that those fed on breast milk had significantly higher IQs by the time they were 7 years old, than those given formula milk. It was suggested that the effect was due to breast milk containing long chain polyunsaturates, special fatty acids similar to those found in oily fish. These are believed to help the nervous system to develop.

During lactation, the dietary demands of the mother are greater than during pregnancy. A breast-feeding mother has to produce milk continually to satisfy the incessant demands of her child. She has to consume sufficient nutrients for herself and her infant. She can obtain most of these nutrients, especially protein, calcium, magnesium, and vitamin B2, from cow's milk. (Newborn babies cannot cope with cow's milk because it contains more protein than the infant can deal with and a high mineral content which may damage their kidneys.) Other calcium-rich foods include cheese, yoghurt, soya milk, and dark green vegetables. At least three servings of such foods should be eaten each day.

If the mother's intake of vitamins and minerals is inadequate, the quantity of milk is more likely to be affected than its quality. The baby's supply of vitamins and minerals is usually maintained at the expense of maternal body stores. The American Medical Association is one of several reputable organizations to suggest that multivitamin-mineral supplementation may be beneficial to lactating women.

A nursing mother's milk contains large amounts of water, so she should drink plenty of fluids (at least eight glasses a day) to prevent the supply of milk from drying up.

Anything the mother consumes may affect the quality of her milk. If she smokes tobacco, drinks alcohol, or takes other drugs, the toxins from these substances may seep into her milk and affect the infant.

Lactating mothers often feel overweight, but should not go on a severe weight-loss diet. The mothers need to retain some fat in the breasts and other fat stores for milk production. However, a slow and steady weight loss, no more than 1 kg (2.2 lb) per week, is possible through a sensible selection of low-calorie, nutritious foods. Most fat is lost, anyway, once lactation stops and, in the long term, mothers who breast-feed tend to retain less fat than those who do not.

 
Psychoanalysis: Breastfeeding

Suckling is the action whereby milk is fed to the infant until it is weaned. By extension, the term refers to breastfeeding as well as bottle-feeding. Before an emphasis was placed on the importance of the object and the infant's environment, psychoanalysts spoke little of maternal suckling. However, Sigmund Freud, in a text that needs to be viewed in historical context, titled "A Case of Successful Treatment by Hypnotism," evokes the case of a young woman, "occasionally hysterical . . . who is willing to feed her infant but behaves as if she doesn't want to" (1892-93a). The dimension of the unconscious conflict is not taken into account here and Freud clings to the idea of will and counter-will. An outline of maternal psychopathology is given, and here the difficulties of breastfeeding are treated by hypnosis.

Suckling is not a psychoanalytic concept. In speaking of suckling we cannot forget the physical link associated with the reality of the nutritive relation. The image of the infant at the mother's breast has considerable metaphoric and symbolic value; it is an image that makes us nostalgic for a sense of original fulfillment and can be compared with that other, "final," image of death, as characterized by the iconography of the old man at the breast. The container, the breast, and its content, milk, are both associated with projected fantasies. The milky substance, a liquid that contrasts with the solidity of the breast, is a vehicle of fantasies of fusion and vampirism. Once the infant's teeth begin to grow, the fantasies are those of oral sadism and cannibalism. There is an analogy to be made between the breast and the penis, between milk and sperm, one of which nourishes and one of which fecundates, and at the same time an incompatibility because sperm is, in fantasy at least, supposed to spoil milk; thus there is a separation between the sexual and the nutritive.

A dichotomy has always existed between the breast as a nourishing object and the breast as an erotic object, a separation that helps avoid the confrontation between an incestuous mother and the importance of maternal libidinal and erotic investment. However, in The Interpretation of Dreams (1900a), commenting on the "dream of the Fates (Knödel), Freud wrote that "at the woman's breast love and hunger meet." For the breast satisfies both the alimentary and the sexual impulses: "To begin with, sexual activity attaches itself to functions serving the purpose of self-preservation and does not become independent of them until later. No one who has seen a baby sinking back satiated from the breast and falling asleep with flushed cheeks and a blissful smile can escape the reflection that this picture persists as a prototype of the expression of sexual satisfaction in later life" (1905d). The nipple is a sexual object throughout Freudian metapsychology. The transition from sucking the nipple to sucking is a key moment in the organization of the earliest feelings of autoeroticism and investment of the mouth as an erogenous zone. Freud does not mention (Laplanche, 1997) the erogenous erotic component for the mother during breast-feeding. For the infant the breast assumes (secondarily) its forbidden erotic value with the organization of the oedipal conflict; initially the infant simply "is the breast" (Freud, 1941f [1938]), during a period of primary identification with the breast and primal fusion.

