Breastmilk

While parents of a new baby have a million things to do, planning for meals menu - isn't one of them. Until a baby is 4 to 6 months old the only items on the menu are either breast milk or infant formula.

New parents want to give their babies the very best. When it comes to nutrition, the best first choice of food for newborn babies is still breast milk, unless otherwise.

Usually you don’t see a manufacturer announcing that the competition's product is better. But only when the competition is actual breast milk, infant formula manufacturers advertise right on the label that breast milk is the best choice of nutrition for newborn babies.

Human breast milk is the ideal nourishment for human babies, simply because its protein content is particularly suited for a baby's metabolism, the fat content is more easily absorbed and digested than the fats in cow's milk.

Ruth Lawrence, M.D., professor of pediatrics and obstetrics at the University Of Rochester School Of Medicine in Rochester, N.Y., and spokeswoman for the American Academy of Pediatrics, states that "There are 4,000 species of mammals, and they all make different milk. Human milk is made for human infants, and it meets all their specific nutrient needs."

More than two decades of researches have established that breast milk is perfectly suited to nourish infants and protect them from illness, infections and allergies. Breast-fed infants have lower rates of hospital admissions, ear infections, diarrhea, rashes, allergies, and other medical problems than bottle-fed babies.

"We've known for years that the death rates in Third World countries are lower among breast-fed babies," says Lawrence. "Breast-fed babies are healthier and have fewer infections than formula-fed babies."

A mother's milk contains cells from her immune system and antibodies against diseases to which she has been exposed. Antibodies she develops after the baby is born are also passed to the baby through her breast milk. For example, if Mom catches the flu, she develops antibodies to that strain of flu virus. Richard Schanler, M.D., associate professor of pediatrics at Baylor College of Medicine, Houston, explains, "The baby will get some protection. The baby might not get the flu at all, or the case may be milder than if he or she wasn't breast-fed to begin with."

Health experts say increased breast-feeding rates would save consumers money, spent both on infant formula and in health-care dollars. It could save lives as well.

However, keep in mind that risks of breast milk may outweigh advantages if a nursing mother takes certain medications or abuses of drugs. The quality and quantity of the mother's diet may affect the quality and quantity of breast milk. A good nutrition has to be part of the mother’s lifestyle.

A century ago, babies who couldn't be breast-fed usually didn't survive. Today, although breast-feeding is still the best nourishment for infants, infant formula is a close enough second choice that babies not only survive but thrive.

Commercially prepared formulas are regulated by the Food and Drug Administration. The safety and nutritional adequacy of commercially prepared formula is also ensured by the agency's nutrient requirements and enhanced by strict quality control procedures that require manufacturers to analyze each batch of formula for required nutrients, to test representative samples for stability during over the shelf life of the product, to code containers to identify the batch, and to make all records available to FDA investigators.

The composition of infant formula is similar to breast milk, but it isn't a perfect match, because the exact chemical makeup of breast milk is still unknown. Human milk is very complex, and scientists are still trying to unravel and understand what makes it such a good source of nutrition for rapidly growing and developing infants. "We're always discovering things in human milk that are there in small quantities that hadn't been looked at before," says John C. Wallingford, Ph.D, an infant nutrition specialist with FDA's Center for Food Safety and Applied Nutrition. "But infant formula is increasingly close to breast milk, especially in the area of fatty acids and lipids," he adds.

More than half the calories in breast milk come from fat, and the same is true for today's infant formulas. This may be alarming to many American adults watching their intake of fat and cholesterol, especially when sources of saturated fats, such as coconut oil, are used in formulas. (In adults, high intakes of saturated fats tend to increase blood cholesterol levels more than other fats or oils.) But the low-fat diet recommended for adults doesn't apply to infants.

“The reason is that infants have a high energy requirement, and they have a restricted volume of food that they can digest. The only way to get the energy density of a food up is to have a high amount of fat”, says Wallingford.

While greater knowledge about human milk has helped scientists improve infant formula, it has become "increasingly apparent that infant formula can never duplicate human milk," wrote John D. Benson, Ph.D, and Mark L. Masor, Ph.D., in the March 1994 issue of Endocrine Regulations. "Human milk contains living cells, hormones, active enzymes, immunoglobulins and compounds with unique structures that cannot be replicated in infant formula."

Benson and Masor, both of whom are pediatric nutrition researchers at infant formula manufacturer Abbott Laboratories, believe creating formula that duplicates human milk is impossible. "A better goal is to match the performance of the breastfed infant," they wrote. Performance is measured by the infant's growth, absorption of nutrients, gastrointestinal tolerance, and reactions in blood.

Wallingford agrees, explaining that while FDA's regulations on what goes into infant formula are to ensure there are enough nutrients, "That’s just a starting point. What's really important is how infants thrive."

Human Milk for Human Infants

The primary benefit of breast milk is nutritional. Human milk contains just the right amount of fatty acids, lactose, water, and amino acids for human digestion, brain development, and growth.

