By Jennifer Shaer MD, FAAP, FABM, IBCLC
It seems like everyone is breastfeeding their babies today. Not too long ago formula feeding was en vogue. What’s going on here? In order to understand the current state of affairs, we need to know a little about the history of breastfeeding.
Prior to the 20th century a woman had little choice but to nurse her baby. If she could not breastfeed, she would find a wet nurse or use artificial feeding. Back then, artificial feeding was often contaminated or insufficient to nourish a baby. Formula became commercially available in the late 1800s. In the early 1900s society began to believe that artificial milk was better than human milk and breastfeeding fell out of favor. It became a status symbol to bottle feed your baby. The lowest breastfeeding rates were in the early 1970s. Since then, breastfeeding rates have been on the rise as the benefits of human milk are again being realized.
It has not been easy to swing the pendulum back toward nature and away from formula feeds. The American Academy of Pediatrics, American College of Obstetrics and Gynecology, American Academy of Family Physicians, World Health Organization and Centers for Disease Control all have statements recommending breastfeeding as the preferred method of feeding babies. After much time and effort, the benefits of breastfeeding are being realized and most babies are being breastfed to some extent.
Why is everyone pushing breastfeeding so much? What are the real benefits? The benefits to the baby are still being realized. In fact, some benefits persist into adulthood. Breastfed babies have a lower risk of respiratory illnesses, ear infections, allergies, asthma, obesity and cardiovascular disease, SIDS, diabetes, diarrheal disease and necrotizing enterocolitis in the premature baby. There are also benefits to the mother. These include a lower risk of breast, ovarian and cervical cancer, lower risk of osteoporosis, faster weight loss and lower risk of postpartum depression. On a personal level, breastmilk is much more convenient. It is always available and warm and it is free. Finally, there are benefits to society as a whole. These are the benefits that policy makers, employers and insurance companies like the best. Since breastfed babies are healthier, there is less sick time from work, fewer medical expenses and lower WIC expenses. There is also a lower environmental burden than with formula feeding.
What about formula? Isn’t it just as good as breastmilk? Before commercial formula was available, artificial feeding was extremely dangerous for a newborn. This is no longer the case. In 1980 the US infant formula act was passed. This act mandates the FDA to regulate formula production. However, despite these regulations there have been numerous formula recalls. Since 1982, formulas have been recalled for contamination with bacteria including salmonella, klebsiella and pseudomonas. There have been recalls for formulas with bits of glass and metal particles and there have been recalls of formulas found to be deficient in vitamin C, deficient in iron and excessive in magnesium. Thankfully, these recalls are rare and we are fortunate in our society to have a relatively safe alternative for women who cannot or simply do not want to breastfeed. The decision of how to feed your baby is a personal one. Many life factors will contribute to the decision. Most notable is the mother’s career. When weighing the pros and cons, keep in mind that while generally safe and nourishing, formula is not comparable to breastmilk. Breastmilk contains antibodies, leukocytes, hormones, cytokines and other bioactive factors. There are hundreds of substances in breastmilk that have yet to be identified. Formula companies routinely add things to their formulas to make them more like breastmilk. However, just by adding something to formula doesn’t mean it will be absorbed and properly used by your baby. For example, the probiotic effects of human milk help ensure that the intestinal tract will not be permeable to enteric pathogens. Unfortunately, simply adding probiotics to formula does not yield the same result. Breastmilk components change from day to day, from feed to feed, from beginning of a feed to the end of a feed and breastmilk offers immense immune protections.
So what are the problems with breastmilk? Recently there has been a lot of talk about the need to supplement breastfed babies with vitamin D to prevent rickets. If breastfeeding is so perfect, then why would it need to be supplemented? Well, the problem here is an environmental one. Vitamin D has never been a large component of breastmilk. Babies produce vitamin D from direct sunlight on the skin. With the very real risk of skin cancer today, babies are being kept completely out of the sun or covered with sunblock inhibiting any vitamin D production. As a result, we need to supply babies with another source of vitamin D.
Some women are being scared away from breastfeeding for fear that their milk is contaminated with mercury and other pollutants from the environment. Despite levels of PCBs, pesticides and mercury in human milk, the CDC states that breastfeeding is still best. A developing fetus in utero is more at risk from any toxins than a breastfeeding baby. Women of childbearing age should take measures to limit their exposure to these toxins but continue to breastfeed. Certainly, steps should be taken to remove these toxins from our environment but babies should continue to receive the benefits of breastmilk despite their presence.
There is a perception that nursing a baby is difficult; many women start to breastfeed but relatively few continue for any significant length of time. Breastfeeding doesn’t have to be difficult. Actually it is instinct for a baby to latch on and nurse. Once established, breastfeeding is much easier than bottle feeding. However, we live in a time where bottle feeding is the norm. Most women having babies today were not breastfed themselves. They have little support from friends, family, colleagues, even doctors. Those we turn to for help are often ill prepared to give appropriate advice. So, when something goes wrong most women are encouraged to give up. The path to success is to educate yourself in what to expect and to know where to turn for help when you have questions.
Make sure to surround yourself with supportive friends and family. Choose a pediatrician who is supportive of breastfeeding. Read what you can about breastfeeding before giving birth. Take a class. Reach out to the Allied Breastfeeding Center for help 1-866-621-2769 or email: firstname.lastname@example.org
So the question is: Is breast really best? Is it worth the effort? The simple answer is yes and yes.