It has become obvious that the object plays a key role in enabling the polarization of the libido into certain zones. This follows their unification when the infant is breastfeeding and the libido experiences a sense of satisfaction, at a time when the mouth that sucks and the nipple that nourishes are inseparable and indistinguishable. The mother "(moreover) makes a gift to the infant (while she is lavishing her attention on him) of feelings arising from her own sexual life . . . and clearly grasps these as a substitute for a separate sexual object" (1905d). Freud returned to this position and developed it in his Outline of Psychoanalysis: "She is not content to nourish, she cares for the infant and thus awakens in him many other physical sensations, agreeable and disagreeable. Thanks to the care she lavishes, she becomes his first seductress. Through these two relations, the mother acquires unique importance, incomparable, unalterable, and permanent, and becomes for both sexes the object of the first and most powerful of his loves, the prototype of all later amorous relations" (1940a [1938]).

The role of the object and precocious maternal seduction as it occurs through breastfeeding are questioned by contemporary analysts. Jean Laplanche (1987) has developed the idea that sexuality is implanted in the infant through the initial seduction of the adult, and emphasizes the unconscious sexuality of the seducer. From this follows the possibility of a significant reassessment of the role of the impulses, the role of the object, and anaclisis; he also raises the question of the primal. For Paul Denis the question of mastery is present at the heart of the initial experiences of feeding, but the encounter between the mouth and the nipple, to the extent that it combines kinesthetic and sensory feelings, instinctual excitation and pleasure/unpleasure, is an essential period during which the activity of the initial representation takes place (the "pictogram" of Piera Aulagnier, 1975). For authors such as Esther Bick, the emphasis is on the presence-absence of the breast during this primitive stage of undifferentiated autosensuality characterized by the encounter between mouth and nipple. The role of the object remains essential for enabling the consensual union and unification of the libido. The mother's container function is experienced as a "skin": "The optimal object is the nipple in the mouth, together with the mother's touch (holding), speech, and familiar odor"(1968).

With respect to bottle or breastfeeding, Freud responds only in terms of privation. In all cases there remains a feeling of "having sucked too little and for too short a time," the nostalgia for the breast being stronger for the child who has been bottle-fed (1940a [1938]). Melanie Klein (1952), writing about breast-and bottle-feeding, returns to the question of the primacy of the object and instinct, the importance of the exterior object and the reality of the breast. For her the breast is the object of intense fantasized projections because it is a primordial object. The cannibalistic oral impulses directed toward the mother's breast are especially intense. As for the mother, the fact of feeding her baby has a restorative effect because it terminates the sadistic fantasies with respect to her own mother: "The nourishing and beneficial milk she dispenses signifies for the unconscious that her sadistic fantasies have not been realized and that their objects have rediscovered their integrity"(1932).

For Donald Winnicott breastfeeding is expanded to the baby's environment in the broad sense and to the richness of the experience the mother offers. The quality of maternal holding and handling is essential, for these are both a function of the mother's internal conflicts and of her own infantile experiences. The foundations of psychic health depend on this "facilitating environment." The experience of the survival of the object in the face of the baby's attacks seems to her essential and in the end helps her advance the idea of difference "between the survival of a part of the mother's body and the survival of a bottle" (1987). Although he is cautious when discussing mothers and does not dismiss the unconscious maternal implications, he emphasizes the importance of the carnal reality of the experience of the breast; in this body-to-body relation, the exchange of glances and the sensual experience are essential to communication.

Breastfeeding is a situation that so profoundly involves the mother's body and psychic life that it is subjected to the unconscious conflicts that affect the mother and to the fantasies awakened through the encounter between a specific mother and a specific infant. Suckling extends the period of pregnancy and birth and is inseparably a part of the woman's sexual life and her life history. Primitive psychic activity is associated with these very first contacts that are always difficult to conceptualize. Psychoanalysts who care for infants are conscious of this in their clinical activity and research.