Cow's milk contains a different type of protein than breast milk. This is good for calves, but human infants can have difficulty digesting it. Bottle-fed infants tend to be fatter than breast-fed infants, but not necessarily healthier.

Breast-fed babies have fewer illnesses because human milk transfers to the infant a mother's antibodies to disease. About 80 percent of the cells in breast milk are macrophages, cells that kill bacteria, fungi and viruses. Breast-fed babies are protected, in varying degrees, from a number of illnesses, including pneumonia, botulism, bronchitis, staphylococcal infections, influenza, ear infections, and German measles. Furthermore, mothers produce antibodies to whatever disease is present in their environment, making their milk custom-designed to fight the diseases their babies are exposed to as well.

A breast-fed baby's digestive tract contains large amounts of Lactobacillus bifidus, beneficial bacteria that prevent the growth of harmful organisms. Human milk straight from the breast is always sterile, never contaminated by polluted water or dirty bottles, which can also lead to diarrhea in the infant.

Human milk contains at least 100 ingredients not found in formula. No babies are allergic to their mother's milk, although they may have a reaction to something the mother eats. If she eliminates it from her diet, the problem resolves itself.

Sucking at the breast promotes good jaw development as well. It's harder work to get milk out of a breast than a bottle, and the exercise strengthens the jaws and encourages the growth of straight, healthy teeth. The baby at the breast also can control the flow of milk by sucking and stopping. With a bottle, the baby must constantly suck or react to the pressure of the nipple placed in the mouth.

Nursing may have psychological benefits for the infant as well, creating an early emotional attachment between mother and child. At birth, infants see only 12 to 15 inches, the distance between a nursing baby and its mother's face. Studies have found that infants as young as 1 week prefer the smell of their own mother's milk. When nursing pads soaked with breast milk are placed in their cribs, they turn their faces toward the one that smells familiar.

Many psychologists believe the nursing baby enjoys a sense of security from the warmth and presence of the mother, especially when there is skin-to-skin contact during feeding. Parents of bottle-fed babies may be tempted to prop bottles in the baby's mouth, with no human contact during feeding. But a nursing mother must cuddle her infant closely many times during the day. Nursing becomes more than a way to feed a baby; it's a source of warmth and comfort.

Benefits to Mothers

Breast-feeding is good for new mothers as well as for their babies. There are no bottles to sterilize and no formula to buy, measure and mix. It may be easier for a nursing mother to lose the pounds of pregnancy as well, since nursing uses up extra calories. Lactation also stimulates the uterus to contract back to its original size.

A nursing mother is forced to get needed rest. She must sit down, put her feet up, and relax every few hours to nurse. Nursing at night is easy as well. No one has to stumble to the refrigerator for a bottle and warm it while the baby cries. If she's lying down, a mother can doze while she nurses.

Nursing is also nature's contraceptive - although not a very reliable one. Frequent nursing suppresses ovulation, making it less likely for a nursing mother to menstruate, ovulate, or get pregnant. There are no guarantees, however. Mothers who don't want more children right away should use contraception even while nursing. Women who are breast-feeding can use barrier methods of birth control, such as condoms and diaphragms. Hormone-containing methods are not first choice. These include injections (such as Depo-Provera), implants (such as Norplant), and birth control pills. A woman who breast-feeds should consult her doctor about which type of contraception is appropriate for her until the baby is weaned.

Breast-feeding is economical also. Even though a nursing mother works up a big appetite and consumes extra calories, the extra food for her is less expensive than buying formula for the baby. Nursing saves money while providing the best nourishment possible.

When Formula Is Necessary

There are very few medical reasons why a mother shouldn't breast-feed, according to Lawrence. Most common illnesses, such as colds, flu, skin infections, or diarrhea, cannot be passed through breast milk. In fact, if a mother has an illness, her breast milk will contain antibodies to it that will help protect her baby from those same illnesses.

A few viruses can pass through breast milk, however. HIV, the virus that causes AIDS, is one of them. Women who are HIV positive should not breast-feed. A few other illnesses, such as herpes, hepatitis, and beta streptococcus infections, can also be transmitted through breast milk. But that doesn't always mean a mother with those diseases shouldn't breast-feed, Lawrence says. "Each case must be evaluated on an individual basis with the woman's doctor," she says.

Breast cancer is not passed through breast milk. Women who have had breast cancer can usually breast-feed from the unaffected breast. Studies have shown, however, that breast-feeding a child reduces a woman's chance of developing breast cancer later.

Silicone breast implants usually do not interfere with a woman's ability to nurse, but if the implants leak, there is some concern that the silicone may harm the baby. Some small studies have suggested a link between breast-feeding with implants and later development of problems with the child's esophagus. Further studies are needed in this area. But if a woman with implants wants to breast-feed, she should first discuss the potential benefits and risks with her child's doctor.

