Breastfeeding, also known as nursing, is the feeding of babies and young children with milk from a woman's breast.
The World Health Organization (WHO) “Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. Exclusive breastfeeding from birth is possible except for a few medical conditions, and unrestricted exclusive breastfeeding results in ample milk production.”
UNICEF “The aim is to create an environment globally that empowers women to begin skin-to-skin with her baby and breastfeed after birth, to breastfeed exclusively for the first six months and to continue to breastfeed for two years or more with age appropriate, responsive complementary feeding.”
Breast milk provides the ideal nutrition for infants. It has a nearly perfect mix of vitamins, protein, and fat - everything your baby needs to grow. And it's all provided in a form more easily digested than infant formula.
Health professionals recommend that breastfeeding begin within the first hour of a baby's life and continue as often and as much as the baby wants. During the first few weeks of life babies may nurse roughly every two to three hours. The duration of a feeding is usually ten to fifteen minutes on each breast. Older children feed less often. Mothers may pump milk so that it can be used later when breastfeeding is not possible. Breastfeeding has a number of benefits to both mother and baby, which infant formula lacks.
Deaths of an estimated 820,000 children under the age of five could be prevented globally every year with increased breastfeeding. Breastfeeding decreases the risk of respiratory tract infections and diarrhea, both in developing and developed countries. Other benefits include lower risks of asthma, food allergies, celiac disease, type 1 diabetes, and leukemia. Breastfeeding may also improve cognitive development and decrease the risk of obesity in adulthood. Mothers may feel pressure to breastfeed; however in the developed world children generally grow up normally when bottle fed.
Health organizations, including the World Health Organization (WHO), recommend breastfeeding exclusively for six months. This means that no other foods or drinks other than possibly vitamin D are typically given. After the introduction of foods at six months of age, recommendations include continued breastfeeding until at least one to two years of age.
Globally about 38% of infants are only breastfed during their first six months of life. Medical conditions that do not allow breastfeeding are rare. Mothers who take certain recreational drugs and medications should not breastfeed. Smoking, limited intake of alcohol, and coffee are not reasons to avoid breastfeeding.
The endocrine system drives milk production during pregnancy and the first few days after the birth. From the twenty-fourth week of pregnancy (the second and third trimesters), a woman's body produces hormones that stimulate the growth of the breast's milk duct system. Progesterone influences the growth in size of alveoli and lobes; high levels of progesterone, estrogen, prolactin and other hormones inhibit lactation before birth; hormone levels drop after birth, triggering milk production. After birth, the hormone oxytocin contracts the smooth muscle layer of cells surrounding the alveoli to squeeze milk into the duct system. Oxytocin is also necessary for the milk ejection reflex, or let-down to occur. Let-down occurs in response to the baby's suckling, though it also may be a conditioned response, e.g. to the cry of the baby. Lactation can also be induced by a combination of physical and psychological stimulation, by drugs or by a combination of these methods.
Not all of breast milk's properties are understood, but its nutrient content is relatively consistent. Breast milk is made from nutrients in the mother's bloodstream and bodily stores. Breast milk has an optimal balance of fat, sugar, water, and protein that is needed for a baby's growth and development. Breastfeeding triggers biochemical reactions which allows for the enzymes, hormones, growth factors and immunologic substances to effectively defend against infectious diseases for the infant. The breast milk also has long-chain polyunsaturated fatty acids which help with normal retinal and neural development. Because breastfeeding requires an average of 500 calories a day, it helps the mother lose weight after giving birth.
The composition of breast milk changes depending on how long the baby nurses at each session, as well as on the child's age. The first type, produced during the first days after childbirth, is called colostrum. Colostrum is easy to digest although it is more concentrated than mature milk. It has a laxative effect that helps the infant to pass early stools, aiding in the excretion of excess bilirubin, which helps to prevent jaundice. It also helps to seal the infants’ gastrointestinal tract from foreign substances, which may sensitize the baby to foods that the mother has eaten. Although the baby has received some antibodies through the placenta, colostrum contains a substance which is new to the newborn, secretory immunoglobulin A (IgA). IgA works to attack germs in the mucous membranes of the throat, lungs, and intestines, which are most likely to come under attack from germs.