The invention of the bottle (1820), followed by the introduction of sterilization (1892-1898), have profoundly altered breastfeeding. Artificial milk eliminates the need for direct recourse to another woman, in the position of wet-nurse, and the baby's survival (in reality) no longer depends on the product of the mother's body. The transition from mother's milk to artificial milk, while it abandons its natural origins, cannot be assimilated to the transition from raw food to cooked food discussed by Lévi-Strauss. But how can social and cultural ideology be made to mesh with unconscious maternal choices?

Bibliography

Bick, Esther. (1968). The experience of the skin in early object relations. International Journal of Psycho-Analysis, 49, 558-566.

Castoriadis-Aulagnier, Piera. (1975). La Violence de l'inter-prétation. Du pictogrammeà l'énoncé. Paris: Presses Universitaires de France, "Le Fil rouge."

Delegay-Siksou, Joyceline. (1986). Allaiter: au sein ou au biberon? Nourrir un enfant. Lieux enfance, 6-7, 35-57.

Denis, Paul. (1997). Emprise et satisfaction, les deux formants de la pulsion. Paris: Presses Universitaires de France.

Freud, Sigmund. (1892-93a). A case of successful treatment by hypnotism SE, 1: 115-128.

——. (1900a) The interpretation of dreams. Part I., SE,4: 1-338; The interpretation of dreams. Part II., SE, 5: 339-625.

——. (1905d). Three essays on the theory of sexuality. SE, 7: 123-243.

——. (1940a [1938]). An outline of psycho-analysis. SE, 23: 139-207.

——. (1941f [1938]). Findings, ideas, problems. SE, 23: 299-300.

Klein, Melanie. (1952). En observant le comportement des nourrissons. In Joan Riviere (Ed.), Developments in psychoanalysis. London: Hogarth Press ——. (1952). Quelques conclusions théoriques concernant la vie émotionnelle des bébés. In Joan Riviere (Ed.), Developments in psycho-analysis. London: Hogarth Press.

Laplanche, Jean. (1987). Nouveaux Fondements pour la psychanalyse. Paris: Presses Universitaires de France.

——. (1997). Le prégénital freudienà la trappe: après l'analyse. Revue française de psychanalyse, 61, 4: 1357-1369.

Winnicott, Donald W. (1987). Babies and their mothers. (Clare Winnicott, Ray Shepherd, and Madeleine Davis, Eds.). Reading, MA: Addison-Wesley.

Further Reading

Sarlin, Charles N. (1981). The role of breast feeding in psychosexual development and the achievement of the genital phase. Journal of the American Psychoanalytic Association, 29, 631-642.

—JOYCELINE SIKSOU

 
Wikipedia: breastfeeding
An infant breastfeeding
International Breastfeeding Symbol (Matt Daigle, Mothering magazine contest winner 2006)

Breastfeeding is the feeding of an infant or young child with milk from a woman's breasts. Babies have a sucking reflex that enables them to suck and swallow milk.

With few exceptions, human breast milk is the best source of nourishment for human infants.[1] However, experts disagree about how long to breastfeed to gain the greatest benefit, and how much more risk is involved in using artificial formulas.[2][3][4]

A mother may breastfeed her infant, or another infant, e.g., as a wet nurse. Women may also express their milk for their babies or to help feed other infants. While there are conflicting studies about the relative value of artificial feeding, it is acknowledged to be inferior to breastfeeding for both full term and premature infants.[5] In many countries including developed countries, artificial feeding is associated with more deaths from diarrhoea in infants[6][7].

National governments and international organizations promote breastfeeding as the best method of feeding infants in their first year and beyond. The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) also promote breastfeeding.[8][9] Regulating authorities recognize the superioriy of breastfeeding but also try to make artificial feeding safer.[3]

Lactation

Main article: Lactation

The production, secretion and ejection of milk is called lactation. It is one of the defining features of being a mammal.

Breast milk

Main article: Breast milk

Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast milk is made from the nutrients in the mother's bloodstream and bodily stores. Some studies estimate that a woman who breastfeeds her infant exclusively uses 400 - 600 extra calories a day in producing milk.[10] The exact composition of breast milk varies from day to day, and even hour to hour, depending on both the manner in which the baby nurses and the mother's food consumption and environment, so the ratio of water to fat fluctuates.

