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Chapter 3: Breastfeeding

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Chapter 3: Breastfeeding CHAPTER 3: BREASTFEEDING Breast milk is the optimal food for infants. A composition changes over time to meet the mother’s breast milk has the perfect combination infant’s changing nutritional needs. Breast of nutrients needed for her infant’s growth milk is designed to perfectly meet the needs of and development. The American Academy the human infant; of Pediatrics (AAP), American College of ▘ Is sanitary and at the right temperature all the Obstetricians and Gynecologists, American time; Academy of Family Physicians, American Dietetic ▘ Provides skin-to-skin contact that is Association, and World Health Organization important for making the infant feel secure are some of the major health organizations that and loved; recommend exclusive breastfeeding for the first ▘ Contains “bioactive factors” that protect 6 months of life.1, 2, 3, 4, 5 Breastfeeding rates are against infections.8 These factors include rising in the United States; in 2004, 70.3 percent secretory IgA, lactoferrin, lysozyme, cytokines, of new mothers reported initiating breastfeeding growth factors, enzymes, and nucleotides. their infants and 36.2 percent reported Antibodies from the mother help provide breastfeeding at 6 months.6 Healthy People 2010 immunity which is important because the established a goal for 75 percent of mothers to part of the infant’s immune system that initiate breastfeeding, 50 percent to breastfeed secretes antibodies does not mature for several at 6 months, and 25 percent to breastfeed at 12 months after birth; 7 months. ▘ Appears to reduce the risk of developing gastrointestinal diseases, respiratory diseases, Breastfeeding helps to establish a secure and and otitis media (ear infections);9,10 loving relationship between the mother and her ▘ May be associated with higher cognitive infant and offers many other positive benefits. development scores;11,12 For these reasons, breastfeeding should be actively ▘ May protect an infant against food allergies;13 promoted and supported as the most desirable ▘ May have a protective effect against obesity in method of infant feeding. children;14 and ▘ Is always available when the mother and This chapter provides information on the benefits infant are together. of breastfeeding; factors affecting the decision to initiate or continue breastfeeding; methods For the mother, breastfeeding: to support breastfeeding mothers; the basics of breastfeeding; practical breastfeeding techniques ▘ Allows for quicker recovery from childbirth and tips; planning for time away from the by helping the uterus to return to its pre- infant; common concerns; and use of cigarettes, pregnant size sooner; 15 alcohol, other drugs, and certain beverages while ▘ Suppresses ovulation for many women. breastfeeding. Counseling points related to the However, to assure that pregnancy is information presented in this chapter are found prevented in the postpartum period, alternate in Chapter 8, pages 159–164. forms of birth control should be used; ▘ May be protective against breast cancer and ovarian cancer;15 Benefits of Breastfeeding ▘ May have an effect on weight loss after For the infant, breast milk or breastfeeding: childbirth in some women; ▘ Is less expensive, more convenient, and ▘ Provides the right balance of nutrients to requires no time for preparation (e.g., no support the infant’s growth and development. sterilization and preparation of bottles is These nutrients are provided in a form that required); and is easy to digest and absorb. Breast milk 50 INFANT NUTRITION AND FEEDING I N F A N T N U T R I T I O N A N D F E E D I N G 51 ▘ Stimulates the release of the hormone Lack of social support has a major prolactin that brings a sense of relaxation and influence on the decision to breastfeed well-being to the mother. and on the duration of breastfeeding. Family and friends are often not aware of The AAP recommends that breastfeeding be the importance of breastfeeding and how continued for the first year and as long as it is to be involved in the care and nurturing mutually desired by both the mother and child.1 of a breastfed infant. Mothers should be Breastfeeding provides significant benefits even if encouraged to talk with their family and a mother breastfeeds for a limited time. Women friends about breastfeeding and to invite should be encouraged to breastfeed even for a them to attend prenatal classes to learn short period; however, exclusive and extended more about breastfeeding. breastfeeding confers the greatest benefits. Time and competing demands are a Factors Affecting the Decision To Initiate reality of life and new mothers can benefit from information on how breastfeeding or Continue Breastfeeding can be successfully combined with other