Breasts begin producing mature milk around the third or fourth day after birth. Early in a nursing session, the breasts produce foremilk, thinner milk containing many proteins and vitamins. If the baby keeps nursing, then hindmilk is produced. Hindmilk has a creamier colour and texture because it contains more fat. While breastfeeding mothers should avoid the use of alcoholic beverages, an occasional celebratory single, small alcoholic drink is acceptable, but breastfeeding should be avoided for 2 hours after the drink.
Breastfeeding can begin immediately after birth. The baby is placed on the mother and feeding starts as soon as the baby shows interest.
According to some authorities, increasing evidence suggests that early skin-to-skin contact (also called kangaroo care) between mother and baby stimulates breastfeeding behaviour in the baby. Newborns who are immediately placed on their mother’s skin have a natural instinct to latch on to the breast and start nursing, typically within one hour of birth. Immediate skin-to-skin contact may provide a form of imprinting that makes subsequent feeding significantly easier. In addition to more successful breastfeeding and bonding, immediate skin-to-skin contact reduces crying and warms the baby.
According to studies cited by UNICEF, babies naturally follow a process which leads to a first breastfeed. Initially after birth the baby cries with its first breaths. Shortly after, it relaxes and makes small movements of the arms, shoulders and head. The baby then begins to feed. After feeding, it is normal for a baby to remain latched to the breast while resting. This is sometimes mistaken for lack of appetite. Absent interruptions, all babies follow this process. Rushing or interrupting the process, such as removing the baby to weigh him/her, may complicate subsequent feeding. Activities such as weighing, measuring, bathing, needle-sticks, and eye prophylaxis wait until after the first feeding.
Children who are born preterm(of a premature birth) have difficulty in initiating breast feeds immediately after birth. By convention, such children are often fed on expressed breast milk or other supplementary feeds through tubes or bottles until they develop satisfactory ability to suck breast milk. Tube feeding, though commonly used, is not supported by scientific evidence as of October 2016. It has also been reported in the same systematic review that by avoiding bottles and using cups instead to provide supplementary feeds to preterm children, a greater extent of breast feeding for a longer duration can subsequently be achieved.
Newborn babies typically express demand for feeding every 1 to 3 hours (8-12 times in 24 hours) for the first two to four weeks. A newborn has a very small stomach capacity. At one-day old it is 5 to 7 ml, about the size of a marble; at day three it is 0.75-1 oz, about the size of a "shooter" marble; and at day seven it is 1.5-2 oz, or about the size of a ping-pong ball. The amount of breast milk that is produced is timed to meet the infant's needs in that the first milk, colostrum, is concentrated but produced in only very small amounts, gradually increasing in volume to meet the expanding size of the infant's stomach capacity.
Experienced breastfeeding mothers learn that the sucking patterns and needs of babies vary. While some infants' sucking needs are met primarily during feedings, other babies may need additional sucking at the breast soon after a feeding even though they are not really hungry. Babies may also nurse when they are lonely, frightened or in pain.
Comforting and meeting sucking needs at the breast is nature's original design. Pacifiers (dummies, soothers) are a substitute for the mother when she cannot be available. Other reasons to pacify a baby primarily at the breast include superior oral-facial development, prolonged lactational amenorrhea, avoidance of nipple confusion, and stimulation of an adequate milk supply to ensure higher rates of breastfeeding success.
During the newborn period, most breastfeeding sessions take from 20 to 45 minutes. After one breast is empty, the mother may offer the other breast.
A mother can "express" (produce) her milk for storage and later use. Expression occurs with massage or a breast pump. It can be stored in freezer storage bags, containers made specifically for breast-milk, a supplemental nursing system, or a bottle ready for use. Using someone other than the mother/wet nurse to deliver the bottle maintains the baby's association of nursing with the mother/wet nurse and bottle feeding with other people.