Foremilk, the milk released at the beginning of a feed, is watery, low in fat and high in carbohydrates; hindmilk, which is increasingly released as the feed progresses is creamier. There is no sharp distinction between foremilk and hindmilk, the change is very gradual. Research from Peter Hartmann's group tells us that fat content of the milk is primarily determined by the emptiness of the breast—the less milk in the breast, the higher the fat content. The breast can never be truly "emptied" since milk production is continuous.

Benefits

Breastfeeding benefits mother and child both physically and psychologically. While nutrients and antibodies pass to the baby, beneficial hormones are released into the mother's body.[11] The bond between baby and mother can also be strengthened during breastfeeding.[12]

Benefits for the infant

The benefits of breastfeeding babies are well documented. The American Academy of Pediatrics states,

“ Extensive research, especially in recent years, documents diverse and compelling advantages to infants, mothers, families, and society from breastfeeding and the use of human milk for infant feeding. These include health, nutritional, immunologic, developmental, psychological, social, economic, and environmental benefits. ”
—American Academy of Pediatrics policy statement[9]

Breastfed babies have a lower risk of sudden infant death syndrome (SIDS) and other diseases. Suckling at the breast encourages the proper development of the infant's teeth and speech organs and helps prevent obstructive sleep apnea.

Breastfeeding is associated with lower risk of the following diseases:

  1. Allergies[13]
  2. Asthma[14][15]
  3. Autoimmune thyroid diseases[16]
  4. Bacterial meningitis[9]
  5. Breast cancer[11]
  6. Celiac disease[17]
  7. Crohn's disease[18]
  8. Diabetes[9][12]
  9. Diarrhea[9][12]
  10. Eczema[19]
  11. Gastroenteritis[20]
  12. Hodgkin's lymphoma[9][12]
  13. Necrotizing enterocolitis[9]
  14. Multiple sclerosis[16]
  15. Obesity[9][12]
  16. Otitis media (ear infection)[9][12]
  17. Respiratory infection and wheezing[9][12]
  18. Rheumatoid arthritis[21]
  19. Urinary tract infection[9]

Breast milk has several anti-infective factors, including the anti-malarial factor para-amino benzoic acid (PABA),[22] the anti-amoebic factor BSSL,[23], lactoferrin, the second most common protein in human milk, that binds to iron and inhibits the growth of intestinal bacteria like E. coli and Salmonella, [24][25] and IgA' which protects breastfeeding infants from microbial infection.[26]

Breast milk contains the right amount of the amino acids cystine, methionine and taurine that are essential for neuronal (brain and nerve) development.[27] A New Zealand study tracking over 1000 children for 8 to 18 years found small but measurable increases in cognitive ability and education achievement. This remained even after adjusting for other factors (such as maternal education level).[28]

One study suggests that in resource-poor settings where safe infant formula is unavailable, exclusive breastfeeding (as compared with "mixed" feeding where breastfeeding is combined with formula, solids or animal milk) may reduce the risk of HIV transmission from mother to child in infants less than 6 months old.[29]

Unlike human milk, the predominant protein in cow's milk is beta-lactoglobulin, an important factor in cow milk allergies.[30]

Benefits for the mother

Breastfeeding is the most cost effective. It provides optimal nourishment for a child at the cost of a little extra food for the mother; infant formulas are much more expensive.

Breastfeeding releases the hormones oxytocin and prolactin. These relax the mother and make her feel more nurturing toward her baby.[31] Breastfeeding soon after giving birth increases oxytocin levels in the mother. This makes her uterus contract more quickly and reduces bleeding. Oxytocin is similar to pitocin, a synthetic hormone used to make the uterus contract.[32]

As fat accumulated during pregnancy is used to produce milk, breastfeeding can help mothers lose weight.[33][34] While frequent and exclusive breastfeeding can delay the return of ovulation, and therefore fertility, it is not a recommended form of birth control. Ovulation returns before menstruation does, and women can become pregnant before menstruation returns.

Breastfeeding is possible throughout pregnancy, but generally milk production will be reduced at some point during the pregnancy.[35]

Breastfeeding mothers have less risk of breast,[9][12] ovarian,[9][12] and endometrial cancer,[36][37] and less risk of osteoporosis[9][12]. Mothers who breastfeed longer than eight months have better bone re-mineralisation.[38] Breastfeeding diabetic mothers require less insulin [39]. Breastfeeding helps stabilize maternal endometriosis,[9], there is less risk of post-partum hemorrhage,[32] and less risk and beneficial effects on insulin levels for mothers with polycystic ovary syndrome.[40]

Some breastfeeding women have pain from thrush or staph infections of the nipple.[41] With continued breast feeding and treatment these can be easily managed and be of little concern for mother and child.

