Tuesday, March 29, 2011

Let's Talk About Breastfeeding - Part I

Whew, now that the stories are told, we can get down to business. I think the major theme that ran through those first six posts was "breastfeeding." First, how badly I wish I had, and second, how obsessed with that goal I became, and third, how thrilled I am at how well it went for me the second time. So let's talk about breastfeeding. In Part I, we'll look at the clinical side. What's so great about breastmilk? What are the benefits of breastfeeding for mother and baby? What's "wrong" with formula? And so on. I'll keep it to summary length, as there's plenty of this information out there. In Part II, I intend to make it more personal. Why did I want so badly to breastfeed? What do I feel I got out of it? What do I feel my son got out of it?

I've adopted the philosophy of many breastfeeding-advocacy sites and groups who now like to say that "breastfeeding is normal and formula is an inferior substitute." I put this right up front because what we're most used to hearing is the catchy phrase "breast is best." This implies that any alternatives to breastfeeding are perfectly fine, but breastfeeding is "better." Along with this come the studies that say "babies who are breastfed have fewer ear infections," "babies who are breastfed have a lower mortality rate," and so on. Why not flip it around? "Babies who are not breastfed have an increased risk of ear infections," "babies who are not breastfed have a higher mortality rate." It changes the way you think.

I don't want to put myself out there as a "boob nazi" or "lactivist." Frankly, as I said in my first post, I don't have any real say in what choice you make. I just want you to make an informed choice. I'll admit it does make me a little sad when I see or hear that someone is feeding their baby formula, but I don't always know the whole story, and there are many reasons why you might need to feed formula, from adoption to fostering to a medical issue with mother or baby. I'm sure all of this will come up in future posts. Anyway, I'm hardly one to talk, considering.

Okay, disclaimers out of the way. Let's get to the meaty stuff. Or the milky stuff, as the case may be.

Formula versus Breastmilk
Let's start with the most common alternative to feeding breastmilk: Infant formula. What is it? Infant formula is a complex combination of various proteins, vitamins, minerals, fats, and sugars, and sometimes beneficial bacteria and/or amino acids such as DHA and RHA, derived from natural and artificial sources, usually using cow's milk or soy milk as a base. In the early days of formula, it was simply cow's milk mixed with some sugar and other additives, which you mixed yourself based on a "formula" (or recipe) created by scientists and doctors, but the formulas that are manufactured today are far more complex and, to be honest, much better than those olden-day home-made milks. They are heavily processed to break down and change the protein and fat content of the base milk, then fats, vitamins, minerals, and sugars are added so that the baby is receiving the right balance of all of these ingredients, vital for the development of the brain, eyes, muscles, bones, and everything else.

Babycenter (http://www.babycenter.com/0_choosing-formula-a-primer_1334669.bc?page=2#articlesection4) has a good overview of the main ingredients in a typical baby formula.

Sounds pretty good, right?

Infant formula is a valid, if inferior, alternative to feeding breastmilk if there is an indicated reason to do so. Many, many babies have been raised on exclusively formula and are perfectly healthy, intelligent, successful people. Formula will not kill your child, and you are not a terrible person for using it. I would never presume to say that.


Let's look at breastmilk for a minute, shall we?

I'm only going to cover the bare basics here, because human milk is a fabulously complex, ever-changing, and still mysterious compound containing hundreds of "ingredients," not all of which have been identified! We know that breastmilk contains all of the water, fats, proteins, sugars, vitamins, minerals, and other nutrients that a baby needs for at least the first six months of life, meaning that a baby requires nothing but breastmilk to be totally healthy and to thrive. These nutrients are present in exactly the right balance, and are primed for easy digestion by a baby's immature digestive tract. Also in breastmilk are antibodies provided by the mother's immune system that coat the baby's intestines and help prevent absorption of harmful bacteria and viruses that may cause infections, diarrhea, and other serious illness. Breastmilk also contains stem cells and amino acids. In addition, the nutrients in breastmilk are more bioavailable than the artificially-introduced nutrients in formula, meaning the baby can make better use of them and absorb them better, just as adults can better utilize the vitamins and minerals in natural foods than those in a multivitamin supplement.

The most amazing thing about breastmilk, I think, is that it changes in composition over time. In fact, the breastmilk a mother's body manufactures for a preemie is different from that for a full-term newborn, which is different from that a 10-month-old baby drinks. Different antibodies are present depending on what diseases the mother has been exposed to. Scientists are still discovering all of the compounds present in breastmilk and figuring out what they do. Far be it for me to try to write a treatise on it! A simple Google search will bring up plenty of pages of information about what's in breastmilk and what those things do.