Several factors have been identified as having commitments in their busy lives. a significant impact on a mother’s decision to initiate or continue breastfeeding. These include the attitudes of healthcare providers; the mother’s Methods To Support Breastfeeding support network that may include fathers/ partners, family members, and/or friends; hospital Mothers in Your Program practices such as providing infant formula to Breastfeeding mothers benefit from education, newborns; a mother’s personal experience; and support, and encouragement. Appropriate, workplace environment. accurate instruction and support can help women breastfeed successfully. Some methods to support Mothers typically know that breastfeeding is the breastfeeding mothers in your clinic or program best way to feed their infants. However, mothers site include the following: may not know about the personal health benefits associated with breastfeeding. Some mothers ▘ Make a place or room available for mothers to are challenged with combining breastfeeding breastfeed their infants when visiting a clinic and other competing demands and may focus or program site. on the barriers to breastfeeding rather than the ▘ Offer all breastfeeding mothers a list of benefits. Exploring both the benefits and barriers professional and peer resources (e.g., WIC is an effective way to counsel a new mother. clinic breastfeeding coordinator, WIC peer Research has shown that the common barriers to counselors, public health nurses, breastfeeding breastfeeding are embarrassment, lack of social mothers group, etc.) to contact for ongoing support, lack of time, and competing demands on encouragement, information, breast pumps, the mother.16 and assistance. ▘ Display culturally appropriate posters and Embarrassment is the primary barrier materials on breastfeeding in the clinic or for women of all backgrounds and in all program site (do not display infant formula regions of the country. Strategies to address and materials with infant formula brand embarrassment include teaching mothers names and logos). how to breastfeed discretely, providing the ▘ Demonstrate positive attitudes towards opportunity to discuss mothers’ concerns, breastfeeding and deliver positive and and reassuring mothers they are doing supportive messages about breastfeeding. something good for their infant. 52 INFANT NUTRITION AND FEEDING I N F A N T N U T R I T I O N A N D F E E D I N G 53 ▘ Provide education about the benefits of improving breastfeeding promotion and support breastfeeding to individuals and groups. in any local or State WIC agency. Use printed materials and audiovisuals on breastfeeding that portray breastfeeding as The Basics of Breastfeeding the preferred infant feeding choice and are appropriate to participants’ cultural and ethnic background, language, and reading Making a Good Milk Supply level. For most new breastfeeding mothers, making ▘ Encourage the mother’s family and friends enough milk is their most important concern. to participate in breastfeeding education and Concern over milk supply is a key reason women support sessions. wean their infants from the breast in the first ▘ Coordinate breastfeeding support with other 6 months of life. health care programs in your community. ▘ If your program is in a hospital clinic, Role of the Breasts encourage hospital practices that are supportive of breastfeeding. During pregnancy, the breasts undergo physiological and anatomical changes that enable ▘ Make available peer counselors and/ or staff who can provide regular and them to produce milk for an infant. The breast ongoing counseling and support services to has many parts, each with very specific functions breastfeeding women. that help the mother produce milk for her infant. Milk production occurs within the alveoli, Refer breastfeeding mothers who which are grape-like clusters of cells located deep request infant formula to a nutritionist, within the breast. Once the milk is produced, it peer counselor, or WIC breastfeeding is squeezed out through the alveoli into the milk expert for nutrition assessment and ducts, which resemble highways, to transport counseling. Determine why the mother the milk through the breast. See Figure 3: How is requesting infant formula and help the Breast Makes Milk on page 54. The milk her address barriers or concerns (e.g., is released through openings in the nipple that if a breastfeeding mother does not wish many mothers cannot see until lactation begins. to totally wean her infant off the breast, counseling can be provided on the The size of a woman’s breasts does not affect her approximate amount and form of infant ability to breastfeed; women with small breasts formula needed). produce the same quantity and quality of milk as those with larger breasts. However, a woman’s The National WIC Association
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