Breast milk may be kept at room temperature for up to six hours, refrigerated for up to eight days or frozen for six to twelve months. Research suggests that the antioxidant activity in expressed breast milk decreases over time, but remains at higher levels than in infant formula.
Mothers express milk for multiple reasons. Expressing breast milk can maintain a mother's milk supply when she and her child are apart. A sick baby who is unable to nurse can take expressed milk through a nasogastric tube. Some babies are unable or unwilling to nurse. Expressed milk is the feeding method of choice for premature babies. Viral disease transmission can be prevented by expressing breast milk and subjecting it to Holder pasteurisation. Some women donate expressed breast milk (EBM) to others, either directly or through a milk bank. This allows mothers who cannot breastfeed to give their baby the benefits of breast milk.
Babies feed differently with artificial nipples than from a breast. With the breast, the infant's tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth. Drinking from a bottle takes less effort and the milk may come more rapidly, potentially causing the baby to lose desire for the breast. This is called nursing strike, nipple strike or nipple confusion. To avoid this, expressed milk can be given by means such as spoons or cups.
"Exclusively expressing", "exclusively pumping", and "EPing" are terms for a mother who exclusively feeds her baby expressed milk. With good pumping habits, particularly in the first 12 weeks while establishing the milk supply, it is possible to express enough milk to feed the baby indefinitely. With the improvements in breast pumps, many women exclusively feed expressed milk, expressing milk at work. Women can leave their infants in the care of others while travelling, while maintaining a supply of breast milk.
Wet nursing was common throughout history. It remains popular in some developing nations, including those in Africa, for more than one woman to breastfeed a child. Shared breastfeeding is a risk factor for HIV infection in infants. A woman who is engaged to breastfeed another's baby is known as a wet nurse. Shared nursing can sometimes provoke negative reactions in the Anglosphere.
Feeding two children at the same time who are not twins or multiples is called tandem nursing. Appetite and feeding habits of each baby may differ, so they may feed at the same or different times, which may involve feeding them simultaneously, one on each breast.
Breastfeeding triplets or larger broods is a challenge given babies' varying appetites. Breasts can respond to the demand and produce larger milk quantities; mothers have breastfed triplets successfully.
Tandem nursing occurs when a woman gives birth while breastfeeding an older child. During the late stages of pregnancy, the milk changes to colostrum. While some children continue to breastfeed even with this change, others may wean. Breastfeeding a child while pregnant with another may be considered a form of tandem feeding for the nursing mother, as she provides nutrition for two.
Induced lactation, also called adoptive lactation, is the process of starting breastfeeding in a woman who did not give birth. This usually requires the adoptive mother to take hormones and other drugs to stimulate breast development and promote milk production. In some cultures, breastfeeding an adoptive child creates milk kinship that built community bonds across class and other hierarchal bonds.
Re-lactation is the process of restarting breastfeeding. In developing countries, mothers may restart breastfeeding after a weaning as part of an oral rehydration treatment for diarrhea. In developed countries, re-lactation is common after early medical problems are resolved, or because a mother changes her mind about breastfeeding.
Re-lactation is most easily accomplished with a newborn or with a baby that was previously breastfeeding; if the baby was initially bottle-fed, the baby may refuse to suckle. If the mother has recently stopped breastfeeding, she is more likely to be able to re-establish her milk supply, and more likely to have an adequate supply. Although some women successfully re-lactate after months-long interruptions, success is higher for shorter interruptions.
Techniques to promote lactation use frequent attempts to breastfeed, extensive skin-to-skin contact with the baby, and frequent, long pumping sessions. Suckling may be encouraged with a tube filled with infant formula, so that the baby associates suckling at the breast with food. A dropper or syringe without the needle may be used to place milk onto the breast while the baby suckles. The mother should allow the infant to suckle at least ten times during 24 hours, and more times if he or she is interested. These times can include every two hours, whenever the baby seems interested, longer at each breast, and when the baby is sleepy when he or she might suckle more readily. In keeping with increasing contact between mother and child, including increasing skin-to-skin contact, grandmothers should pull back and help in other ways. Later on, grandmothers can again provide more direct care for the infant.