Bonding

The hormones released during breastfeeding strengthen a mother's nurturing feelings towards her child. This is very important as up to 80% of mothers suffer from some form of postnatal depression, though most cases are very mild. The woman's partner and other caregivers can support her in a variety of ways and this support is an important factor in successful breastfeeding. Teaching partners how to manage common difficulties is associated with higher breastfeeding rates.[42]

Breastfeeding can affect family relationships. While some partners may feel left out when the mother is feeding the baby, others find breastfeeding strengthens family bonds. Looking after a new baby and breastfeeding take time. This can add pressure to the family, as the partner has to care for the mother as well as doing tasks she would otherwise do. However, as partners are often very willing to give this support, this pressure can help to strengthen family bonds.[43]

If the mother is away, an alternative caregiver may be able to feed the baby with expressed breast milk (EBM). The various breast pumps available for sale and rent help working mothers to feed their babies breast milk for as long as they want. However, the mother must produce and store enough milk to feed the child for the time she is away and this may not always be practical. Also, the other caregiver must be comfortable in handling breast milk. These two factors may prompt the mother - perhaps against her wishes - to give up breastfeeding.

Recommendations and research

The World Health Organization advises:[44]

“ A vast majority of mothers can and should breastfeed, just as vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother's milk be considered as unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed milk from the infant's own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast milk substitute fed with a cup, which is a safer method than a feeding bottle or a teat – depends on individual circumstances. Infants who are not breastfed, for whatever reason, should receive special attention from the health and social welfare system since they constitute a risk group. ”

Breastfeeding complications

Main article: Breastfeeding complications

Despite being a natural human activity, breastfeeding difficulties are not uncommon. Putting the baby to the breast as soon as possible after birth helps to avoid many difficulties. The AAP breastfeeding policy says: Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed.[9] Many breastfeeding difficulties can be resolved with proper hospital procedures, properly trained midwives, doctors and hospital staff, and lactation consultants.[45]. There are few cases where breastfeeding is contraindicated.

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 birth weight in 5–6 months. By one year, the typical breastfed baby will weigh about 2½ times birth weight. At one year, breastfed babies tend to be leaner than bottle fed babies.[46] By two years, differences in weight gain and growth between breastfed and formula-fed babies are no longer evident.[47]

Methods and considerations

There are many books and videos to advise mothers about breastfeeding. Lactation consultants in hospitals or private practice, and volunteer organizations of breastfeeding mothers such as La Leche League 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. [48]. Early breast-feeding is associated with fewer nighttime feeding problems [49]

Time and place for breastfeeding

Breastfeeding at least once every two to three hours helps to keep up the milk production. For most women, eight breastfeeding or pumping sessions every 24 hours keeps their milk production high.[9] 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.[50] Feeding a baby on demand (sometimes referred to as "on cue"), may mean breastfeeding much more than the recommended minimum. Feeding when the baby shows early signs of hunger, is the best way to maintain milk production and ensure the baby's needs for milk and comfort are being met.[8] 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, potentially creating problems.[51].

Babies usually show they are hungry by waking up (newborns), mouthing their fists, moaning or fussing. Crying is a late indicator of hunger. When babies' cheeks are stroked, the rooting instinct makes them move their face towards the stroking and open their mouth.

Breastfeeding can make mothers thirsty, especially at first, when both mother and baby are inexperienced and when feeding sessions can last for an hour or more (there is no time limit for breastfeeding). Having water readily available helps mothers maintain proper hydration.

Place

Rooming-in bassinet

Most states now have breastfeeding laws which allow a mother to breastfeed her baby anywhere she is allowed to be. In hospitals, rooming-in care is used for breastfeeding. There are breastfeeding rooms in some places, including hypermarkets.

Latching on, feeding and positioning

When the nipple strokes the baby's cheek the baby will open its mouth and turn towards the nipple. So that the baby will latch on well, the nipple should be pushed into its mouth 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.

Many women wear nursing brassieres for easier access to the breast, but these are not always necessary and certainly not required. In the very early days, wearing a nursing bra can make breastfeeding complicated and uncomfortable. Wearing a bra at any time after birth will not affect how the breast changes with pregnancy and breastfeeding. Many women find that the size of their breasts change dramatically and so fitting a bra is better done after childbirth rather than before. An ill-fitting bra, whether designed for nursing or otherwise, can cause plugged ducts or mastitis.

