Target Health Blog

Breastfeeding

March 11, 2019

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Quiz
Source:

When the baby sucks its mother's breast, a hormone called oxytocin compels the milk to flow from the alveoli (lobules), through the ducts (milk canals) into the sacs (milk pools) behind the areola and then into the baby's mouth.
Graphic credit: by NCI NIH -
http://www.womenshealth.gov/breast-cancer/what-is-breast-cancer/, Public Domain, https://commons.wikimedia.org/w/index.php?curid=38265499

Breastfeeding, also known as nursing, is the feeding of babies and young children with milk from a woman's breast. Health professionals recommend that breastfeeding begin within the first hour of a baby's life and continue as often and as much as the baby wants. During the first few weeks of 1) ___ babies may nurse roughly every two to three hours and the duration of a feeding is usually ten to fifteen minutes on each breast. Older children feed less often. Mothers may pump milk so that it can be used later when breastfeeding is not possible. Breastfeeding has a number of benefits to both mother and baby, which infant formula lacks.

Deaths of an estimated 820,000 children under the age of five could be prevented globally every year with increased breastfeeding. Breastfeeding decreases the risk of respiratory tract infections and diarrhea, both in developing and developed countries. Other benefits include lower risks of asthma, food allergies, type 1 diabetes, and leukemia. Breastfeeding may also improve cognitive development and decrease the risk of obesity in adulthood. Mothers may feel pressure to 2) ___, but in the developed world children generally grow up normally when bottle fed. Benefits for the mother include less blood loss following delivery, better uterus shrinkage, and decreased postpartum 3) ___. Breastfeeding delays the return of menstruation and fertility, a phenomenon known as lactational amenorrhea. Long term benefits for the mother include decreased risk of breast cancer, cardiovascular disease, and rheumatoid arthritis. Breastfeeding is less expensive than infant formula.

Health organizations, including the World Health Organization (WHO), recommend breastfeeding exclusively for six months. This means that no other foods or drinks other than possibly vitamin D are typically given. After the introduction of foods at six months of age, recommendations include continued breastfeeding until one to two 4) ___ of age or more. Globally about 38% of infants are only breastfed during their first six months of life. In the United States in 2015, 83% of women begin breastfeeding and 58% were still breastfeeding at 6 months, although only 25% exclusively. Medical conditions that do not allow breastfeeding are rare. Mothers who take certain recreational drugs and medications should not breastfeed. Smoking, limited amounts of alcohol, or coffee are not reasons to avoid breastfeeding.

Changes early in pregnancy prepare the breast for lactation. Before pregnancy the breast is largely composed of adipose or 5) ___, tissue but under the influence of the hormones estrogen, progesterone, prolactin, and other hormones, the breasts prepare for production of milk for the baby. There is an increase in 6) ___ flow to the breasts. Pigmentation of the nipples and areola also increases. Size increases as well, but breast size is not related to the amount of milk that the mother will be able to produce after the baby is born. By the second trimester of pregnancy colostrum, a thick yellowish fluid, begins to be produced in the alveoli and continues to be produced for the first few days until the milk “comes in“, around 30 to 40 hours after delivery. There is no evidence to support increased fluid intake for breastfeeding mothers to increase their milk production. Oxytocin contracts the smooth muscle of the uterus during birth and following delivery, called the postpartum period, while breastfeeding. Oxytocin also contracts the smooth muscle layer of band-like cells surrounding the alveoli to squeeze the newly produced milk into the duct system. Oxytocin is necessary for the milk ejection reflex, or let-down, in response to suckling, to occur.

Not all of breast milk's properties are understood, but its nutrient content is relatively consistent. Breast milk is made from nutrients in the mother's bloodstream and bodily stores. It has an optimal balance of fat, sugar, water, and protein that is needed for a baby's growth and development. Breastfeeding triggers biochemical reactions which allows for the enzymes, hormones, growth factors and immunologic substances to effectively defend against infectious diseases for the infant. The breast milk also has long-chain polyunsaturated fatty acids which help with normal retinal and neural development. The composition of breast milk changes depending on how long the baby nurses at each session, as well as on the child's age. The first type, produced during the first days after childbirth, is the colostrum, which is important to the baby because, colostrum is easy to digest although it is more concentrated than mature milk. It has a laxative effect that helps the infant to pass early stools, aiding in the excretion of excess bilirubin, which helps to prevent jaundice. It also helps to seal the infant's gastrointestinal tract from foreign substances, which may sensitize the baby to foods that the mother has eaten. Although the baby has received some antibodies through the placenta, colostrum contains a substance which is new to the newborn, secretory immunoglobulin A (IgA). IgA works to attack germs in the mucous membranes of the throat, lungs, and intestines, which are most likely to come under attack from germs.

