Monday, August 31, 2009


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Monday, August 17, 2009

Breastfeeding: How does it benefit mom?

How does breastfeeding benefit mom?
It often seems that when we talk about breastfeeding we most often focus on the benefits for baby; however, there are numerous advantages for Mom (and even Dad) as well. So, let's dig in to how breastfeeding benefits mom.

How does breastfeeding benefit Mom
  • Breastfeeding promotes quicker shrinking of the uterus (aka, uterine involution). Oxytocin, the "let down hormone, levels increase during breastfeeding to stimulate the ejection of milk. Oxytocin also causes the uterus to contract and return to pre-pregnancy size much faster. A big plus for moms who've only had an expanding belly over the previous 9 months.
  • Breastfeeding decreases post-partum blood loss. This is also due to the oxytocin stimulating the uterine contractions that help control bleeding after a woman gives birth.
  • Breastfeeding delays resumption of menses. Exclusive breastfeeding for the first six months after childbirth postpones the return of menstruation, and while not 100% fail-safe, can provide a natural form of birth control and spacing between pregnancies.
  • Breastfeeding enhances mother-infant bonding. Some studies have detected a relationship between higher maternal levels of oxytocin and an enhanced mother-infant bonding experience, possibly creating greater feelings of love and euphoria in breastfeeding mothers.
  • Breastfeeding promotes psychological well-being. Researchers have indicated a possible role of oxytocin in mitigating the effects of stress in the post-partum period. Prolactin is the milk-producing hormone secreted during pregnancy to generate breastmilk. Prolactin has been associated with elevation of mood and buffering the effects of stress in breastfeeding mothers. In fact, researchers have proposed that women who've had more than one pregnancy reduce the risk of depression with breastfeeding.
  • Breastfeeding is associated with lower risk for breast and ovarian cancers. A large-scale systematic review of 47 studies conducted in 30 countries estimated a 4.3% lower risk of breast cancer for every 12 months of breastfeeding. Essentially, the longer a woman breastfeeds throughout her lifespan, the lower her risk for breast cancer. Another large, prospective trial suggests that women who'd breastfed for 18 or more months over their lifespan had a significant reduction in risk of ovarian cancer in comparison to those who had never breastfed.
  • Breastfeeding may offer protection against osteoporosis. Studies have suggested a positive relationship between duration of breastfeeding and bone mass of the hip and lower risk of hip fracture in older women.
  • Breastfeeding provides a convenient, safe source of nutrition for baby. Since it comes straight from the "tap", there's no need to worry about water safety or proper mixing and warming. And as new mom, I personally appreciate not having to get up in the middle of the night to prepare a bottle.
  • Breastfeeding is less expensive than formula feeding. According to the American Academy of Pediatrics, families can save an estimated $400 in the first year of breastfeeding compared to formula feeding!
So, there you have it. Now we know that even moms stand to benefit from breastfeeding. Great! However, many will admit that the experience is easier said than done. So stay tuned for the next blog in which I'll discuss how to stick with the decision to breastfeed.

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Monday, August 10, 2009

Breastfeeding: What are the benefits for baby?

Breastfeeding: What's in it for baby? Copyright 2009 - Michelle Loy, MPH, MS, RD - Go Wellness
I must admit that I used to look at breastfeeding advocates and think to myself, "Oh, she's one of those people." You know, those people who are just fanatical over breastfeeding. However, once I really learned about the host of health benefits resulting from breastfeeding, I could no longer deny the advocate in me! I do hope that once you read about some of these benefits, that you, too, will see where I'm (and they're) coming from. In continuation of my series on the what, why, and how of breastfeeding, today's blog post is dedicated to the first of two posts on the why.

