Birth and Infant Feeding

By Bettina Forbes and Casi Leahy

Birth
Infant Feeding
Resources

Expecting parents face many exciting decisions; what to name the baby, how to decorate the nursery, and where to register are a few that tend to take center stage. All parents want a healthy, happy baby. This is a special and miraculous time as the baby grows and becomes ready to enter the world.

Planning the birth and deciding on which feeding method to choose are two important topics all parents need to consider. Many parents are unaware of the great deal of evidence-based information regarding birth and infant feeding. Without the proper information, are parents truly exercising their right to choose what is best for their families and their babies? Or is their decision-making process and the act of carrying out their decisions being undermined by cultural and institutional barriers? Unfortunately, there are a lot of mixed messages and conflicting agendas that conspire to deny parents access to the best, most accurate information that they need to make these important decisions with confidence and without regret. Parents deserve information based in scientific research and they also deserve to be educated about misleading industry marketing practices, in order to make informed choices. We have put together a collection of resources, including websites, medical and scientific articles,and support groups to bring more critical information into the hands of expecting parents, their families, friends, and supporters.

Birth

According to a new Canadian study of approximately 13,000 births, a midwife-assisted home birth is safer than a hospital birth for low-risk pregnancies. Interestingly, however, the American, Australian and New Zealand Colleges of Obstetricians and Gynecologists oppose home births. Talk show host Ricki Lake made a compelling film called “The Business of Being Born” (watch the trailer on our Video page, Other & Movies) which, true to its title, exposes the big business behind highly medicalized births in the U.S.. Almost 31% of all births are cesarean, but yet only 7% of cesareans are truly necessary, a sobering fact considering the increased risk of mortality and the many adverse maternal and breastfeeding outcomes associated with cesarean delivery. Increased C-sections carry a high pricetag for managed health care, too, and contribute to the current health care crisis. Even without a cesarean, highly medicalized births are more traumatic for new parents and babies, and a new study reveals that drugs commonly used to decrease bleeding after birth interfere with breastfeeding—whereas breastfeeding is shown to reduce post-partum bleeding naturally.

For those of you who do not have an option of a home birth delivery, planning a safe and natural delivery without medical intervention may seem challenging; however, planning is key. Expectant parents need to educate themselves on the natural birth process and seek assistance from health care professionals that will not only respect their decisions but offer support and encouragement in the birthing process. For example, the use of a doula or trained labor assistant has been shown to reduce the need for epidurals and cesarean delivery, especially after induced labor. Childbirth classes that focus on non-pharmacological pain relief measures, comfort techniques, and stress evidenced based birthing techniques is a great way to prepare. Letting labor begin on its own, using movement to promote progress, the importance of continued support throughout the labor, avoiding unnecessary medical interventions, utilizing non supine (back lying) positions and following natural pushing urges, as well as no separation of mother and baby (immediate skin to skin contact) with early introduction of breastfeeding (within the first hour) are some of the care practices promoted by Lamaze International (2009) and leading health experts; these care practices focus on pregnancy and birth as a normal and natural process. Many parents who take this approach report feeling empowered by the birth process and experience fewer breastfeeding difficulties.

Infant Feeding

Consider taking the Life Health Choices Infant Feeding Quiz before reading this section.

The benefits of breastfeeding for an infant and a mother are well-documented. Breastmilk provides infants with the optimum nutrition needed for growth and development and there are few instances where breastfeeding is contraindicated or not possible. The American Academy of Pediatrics (AAP) and The World Health Organization (WHO) recommend that all infants be breastfeed exclusively, with no supplementation, for the first six months of life with continued breastfeeding for at least 12 months (AAP 2005) or two years (WHO 2003), and they encourage continued breastfeeding for as long as mother and baby wish. Although breastfeeding initiation rates have continued to climb in the United States, only 11% of new mothers are achieving the AAP recommendation of six months exclusive breastfeeding (CDC, 2009). While 77% of new mothers are trying to breastfeed, 60% are not achieving their personal goals, it is not their fault, if you consider the many institutional and cultural obstacles (read Best for Babes’ Booby Trap) none of us should be surprised.

This trend strongly suggests that more support and systemic changes are needed for new families during the vulnerable time after birth. Many mothers faced with breastfeeding challenges are quick to wean if they do not have the appropriate information and, more importantly, support to overcome these challenges. The number one reason most women initiate weaning is “perceived milk insufficiency” when, in many cases, this can be resolved with appropriate support. With most hospitals performing poorly on breastfeeding support, it is no wonder that breastfeeding mothers are experiencing unnecessary difficulties.

