The American Academy of Pediatrics New Mother's Guide to Breastfeeding

Choosing to Breastfeed

“Nursing my daughter was a decision I made even before she was conceived. I was not breastfed as a child but had seen with other parents the bond that breastfeeding brings to the mother–child relationship. I also understood the nutritional and immunologic benefits that mother’s milk provides the infant and wanted the very best for my child.”
--Stacy, 31, mother of Adam

With three weeks remaining until her baby’s due date, Vicki could hardly wait for the day to arrive. She and her husband had completed their natural-childbirth course and toured the hospital where their baby would be born. They had baby clothes ready and had even bought their first supply of diapers. Yet as Vicki focused on tying up loose ends at work prior to her maternity leave, she couldn’t help feeling nervous about some aspects of new motherhood. Will I be able to breastfeed? she wondered. My cousin tried, but she quit after a week. And what about when I start working again? she asked herself as she packed a box of papers to take home. The baby will have to use a bottle then. Should I start him on formula so he doesn’t have to switch later on?

Suddenly weary, Vicki sat down and rested a hand on her stomach. Feeling a slow, rolling movement beneath her hand, she looked down with a wan smile. “I want the best for you,” she said to her baby. “I just wish I had someone to teach me about this. What’s really important for your health, and how can I make sure you get it?”

Does Breastfeeding Make Sense for Me?

If you, too, are about to give birth, you may share Vicki’s concerns or have other urgent questions about how, when, and even whether you should breastfeed your child. The act of nursing--one of nature’s most rewarding and beneficial processes--can sometimes seem intimidating when you face a host of other commitments and hear a great deal of conflicting advice. In the following chapters, you will find clear answers to many of these questions, solutions to your problems, and information about the array of breastfeeding support services--hospital nurses, pediatricians, obstetricians, family physicians, lactation specialists, and breastfeeding support groups--that are in place to help mothers breastfeed their children successfully.

Such efforts have been made because an enormous amount of research demonstrates how beneficial breastfeeding is for babies. We now know that nursing your child not only strengthens the quality of your relationship with her but improves her health, enhances her brain development, and provides her with precisely the type of nourishment she needs at each critical stage of her development. The benefits of human breastmilk so greatly exceed that of any alternative method of infant feeding, in fact, that health organizations around the globe have united to promote this natural source of nutritional and emotional sustenance for babies. The World Health Organization (WHO), for example, encourages women to breastfeed exclusively for six months and to continue to breastfeed for at least two years to take advantage of human milk’s ability to provide the best nutrition and protect against infection. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding (no water, formula, other liquids, or solids) for about the first six months of life, followed by breastfeeding with the introduction of solid foods for the next six months, and continued breastfeeding thereafter as long as mutually desired by mother and baby.

As you prepare for motherhood, you will want answers to all of your questions about breastfeeding. You will want to consider how it is possible to combine breastfeeding with work outside the home, how you can fully involve your partner* in parenting a breastfed infant, and how to adjust if breastfeeding doesn’t begin smoothly. You will need to understand how breastfeeding works so you can feel assured that certain behaviors are normal or recognize any difficulties. Finally, you will want to find knowledgeable breastfeeding support services in your area.

As pediatricians, we want to share all we know to help you. With this guide, we will provide information, encouragement, and support as you learn this vital new skill. We will show you how many millions of women--working outside the home or not, married or not, first-time or experienced mothers--have provided the best for their babies through breastfeeding, and how you can too.

Did My Mother Breastfeed?

When you were an infant you may not have been breastfed, though your mother may have been and your grandmother was even more likely to have been breastfed. Breastfeeding, like many other techniques for nurturing children, has passed in and out of fashion according to parenting trends, society’s needs, and the accumulation of reliable research.

Of course, few alternatives were available to mothers a century ago. In the early 1900s, the majority of American women breastfed their infants, and over half of the babies were still being breastfed beyond the first year of life. Mothers who could not or chose not to breastfeed used a wet nurse, fed animal milk to their babies, or made do with crude mixtures of flour, rice, and water called “pap.” The newborns’ chances of survival decreased significantly as a result. During the decades that followed, however, glass bottles and rubber nipples became more widely available and pasteurization and vitamin supplementation more commonplace. As a result, alternatives to breastfeeding became more practical and prevalent, though almost nothing was known about how these artificial infant feedings affected children’s long-term health and development. During World War II, as more women worked outside the home, formula feeding increased even more and continued to increase through the 1950s and 1960s. By 1966, only eighteen percent of babies were being breastfed at the time they left the hospital, and this percentage dropped sharply soon after the babies arrived home. In the early 1970s in the United States, breastfeeding rates hit a record low.