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.[52]

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.

The length of feeds varies a lot. Regardless of the time taken, the breastfeeding mother should be comfortable.

  • Upright: The sitting position with the back straight and leaning back comfortably.
  • Mobile: The mother carries her nursling in a sling or other baby carrier while breastfeeding. Doing so permits the mother to incorporate breastfeeding into the varied work of daily life
  • Lying down: Good for night feeds or for those who have had a caesarean section
    • On her back: Mother is usually sitting slightly upright; particularly useful for tandem breastfeeding (nursing more than one child)
    • On her side: The mother and baby lie on their sides
  • Hands and knees: The mother is on all fours with the baby underneath her (not usually recommended)

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.

  • Cradling positions:
    • Cradle hold: The baby is held with its head in the woman's elbow horizontally across the abdomen, "tummy to tummy", with the woman in an upright and supported position image
    • Cross-cradle hold: As above but the baby is held with its head in the woman's hand
  • Football hold: The woman is upright and the baby is held securely under the mother's arm with the head cradled in her hands. This position is especially useful for feeding twins simultaneously image
  • Feeding up hill: The baby lies stomach to stomach with the mother who is lying on her back; this is helpful for babies finding it difficult to feed
  • Lying down:
    • On its side: The mother and baby lie on their sides
    • On its back: The baby is lying on its back (cushioned by something soft) with the mother on her hands and knees above the child (not usually recommended)

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. Favored positions include:

  • Double cradle hold
  • Double clutch hold image
  • One clutched baby and one cradled baby
  • Lying down

Exclusive breastfeeding

Exclusive breastfeeding is when an infant receives no other food or drink, or even water, besides breast milk.[8] National and international guidelines recommend that all infants be breastfed exclusively for the first six months of life. It is generally accepted that newborns should be exclusively breastfed for around 6 months. 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.

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.[53] 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.[54]

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. Babies or toddlers that are truly feeding cannot physically bite the nipple.

"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 [1] 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.[55] Because It takes less effort to suck from a bottle, a baby might lose its 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.[citation needed]

Some women donate their expressed breast milk (EBM) to others, either directly or through a milk bank. Though some 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.[56]

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. When feeding from the breast, the tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth; when feeding from a bottle, 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 induce the infant to prefer 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 infants at the same time is called tandem breastfeeding The most common reason for tandem breastfeeding is the birth of twins. 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, while also trying to get them to breastfeed together.

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 [57] [2] [3].

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[58]).

Extended breastfeeding

Breastfeeding past one year is called extended breastfeeding or "sustained breastfeeding" by supporters and those outside the U.S. [59]) Some women breastfeed a child till the age of 3 or more. 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. Detractors may believe that prolonged breastfeeding can result in emotional or psycho-sexual problems in the child [60]. However, there is no solid evidence to support either of these ideas.

Example

H.L. Hunt, the Texas oil man, was nursed by his mother until he was seven years old (1896). Hunt was something of a prodigy and his mother rewarded him by allowing him to continue nursing at her breast long past the customary weaning age. He finally stopped this practice when his father found him suckling his mother while she was standing in their kitchen kneading dough. As an adult, H.L. Hunt wrote about this without embarrassment. [61]

Shared breastfeeding

In developing nations in Africa, it is sometimes common for more than one woman to breastfeed a child. Shared breastfeeding is a risk factor for HIV infection in infants.[62] 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.

Weaning

Weaning is the process of introducing the infant to ordinary food and reducing the supply of breast milk. The infant is fully weaned once it relies on ordinary food for all its nutrition and it no longer receives any breast milk. Most mammals stop producing the enzyme lactase at the end of weaning, and become lactose intolerant. Many humans have a mutation that allows the production of lactase throughout life and can drink milk - usually cow or goat milk - well beyond the age of weaning.[63]

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 the U.S. FDA withdrew this indication for the drug in 1994.[64]

History of breastfeeding

Main article: History of breastfeeding

Before the last few hundred years, alternatives to breastfeeding were rare. Attempts in 15th century Europe to use cow or goat's 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 appear on the market in the mid 19th Century but their use did not become widespreadi 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.

See also

References

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