Ina May's Guide to Breastfeeding
INTRODUCTION: BREAST IS BEST
Pregnancy can be a time of great wonder and excitement as you prepare for the birth of your baby. One of the great blessings of pregnancy is that your body and nature take complete care of the nourishment of your little one during his time inside your body (as long as you eat well). Who could design a machine that could reproduce and nourish its offspring so beautifully as this? You don’t even have to think about how to do it!
One decision that does merit a conscious choice on your part is the first food that will nurture your baby once he is born. Will it continue to come from you or will you buy it from the shelves of a grocery store? Does it matter? You probably wouldn’t have picked up this book if you didn’t already have some idea of the benefits of breastfeeding and the possible undesirable consequences of feeding artificial milks to babies as a first choice. Even so, you may be surprised to find out how much your decision matters.
Assuming that pediatricians are the accepted medical experts on the needs and health of babies and young children, let’s start with what their professional organization has to say on the subject of infant feeding. The American Academy of Pediatrics issued its first policy statement in support of breastfeeding in 1977, and in 1997 it followed up with a much stronger statement. In 2005 the AAP found it necessary to replace its 1997 policy statement with a newer version, because so many important recent studies corroborated what common sense had always recognized—that breast is best.1
Excerpts from the American Academy of Pediatrics’
Policy Statement on Breastfeeding
and the Use of Human Milk
· Human milk is the preferred feeding for all infants, including premature and sick newborns, with rare exceptions.
· When direct breastfeeding is not possible, expressed human milk, fortified when necessary for the premature infant, should be provided.
· Breastfeeding should begin as soon as possible after birth, usually within the first hour. Except under special circumstances, the newborn infant should remain with the mother throughout the recovery period. Procedures that may interfere with breastfeeding or traumatize the infant should be avoided or minimized.
· Newborns should be nursed whenever they show signs of hunger, such as increased alertness or activity, mouthing, or rooting. Crying is a late indicator of hunger.
· Appropriate initiation of breastfeeding is facilitated by continuous rooming-in.
· No supplements (water, glucose water, formula, and so forth) should be given to breastfeeding newborns unless a medical indication exists.
· Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first six months after birth.
Now let’s turn to another health authority, the World Health Organization (WHO). The WHO ranks the safety of milks in the following way: first, the baby’s mother’s milk taken directly by the baby from the mother’s breast; second, the baby’s mother’s milk taken from a bottle; third, the milk of another mother; and last, bottle-feeding of artificial milk formulas. Please note that the WHO does not say that artificial milk formulas shouldn’t be consumed but that it is better for the baby if they are used only as a last resort.
Here is a very practical reason to begin nursing your baby. When you choose to feed your baby this way, you are preserving your ability to have a choice about your feeding method. You can always stop breastfeeding and switch to artificial feeding later. What is there to lose? On the other hand, if you begin with artificial feeding and then find that your baby is allergic to several different products (which happens sometimes), it can be quite difficult to switch back to breastfeeding.
Artificial Milks Don’t Measure Up to Human Milk for Babies
It should not come as any surprise that the most desirable milk for a human baby is human milk. It is the most complete and perfect food for babies, just as camel milk is best for baby camels and cow’s milk is best for calves. Breast milk even tastes better to young humans than other milks do. I’ve met many adults who were breastfed until the age of four or five who can recall the taste of their mother’s milk, and each remembers it as incredibly delicious. Do you know anyone who buys infant formula because it is so delicious or who even has fond memories of it? I don’t.
The composition of breast milk varies from mother to mother, and the composition of a given mother’s milk varies according to her baby’s needs. This means that if your baby is born prematurely, your milk will automatically adjust itself to contain the most advantageous mix of nutrients for him at his particular stage of development. No matter how many claims a manufacturer of a substitute milk formula makes about its similarities to breast milk, any substitute milk, no matter what brand, is quite different from human milk and is an inferior food source for human babies. As the AAP says, the superiority of human milk for human babies stands whether we are talking about the baby’s growth, its development, or all other short-and long-term outcomes.
Immunologically speaking, mother’s milk is medicine as well as food. It contains living cells, many of which will coat the mucous membranes of your baby’s entire digestive system, protecting him against all kinds of bacteria and viruses. Artificial milk products do not contain any living cells, because anything that once lived in any formula concoction was long since killed during the production process. The protection offered by breast milk is important because, during birth, your baby leaves the sterile environment of your womb and sticks his head out into the highly contaminated environment outside. His system is not fully prepared for this shock, and he can use all the protection he can get.
