Most people have a vague idea that breastfeeding is better for babies. Some can even tell you why – when I ask people if they know what the benefits are, I hear answers ranging from “it’s cheaper” to “it helps the baby’s immune system” (both are true, by the way). But how is breastfeeding better for babies, really? The review of many studies (1) reveals the following important and consistent findings:
- Acute Ear Infection (Otitis Media): 50% reduction in risk among babies fed breast milk exclusively for three to six months (compared to those fed formula exclusively).
- Eczema (Atopic Dermatitis): 42% reduction in risk among babies fed breast milk exclusively for at least three months (compared to those who were breastfed for less than 3 months).
- Diarrhea and Vomiting (Gastrointestinal Infections): 64% reduction in risk among babies who were fed any breast milk compared to those who were not.
- Lower Respiratory Tract Diseases Requiring Hospitalization: 72% reduction in risk among infants less than one year of age who were exclusively breastfed for four months or more (compared to those who were never breastfed).
- Type 1 Diabetes: 19 to 27% reduction in risk of childhood type 1 diabetes among children who were breastfed for at least three months (compared to those breastfed for less than three months).
- Type 2 Diabetes: 39% reduction in risk of adult-onset diabetes among adults who were breastfed at all as infants.
- Childhood Leukemia: 15% to 19% reduction in risk of acute lymphocytic leukemia and acute myelogenous leukemia among children who were breastfed for at least six months (compared to those who were never breastfed).
- Sudden Infant Death Syndrome (SIDS): 36% reduction in the risk of SIDS among babies who were breastfed at all (compared to those who were never breastfed).
The bottom line is breastfeeding makes a huge difference for babies. The antibodies babies receive with breast milk beat anything else we can give them.
Breastfeeding Benefits Mum, Too
What about mum? We know that, for most mothers, breastfeeding creates an awesome bond with the baby. It also burns approximately 500 additional calories per day, which some new mums find quite attractive. Beyond that, breastfeeding has very specific and quantifiable benefits for the health of the mother in terms of reducing the risk of serious disease (1):
- Type 2 Diabetes: 4 to 12% reduction in risk among women without a history of gestational diabetes for each year of breastfeeding over a woman’s lifetime.
- Breast Cancer: Results vary, but indicate as high as a 28% reduction in risk among women who breastfed for 12 months or more.
- Ovarian Cancer: 21% reduction in risk with “some” breastfeeding.
In addition to these clear relationships, there is also evidence that suggests women who breastfeed lower their risk of cardiovascular disease (2) and rheumatoid arthritis (3).
In case you need more evidence that breastfeeding has proven medical benefits, just look to the IRS (yes, the Internal Revenue Service). Last week it announced that it will consider breast pumps and related lactation supplies as tax deductible "medical equipment" starting with 2010 tax filings.
Formula Has Its Place
Although breastfeeding has distinct advantages, there are very legitimate reasons that a woman may be unable to breastfeed. Medical reasons might include severe infant hypoglycemia, galactosemia or another illness or congenital malformation, such as a tracheoesophageal fistula. The mother could be on medication that is incompatible with breastfeeding, or have a severe illness or medical emergency that requires separation. Because of the risk of passing the disease through the breast milk, a mother who is HIV positive should not breastfeed. Interestingly, in developing countries the risk of gastrointestinal infection is far greater than the risk of passing HIV through the breast milk, so HIV-positive mothers are encouraged to breastfeed.
In addition to these medical indications, some mothers struggle so much with breastfeeding that, ultimately, formula becomes a better option for their family. I would never want a woman who cannot breastfeed to feel guilty. As with any situation, we as providers are here to support our mothers and their choices.
How Did We Get Here?
With all the known benefits of breastfeeding, how is it that we have reached a place where breast milk and formula are still spoken of in some circles as if they are equal? One word: commerce. The commercial machine driving the sales of formula in the United States is long standing and pervasive. Think about it: when Similac was introduced in the late 1920s, women could only get it in their physician’s office. That’s a pretty strong endorsement! By the 1950s, more than half of all babies in the U.S. were raised on formula; by the 1970s, that proportion had risen to 75%.
The tide of commercialism is difficult to turn. Still, we have made great strides. According to information from the Centers for Disease Control, 75% of mothers initiated breastfeeding in 2007. Where we still fall short is in the continuation of breastfeeding – achieving the durations that provide the greatest protective benefits for mother and child. Healthy People 2010 objectives call for 50% of mothers to continue breastfeeding for at least six months and 25% to continue for at least one year. We’re still a bit short of reaching these goals as a nation.
Most pregnant women we see understand the benefits and fully intend to breastfeed. But women today face obstacles that include unsupportive family members, access to assistance resources, social stigma and the challenge of maintaining breastfeeding while working full time. Not to mention the physical difficulties that some women encounter, including sore nipples, engorged breasts, mastitis, leaking milk, pain and failure to properly latch the infant.
Our job as clinicians is not only to assure pregnant women are educated in the benefits of breastfeeding, but that they are able to overcome obstacles to breastfeeding successfully. Be sure to check back in the Wellness Journal for future posts by my colleagues addressing the most common obstacles. In the meantime, check out this Call to Action to Support Breastfeeding published by the Surgeon General.
Helen Welch, CNM, MSN is a Certified Nurse Midwife who sees patients at the Peterkort South office of Women’s Healthcare Associates. In case you couldn’t tell, she was born in England (into the hands of a midwife, we might add)
1. Ip S, MD et al, Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, Agency for Healthcare Research and Quality, 2007
2. Schwarz, E, MD et al, “Lactation and Maternal Measures of Subclinical Cardiovascular Disease,” Obstetrics & Gynecology, January 2010; Volume 115 - Issue 1 - pp 41-48
3. Karlson, E., Arthritis and Rheumatism, November 2004; vol 50: pp 3458-3467