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Breastfeeding is the practice of a human mother feeding a baby (and sometimes a toddler or a young child) with milk produced from her mammary glands, usually directly from the nipples. Babies have a sucking instinct allowing them to extract the milk.
Throughout pregnancy a woman's body produces hormones which stimulate the growth of the milk duct system in the breasts: progesterone, estrogen, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, oxytocin, and human placental lactogen (HPL). By the fifth or sixth month of pregnancy, the breasts are sufficiently developed to produce milk. Near the time of birth, the breasts may begin to secrete a thick, yellowish fluid called colostrum (or "beestings"), which is the first milk the infant receives. It contains important antibodies from the mother's body providing immunological protection. Colostrum has no fat and little sugar - these substances appear three to four days after birth when the suckling action of the infant further stimulates the breast to produce mature breast milk. Thereafter the breast produces milk on a basis of supply and demand in response to how often a child feeds and how much milk he or she consumes. The production, secretion and ejection of milk is called lactation. Some breastfeeding advisers recommend at least one feeding every four hours to prevent premature termination of lactation.
The exact integrated properties of breast milk are unknown, but the nutrient content after this period is relatively consistent and draws its ingredients from the mother's food supply. If that supply is found lacking, content is obtained from the mother's bodily stores. The exact composition of breast milk varies from day to day, depending on food consumption and environment, meaning that the ratio of water to fat fluctuates. Foremilk, the milk released at the beginning of a feed, is watery, low in fat and high in carbohydrates relative to the creamier hindmilk which is released as the feed progresses. The breast can never be truly "emptied" since milk production is a continuous biologic process.
Breast milk consumption has been linked to a decreased risk for several infant conditions including Sudden Infant Death Syndrome (SIDS). The sucking technique required of the infant encourages the proper development of both the teeth and other speech organs.
Numerous health benefits of breastfeeding have been medically documented. According to the American Academy of Pediatrics' policy statement on breastfeeding and the use of human milk, "Extensive research, especially in recent years, documents diverse and compelling advantages to infants, mothers, families, and society from breastfeeding and the use of human milk for infant feeding. These include health, nutritional, immunologic, developmental, psychological, social, economic, and environmental benefits."
Breastfeeding has also been shown to be beneficial to the mother. The act of breastfeeding releases hormones which have been found to both relax the mother and cause her to experience nurturing feelings toward her infant. Breastfeeding as soon as possible after giving birth increases levels of oxytocin which encourages a more rapid contraction of the uterus and in turn decreases postpartum bleeding. Breastfeeding can also allow the mother to return to her pre-pregnant weight as the fat stores accumulated during pregnancy are utilized in milk production. Frequent and exclusive breastfeeding delays the return of menstruation and fertility (this is known as lactational amenorrhea) allowing for improved iron stores and the possibility of natural child spacing. Breastfeeding mothers experience improved bone re-mineralization postpartum, and a reduced risk for both ovarian and pre-menopausal breast cancer. In some cases, women who breastfeed have been known to have an orgasm while feeding.
The American Academy of Pediatrics (AAP) provides the following recommendation, "Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months after birth. [...] It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired."
The World Health Organization (WHO) states that "a recent review of evidence has shown that, on a population basis, exclusive breastfeeding for 6 months is the optimal way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond."
There are certain women who, for one reason or another, may be unable to breastfeed. These reasons include damage to the mammary glands through previous surgery, breast infection or breast abscess, cancer (especially of the breast), previous diseases such as HIV, AIDS or active, untreated tuberculosis
Breastfeeding mothers must use caution if they regularly consume nicotine through tobacco smoking. In addition to reducing the milk supply, heavy use of cigarettes (more than 20 per day) has been shown to cause vomiting, diarrhea, rapid heart rate, and restlessness in infants. In general, though, nicotine in breast milk is not easily absorbed into the infant's intestinal tract and is quickly metabolized. Research is ongoing to determine whether the benefits of breastfeeding out-weigh the potential harm of nicotine in breast milk. The effects of a smoky environment are thought to have links to Sudden Infant Death Syndrome (SIDS).
Heavy alcohol consumption is known to be harmful to the infant, but there is no consensus on how much alcohol may be safely consumed. It is generally agreed that small amounts of alcohol may be occasionally consumed by a breastfeeding mother. Levels of alcohol in breast milk peak 30 to 90 minutes after one drink of moderate alcoholic content. Considering the known dangers of alcohol exposure to the developing fetus, many medical professionals believe it is prefereable to err on the side of caution with alcohol exposure to a baby and have breastfeeding women restrict their alcoholic intake.
Excessive caffeine consumption by the mother can cause irritability, sleeplessness, nervousness and increased feeding in the breastfed infant. Moderate use (one to two cups per day) usually produces no effect. Breastfeeding mothers are advised to avoid or restrict caffeine intake.