Initiating a healthy lifestyle begins at birth and the feeding method you choice can help promote optimal health for your infant. The American Academy of Pediatrics tells us that breastfeeding is good for baby and mom. Read their Parenting Corner Q&A on Breastfeeding, updated September 2009. According to the AAP, breastfed children are less likely to have:

ear infections
diarrhea
pneumonia, wheezing, bronchiolitis
other bacterial and viral infections, such as meningitis
research suggests it may help to protect against obesity, diabetes, SIDS, and some cancers

and breastfeeding helps mothers to

release hormones that promote mothering behavior
promote rapid uterine involution after delivery, decreasing postpartum bleeding and helping the uterus return to its pre-pregnancy size
burn more calories, which may help to lose weight gained during pregnancy
delay the return of menstrual periods to help keep iron in the body
provide contraception, only if these three conditions are met: 1) mom is exclusively breastfeeding and not giving baby any supplements; 2) it is within six months of birth; and 3) menstrual periods have not returned
reduce the risk of ovarian cancer and breast cancer, with a 60% decrease in breast cancer if there is family history
reduce the risk of osteoporosis, keeping bones strong, which helps protect against bone fractures in older age
lower the risk of heart disease, the number one cause of death in women.

Finally, and very importantly, breastfeeding provides warmth, closeness, comfort and bonding, between mother and child. As we now know, large amounts of the mammalian hormone oxytocin are excreted during labor and stimlulation of the nipples, facilitating both birth and breastfeeding. Recent studies are beginning to investigate the role of oxytocin in mating, trust, anxiety, love and maternal behaviors. In the April 2009 Progress in Neurobiology article: Oxytocin: The Great Facilitator of Life, it states:

"Although Oxt is implicated in a variety of “non-social” behaviors, such as learning, anxiety, feeding and pain perception, it is Oxt's roles in various social behaviors that have come to the fore recently. Oxt is important for social memory and attachment, sexual and maternal behavior, and aggression. Recent work implicates Oxt in human bonding and trust as well. Human disorders characterized by aberrant social interactions, such as autism and schizophrenia, may also involve Oxt expression. Many, if not most, of Oxt's functions, from social interactions (affiliation, aggression) and sexual behavior to eventual parturition, lactation and maternal behavior, may be viewed as specifically facilitating species propagation."

The highest quality information available today points to the importance of breastfeeding our children, whenever possible, to support their physical, social and emotional health. It makes sense that we encourage increased funding of public health resources to assist mothers in reaching their breastfeeding goals, and that we also carefully evaluate the role of private interests that profit from the sale of baby formula. In the past few decades, the marketing resources and political clout of the $8 billion formula industry has inappropriately influenced new mothers when they are most vulnerable, and destroyed the breastfeeding support infrastructure. It is time for all parents to have evidence-based data to inform their infant feeding decisions and, if they choose to breastfeed, be supported in achieving their personal breastfeeding goals. To close, in the words of the AAP, from their 2005 article Breastfeeding and the Use of Human Milk:

"Human milk is species-specific, and all substitute feeding preparations differ markedly from it, making human milk uniquely superior for infant feeding. Exclusive breastfeeding is the reference or normative model against which all alternative feeding methods must be measured with regard to growth, health, development, and all other short- and long-term outcomes. In addition, human milk-fed premature infants receive significant benefits with respect to host protection and improved developmental outcomes compared with formula-fed premature infants."

Resources:

Support

Best For Babes
Birthing From Within
Business of Being Born
Dona International
Find A Lactation Consultant
Human Milk Banking Association of North America
La Leche League International
Lamaze International
My Best Birth
Reducing Infant Mortality
The Lactation Lady

World Alliance For Breastfeeding Action

Articles

Booby Trap (Best For Babes)
Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries (Tufts-New England)
Breastfeeding Report Card - United States, 2009 (CDC)
Breastfeeding, the Immune Response and Long-term Health (JAOA)
Donor Breast Milk Versus Infant Formula For Preterm Infants (Fetal Neonatal)
Facts For Life - Breastfeeding (UNICEF, WHO, World Food Programme et al)
Global Strategy for Infant and Young Children Feeding (WHO)
How Breastmilk Protects Newborns
Mucosal Immunity: Integration Between Mother and the Breastfed Infant (PubMed)

Our very best wishes to you as you embark on the miraculous journey of pregnancy, birth and parenthood. We hope that the Life Health Choices website and the many other resources provided here will support you in making the best decisions for your growing family.

Bettina Forbes, CLC, Best For Babes
Casi Leahy, BA, RN, MSN, LCCE, IBCLC, The Lactation Lady
Louise Kuo Habakus, MA, HHP, AADP, Life Health Choices