Exclusive breastfeeding (meaning that a baby consumes nothing but his mother’s milk) until the age of six months will continue to protect your growing baby’s digestive tract, reducing the risk of allergy-causing foreign proteins entering his system. Such protection is especially important in families with a history of allergies, whether these allergies manifest as asthma, a specific food allergy, dermatitis, or allergy rhinitis (runny nose). Some babies started on artificial milk have to be switched from brand to brand several times during the early weeks of life because of their inability to tolerate these products. After the age of six months, babies begin to produce enough of their own antibodies to protect their intestinal walls against food antigens that may cause allergies.
Another strong reason for the ideal of exclusive breastfeeding for six months is that babies’ digestive systems are just not sufficiently developed before that time to digest solid foods well. Incomplete digestion can cause intestinal pain, diarrhea, gas, inconsolable crying, and, in severe cases, damage to the baby’s intestinal tract.
Babies who get artificial formulas instead of mother’s milk miss out on these benefits and are more open to infection. Strong evidence shows that in all populations, in both wealthy and poor countries, these babies will have a higher incidence and severity of many serious diseases, including bacterial meningitis, bacterial infection of the blood, diarrhea, respiratory-tract infection, serious gastrointestinal infection, middle-ear infection, urinary-tract infection, and late-onset infection in premature babies.2–13 And, according to one study, preemies who are fed artificial milk formulas have a higher incidence of the kind of blindness (retinopathy of prematurity) that has long been associated with premature birth.14–15 Published research has shown that more than 1,000 childhood deaths per year in the United States could be prevented through breastfeeding and that for every 1,000 bottle-fed babies in the United States, seventy-seven hospital admissions are likely to result. Compare this with the five hospital admissions that can be expected for every 1,000 breastfed babies.16
And there’s more. Several studies have suggested increased rates of sudden infant death syndrome in the first year of life, as well as a higher incidence of diabetes mellitus; childhood cancers such as leukemia, Hodgkin’s disease, and lymphoma; overweight and obesity; asthma and high cholesterol levels in older children and adults who were fed artificial milks compared with those who got their mothers’ milk.17–22
Breastfed babies are not only healthier; there is some evidence demonstrating that they tend to be more intelligent. Several studies on the development of intelligence in babies have shown that the feeding of artificial milks was associated with lower performance.23–25 A study involving about three hundred premature babies who were too small to suckle compared those given breast milk with those who received formula through a tube. When the two groups were IQ-tested at the age of eight years and the mothers’ social and educational status were taken into account, the breastfed children scored significantly higher on the IQ tests than their formula-fed counterparts did.
Does this mean that a baby who is bottle-fed on formula will not be as intelligent as his breastfed sibling? I certainly wouldn’t go that far, especially if the formula-fed baby receives high-quality loving attention while being fed. It’s possible that the bottle-fed babies in some of these studies received less of their mothers’ touch while feeding, since bottles can be propped on pillows, leaving the mother free to do something else while her baby feeds. Babies need more than milk to thrive—they need love expressed through touch. Skin is our most sensitive organ, and touch is the first language we speak. There is a lot of evidence from studies of other mammals about how important licking and touch are to the good health and even survival of their newly born young, and there’s plenty more showing that human babies who are cuddled and given plenty of touch when young grow up to be more comfortable “in their own skins” than those who grow up deprived of touch. My opinion is that babies fed on artificial milks, particularly preemies and babies under the age of three to four months, need to be held as close to the breast as breastfed babies are, so they get the cuddling and loving touch they need and deserve. This is true as well if Dad is the one holding the bottle.
Breastfeeding is also the best analgesic for babies. Mothers who breastfeed their babies during painful procedures—for example, the heel poke to draw blood (sometimes called the PKU screening), which is generally given to babies within the first ten days of life—often find that their babies cry little if at all.26–27 The analgesic effects also extend to times when a baby has his first cold or flu and, like the rest of us, feels miserable. Breastfeeding then becomes an especially valued comfort for both mother and baby.
Artificial Milks Are Frequently Recalled
The Food and Drug Administration (FDA) has been busy for decades issuing statements about “recalls” of artificial milk products that have been contaminated in various ways or that lack essential ingredients. See Appendix B for a list of FDA and firm recalls and warnings that took place in the United States during the first decade of the twenty-first century. Between 1982 and 1994, there were twenty-two significant recalls of various brands of artificial milks in the United States, with seven of these involving contamination or ingredients that were potentially life-threatening to babies. If you do need to use formula feeding at some point, be a smart shopper.
