Breastfeeding: History, Health, and Society

February 8, 2008

Overview

• Culture and history of breastfeeding • AAP policy• Proven health benefits • Baby-Friendly hospitals• Breast vs. Formula• Breastfeeding in society• Resources

Breastfeeding Around the World

• In ancient Greece and Rome, women fed their own infants. This was an activity considered below royalty, so they began the practice of hiring wet nurses

• In India, traditionally, breastfeeding was not done until the fifth day so that the baby would not ingest colostrum.

• Cuba’s constitution has a provision for breastfeeding mothers to take “mandatory paid vacation” from work to feed their infants, six weeks before and six weeks after the birth; plus continuing breaks during the workday.

• Primary feeding method in developing countries- economical• Japan was the first developed nation to promote breastfeeding with

“Baby Friendly Hospitals”

Historical Attitudes About Breastfeeding

1750-1820• Babies not breastfed until 2 or 3 days old• Frequent pregnancy left many women feeble and unable to

nurse- wet nurses were preferred over animal milk• Tight corsets inhibited health breast development and

made breastfeeding very difficult for some women• Infants in orphanage hospitals were fed directly from a

goat’s udder

Historical Attitudes About Breastfeeding

1820-1870• Breastfeeding becomes popular again• Impress upon fathers and other children what a mother’s

role is.• Mothers were encouraged to breastfeed on a schedule

(which actually inhibits natural supply and demand)• Others encouraged to feed right after birth• Baby food first marketed in 1850s and encouraged milk

substitutes which led to trend towards bottle feeding

Historical Attitudes About Breastfeeding

1870-1920• “Liberated” and “progressive” mothers of the 1880s saw

breastfeeding as out-of-date• Mrs. Panton: “Let no mother condemn herself to be a

common or ordinary ‘cow’ unless she has a real desire to nurse…”

• By 1914, trend switched toward breastfeeding again. People worried that becoming too lackadaisical about breastfeeding would be bad for future generations of women and children

Historical Attitudes About Breastfeeding

1920-1946• Truby King- “Breastfed is Bestfed.”• Believed in strict feeding schedules, quantities, and

allowing the infant to “cry it out.”• Warned against over-feeding• By 1930, it was proven that infants ate varying

amounts in a supply-demand pattern

Historical Attitudes About Breastfeeding

1946-1981• Freudian concerns

– Biting the nipple– Time of weaning– Separation trauma

• Bottle-feeding increasingly accepted• 1970s

– Physical and emotional benefits of breastfeeding for mother and child

– New mothers increasingly want to feed their children naturally

Historical Attitudes About Breastfeeding

1981-2007• Breastfeeding regarded as the most natural and

healthiest way of feeding infants (see AAP)• However, contemporary U.S. generally adopts a

“no-guilt” policy for women who choose to, or must, feed formula for personal reasons

Breastfeeding Continues to Increase Into the New

Millennium• Breastfeeding increasing among populations that historically do not breastfeed (young, black, uneducated, WIC participants)

• Low SES mothers most concerned with convenience and uncomfortable embarrassment related to breastfeeding

• Breastfeeding remains high in educated, high SES families• Baby-friendly hospitals are increasing acceptance and knowledge of

breastfeeding practices among all SES• High SES mothers may have more control over their environments

and more opportunity to breastfeed while employed• Working mothers wean earlier than stay-at-home moms, but

changing workplace policies are allowing women to breastfeed at work

– Ryan, A. S., Wenjun, Z., & Acosta, A. (2002). Breastfeeding continues to increase into the new millennium. Pediatrics,110, 1103-1109.

American Academy of Pediatrics• “Although economic, cultural, and political pressures often

confound decisions about infant feeding, the AAP firmly adheres to the position that breastfeeding ensures the best possible health as well as the best developmental and psychosocial outcomes for the infant. Enthusiastic support and involvement of pediatricians in the promotion and practice of breastfeeding is essential to the achievement of optimal infant and child health, growth, and development.”

http://aappolicy.aappublications.org

“Baby-Friendly Hospitals”

• Designation by WHO given to hospitals that promote breastfeeding over formula feeding because of health and psychological benefits:

• Particularly in developing countries because of high infant-mortality associated with formula feeding.

Baby-Friendly Hospital Protocol:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.

2. Train all health care staff in skills necessary to implement protocol3. Inform all pregnant women of the benefits and management of breastfeeding4. Give newborns no food or drink other than breast milk unless medically indicated5. Help mothers initiate breastfeeding within ½ hour of birth6. Show mothers how to breastfeed and maintain lactation even if separated from

the infant7. Practice rooming in- allowing mother and child to stay together 24 hours a day8. Encourage breastfeeding on demand9. Give no artificial teats or pacifiers to breastfeeding infants10. Foster the establishment of breastfeeding support groups and refer mothers to

them upon discharge from the hospital

• In 2005, 15,000 hospitals worldwide were certified “Baby Friendly”

Health Benefits• Infant

– Essential nutrients provided naturally– Colostrum rich in anti-bodies needed to build immune system– Protects against common infection (upper-respiratory, ear infections,

gastroenteritis, otitis media, asthma)– Lower incidence of SIDS, – Lower risk of diabetes and obesity– Lower risk of certain types of cancer, including leukemia – Improved cognitive development

• Mother– Decreased risk of ovarian cancer– Decreased risk of pre-menopausal cancer– More weight loss after pregnancy/return to normal weight– No ovulation while breastfeeding– Psychological and physical attachment to child: strengthens attachment

bond

Other Benefits

• Bonding experience for mother and infant• Skin-to-skin contact is good stimulation for baby• Economical- It’s free! (Formula costs more than

$120/month)

Breast Milk or Formula?

• Research and the AAP strongly advise breastfeeding for obvious health (and economical) reasons.

• However, in modern society, extenuating medical circumstances and/or convenience compel doctors and mothers to consider formula or a combination of breast milk and formula

• Many mothers pump their breast milk so that it is available even when she is not.

When Pediatricians and Mothers Consider Formula

• Persistent difficulties in latching on and/or sucking• Maternal medical condition that could be passed

through breast milk (HIV/AIDS)• Low milk production- not enough to satisfy

supply/demand• Failure to thrive/ low weight• Uncomfortable with exposure or act of

breastfeeding• Convenience

A Personal Choice

• Consider your comfort level and lifestyle when deciding to breastfeed or use formula

• Combining breast and formula is an option for many mothers

• Commercially-made formula is nutritionally complete

• There appears to be no difference between attachment and adjustment of infants who were breastfed and infants who were bottle-fed.

Breastfeeding in Society• Public or private?

– One Viewpoint• “I just don’t like the idea of whipping my breast out in public.”• Breastfeeding is a private event between mother and child, should be done in private; or in restrooms

when in public. Mother should not expose herself in public– Opposing Viewpoint

• “As long as I’m discrete about it…You don’t eat your dinner in the bathroom, why should my child?”• Discrete breastfeeding in public while covering yourself is ok• Especially for children who are slow feeders, mother doesn’t miss out on social events

• Especially first-time mothers may feel guilty if they can’t breastfeed exclusively• Supporters of “breast-only” feeding may judge others who choose to formula feed, or

combine breast and formula, contributing to the “good mother, bad mother” stereotypes

• http://www.youtube.com/watch?v=rrnxtiYmXig

Resources

• La Leche League International www.lalecheleague.net

• The American Academy of Pediatrics www.aap.org• INOVA Fair Oaks Women’s Center

www.inova.com/inova_fair_oaks_hospital/services/womens/index.jsp

• The Birthing Inn at INOVA Loudoun www.thebirthinginn.org