Breastfeeding Health Article

Physiology of Breastfeeding

During pregnancy, the body increases its production of a hormone called prolactin, which stimulates the breast to make milk. Suckling by the infant stimulates the release of prolactin. The size of the breasts is not a factor in milk production. Oxytocin, another hormone, allows the breast tissue to "let down" or release milk from the milk ducts to the nipples.

Colostrum, the first milk produced, has all the nutrients a newborn infant needs. It also contains many substances to protect against infections. The body produces colostrum for several days until the "mature milk" comes in. Mature milk adjusts to the baby's needs for the rest of the time the infant is breastfed.

Nutritional Needs of the Mother

Milk production requires about 800 calories a day. The Recommended Dietary Allowances for calories during breastfeeding is 500 more calories a day than is required by a nonpregnant woman. Nutritional requirements do not change significantly from pregnancy, with the exception of decreases in folate and iron, and increases in vitamin A, vitamin C, niacin, and zinc. The diet can be the same as during pregnancy, plus an additional glass of milk. Women who are on medication should check with their physicians, since most drugs are absorbed in breast milk.

Weaning

The decision to wean should be based on the desires and needs of the mother and child. Weaning should be gradual. Women returning to work can pump and store their milk for later use. Solid foods should be given based on the age and developmental stage of the child. In some countries, many toddlers become malnourished because they are given too many high carbohydrate foods, such as cassava, potatoes, and other root vegetables, too early. These foods are filling, but they are low in protein and other nutrients essential for growth and development.

Breast Implants and Breast Reduction

Many women with breast implants breastfeed successfully, though it is not known whether the health of the infant is affected by breast implants. Women who have had a breast reduction may not be able to breastfeed, since the surgical procedure removes glandular tissue and realigns the nipple.

Who Should Not Breastfeed?

Women with HIV/AIDS, hepatitis, cancer, and other conditions where the immune system may be compromised should not breastfeed. A case-by-case assessment should be made with women exposed to certain environmental toxins and those who use illicit drugs.

Policies and Recommendations

A woman's ability to breastfeed for the optimal recommended time depends on the support she receives from her family, health care providers, and the workplace. Health care institutions should adopt policies and initiatives that include:

• A written breastfeeding policy
• A breastfeeding education program
• Rooming-in of mother and child
• Breastfeeding on demand
• Limited use of pacifiers, water, and formula

With the increased number of women in the workforce, employers can do a lot to support and encourage breastfeeding, such as providing adequate breaks; flexible hours; job sharing; part-time work; refrigerators for storage of breast milk; and on-site child care.

A public health campaign can greatly increase the initiation and duration of breastfeeding. These campaigns should target all social groups, including men, future parents, grandparents, health care providers, and employers. In addition, culturally appropriate programs and materials should be available. Breastfeeding saves lives and money, and it benefits all of society.

SEE ALSO BEIKOST; INFANT NUTRITION; MASTITIS; PREGNANCY.

Delores C. S. James

Bibliography

James, Delores C.; Jackson, Robert T.; and Probart, Claudia K. (1994). "Factors Affecting Breastfeeding Prevalence and Duration among International Students." Journal of the American Dietetic Association 94(2):194–196.

Worthington-Roberts, Bonnie S., and Rodwell-Williams, Sue (1993). Nutrition in Pregnancy and Lactation, 6th edition. Madison, WI: Brown & Benchmark.

U.S. Department of Health and Human Services, Office on Women's Health (2000). HHS Blueprint for Action on Breastfeeding. Washington, DC: U.S. Government Printing Office.

Internet Resources

American Academy of Pediatrics. "A Woman's Guide to Breastfeeding." Available from <http://www.aap.org/>

Ryan, A. S. (1997). "The Resurgence of Breastfeeding in the United States." Pediatrics (online). Available from <http://www.pediatrics.org>

UNICEF. "Breastfeeding and Complementary Feeding." Available from <http://www.childinfo.org/>

World Health Organization. "Global Databank on Breastfeeding." Available from <http://www.who.int/nut>