Human breast milk is the best food for newborn babies. In December 1997, the American Academy of Pediatrics issued a policy statement advocating breast milk as the ideal, exclusive food for babies in the first six months of life. They also recommended that breast-feeding continue for at least 12 months or longer if mutually desired.1
In the United States, only about 50% of new mothers giving birth in a hospital breast-feed their babies. This number declines rapidly, with only about 20% of women still breast-feeding at six months.2 There is a large body of evidence on the benefits of breast-feeding for both mother and infant. With adequate support and good information on preventing some of the common problems associated with breast-feeding, a woman’s chances of successfully breast-feeding her new baby are greatly improved.
Breast feeding provides significant benefits for baby and mother.
Benefits for baby
One significant advantage of human breast milk is its abundance of immune-protective and anti-infective agents, including immunoglobulins (primarily immunoglobulin A, or IgA), lactoferrin, Bifidobacterium bifidum, white blood cells, and other factors. These agents are known to help the newborn fight a wide variety of illnesses. Many scientific studies in the United States and other developed countries have demonstrated the health protective benefits of breast milk.
Breast-feeding has been found to help prevent: diarrhea,6 7 8 9 10 lower respiratory tract infection,11 12 13 14 ear infections (otitis media),15 16 17 18 19 20 meningitis,21 22 urinary tract infection,23 and other serious infections (botulism, necrotizing enterocolitis, bacteremia).24 25 26 27 28 In addition, breast-feeding may possibly help prevent: sudden infant death syndrome (SIDS),29 30 31 insulin-dependent diabetes mellitus,32 33 inflammatory bowel disease (Crohn’s disease, ulcerative colitis),34 35 cancer (lymphoma),36 37 allergic diseases,38 39 40 and other chronic digestive diseases.41 42 43 Breast-feeding may also enhance cognitive development.44 45
The protein composition of breast milk is perfect for growing babies and is easy for them to digest. Breast milk also provides absorbable nutrients; the iron and zinc found in human milk is extremely easily absorbed (bioavailable) compared with iron and zinc from other foods. When infants are exclusively breast-fed, 50% of the iron is absorbed. By comparison, absorption of iron from cow’s milk and iron-fortified commercial formula is much lower, only 10% and 4%, respectively.46
Breast milk is also quick, easy, and cost-effective. It’s always available and does not need to be prepared, and the cost of providing the necessary additional nutrition to a breast-feeding mother is about half the cost of commercial formula.47 48 49 And breast-feeding promotes bonding, allowing a mother and her baby to be in close physical contact, enhancing the formation of a close mother-baby bond.50
Benefits for mother
Several problems common to breast-feeding mothers can be prevented or eased through simple techniques or addressed with common, simple treatment options.
Correcting the baby’s position on the breast is the most important tactic for preventing and relieving sore nipples. A physician, nurse, or lactation consultant can assist in assessing and correcting an infant’s grasp of the nipple. Sore nipples can progress to more painful, cracked, and fissured nipples. As the condition worsens, the nipples are more susceptible to infection. In addition to correcting the baby’s position, there are a number of self-help measures frequently recommended for the relief of sore nipples. These are most effective when begun at the onset of symptoms.
Check the position of the baby on the breast; the infant’s tongue should be under the nipple and the mouth should grasp both the nipple and part of the areola. Vary the position of the breast-feeding infant with each feeding to avoid soreness of a particular area of the nipple.
The infant should be fed on demand; an overly hungry infant may suck harder, causing nipple soreness. Mothers with sore nipples should begin each feeding on the side that is least sore, switching to the sore breast after the let-down reflex has occurred. The infant should not be allowed to suck on an empty breast, which can cause damage to the nipple. If the nipples are sore, a breast-feeding session of ten minutes on each side should be sufficient to nourish the baby.
Ice packs applied to the breasts prior to breast-feeding can have a pain-relieving effect. Allowing nipples to air-dry after nursing can help to reduce nipple soreness.
In the case of cracked nipples, the application of an ointment or cream can aid healing. Ointments or creams allow the skin’s internal moisture to heal deep cracks and fissures while keeping the skin pliable.59 A frequently recommended and safe ointment for cracked nipples is medical grade, purified anhydrous lanolin (derived from wool fat). The nipples should be patted dry prior to application of a small amount of lanolin.
Doctors often recommend additional options for women with engorgement. A well-fitted bra can relieve some of the discomfort of engorgement. Applications of moist heat may encourage flow of milk from the breasts. Women may apply hot packs to the breasts just prior to breast-feeding. Other suggestions include frequent warm showers or alternating hot and cold showers. Cold packs applied to the breasts after breast-feeding can provide a slight pain-relieving effect.