Breasts begin producing mature milk around the third or fourth day after birth. Early in a nursing session, the breasts produce foremilk, a thinner milk containing many proteins and vitamins. If the baby keeps nursing, then hindmilk is produced. Hindmilk has a creamier color and texture because it contains more fat. Newborn babies typically express demand for feeding every one to three hours (8-12 times in 24 hours) for the first two to four weeks. A newborn has a very small stomach capacity. At one-day old it is 5-7 ml, about the size of a large marble; at day three it is 22-30 ml, about the size of a ping-pong ball; and at day seven it is 45-60 ml, or about the size of a golf ball. The amount of breast milk that is produced is timed to meet the infant's needs in that the first milk, colostrum, is concentrated but produced in only very small amounts, gradually increasing in volume to meet the expanding size of the infant's 7) ___ capacity.

According to La Leche League International, “Experienced breastfeeding mothers learn that the sucking patterns and needs of babies vary. While some infants' sucking needs are met primarily during feedings, other babies may need additional sucking at the breast soon after a feeding even though they are not really hungry. Babies may also nurse when they are lonely, frightened or in pain. Comforting and meeting sucking needs at the breast is nature's original design. Pacifiers (dummies, soothers) are a substitute for the mother when she cannot be available. Other reasons to pacify a baby primarily at the breast include superior oral-facial development, prolonged lactational amenorrhea, avoidance of nipple confusion, and stimulation of an adequate milk supply to ensure higher rates of breastfeeding success.“ During the newborn period, most breastfeeding sessions take from 20 to 45 minutes. After one breast is empty, the mother may offer the other breast. Some mothers may prefer to start a breastfeeding session on the breast which the infant was most recently feeding so as to vary the side on which the infant ends because the strength of the infant's suck usually decreases during the course of one feed.

Health organizations recommend exclusive breastfeeding for six months following birth. Exclusive breastfeeding is defined as “an infant's consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk and no foods) except for vitamins, minerals and medications.“ In some countries, including the United States, UK, and Canada, daily vitamin D supplementation is recommended for all breastfed infants. After solids are introduced at around six months of age, continued breastfeeding is recommended. The AAP recommends that babies be breastfed at least until 12 months, or longer if both the mother and child wish. WHO's guidelines recommend “continue[d] frequent, on-demand breastfeeding until two years of age or beyond.“ Approximately 60% of full-term infants develop jaundice within several days of birth. Jaundice, or yellowing of the skin and eyes, occurs when a normal substance, bilirubin, builds up in the newborn's bloodstream faster than the liver can break it down and excrete it through the baby's stool. By breastfeeding more frequently or for longer periods of time, the infant's body can usually rid itself of the 8) ___ excess. However, in some cases, the infant may need additional treatments to keep the condition from progressing into more severe problems. Support for breastfeeding is universal among major health and children's organizations. WHO states, “Breast milk is the ideal food for the healthy growth and development of infants; breastfeeding is also an integral part of the reproductive process with important implications for the health of mothers.“ Breastfeeding decreases the risk of a number of diseases in both 9) ___ and babies. The US Preventive Services Task Force recommends efforts to promote breastfeeding. A United Nations resolution promoting breast feeding was passed despite opposition from the Trump administration. Lucy Sullivan of 1,000 Days, an international group seeking to improve baby and infant nutrition, stated this was “public health versus private profit. What is at stake: breastfeeding saves women and children's lives. It is also bad for the multibillion-dollar global infant formula (and dairy) business.

Most US states now have laws that allow a mother to breastfeed her baby anywhere. In hospitals, rooming-in care permits the baby to stay with the mother and simplifies the process. Some commercial establishments provide breastfeeding rooms, although laws generally specify that mothers may breastfeed anywhere, without requiring a special area. Despite these laws, many women in the United States continue to be publicly shamed or asked to refrain from breastfeeding in public. In the United Kingdom, the Equality Act 2010 makes the prevention of a woman breastfeeding in any public place discrimination under the law. In Scotland, it is a criminal offense to try to prevent a woman feeding a child under 24 months in public. In 2014, newly elected Pope Francis drew worldwide commentary when he encouraged mothers to breastfeed babies in 10) ___. During a papal baptism, he said that mothers “should not stand on ceremony“ if their children were hungry. “If they are hungry, mothers, feed them, without thinking twice,“ he said, smiling. “Because they are the most important people here.“

ANSWERS: 1) life; 2) breastfeed; 3) depression; 4) years; 5) fat; 6) blood; 7) stomach; 8) bilirubin; 9) mothers; 10) church

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