How does baby benefit from breastfeeding?
  • Human milk provides superior nutrition. Since it's made for humans by humans, how could one go wrong? The nutrient composition of breast milk is almost perfectly tailored for an infant with the exception of a few nutrients, such as Vitamin D and fluoride. In addition, breast milk contains other factors that also enhance the digestion and absorption of nutrients, such as calcium, iron, and zinc! And I can't stop there. The other remarkable thing about human milk production is that the composition of the milk actually changes according to baby's needs across the feeding, across the day, and across the infant's lifespan! Amazing! So how does it work? During an actual feeding, the initial milk ejected, the foremilk, contains a higher concentration of protein and water and less fat. This helps satisfy a baby's fluid and protein needs earlier on in the feeding. Then about 1/3 of the way through the feeding the milk contains a higher percentage of fat, which enhances satiety and helps meet energy needs. The composition changes across the day by consisting of a higher percentage of foremilk in the morning while containing a higher percentage of hind milk in the afternoon and evening. It's speculated that this helps the infant stay more alert earlier in the day while helping the infant rest better in the evening due to the nutrient content of the two types of milk. Finally, the milk changes across the lifespan to meet the infant's different nutrient needs at different stages of growth. And this process cannot be duplicated by any human milk substitute!
  • Human milk contains factors that provide immunological protection. You could call it baby's first immunization! In approximately the first two weeks of life, almost everything the mother has developed an immunity to is passed on to the baby through maternal antibodies. Human milk also contains a multitude of other factors that weaken or destroy harmful bacteria or help generate antibodies. And it's these very factors that have not been duplicated in formula to this day. On the other hand, there are also compounds called bifidus factors that actually promote the growth of friendly bacteria in the infant's GI tract, which, in turn, prevents more harmful bacteria from establishing there.
  • Breastfeeding decreases the risk for allergies, especially among those with a family history of allergies. First of all, when an infant is exclusively breastfed for the first 6 months of life, there is a delay in the introduction of other foods that helps reduce exposure to potential food allergens, such as cow's milk or soy protein from formula. In addition, the colostrum helps coat and protect the infant's GI tract from penetration by allergens and other foreign bodies that contribute to allergies.
  • Breastfeeding lowers the risk of childhood obesity. The choice between breast milk or formula affects the baby's earliest sensory experiences with food. Infants fed breast milk are exposed to a greater variety of food flavors via the maternal diet whereas those who consume formula are exposed to one flavor. This could affect an infant's acceptance of new foods, like vegetables, later on down the road. So this could mean having a less picky eater as a result of breastfeeding. It is also theorized that breastfeeding helps the infant stay in tune with his/her hunger and satiety cues better. It is conceived that the breastfed infant is better able to control the flow of milk from the breast whereas a bottle-fed infant receives formula more quickly and easily, which could lead to overfeeding. Therefore, the bottle-fed baby gets used to a greater feeling of fullness and begins to more easily override satiety cues. While our understanding of how it is that breastfeeding helps reduce the risk of childhood obesity is still unclear, there is still plenty of research supporting the fact that breastfed infants are less likely to experience childhood obesity than their formula-fed counterparts.
  • Breastfeeding improves cognitive development. Many studies support an association between breastfeeding and improved cognitive development through early childhood; however, it's still unclear if there are factors other than the actual breast milk contributing to this relationship (i.e., genetics, environment). Breast milk is naturally rich in the essential fatty acids DHA and arachidonic acid, which help promote brain development, and researchers suspect that these fatty acids could play a pivotal role in the link between breastfeeding and cognitive function. The effect may be even more pronounced in pre-term infants since large amounts of these fatty acids accumulate in the brain during the last trimester, and because premature infants are born early, they miss out on the full transfer of these vital nutrients.
  • Breastfeeding reduces the risk for sudden infant death syndrome (SIDS). SIDS is the leading cause of death for infants during the first year of life, and several studies suggest that exclusive or partial breastfeeding reduces the risk for SIDS. In fact, a recent case-control study detected a 50% reduction in risk of SIDS for breastfed infants.
  • Breastfeeding may lessen the risk for diabetes later in life. In comparison to formula-fed infants, breastfed infants tend to have a lower risk for developing both type 1 and type 2 diabetes later in life, especially those infants at higher risk of developing the diseases. It appears that infants who are breastfed for a longer period of time and those who are exclusively breastfed have lower risk than infants who are not breast fed at all, experience shorter duration of breastfeeding, and/or encounter early introduction of formula or cow's milk. Due to some study limitations, such as parent recall of breastfeeding practices and other potentially confounding factors, more research needs to be conducted in this area.
  • Breastfeeding may decrease the risk for cardiovascular disease later in life. Several studies suggest a protective effect of breastfeeding on certain cardiovascular risk factors, such as atherosclerosis, blood pressure, cholesterol profile, along with other cardiovascular risk factors. Again, there are limitations to the results of such studies due to parental recall of breastfeeding practices and other potentially confounding factors.
Preliminary studies suggest a large number of other health benefits related to breastfeeding, but I hope that this helps increase your understanding of some of the health-related benefits of breastfeeding for the infant.  Stay tuned for my next post regarding the advantages of breastfeeding for mom!