Some infants will have a difficult time correctly latching on to an engorged breast. This can lead to inadequate nourishment and sore nipples. Expressing some excess milk, manually or with a pump, just prior to breast-feeding may relieve this difficulty. Women may also express milk after the infant has finished feeding to relieve any remaining sense of fullness. Massaging the breasts while breast-feeding may encourage milk flow from all the milk ducts and help to relieve engorgement.
A woman should continue breast-feeding from both breasts; the milk from the infected breast is still good for the baby. Moist heat over the painful breast can be helpful, and cold applications after breast-feeding can help alleviate swelling and pain. Breast-feeding women should also avoid constricting or under-wire bras that may irritate the infected breast.
Who can breast-feed?
Galactosemia is a rare metabolic condition that leads to an inability to break down galactose, one of the components of milk sugar (lactose). Infants with galactosemia should not breast-feed, but should be fed a special formula without lactose.60
Phenylketonuria (PKU) is another rare metabolic disorder, in which a newborn is unable to break down the amino acid phenylalanine. The resulting build-up of phenylalanine in the system can be harmful. There is some disagreement regarding whether it is safe to breast-feed infants with PKU. Some sources recommend against breast-feeding the infant with PKU.61 However, breast milk is low in phenylalanine and there is evidence that the exclusively breast-fed infant with PKU will not have damaging levels of phenylalanine accumulate in the bloodstream. A mother interested in breast-feeding her infant with PKU should work closely with a doctor. Close monitoring of the infant’s blood phenylalanine levels will be necessary.62
For infants in the United States and other developed countries born to mothers infected with the human immunodeficiency virus (HIV) it may be safer not to breast-feed.63 However, there is controversy over this issue. Some researchers have found HIV in human milk, indicating that there is the potential for passing the virus to a healthy baby while breast-feeding. Other studies indicate a very low risk of actually passing the infection to the baby through the breast milk.64
Additionally, a mother with untreated active tuberculosis should not breast-feed her infant. And the infant whose mother abuses drugs should not be breast-fed.65
Pregnant and breast-feeding women should choose a well-balanced and varied diet that includes fresh fruits and vegetables, whole grains, legumes, and fish. Many doctors recommend limiting intake of refined sugars, white flour, fried foods, processed foods, and chemical additives.
The caloric needs of a breast-feeding woman are even higher than during pregnancy. An extra 400 to 500 calories per day above pregnancy requirements are needed. Most women should consume approximately 2,800 calories per day to meet the energy needs of breast-feeding.66 Therefore, under most circumstances, doctors discourage dieting (i.e., calorie restriction). Weight loss following pregnancy usually occurs naturally, particularly if a woman can engage in moderate exercise. Breast-feeding uses up fat stores, and is a natural way to lose weight.
A woman should continue to take prenatal vitamins in order to meet the nutrient requirements of breast-feeding. Especially important is continued intake of calcium and calcium-rich foods.
Breast milk contains essential fatty acids. The fat composition of breast milk varies with a woman’s diet. If a woman consumes foods that provide essential fatty acids (e.g., vegetable oils such as canola oil, corn oil, and safflower oil; nut and seed oils; and fish), the breast milk she produces will contain higher quantities of essential fatty acids.67
Drinking to quench thirst is enough to support a healthy milk supply.68 Women are frequently instructed to drink extra fluids to increase milk supply. This is a common misunderstanding, however, and excessive fluid intake should be avoided.69
It is best to avoid all unnecessary medications, herbs, and nutritional supplements when breast-feeding. Most prescribed and over-the-counter medications, when taken by a breast-feeding mother, are considered safe for the infant. However, a doctor should always be consulted before any medication is taken. There are a few medications that mothers may need to take that may make it necessary to interrupt breast-feeding temporarily.
