Breastfeeding: Why It’s a Public Health Issue

The American Academy of Pediatrics issued its latest white paper on breastfeeding last week. The most important quote, and for me an obvious statement, is that breastfeeding is a "public health issue and not (just) a lifestyle choice."  Breast feeding benefits public health by decreasing infectious disease (breast fed children are less lightly to have digestive-tract illnesses and probably less lightly to get ear infections) and by providing better nutrition (breast fed babies get optimal nutrition and have less obesity in the long term.)

I have seen over 40,000 newborns and have always thought that breastfeeding was the healthiest choice for babies in most cases. My wife and I were lucky that we were both breastfed in spite of being born at mid-20^th century to middle class families when bottle feeding (especially with the expensive formulas such as Similac and Sobee) was widely advertised as "classy" alternatives to both evaporated milk and breast milk.  Our mothers were comfortable with breastfeeding.  My wife, who was a busy gynecologic surgeon, and who went back to work less than a month after each of our 4 children was born, breastfed until our children self-weaned around 9 to 12 months. My wife pumped at work during the day and just fed the children by breast when she was home.  Finding an appropriate place to pump at work is a big problem for many but she was lucky to have her own office.

Recently, the Healthy Kids blog featured an interview with Esther Chung, MD, MPH, of Jefferson University Hospitals, about ways expectant mothers (and their partners) can prepare for successful breastfeeding.  As Dr. Chung said, nursing may be natural, but it isn't always easy. The number of breastfeeding failures is sky high with less than ½ of initial breast feeding mothers still breastfeeding from the breast, not a bottle, by 2 months. Here are some ways to keep going once you've started nursing.

Is my baby getting enough milk? Trust Nature – and know the signs. These days I see many mothers who bottle-feed with breast milk because it is "easier."  Pumping and storing breast milk for times when someone else has to feed your baby, or for when you're sick or otherwise can't nurse, is a great idea because it keeps up your milk production while giving your baby this wonderful food. But more and more moms are bottlefeeding their own breastmilk to their babies because they're concerned with measuring the exact amount their baby is receiving. In a culture obsessed with measuring it's hard to relax and trust Nature.  How will you know your baby's getting enough? Signs of success include:

Of course, if your breastfed baby is not gaining weight, is lethargic or still seems hungry after nursing, has scant, dark urine or hard stools or just doesn't seem 'right' to you, call your pediatrician today.

Understand a breastfed baby's healthy growth patterns. Part of the problem with ongoing breastfeeding is doctors and nurses – and their own fears about a baby's weight gain and growth.  A healthy newborn baby is supposed to lose weight (up to 10% or more of birth weight) and then gain the weight back within 2 weeks. But we get obsessed with measuring and find breast feeding failure at 2 days which is actually impossible since breast milk doesn't usually come in until about 3 to 4 days! It's not just a problem in baby's first weeks. There's plenty of evidence that breastfed babies follow a different growth pattern over the first six to 12 months of life. Yet most growth charts are still based on higher weight gains for formula-fed babies.  You can find World Health Organization growth charts here for breastfed baby boys and girls. If your doctor thinks your breastfed baby isn't growing or gaining at a normal rate, be sure she knows that you're breastfeeding – and compare her growth to the healthy rates on these charts.

Be flexible.  The rest of the story is that breasfeeding isn't always best – such as if a mother is very ill or taking drugs that would pass into breastmilk.  And some babies have trouble breastfeeding, due to sucking problems, prematurity or other medical conditions.  Even when breastfeeding does work, it may take a few weeks to settle into a routine.  I always tell new mothers that "breastfeeding is a lot like sex, think about it too much and it doesn't work."  Not obsessing is often the best way.

Gary A. Emmett, M.D., Thomas Jefferson University Hospital, Jefferson Medical College.