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Monday, August 3, 2009

Breastfeeding - A moral decision?

At 8 1/2 months pregnant with my second child, I am in the last stretch of preparations before our little guy's arrival. With this being my second pregnancy, I am thankful that there are not as many critical decisions for me to make -- What car seat? What stroller? What nursery theme? The list goes on and on, especially for new parents. However, I believe one of the most important decisions a parent makes regarding a new baby relates to how to feed the baby. Human breast milk or human milk substitute (aka, formula)? As a Registered Dietitian and someone who is well aware of the multitude of benefits of breastfeeding for both baby and mom, the decision was easy for me. Yes, yes, yes -- breast is the best!

Yes, you got that right. I am quite gung ho for breastfeeding. At the same time, I also realize that making the decision is not a moral issue -- at least it shouldn't be. You are not a good parent if you do and a bad parent if you don't! However, to me, it is a health issue and I realize that for many parents the decision is not so easy. I can understand why as there are still so many sociocultural and environmental factors that seem to easily persuade parents to choose formula over breastfeeding. Let's first take a look at our environment. I see the plethora of very persuasive marketing by the formula industry to moms-to-be and new moms. During the first pregnancy, I was inundated with a new fantastic coupon deal for formula at nearly every OB visit, diaper bags provided by several formula companies, free samples, and even materials provided by the formula companies that would appear to support breastfeeding (i.e., ice packs for storage, etc.) -- don't even get me started on this. It is influences such as these that seem to easily sway parents to choose formula over breastfeeding or to simply give up on breastfeeding altogether. In terms of sociocultural influences, I believe that there are very subtle ways in which sociocultural factors can influence a woman's choice to breastfeed. I was reading a new book to my daughter the other day called "I'm a Big Sister". I noticed something in the story that others might not. The story presents a situation in which the big sister gets to help bottle feed the baby. Now, the reader can fill in the blanks and assume that the bottle is filled with formula or breast milk. It did not say. However, I just found this scenario interesting as I believe that our minds can be influenced in the most subtle ways when it comes to nutrition. Why not have the father and the little girl assist the mother while she's nursing the new baby rather than insinuating that in order for father and big sister to help s/he must participate in bottle feeding? Another example...the other day I was presented several questions from a reporter for a local university newspaper. One of the questions posed was "What can a parent feed a child who's allergic to cow's milk and soy?" Initially, I thought about how I'd actually like to educate and encourage the parent to feed a new baby breast milk first and foremost -- before any formula.

I get it...the decision is not easy, initiating the process is not always easy, and there are a lot of factors still working against the successful lactation experience. However, I will tell you, the rewards are well worth it. As a public health professional and advocate, I'm feeling a personal duty to spend the next few blogs writing about the what, why, and how of this very important issue in the hopes that if you're a parent-to-be, a new parent, or someone who knows someone about to make this important decision, you'll strengthen your decision for breastfeeding or at least consider this option more strongly. So, let's start with the what.

What is the recommendation regarding breastfeeding?
  • The American Academy of Pediatrics, American Dietetic Association, and U.S. Department of Health and Human Services recommends exclusive breastfeeding during the first six months of life (with some exceptions that you will find here). These organizations also suggest continuing breastfeeding along with appropriate introduction of solid foods for at least the first year of life.
  • The World Health Organization recommends breastfeeding through at least the first two years of life with the proper addition of complementary foods.
  • The national Healthy People 2010 goals include objectives targeting breastfeeding rates in the U.S. 1) Increase the rate of mothers initiating breastfeeding in the early postpartum period to 75%. 2) Increase the rate of mothers continuing breastfeeding to at least six months to 50%. and 3) Increase the rate of mothers continuing breastfeeding to at least one year to 25%.
Stay tuned for the why's of breastfeeding. How will it benefit baby?
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