It’s important to remember that when certain lots of formula are listed as “recalled” on the FDA website, many packages and cans from that lot have already been bought and fed to babies. How many mothers go to the FDA website to make sure that they’re not feeding their babies a contaminated product? Not many, but if you feed your baby formula, this is the smart thing to do. Such recalls have been going on for decades, and it seems likely that they will continue, if past experience is any indication. Need I say it? Breast milk has never had to be recalled.
Health Advantages for Mothers Who Breastfeed
As many biologists have pointed out, Mother Nature is no fool. Her design for breastfeeding provides health benefits for mothers as well as babies. One of the most important benefits has to do with the role played by the natural hormone oxytocin. It is released from the mother’s pituitary gland during labor, rising to higher levels as the baby is being pushed out of the vagina and peaking with the expulsion of the placenta. When the baby stimulates the breasts by nuzzling and licking the nipple or by breastfeeding, even more oxytocin is released in the mother. It causes uterine contractions (sometimes called “afterpains”), which hasten the process of the uterus returning to its prepregnant size. When such contact between mother and baby is facilitated, the advantage for the mother is a much-reduced chance of late postpartum hemorrhage; oxytocin is nature’s way of preventing hemorrhage following birth.28Women whose babies are fed on artificial milks miss out on this antihemorrhagic benefit. They also miss out on the suppression of ovulation and menstruation that accompanies unrestricted breastfeeding. At six months postpartum, women who have not had a period, are not supplementing with artificial milk regularly, and are not going longer than four hours between daytime feedings or longer than six hours between night feedings have less than a two percent chance of becoming pregnant.29–31
Moms who breastfeed generally return to their prepregnancy weight more quickly than those who don’t.32 They get to eat an extra 500 to 600 calories a day and still lose weight (which is rather nice if you enjoy eating). And many studies show that if you are a working mother who decides to breastfeed, you are likely to miss fewer days of work, because your baby will be healthier.
Breastfeeding also has a positive long-term impact on women’s health. Women who don’t breastfeed have an increased risk of both breast cancer and ovarian cancer later on in life.33–38 One of the most fascinating studies in this area involves women from fishing villages near Hong Kong who had the unusual habit of breastfeeding only with the right breast. This custom enabled researchers to compare the fate of the women’s breasts. The researchers found a fourfold, highly significant increased risk of cancer in the unsuckled breast after menopause. We’re talking about the prevention of diseases that are often fatal and that are always terribly expensive in terms of human suffering and cost of health care. Moms who don’t breastfeed also have a higher incidence of osteoporosis and hip fractures when they are postmenopausal.39–41
Imagine that: The breastfeeding mother is multitasking every time she feeds her baby. As she nourishes her child, she loses weight at a safe rate, gains a pretty effective contraceptive treatment, and reduces her risk of two kinds of potentially deadly cancer and the brittle bones and subsequent fractures that can occur during the period after menopause.
The Impact of Artificial Feeding on Your Time and Budget
Are you living on a tight budget? If so, you can save a significant amount of money by nursing your baby—it costs nothing beyond the slight increase in your daily caloric needs. At most, it will set you back a few extra cents per day versus the cost of feeding substitute milks. We’re talking about $1,800 to $2,600 per year per baby, just to buy the formula. Mothers enrolled in the Women, Infants, and Children (WIC) assistance program who are not breastfeeding are often surprised to find out that their monthly allotment of formula does not suffice and that they must pay for the rest of what they need each month at the going rate. Those who are most strapped for funds may start diluting the formula to make it last or begin introducing solid food before their baby’s digestive system is prepared to deal with it.
Formula companies have been incredibly successful for more than half a century in convincing people, including most of the medical profession, that their product is almost as good as mother’s milk (while implying that breastfeeding is something that only a few lucky women can manage). Guess who pays for this propaganda? Answer: not only each family with a substitute-milk-fed baby but the entire society, because of health-care costs, the missed benefits of breast milk, and the pollution factor (more on this later). It’s not a stretch to say that the U.S. government has for decades subsidized a mammoth industry that directly competes with mother’s milk as a major national resource.
