This month´s topic for healthy discussion from San Juan Regional Medical Center is:

Babies Benefit from Breast Feeding

Breast is best when it comes to feeding your newborn infant. That´s the message that has reached the majority of women who now nurse their babies at least for the first weeks or months following delivery.

At six months of age and beyond, however, rates of breast feeding are considerably lower than health experts would like to see. Countless women stop nursing early either because of family or social expectations, difficulties with nursing or lack of support when problems arise.

Sarah married at 39 and considered herself fortunate to become pregnant in her first year of marriage. "I really loved my job, but I knew I wanted to nurse my baby and spend time with him," she said.

Sarah cut her work back to two days a week, and she and her husband were able to coordinate their schedules to care for their son. "The biggest challenge for me was working out the breast feeding," Sarah said.

She was able to initiate breast feeding with only a little temporary soreness and had a routine well-established when she returned to work part-time after her maternity leave. To make her plan work, Sarah had to get ahead on her pumping schedule and always leave enough milk at home with her husband so he could feed the baby on schedule.

"I can´t say it was easy," said Sarah, "but we made it work. It helped having supportive co-workers who understood if I had to rush out of a meeting that went extra long. I weaned the baby at about 10 months, but I know it would have been much harder if I´d been working full-time."

Saved by the Pump

Sarah was fortunate in that nursing problems for her were mainly centered around scheduling. Many women experience difficulty getting nursing established, often feeling overwhelmed by sleep problems and nipple pain.

Melody had a tough time getting breast feeding up and running even though she was home full-time with her baby. Like many women, Melody experienced raw, cracked nipples in the first week which made nursing very painful to her. "I was saved by the pump," she said.

An electric breast pump can be a big help to women who struggle with nursing because of painful nipples. Using either the pump or a nipple shield, a woman can give her nipples a chance to heal and then gradually toughen up.

Although there´s some risk that too much bottle feeding might disrupt nursing, new nipple designs that require more work on the baby´s part help offset that problem. And for many women who experience serious pain, the pump may make the difference between abandoning breast feeding and sticking with it.

Some lactation experts are concerned that breast pumps are playing too large a role for some women. Originally developed to meet the needs of mothers with premature infants and multiple births, electric pumps are now used just as often by women with full-term single babies, according to one study.

One mother who was pumping instead of nursing after eight weeks cited pain in the first week as the reason she was using the pump. Nursing experts worry that continued use of the pump turns what should be a close bonding experience for mother and baby into an isolating, impersonal experience for the mother who may not be the one feeding the baby, despite the fact that the baby is getting her milk.

Nursing Has Many Benefits

Mother´s milk is obviously the natural option with the perfect mix of nutrients to support a baby´s growth and development. Scientists have long known that a baby who is breast fed gains increased immunity from the mother´s immune system. Studies show other advantages:

• babies who are breast fed are less likely to develop type 2 diabetes later in life;
• the risk of infection is lowered; one study showed that if all infants were fully breast fed up to four months of age, 56 percent of hospital admissions in infants under one year would be avoided;
• breast feeding is associated with a lower body mass index at three years of age, decreasing the risk of obesity in later life.

The World Health Organization recommends exclusive breast feeding for the first six months of life and then continued breast feeding as other foods are introduced at two years and beyond.

Despite the health benefits, the recommendations and the fact that newborns come with a strong urge to suck, many women either never try breast feeding or abandon it because of perceived difficulties.

A Canadian study found that in 2003, 84 percent of mothers of newborns began breast feeding. By four months only 48 percent of them were still breast feeding and only 32 percent were nursing exclusively. Many women cited difficulties rather than choice as the reason they had quit.

One study of women who had quit nursing by four weeks postpartum found that perceived inadequate milk supply was the most common reason given for quitting; difficulty with breast feeding technique was the next most common reason cited, followed by sore nipples.

All of these problems can be addressed, most often successfully, especially with the help of a health professional. The missing factor for most of these women was information, encouragement and support. Many women cite a sense of frustration and failure when nursing doesn´t go as planned.

Women who are pregnant should get information about breast feeding and seek support ahead of time. Being aware of potential challenges in the first few weeks and being willing to persevere will increase chances of success.

It´s important not to panic if a problem develops, but to seek help from a supportive caregiver. Know that most early problems can be overcome and, once established, breast feeding creates a rewarding and nurturing bond between a mother and her baby.