At about this time, however, medical research began to reveal new truths about the advantages of mother’s milk for infant health and development. Scientists noted that babies who breastfed were more resistant to diseases in the environment. They caught fewer colds, suffered from fewer ear infections, and experienced fewer allergies. Even their mothers appeared to recover from childbirth more quickly and easily. Such findings, along with the mid-seventies movement toward a more natural childbirth and parenting experience, caused breastfeeding rates to begin climbing again. In 1982, nearly sixty-two percent of newborns were nourished by their mother’s milk after birth. By 2000, this number had increased to more than sixty-eight percent. Unfortunately, work conflicts and lack of support caused many mothers to give up nursing quite early, and this continues to be the case. Of the American newborns breastfed in 2000, only about thirty-one percent were still nursing by their sixth month, and less than eighteen percent by their first birthday. Yet studies keep revealing the fascinating ways in which the content of breastmilk changes to suit the baby at every stage of development, continuing to provide precisely the developmental, psychological, and health benefits a baby needs through the first year and beyond.

Today, mothers are not forced to choose between only two alternatives--breastfeeding their babies or giving them formula. They may opt to breastfeed their babies directly; provide them with bottles of breastmilk that they have expressed and stored for later use; obtain donated, processed breastmilk from a milk bank when their own milk production is insufficient or their milk cannot be used; or use commercially produced formula available in supermarkets and pharmacies as either a supplement to their own breastmilk or a replacement for breastfeeding. Which option you choose at any particular time will depend on your circumstances and you and your baby’s needs. However, before you make your decision, you owe it to your baby to learn how breastfeeding benefits you both. Consider the support services (lactation specialists, breastfeeding support groups, and on-line information), efficient aids to breastfeeding (breast pumps, breastmilk-storage containers), and increased social acceptance (more breastfeeding in public, maternity leave, private rooms provided at work for nursing mothers) now available to help you succeed. It is our hope that as you read about breastfeeding’s benefits for your baby and consider how nursing can be a part of your life, you will decide to give breastfeeding a try. After all, babies are not babies for very long. They deserve the healthiest start they can get.

Why Is Breastfeeding So Good for My Baby?

Formula for babies has become such a pervasive part of our culture that many people assume it must be as good for babies as human milk. After all, formula is designed to contain many of the nutrients provided in breastmilk--and babies who are fed formula clearly grow and develop adequately. Yet the fact remains that human milk and infant formula differ in a number of fundamental ways. Breastmilk is such a rich, nourishing mixture that scientists have yet to identify all of its elements; no formula manufacturer has managed or will ever be able to fully replicate it.
uimmunologic benefits

Human milk provides virtually all the protein, sugar, and fat your baby needs to be healthy, and it also contains many substances that benefit your baby’s immune system, including antibodies, immune factors, enzymes, and white blood cells. These substances protect your baby against a wide variety of diseases and infections not only while he is breastfeeding but in some cases long after he has weaned. Formula cannot offer this protection.

If you develop a cold while breastfeeding, for example, you are likely to pass the cold germs on to your baby--but the antibodies your body produces to fight that cold will also be passed on, through your breastmilk. These antibodies will help your infant conquer the cold germs quickly and effectively and possibly avoid developing the cold altogether. This defense against illnesses significantly decreases the chances that your breastfeeding baby will suffer from ear infections, vomiting, diarrhea, pneumonia, urinary-tract infections, or certain types of spinal meningitis. Even infants in group child-care programs, who tend to catch more germs due to their close proximity, are less likely to become ill if they are breastfed or fed bottled breastmilk that their mothers have expressed.

Allergists recommend breastfeeding as a way to decrease the risk of developing food allergies and eczema in families prone to these conditions. Human breastmilk contains human milk proteins, not the proteins of cow’s milk or soy milk, which are “foreign” to the baby’s immune system and may stimulate an allergic response. Transfer of the mother’s antibodies and other immunologic substances may also explain why children who breastfeed for more than six months are less likely to contract childhood acute leukemia than those who receive formula. Studies have demonstrated a reduced risk of Sudden Infant Death Syndrome (SIDS) among babies who breastfeed, though the reasons for this are not fully understood. Recent research even indicates that breastfed infants are less likely to be obese in later life and that breastfed daughters are at reduced risk of developing breast cancer as adults.

Health Risks for Formula-Fed vs. Breastfed Babies

A formula-fed baby has the chance of contracting as a breastfed baby during the breastfeeding period:

2 to 7 times allergies, eczema
3 timesear infections
3 timesgastroenteritis
3.8 times meningitis
2.6 to 5.5 times urinary-tract infections
2.4 times diabetes, type 1
2 timesSudden Infant Death Syndrome (SIDS)
1.7 to 5 timespneumonia/lower-respiratory-
tract infection
1.5 to 1.9 times inflammatory bowel disease
1 to 6.7 timesHodgkin’s lymphoma

Adapted from: American Family Physician, April 1, 2000, Vol. 61, No. 7.