Breast milk is always available and never requires sterilization or heating—a huge advantage for you. Have you thought about how much time and energy this can save? I remember one father-to-be who wondered how much trouble it was going to be for his wife to sterilize her nipples before each feeding! If you have anyone with similar worries in your family, I suggest that you tell them about nature’s design—special oil glands create an antimicrobial environment around your nipples.
Better yet, breast milk is naturally organic. Almost all of the artificial milks for babies on the market are not organic, which means that they are likely to contain toxic chemicals, antibiotics, and bovine growth hormone if produced in the United States. It is possible to buy organic cows’ milk or soy formulas, but, as you might expect, these are more expensive and harder to find. And even an organic product may contain ingredients (corn syrup is an example) that you may not want your newborn to eat because of its negative effects on babies’ general health.
Artificial milks are incredibly wasteful when produced on a mass scale. The following information comes from the website of the World Alliance for Breastfeeding Action:
· Packaging of baby milks wastes resources such as tin, paper, and plastic. If every baby in the United States was bottle-fed, almost 86,000 tons of tin plate would be used each year in the required 550 million discarded tin cans. Another 1,230 tons of paper would be used if these tin cans had paper labels.
· Feeding bottles, teats (nipples), and related equipment require plastic, glass, rubber, and silicon. In 1987, 4.5-million feeding bottles were sold in Pakistan alone. The number per baby is even greater in industrialized countries (most babies in the United States have at least six bottles). Furthermore, Western hospitals and consumers are increasingly using “one-trip” disposable bottles and nipples.
· Waste materials from the production of baby milks are rarely recycled, so they increase our disposal problems. The two most common disposal methods, landfill and incineration, cause their own pollution.
· Baby milks are the end product of a number of industrial processes. The energy used to create the temperatures needed for these processes and the mechanical procedures used for production cause air pollution (acid rain and greenhouse gases) and also use natural resources in the form of fuel.
· The milk and packaging materials often travel considerable distances before processing, and, once ready for the market, baby milks have to be transported to the consumer. Many countries import baby milk from thousands of miles away, causing considerable unnecessary pollution. Ecuador, for example, imports baby milks from the United States, Ireland, Switzerland, and the Netherlands.
· Water, bottles, and nipples have to be sterilized before use. Water and the energy to boil it are normally easily available in the Northern Hemisphere, but this is no reason to waste them. The energy usually comes from polluting nuclear and conventional power stations. In the Southern Hemisphere, water and fuel are often precious resources. A three-month-old bottle-fed baby needs more than one quart (one liter) of water a day for mixing with formula, and each artificially fed baby needs at least an extra 1,500 pounds (73 kg) of firewood or its equivalent per year.
· Manufacturers use huge amounts of paper and other resources to promote their baby milks.
All that, and we still have to count the environmental costs of maintaining the cows to produce the milk. The tremendous amount of land and resources used by the dairy industry are a major contributor to the pollution of our environment.
Let’s compare this with the environmental impact of breastfeeding:
· Breast milk produces no waste: It is produced in the right amounts for the baby’s needs.
· Mothers need only the smallest amount of extra energy to produce milk, which is often taken from body fat (even malnourished mothers can produce enough quality breast milk to feed a baby).
· Breast milk needs no extra packaging.
· Breast milk is ready to use at the right temperature.
· Breast milk does not have to be shipped around the world. A mother has a ready supply wherever she goes.
· Most women do not menstruate when breastfeeding and therefore need fewer sanitary pads, tampons, or cloths. This reduces the need for fibers, bleaching, packaging, and disposal. If a baby is unrestrictedly breastfed for six months and breastfeeding continues into the second year, the average mother will not have a period until her baby is at least fourteen months old.
What other human activity would permit you to give your baby the best possible nurturing and health protection at the same time that you enhance your own long-term health, provide the most economical infant food possible, and protect the natural environment?
Times of Crisis
Many families these days take the trouble to pack an emergency kit in case of a tornado, flood, hurricane, earthquake, or other natural disaster. Breastfeeding mothers have an obvious advantage here, because the perfect food for their babies is with them at all times.
A couple of weeks after Hurricane Katrina devastated New Orleans and the Gulf Coast in 2005, another powerful hurricane, Rita, appeared to be heading for Houston, Texas. The mayor of the city ordered everyone to evacuate, and within hours, a million and a quarter Houstonians were in their cars, inching along a freeway that was not designed to accommodate anything like this volume of traffic. It wasn’t long before tens of thousands of radiators were boiling over. According to the news reports, many families, having failed to anticipate the major traffic jam, had neglected to bring enough water or other drinks along with them. I think I would have preferred to be a breastfeeding mother that day rather than one who depended on manufactured milks.