These techniques require the mother's commitment over a period of weeks or months. However, even when lactation is established, the supply may not be large enough to breastfeed exclusively. A supportive social environment improves the likelihood of success. As the mother's milk production increases, other feeding can decrease. Parents and other family members should watch the baby's weight gain and urine output to assess nutritional adequacy.
Extended breastfeeding means breastfeeding after the age of 12 or 24 months, depending on the source. Worldwide, infants are weaned on average between ages two and four. Breast-feeding continues until children are six or seven years old in some cultures but in other countries extended breast-feeding is less common. In Western countries such as the United States, Canada, and Great Britain, extended breastfeeding is relatively uncommon and can provoke criticism.
In India, mothers commonly breastfeed for 2 to 3 years.
The ABCs of Breastfeeding
A = Awareness. Watch for your baby's signs of hunger, and breastfeed whenever your baby is hungry. This is called "on demand" feeding. The first few weeks, you may be nursing eight to 12 times every 24 hours. Hungry infants move their hands toward their mouths, make sucking noises or mouth movements, or move toward your breast. Don't wait for your baby to cry. That's a sign he's too hungry.
B = Be patient. Breastfeed as long as your baby wants to nurse each time. Don't hurry your infant through feedings. Infants typically breastfeed for 10 to 20 minutes on each breast.
C = Comfort. This is key. Relax while breastfeeding, and your milk is more likely to "let down" and flow. Get yourself comfortable with pillows as needed to support your arms, head, and neck, and a footrest to support your feet and legs before you begin to breastfeed.
What's the Best Position for Breastfeeding?
The best position for you is the one where you and your baby are both comfortable and relaxed, and you don't have to strain to hold the position or keep nursing. Here are some common positions for breastfeeding your baby in pictures:
Are There Medical Considerations With Breastfeeding?
In a few situations, breastfeeding could cause a baby harm. You should not breastfeed if:
You are HIV positive. You can pass the HIV virus to your infant through breast milk.
You have active, untreated tuberculosis.
You're receiving chemotherapy for cancer.
You're using an illegal drug, such as cocaine or marijuana.
Your baby has a rare condition called galactosemia and cannot tolerate the natural sugar, called galactose, in breast milk.
You're taking certain prescription medications, such as some drugs for migraine headaches, Parkinson's disease, or arthritis.
Talk with your doctor before starting to breastfeed if you're taking prescription drugs of any kind. Your doctor can help you make an informed decision based on your particular medication.
Having a cold or flu should not prevent you from breastfeeding. Breast milk won't give your baby the illness and may even give antibodies to your baby to help fight off the illness.
Why Do Some Women Choose Not to Breastfeed?
Some women don't want to breastfeed in public.
Some prefer the flexibility of knowing that a father or any caregiver can bottle-feed the baby any time.
Babies tend to digest formula more slowly than breast milk, so bottle feedings may not be as frequent as breastfeeding sessions.
The time commitment, and being "on-call" for feedings every few hours of a newborn's life, isn't feasible for every woman. Some women fear that breastfeeding will ruin the appearance of their breasts. But most breast surgeons would argue that age, gravity, genetics, and lifestyle factors like smoking all change the shape of a woman's breasts more than breastfeeding does.
What Are Some Common Challenges With Breastfeeding?
Sore nipples. You can expect some soreness in the first weeks of breastfeeding. Make sure your baby latches on correctly, and use one finger to break the suction of your baby's mouth after each feeding. That will help prevent sore nipples. If you still get sore, be sure you nurse with each breast fully enough to empty the milk ducts. If you don't, your breasts can become engorged, swollen, and painful. Holding ice or a bag of frozen peas against sore nipples can temporarily ease discomfort. Keeping your nipples dry and letting them "air dry" between feedings helps, too. Your baby tends to suck more actively at the start. So begin feedings with the less-sore nipple.