Tough but Worthwhile

For all its health benefits, breast-feeding isn't always easy. In the early weeks, it can be painful. A woman's nipples may become sore or cracked. She may experience engorgement more than a bottle-feeding mother, when the breasts become so full of milk they're hard and painful. Some nursing women also develop clogged milk ducts, which can lead to mastitis, a painful infection of the breast. While most nursing problems can be solved with home remedies, mastitis requires prompt medical care.

Women who plan to go back to work soon after birth will have to plan carefully if they want to breast-feed. If her job allows, a new mother can pump her breast milk several times during the day and refrigerate or freeze it for the baby to take in a bottle later. Some women alternate nursing at night and on weekends with daytime bottles of formula.

In either case, a nursing mother is physically tied to her baby more than a bottle-feeding mother. The baby needs her for nourishment, and she needs to nurse regularly to avoid getting uncomfortably full breasts. But instead of feeling it's a chore; nursing mothers often cite this close relationship as one of the greatest joys of nursing.

If a woman is unsure whether she wants to nurse, she can try it for a few weeks and switch if she doesn't like it. It's very difficult to switch to breast-feeding after bottle-feeding is begun.

If she plans to breast-feed, a new mother should learn as much as possible about it before the baby is born. Obstetricians, pediatricians, childbirth instructors, nurses, and midwives can all offer information about nursing. But perhaps the best ongoing support for a nursing mother is someone who has successfully nursed a baby.

For a Breast-Feeding Sucess
It's helpful for a woman who wants to breast-feed to learn as much about it as possible before delivery, while she is not exhausted from caring for an infant around-the-clock, agrees Julie Stock of the La Leche League, an international breast-feeding support and educational organization. "If you know a lot beforehand, you start to build a sense of confidence. Many attempts at breast-feeding fail because of wrong information."

Once the baby is born, breast-feeding as soon as possible after delivery and often is the first of three essential keys for success, says Stock.

The second key is no artificial nipples - that includes pacifiers as well as bottles of water or formula - during the first few weeks. Stock explains that some babies can become very confused by the different feel and different way of sucking needed with a bottle or pacifier, and they may not be able to switch back to the breast.

Finally, it is important to make sure that the baby "latches on" to the mother's nipple correctly. "If a mother has those three things going for her, in general that will eliminate about 90 percent of the common problems that mothers have," says Stock.

The La Leche League has local chapter meetings throughout the country where expectant and new mothers can learn about breast-feeding, nutrition, and other aspects of child care. For the number of your local chapter, call the La Leche League at 1-708-455-7730 or write to La Leche League International, 9616 Minneapolis Avenue, P.O. Box 1209, Franklin Park, Illinois, 60131-8209

Tips for Breast-Feeding Success
The following tips can help foster successful nursing:

• Get an early start: Nursing should begin within an hour after delivery if possible, when the infant is awake and the sucking instinct is strong. Even though the mother won't be producing milk yet, her breasts contain colostrum, a thin fluid that contains antibodies to disease.
• Proper positioning: The baby's mouth should be wide open, with the nipple as far back into his or her mouth as possible. This minimizes soreness for the mother. A nurse, midwife, or other knowledgeable person can help her find a comfortable nursing position.
• Nurse on demand: Newborns need to nurse frequently, about every two hours, and not on any strict schedule. This will stimulate the mother's breasts to produce plenty of milk. Later, the baby can settle into a more predictable routine. But because breast milk is more easily digested than formula, breast-fed babies often eat more frequently than bottle-fed babies.
• No supplements: Nursing babies don't need sugar water or formula supplements. These may interfere with their appetite for nursing, and that can lead to a diminished milk supply. The more the baby nurses, the more milk the mother will produce.
• Delay artificial nipples: It's best to wait a week or two before introducing a pacifier, so that the baby doesn't get confused. Artificial nipples require a different sucking action than real ones. Sucking at a bottle could also confuse some babies in the early days. Remember, they’re also learning how to breast-feed.
• Air dry: In the early postpartum period or until her nipples toughen, the mother should air dry them after each nursing to prevent them from cracking, which can lead to infection. If her nipples do crack, the mother can coat them with breast milk or other natural moisturizers to help them heal. Vitamin E oil and lanolin are commonly used, although some babies may have allergic reactions to them. Proper positioning at the breast can help prevent sore nipples. If the mother's very sore, the baby may not have the nipple far enough back in his or her mouth.
• Watch for infection: Symptoms of breast infection include fever and painful lumps and redness in the breast. This situation requires immediate medical attention.
• Expect engorgement: A new mother usually produces lots of milk, making her breasts big, hard and painful for a few days. To relieve this engorgement, she should feed the baby frequently and on demand until her body adjusts and produces only what the baby needs. In the meantime, the mother can take over-the-counter pain relievers, apply warm, wet compresses to her breasts, and take warm baths to relieve the pain.
• Eat right, get rest: To produce plenty of good milk, the nursing mother needs a balanced diet that includes 500 extra calories a day and six to eight glasses of fluid. She should also rest as much as possible to prevent breast infections, which are aggravated by fatigue.

(Modified from originally written by Rebecca D. William, Isadora Stehlin and Dori Stehlin )