Dr. Sears' website has an interesting chart comparing the ingredients of breastmilk and formula. (http://www.askdrsears.com/html/2/T021600.asp)

Other Benefits of Breastfeeding
There is more to breastfeeding than just the milk the baby receives. While the milk alone is incredibly important, as you may have gathered, there's a lot more to it. The act of breastfeeding, itself, has many positive effects on both baby and mother. Thus, even if a woman is truly unable to produce enough breastmilk to fully support her baby (we'll talk about this in a separate post down the line), continuing to feed from the breast as much as possible while supplementing with formula has additional benefits.

In the early days and weeks of a newborn baby's life, skin-to-skin contact with a parent helps the baby to regulate his body temperature, respiration, and heart rate. (This is also why placing the newborn on the mother's chest directly after birth is so beneficial.) Babies who are touching another human are calmer, less fussy, and show less stress reaction than babies who are separated from their parents or denied skin-to-skin contact. Breastfeeding automatically creates this contact between mother and baby, and the skin-to-skin contact also helps to stimulate milk production in the mother. Here is more about the benefits of skin-to-skin contact (http://www.naturalchild.org/guest/jack_newman2.html).

Then there's the whole "breastfed babies are healthier" thing. It's true. Scientists are still not entirely sure of all of the "whys" of this, but we can probably think of a few obvious reasons. Breastmilk contains all of those antibodies that can help the baby fight infection. Also, the bioavailability of the fats, proteins, and nutrients in breastmilk mean that the baby efficiently absorbs all of those building blocks of a healthy body that are necessary for the body to function normally.

Breastfed babies are less likely to develop ear infections, asthma,  diabetes, obesity, certain cancers, diarrhea, and other digestive issues. There may be many reasons for this, but the statistics are clear. In fact, the journal Pediatrics published an article in April of 2010 that stated that if 90% of American women breastfed their babies for the first six months of life, approximately 900 babies' lives per year would be saved, along with about $13 billion in healthcare costs (per year). (http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1616v1)

Breastfeeding also provides health benefits to the mother. Women who have breastfed show lower instances of breast and ovarian cancers as well as diabetes and other health concerns. There appears to be a cumulative effect, in that the more years a woman breastfeeds, the lower her risks of these cancers.

The hormones secreted during breastfeeding also have a beneficial effect on the mother. Oxytocin, the "bonding" or "love" hormone, is necessary for the "let-down" or milk-ejection reflex that causes milk to start flowing. Oxytocin also produces feelings of love and closeness between mother and baby. (Oxytocin is also produced during orgasm, incidentally, probably facilitating the feelings of love between a woman and her partner.) Prolactin, the hormone that regulates milk production, is also known as the "mothering" hormone and stimulates the mother to care for her baby.

It's Natural
I want to conclude with a simple thought. All mammals feed their young their own milk. Humans are mammals. Why should it be different for us? The milk produced by each mammal is uniquely suited to the needs of their young. Why should it be different for us? Indeed, if we consider how much we know about the detrimental effects of processed and artifical foods on the adult body, and how much more benefit we derive from eating foods closer to their natural state, then it makes sense that the same should hold true for babies. How could an artifically-created substance be better for a baby than that which was created (either through evolution or by G-d, depending on what you believe) in nature to uniquely suit the needs of that baby?

I don't claim that this is anywhere close to a comprehensive overview. I also don't claim to be any kind of authority on the matter. I've simply tried to compile a basic summary of the wealth of information out there about breastfeeding and breastmilk into a digestible form. There's more to know, and more to learn, and plenty more information where all of this came from.


  1. I really like your emphasis on the fact that scientists really don't know everything about the composition of breast milk yet, nor do they fully understand what pieces give which benefits, and that they are unable to suitably recreate it. This fact about whole foods in general is one of the things that really struck a chord with me when I read Michael Pollan's book, In Defense of Food. I think that at a certain time in our recent past, people thought formula was better because it was standardized, and it was created by "experts". It's sad that so much damage was caused because we have overrated the extent of our knowledge.

  2. Thank you, Gaidig! I had hoped that would come through to an extent.

    I was reading something recently about people in Appalachia who used to use molasses as their everyday sweetener. This meant that they had good iron levels and helped keep them healthy. But as they started to modernize and be "connected," they also started eating refined and processed foods, including using white sugar instead of molasses for sweetening. Suddenly, there was an epidemic of anemia in a place that had never seen problems with anemia before.

    The same sort of thing happened with infant formulas. It's "modern," it's "perfectly balanced," it's based on "science;" therefore, it must be healthier, right? Unfortunately not.

    It may be that one day someone will create an artificial human milk substitute that really is better than breastmilk. If so, I think that day is many many many years away.