Dry, cracked nipples. Avoid soaps, perfumed creams, or lotions with alcohol in them, which can make nipples even more dry and cracked. You can gently apply pure lanolin to your nipples after a feeding, but be sure you gently wash the lanolin off before breastfeeding again. Changing your bra pads often will help your nipples stay dry. And you should use only cotton bra pads.
Worries about producing enough milk. A general rule of thumb is that a baby who's wetting six to eight diapers a day is most likely getting enough milk. Avoid supplementing your breast milk with formula, and never give your infant plain water. Your body needs the frequent, regular demand of your baby's nursing to keep producing milk. Some women mistakenly think they can't breastfeed if they have small breasts. But small-breasted women can make milk just as well as large-breasted women. Good nutrition, plenty of rest, and staying well hydrated all help, too.
Pumping and storing milk. You can get breast milk by hand or pump it with a breast pump. It may take a few days or weeks for your baby to get used to breast milk in a bottle. So begin practicing early if you're going back to work. Breast milk can be safely used within 2 days if it's stored in a refrigerator. You can freeze breast milk for up to 6 months. Don't warm up or thaw frozen breast milk in a microwave. That will destroy some of its immune-boosting qualities. Thaw in the refrigerator or in a bowl of warm water.
Inverted nipples. An inverted nipple doesn't poke forward when you pinch the areola, the dark skin around the nipple. A lactation consultant - a specialist in breastfeeding education - can give simple tips that have allowed women with inverted nipples to breastfeed successfully.
Breast engorgement. Breast fullness is natural and healthy. It happens as your breasts become full of milk, staying soft and pliable. But breast engorgement means the blood vessels in your breast have become congested. This traps fluid in your breasts and makes them feel hard, painful, and swollen. Alternate heat and cold, for instance using ice packs and hot showers, to relieve mild symptoms. It can also help to release your milk by hand or use a breast pump.
Blocked ducts. A single sore spot on your breast, which may be red and hot, can signal a plugged milk duct. This can often be relieved by warm compresses and gentle massage over the area to release the blockage. More frequent nursing can also help.
Breast infection (mastitis). This occasionally results when bacteria enter the breast, often through a cracked nipple after breastfeeding. If you have a sore area on your breast along with flu-like symptoms, fever, and fatigue, call your doctor. Antibiotics are usually needed to clear up a breast infection, but you can most likely continue to breastfeed while you have the infection and take antibiotics. To relieve breast tenderness, apply moist heat to the sore area four times a day for 15 to 20 minutes each time.
Stress. Being overly anxious or stressed can interfere with your let-down reflex. That's your body's natural release of milk into the milk ducts. It's triggered by hormones released when your baby nurses. It can also be triggered just by hearing your baby cry or thinking about your baby. Stay as relaxed and calm as possible before and during nursing -- it can help your milk let down and flow more easily. That, in turn, can help calm and relax your infant.
Premature babies may not be able to breastfeed right away. In some cases, mothers can release breast milk and feed it through a bottle or feeding tube.
Breastfeeding is a natural, healthy process. But call your doctor if:
Your breasts become unusually red, swollen, hard, or sore.
You have unusual discharge or bleeding from your nipples.
You're concerned your baby isn't gaining weight or getting enough milk.
Where Can I Get Help With Breastfeeding?
Images of mothers breastfeeding their babies make it look simple - but most women need some help and coaching. It can come from a nurse, doctor, family member, or friend, and it helps mothers get over possible bumps in the road.
Reach out to friends, family, and your doctor with any questions you may have. Most likely, the women in your life have had those same questions.
Women who don't have health problems should try to give their babies breast milk for at least the first six months of life. Most women with health problems can breastfeed. There are rare exceptions when women are advised not to breastfeed because they have certain illnesses. Some medicines, illegal drugs, and alcohol can also pass through the breast milk and cause harm to your baby. Check with your health care provider if you have concerns about whether you should breastfeed.
If you are having problems with breastfeeding, contact a lactation consultant.