In late November 2006, a California family became stranded in their car in the Oregon mountains during an unusual series of heavy snow-and rainstorms. They waited for more than a week to be rescued. Finally, James Kim, the father, built a fire for his wife, their four-year-old, and their seven-month-old baby, and began hiking out to find help. Sadly, Mr. Kim died of hypothermia before he could reach help, but his family was rescued alive. His wife had managed to sustain the two children by breastfeeding them. “The fact that Kati Kim was able to breastfeed both of her children for the amount of time that they were stranded most likely was lifesaving for them…. Breast milk not only provides the calories needed to sustain life, it also helps prevent dehydration,” said Dr. Sheela Geraghty, assistant professor of pediatrics and medical director at the Center for Breastfeeding Medicine at Cincinnati Children’s Hospital Medical Center.
Given all of the health benefits for babies and mothers that come with exclusive breastfeeding, you might wonder whether any countries have enacted national policies to make breastfeeding easier for mothers. The answer is yes. Norway, for instance, is a highly developed, wealthy country that has managed to successfully reclaim breastfeeding as the norm for babies. In 1970, only twenty percent of Norwegian babies were breastfed, a similar proportion to U.S. babies at the same time. Today, almost all Norwegian babies get their mothers’ milk as their first food, and eighty percent of these babies are still being nursed by their mothers six months later. It is important to recognize that Norway accomplished this major change in its health policy without keeping mothers of young children confined to their homes or setting women with different viewpoints against one another. Much of that country’s success can be attributed to wise public policies created by a coalition of physicians, feminists, and legislators, who all agreed that the lost art of breastfeeding ought to be revived for the good of babies and their mothers. See Chapter 15 for more information on how Norway learned to make breastfeeding easier for its mothers.
Closer to home is a Tennessee village called “The Farm,” where I have lived and worked as a community midwife for several decades. Since the beginnings of my village, in 1971, virtually every woman there has breastfed her baby for at least the first several months. Of the first group of almost a thousand women, everyone nursed for at least a year, with only a handful of exceptions. At The Farm today, every woman expects to be able to breastfeed, because she knows literally hundreds of women who nursed their babies as long as they wished.
Were the women in my village a favored type of human to have had such success at breastfeeding when so many experience various difficulties in other parts of the United States? Actually, our breastfeeding mothers have always been an ordinary mix of young adults, as far as physical attributes go. What was unusual about us was that as a group, in the pioneering days of our community—when we were laying down the foundations and values of our lifestyle—we put ourselves into a situation that required every woman to breastfeed for the health and safety of her baby. During these early years, we had neither electricity nor running water, so it was virtually impossible to feed our babies with formulas. It turned out that the women in our group were able to reliably produce enough milk to fully nourish their babies—real-life evidence that breastfeeding works very well when conditions are right and small challenges are addressed before they become big problems. This allowed each new mother to begin nursing without the fear of failure.
My hope is that it is reassuring for you to know that a sizable group of women has had nearly one hundred percent success in breastfeeding in the modern world. This should let you know that there’s nothing wrong with nature’s design. Our experiences living as a community at The Farm provided us with some valuable insights about women’s and babies’ needs in the time after birth. What I consider most valuable about our circle of women’s experience in recovering the female capacity to breastfeed is that it demonstrates what might be needed to reestablish a culture of breastfeeding in areas of the world where such a culture no long exists. I will bring up this community experience in later discussions throughout the book, because of the lessons that can be drawn from it for people living in entirely different circumstances.
Millions of people have been and still are negatively affected by the huge loss in breastfeeding in the United States during the first half of the twentieth century. My aim in this book is to inform you as well as possible in order to insulate you against the negative influences and senseless taboos that have become part of North American culture over the last few decades. At the same time, I hope to provide you with practical information about how breastfeeding works, making it easier and more enjoyable for you and your baby.
A Note About Gender
In alternate chapters, I will switch between using feminine or masculine pronouns when referring to your baby.
A Note About Etiquette
Although I strongly advocate that new parents make every effort to nurse their babies, as a matter of compassion I also believe it’s important for those of us who breastfeed to refrain from being judgmental of those who do not. How would it make you feel for someone to make comments about a way of feeding that you have no way to reverse? It is possible to educate without issuing statements that make people feel criticized.