REFERENCES:
Indu B. Ahluwalia et al, "Why Do Women Stop Breastfeeding?" Journal of the American Academy of Child and Adolescent Psychiatry, June 2006.
"“Breastfeeding May Help Prevent Childhood Obesity," AORN Journal, August, 2006.
John R. Britton et al, "Breastfeeding, Sensitivity and Attachment," Pediatrics, November 2006.
"Full Breastfeeding Reduces Infants´ Hospital Admissions," Nursing Standard, October 11, 2006.
Roslyn Giglia and Colin Binns, "Alcohol and Lactation: A Systematic Review," Nutrition and Dietetics: The Journal of the Dietitians Association of Australia, June 2006.
M. Jane Heinig, "The Ones That Got Away," Journal of Human Lactation, November 2006.
Wendy Hicks, "Respecting Women’s Choices," Kai Tiaki: Nursing New Zealand, October 2006.
Matt Kaplan, "Breast Is Best, But Watch Out for the Allergies," New Scientist, August 5, 2006.
Christa M. Kelleher, "The Physical Challenges of Early Breastfeeding," Social Sciences and Medicine, November 15, 2006.
Jacqueline C. Kent et al, "Volume and Frequency of Breastfeeding and Fat Content of Breast Milk Throughout the Day," Pediatrics, March 2006.
Miriam H. Labbok, "Trends in Exclusive Breastfeeding," Journal of Human Lactation, August 2006.
Sally Ann Lederman et al, "Response to Geraghty et al Regarding the Use of Pumps and Breastfeeding," Journal of Human Lactation, November 2006.
Christopher G. Owen et al, "Does Breastfeeding Influence Risk of Type 2 Diabetes in Later Life?" American Journal of Clinical Nutrition, November 2006.
Alfredo Pisacane et al, "A Controlled Trial of the Father’s Role in Breastfeeding Promotion," Journal of the American Academy of Child and Adolescent Psychology, February 2006.
Debbie Sheehan et al, "The Impact of a New Universal Postpartum Program on Breastfeeding Outcomes," Journal of Human Lactation, November 2006.
Liz Smith, "CDC Reports on Socioeconomic Disparities in Breastfeeding," American Family Physician, October 1, 2006.
Elsie Taveras et al, "To What Extend is the Protective Effect of Breastfeeding on Future Overweight Explained by Decreased Maternal Feeding Restriction?" Pediatrics, December 2006.
Caroline Wellbery, "Intervention to Increase Breastfeeding Rates," American Family Physician, June 1, 2006.

Breast Fed Babies Weigh Less Later

Babies who are breast fed are less likely to be heavy later on. One study found that the length of time a baby is breast fed correlates with a lower body mass index at three years of age. Researchers also found that children who are not fed any infant formula as babies are less likely to be overweight at age three.

A partial explanation is that mothers who breast feed may be less likely to pressure their babies to eat when the baby is not hungry. It´s also possible that the make-up of breast milk, with higher levels of insulin and leptin, may protect against gaining excess weight in the future.

[SOURCE: Elsie Taveras et al, "To What Extent is the Protective Effect of Breastfeeding on Future Overweight Explained by Decreased Maternal Feeding?"]

Reasons Women Stop Breast Feeding

The majority of women today begin breast feeding their newborns, but many women stop nursing in the following weeks or months, often much earlier than originally planned. Women cite many reasons for stopping early including:

• a belief that they are not producing enough milk;
• nipple and breast pain;
• poor latching to the nipple by the infant;
• lack of support from friends and family;
• fatigue;
• a desire to return to work or school.

Lactation specialists advise women to get information and seek help when problems develop when nursing. Advice, help with technique and a little support can resolve most problems and turn nursing into a positive experience for mother and baby.

[SOURCE: M. Jane Heinig, "The Ones That Got Away," Journal of Human Lactation, November 2006]

Staying Abreast Of Drugs, Supplements

Nursing mothers and their physicians now have an updated reference for questions related to the safety of hundreds of drugs and supplements for women who are breast feeding.

The twelfth edition of Dr. Thomas Hale´s Medications and Mother´s Milk, has added over 70 new listings and now offers reference information on 814 drugs, vitamins, herbs and vaccines. Women who are breast feeding and their physicians can find balanced information useful for every day needs like treating a cold to more complex issues such as treating depression.

[SOURCE: Dr. Thomas Hale, Medications and Mother´s Milk, 12th ed. Hale Publishing Co. 2006]

Breast Feeding Keeps Babies Out of Hospital

According to a study comparing the rate of hospital admissions in the first year of life, breast feeding keeps babies out of the hospital. The study compared the rate of admissions for breast fed and non-breast-fed babies and found that one in three hospital admissions could have been avoided for each additional month an infant was breast fed.

Researchers concluded that if all infants were breast fed up until four months of age, more than half of hospital admissions in infants under a year old would be avoided. The savings in emotional stress on the part of parents and infants and in health care costs would be enormous.

[SOURCE: "Full Breastfeeding Reduces Infants´ Hospital Admissions," Nursing Standard, October 11, 2006]

Biology of Breast Feeding

Female infants are born with milk-secreting glands that will one day make it possible for them to nurse a future child. The milk-secreting cells present at birth don´t develop further until a girl reaches puberty. And the final stage of cell development occurs only when a woman becomes pregnant, and hormone surges control the development of the mammary glands and the secretion of milk.

For a few days after birth breasts secrete a substance called colostrum. Hormone changes in the days after birth prompt the beginning of milk secretion which continues as long as the baby nurses regularly.

[SOURCE: Roslyn Giglia and Colin Binns, "Alcohol and Lactation: A Systematic Review," Nutrition and Dietetics: The Journal of the Dietitians Association of Australia, June 2006]

Is 6 Months Enough?

A Finnish study that followed 200 mothers of newborns for 20 years found that infants who had been breast fed exclusively for nine months or more were more likely to have allergic symptoms than infants who had been breast fed exclusively for two to six months. The difference between the two groups was significant with 56 percent of those breast fed exclusively for nine months or more having allergic symptoms at age 5, compared with only 20 percent in the other group.

Exclusive breast feeding during the first six months of life is believed to lower the risk of allergies, but this study suggests that introducing other foods at six months (as the World Health Organization and most pediatricians recommend) while continuing to breast feed may help the immune system develop.

[SOURCE: Matt Kaplan, "Breast Is Best, But Watch Out for the Allergies" New Scientist, August 5, 2006]