The recreational use of marijuana in conjunction with breastfeeding is a controversial issue. The AAP Committee on Drugs lists marijuana in their table of Drugs of Abuse for Which Adverse Effects on the Infant During Breastfeeding Have Been Reported yet they reference only one study in the literature and this study reports no effect. There is a lack of research on the effects of marijuana on the breastfed infant.
Some breastfeeding advisers suggest mothers avoid certain gas producing food, such as beans, if the baby starts to develop colic or gas.
In the few cases where it is not possible for a mother to breastfeed, or if she chooses not to do so, breast milk may be expressed and fed to an infant by bottle, milk may be offered from another breastfeeding woman, or infant formula can be offered. While proven inferior to breast-feeding, infant formula has in recent times been marketed in all countries as being a superior feeding-solution.
See also: wet nurse
There are many texts available to new mothers to assist in the establishment of breastfeeding. The baby will usually indicate hunger by crying or moaning and fussing. When the baby's cheek is stroked, the baby will move his or her face towards the stroking and open his or her mouth, demonstrating the rooting instinct. Breastfeeding can make the mother thirsty and can last for up to an hour – it is therefore common for the mother to require a drink during the process. As a habit of bending over the baby can contribute to back pain, it is a good idea to cradle the baby on a cushion or pillow for extra height.
Inverted or flat nipples can be massaged to give extra area for the baby to latch onto. By tickling the baby's cheek with the nipple the baby will open its mouth and turns toward the nipple, which should then be pushed in so that the baby has a mouthful of nipple and areola – the nipple should be at the back of the baby's throat.
The baby may pull away from the nipple after a few minutes and is ready to start eating from the other side (possiby after being held upright and tapped lightly on the back to induce a burp). By slipping your little finger into the corner of the baby's mouth it is possible to break suction, pull the baby away and place him or her on the other side. Babies need at least 10 minutes a side to allow the hindmilk to appear but if they are still sucking after 30 minutes then they should be moved over to the other side, as they are not receiving much milk at this time.
Breastfeeding may hurt some women, sometimes related to an incorrect technique, but usually eases over time. Milk ducts can block up on occasion. This should be addressed with massage and by encouraging the baby to suck from that side to keep it as empty as possible until the problem goes away. This will hurt much more than usual.
Fair skinned mothers are most likely to experience cracked nipples, but it can happen to anyone. The baby's rough tongue can also cause grazes and the suction can cause bruising. If breastfeeding is endured for the initial six weeks then this should become easier. Mothers determined to breastfeed their babies can buy or hire electric breast pump equipment.
Weaning is the process of gradually introducing the infant to what will be its adult diet and withdrawing the supply of milk. The infant is considered to be fully weaned once it no longer receives any breast milk (or bottled substitute). This often leads to lactose intolerant.
When in public with a breastfed baby it is often difficult to avoid the need to feed the infant. The public reaction at the sight of breastfeeding can make the situation uncomfortable for those involved. There are numerous laws around the world that have made public breastfeeding legal and companies are not allowed to deny that right.
In the US the "Right to Breastfeed Act" (HR 1848) was signed into law on September 29, 1999 affirming the right of a woman to breastfeed her child anywhere on federal property. However, not all state laws have affirmed the same right in their respective public places. Nowhere is breastfeeding in public illegal.
Many mothers choose to purchase pumping equipment or express milk ("milk" themselves) by hand so that they can carry a small bottle of milk with them if they plan to be out at mealtimes. This allows them the advantages of breastfeeding while avoiding possibly uncomfortable situations. Unfortunately, breastfed babies can have trouble transitioning to a bottle, so this may not work for everyone.
Feeding two infants simultaneously is called tandem breastfeeding. The most common need for this is after the birth of twins whereby both babies are fed at the same time. It is not necessarily the case, however, that the appetite and feeding habits of both babies are the same. This leads to the complication of trying to feed each baby according to their individual requirements while also trying to breastfeed them both at the same time.
Tandem breastfeeding is also convenient if a woman gives birth to a newborn while still feeding an older baby or child. Under these circumstances it is possible for the newborn baby to miss out on the beneficial colostrum.
Although some may find it controversial, some women breastfeed their offspring for as many as three to seven years from birth. This is referred to as extended breastfeeding.
Although not widely known in developed countries, women who have never been pregnant are able to lactate and therefore breastfeed as well. If their nipples are stimulated in a breastfeeding manner for a while (such as a breast pump or an actual baby suckling), eventually the breasts will begin to produce milk which can be used to feed a baby. For this reason, adoptive mothers, usually initially in conjuction with some form of supplementation, are able to breastfeed their infants. (There is also anecdotal evidence for male lactation in some males.)
Some reports have suggested that the act of circumcision may have a negative effect on the feeding habits of the baby . The topic of circumcision itself is hotly debated, however, and findings of its impact can often be viewed with bias.
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