“Should my baby be breastfed or bottle-fed?” is a dilemma facing most mothers. Human milk is both natural and complete, containing the right proportions of fat, carbohydrate, and protein for maximum growth.
You might think that correct breastfeeding would be instinctive, but effective feeding needs to be learned. The positioning of the baby and mother is a critical factor. Given sufficient help, nearly all mothers can breastfeed successfully. It is best started within half an hour of the birth.
One significant advantage to the baby is that the baby has more control over the rate and frequency of feeding and may vary milk intake from feed to feed. Babies alter their milk intake to take account of fluctuations in its fat content so that they maintain a constant intake of energy each day.
At two months the biggest feed is in the morning but by 4 to 6 months it is at the end of the day. A survey of about 16,000 babies in Sydney showed that about 85 percent were breastfed when they left the hospital, but only 50 percent after three months. A smaller survey at Leongatha in Victoria, indicated that 36 percent were still breastfeeding at 12 months.
Of the women who had breastfed for 6 months, most felt satisfied that they had fed for long enough. Worry about the amount and quality of the milk their baby is receiving is the major reason mothers stop breastfeeding.
Allergy to breast milk is rare, and it contains a number of ingredients that help prevent the growth of bacteria. A study reported suggested that breastfeeding resulted in higher intelligence and greater visual acuity, possibly because of the presence of a mixture of long-chain fatty acids which has not yet been duplicated in commercial formulas.
Breastfeeding also produces a lower risk of insulin-dependent diabetes, coeliac disease, sudden infant death and childhood lymphoma. Constipation and gastrointestinal and respiratory illnesses are also lost in breastfed babies.
Breastfeeding also gives advantages to the mother, since it lowers the risk of premenopausal breast cancer and of ovarian cancer. It also helps reduce fat reserves in the mother and restore the uterus to normal.
Prolactin, a hormone produced by the pituitary gland in the brain, plays a critical role in the production of milk. It stimulates the glands in the milk sacs (alveoli) to produce milk. Milk is stored in milk ducts. Prolactin is normally inhibited by other hormones produced in the hypothalamus in the brain.
During pregnancy little milk is produced. Three to four days after birth the level of inhibitors falls, enabling more milk to be produced.
Stimulation of the nipple by the baby’s sucking is the main factor controlling the release of prolactin. The more the baby feeds, the more prolactin is released, and the greater the milk flow. Prolactin levels often fall at night so that the production of milk falls too. So the baby will feed more often at night to get the milk it wants.
The near-surface milk is called foremilk and is low in fat. The muscle around the milk ducts can contract, forcing the milk into the milk cavities near the nipple. Milk from the deeper cavities of the breast is called hindmilk.
Release of this from the deeper areas is usually felt by the mother as a tingling sensation and is called milk “let down”. It is often indicated by a change in the baby’s sucking rhythm and occurs 23 minutes after the initial flow of milk.
The hormone oxytocin, which also influences labor contractions, is also generated by sucking and feeding. Oxytocin controls milk letdown. Production of oxytocin can be stopped by pain, anxiety, stress, or smoking so adequate rest and relaxation is essential for a supply of good milk. Smoking possibly decreases both prolactin and oxytocin.
Most babies breastfeed at intervals of two to four hours, 24 hours a day, for about eight weeks, but there is a lot of variation. Some will feed five times a day, others up to 12 times. Normally babies will not sleep through the night before eight weeks.
A baby needs up to 150ml of milk a day for every kilogram of body weight, so a 4kg baby would need over half a liter a day. Although after the first or second week most mothers are comfortable with feeding, the supply of milk is not fully established until four to six weeks.
It is important that the mother learns the correct positioning of the baby and of herself. The baby needs to suck both the nipple and the areola (the pigmented area around the nipple) so that the underlying milk cavities become fully emptied and the surrounding ducts are stimulated.
It is probably best to completely, empty one breast before changing to the other. This helps ensure that the nutrient and fat-rich hindmilk is taken. Also the nipple will become sore if it alone is sucked.
If there is a problem with the milk supply, the drug maxolon can be used for a short time to increase the supply.
A feeding mother needs to ensure that she is getting sufficient nutrients and calories. Should the mother be a vegan (eating no animal products) it is essential to give the baby a Vitamin B12 supplement.
Sometimes additional bottle feeds are given because of a worry about milk supply. This is usually counterproductive because it will reduce the amount of milk-sucking stimulus and so will in fact reduce the supply.
Quite commonly a baby may effortlessly regurgitate what seems to be alarming amounts of milk. This will not hamper growth and usually stops by about 9 months. If it is a concern, a small quantity of instant thickener cornstarch, such as Karicare, given before and during feeding, will usually stop it.
Babies that do have feeding difficulties, or are not thriving, should be carefully examined.
One problem that needs prompt attention is mastitis in the mother. It is most likely during the first month of feeding. It usually starts as a hot, tender swollen area of the breast produced by a milk sac becoming too full and bursting. The milk overflow into breast tissue causes inflammation, sometimes called “non-infective” mastitis.
The overflow often results from the faulty positioning of the baby on the breast, causing poor drainage of some areas. It is important that the baby continues to feed to drain the area. Pressure on the breast blocking a milk duct, from baby or bra, can also cause milk build-up.
Should the breast remain engorged with milk it provides a medium for the growth of bacteria such as Staphylococcus aureus (golden staph). If these infect the mother she will feel unwell with flu-like fever and aches (mastitis proper). In most cases these bacteria are resistant to penicillin. Treatment involves taking a broad-spectrum antibiotic such as flucloxacillin for 10 days.
It is important that breastfeeding is continued during this time. The inflammation can be reduced by taking aspirin.
A breastfeeding mother runs little risk of giving her baby an infection. Most dangers occur to the fetus during pregnancy. However, mothers who are HIV-positive should bottle-feed to minimize the risk of transmitting the virus.
Advantages of breastfeeding
Breastfeeding has many advantages:
- milk already fully prepared;
- allergic reactions rare;
- may produce higher intelligence;
- may produce higher visual acuity;
- lowers the risk of insulin-dependent diabetes;
- lowers the risk of coeliac disease;
- lowers the risk of sudden infant death;
- lowers the risk of childhood lymphoma;
- lowers the risk of constipation;
- lowers the risk of gastrointestinal illness;
- lowers the risk of respiratory illness.
Advantages for the mother:
- prepared and available;
- lowers the risk of premenopausal breast cancer and ovarian cancer.