Initiating the breast-feeding relationship
A new mother should try to breast-feed her baby as soon as possible after delivery, ideally within the first hour of life.84 An infant should be fed on demand. A hungry infant will first get fussy, with increased activity and rooting (a reflex wherein the infant appears to be searching for the breast with his or her mouth) or mouthing behavior. Crying is a late sign of hunger. To get into the habit of feeding their babies, new mothers are often instructed to follow a schedule of breast-feeding every four hours around the clock. However, these imposed schedules, if followed beyond the first few weeks of life, often lead to frustration and confusion. The only infant who needs to be breast-fed on such a schedule is the infant who does not demand to be fed. Feeding on demand is the best way to increase milk supply. Most infants will empty the breast in 10 to 15 minutes. Some doctors advise gradually increasing the duration of breast-feeding over the first week of life. If this regimen is followed, it is important to breast-feed for at least five minutes on each side to get the benefit of the let-down reflex (which promotes the release of milk from the storage ducts in the breasts).85
Infants need no additional foods or liquids, if exclusively breast-feeding. Early introduction of these items may make successful breast-feeding difficult. Most breast-fed infants will not require any supplemental vitamins or minerals to meet daily requirements until at least six months of age.86 Vitamin D may be required for infants whose mothers are vitamin D-deficient or those infants not exposed to adequate sunlight. Iron may be required for infants with low iron stores or anemia.87
Anxiety over milk supply
Some low-birth-weight infants will require intensive care and ventilation in the hospital. Mothers of these infants often have difficulty continuing to produce breast milk. These mothers must rely on expressing breast milk manually because their babies cannot effectively breast-feed. Pumping milk is much less efficient than breast-feeding. Due to the inadequacy of pumping milk, milk production can decline. In low-birth-weight infants in an intensive care setting, skin-to-skin holding over a four-week period postpartum has increased a mother’s milk supply.88 In contrast, women who did not participate in skin-to-skin holding of their low-birth-weight infants did not experience an increase in milk production. These findings may have implications for all mothers experiencing a diminishing milk supply. In addition, some doctors will prescribe a day of rest to busy mothers whose milk supply seems to be lessening.89 Spending a day in close and relaxed contact with one’s newborn, with its associated increase in frequency of feedings, can effectively increasing milk supply.
Stress and fatigue can greatly inhibit the let-down reflex, lessening the production of milk. In a clinical trial involving mothers of premature infants, mothers who listened to an audiocassette tape based on relaxation and imagery techniques increased milk production by more than 60%, compared with mothers not listening to the tape.90 Whether relaxation techniques would increase milk supply in the mothers of full-term infants is not known.
Nutritional supplements that may be helpful for breast-feeding support
Docosahexaenoic acid (DHA), an omega-3 fatty acid present in cod liver oil and other fish oils, is important for normal development of the brain and eyes. Studies have shown that higher concentrations of DHA in mothers’ milk are associated with better visual acuity in the infants.91 Other studies have suggested that DHA improves the development of infants, although not all research agrees.92 Because DHA in the mother’s diet passes into the breast milk,93 some doctors advise nursing mothers to supplement their diet with cod liver oil or another fish-oil supplement. Women wishing to use this or any supplement while breast-feeding should consult their doctors and use only under the supervision of a qualified healthcare practitioner.
Are there any side effects or interactions with breast-feeding support?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful for breast-feeding support
Numerous herbs are used traditionally around the world to promote production of breast milk.94 Herbs that promote milk production and flow are known as galactagogues. Stinging nettle (Urtica dioica) enriches and increases the flow of breast milk and restores the mother’s energy following childbirth.95 Vitex (Vitex agnus castus) is one of the best-recognized herbs in Europe for promoting lactation. An older German clinical trial found that 15 drops of a vitex tincture three times per day could increase the amount of milk produced by mothers with or without pregnancy complications compared with mothers given vitamin B1 or nothing. Vitex should not be taken during pregnancy.96 Goat’s rue (Galega officinalis) also has a history of use in Europe for supporting breast-feeding. Taking 1 teaspoon of goat’s rue tincture three times per day is considered by European practitioners to be helpful in increasing milk volume.97 Studies are as yet lacking to support the use of goat’s rue as a galactagogue. In two preliminary trials, infants have been shown to nurse longer when their mothers ate garlic than when their mothers took placebos.98 99 However, some infants may develop colic if they consume garlic in breast milk.
For sore nipples, some healthcare practitioners may recommend a warm, moist poultice of herbs with demulcent (soothing) properties. Demulcents are traditionally used to aid healing and soothe any irritated tissue. Examples of herbs traditionally used as demulcents to relieve sore nipples are marigold (Calendula officinalis), comfrey (Symphytum officinalis), and chickweed (Stellaria media). To prepare a poultice, the dried herbs are moistened with boiling water and wrapped within two layers of gauze. The poultice is then applied to the breasts. Application of a hot water bottle over the poultice will keep the poultice warm longer. Any residue should be washed from the breast before the baby breast-feeds. Individuals wishing to use herbs during breast-feeding should do so only under the supervision of a qualified healthcare practitioner.
The safety of using anise during pregnancy and breast-feeding is unknown, though it is very likely safe and has traditionally been used to support breast-feeding in some cultures.100
Are there any side effects or interactions with breast-feeding support?
Refer to the individual herb for information about any side effects or interactions.