Deciding to breastfeed

For most infants, the American Academy of Pediatrics recommends breast milk as the primary source of nutrition for the first year of life. This recommendation is based on research that has shown breast milk to be the best source of nutrition for infants, with the added advantage of helping protect infants from certain diseases. Breastfeeding also offers health benefits to the mother.


Breast milk vs. formula
Breast milk contains more than 200 ingredients, some of which are still unknown. The ingredients combine in just the right amounts to promote brain development, normal digestion and proper growth. To meet the needs of a growing baby, the exact composition of breast milk changes during each feeding, throughout the day and as the baby enters each developmental stage.
Infant formulas are made to resemble breast milk as closely as possible, and most babies will thrive on formula when breastfeeding is not possible. Formulas are never exactly like breast milk, however. Some components of breast milk cannot be reproduced, and the composition of infant formula does not change to meet the baby's evolving needs. Formula is not as easily digested as breast milk, and its nutrients are not as readily absorbed by the infant's intestinal tract.


Benefits for the baby
Breast milk contains ingredients that help protect babies from disease until their own defenses mature. Breastfed infants have fewer and less severe episodes of diarrhea, vomiting, colds, ear infections, pneumonia, blood infections, urinary infections and meningitis (inflammation of the membranes surrounding the brain or spinal cord). Research also suggests that breastfeeding may provide protection from sudden infant death syndrome (SIDS).
Infants who are breastfed at least four months or longer have a lower incidence of:

childhood diabetes
Crohn's disease (a chronic inflammatory condition of the gastrointestinal tract)
childhood cancers such as leukemia (an uncontrolled, malignant growth of white blood cells in bone marrow) and lymphoma (a malignant growth of lymphoid tissue, the tissue that helps protect the body from invasion by bacteria or other organisms)
Because allergies are also less common among breastfed infants, complete breastfeeding until age 6 months is strongly recommended for infants born into families with a history of allergies.

In addition to the nutritional and health advantages, research also suggests that breastfeeding may help promote intellectual development.


Benefits for the mother
Breastfeeding causes the uterus to contract, which decreases vaginal discharge after delivery and helps the uterus return to its prepregnancy size. By stopping to breastfeed every two to three hours, you'll get some of the rest you need to recover from childbirth. Some mothers who breastfeed also find it easier to return to their prepregnancy weights.
Research has shown that breastfeeding may help protect the mother from:

ovarian cancer
breast cancer before menopause
osteoporosis (the loss of bone mass that leads to brittle bones)
Financially, breastfeeding is often more economical than formula feeding. The cost of an adequate diet for the breastfeeding mother is typically less than formula, especially if the baby needs a special type of formula. Breastfeeding also has the advantage of convenience. It's fresh, readily available at the right temperature, requires no preparation, and is easily transported. There are no bottles to warm up in the middle of the night or carry along on trips or outings. Of course, some preparation may be needed if the milk is expressed and stored for future use.


Preparation for breastfeeding
Before the baby is born, discuss breastfeeding with your doctor. It's also a good idea to find out if breastfeeding is supported in the facility where you'll deliver the baby. To promote bonding and successful breastfeeding, make sure you'll be able to nurse your baby within the first hour after delivery. Your baby is most likely to be alert during this time and want to suckle, but later may become quiet.
It's also important to learn as much about breastfeeding as possible before delivery. Attend a breastfeeding class, read about breastfeeding, and talk to women who've successfully nursed their babies.

You may also want to find a source of lactation education and support in your area, such as a lactation consultant (a professional who specializes in breastfeeding) or a support group. To find a breastfeeding specialist, ask a nurse in the postpartum unit at your hospital, your doctor or your baby's doctor -- many hospitals have breastfeeding specialists on staff. As another option, the nonprofit organization La Leche League provides education, information, support and encouragement for breastfeeding mothers through support groups with specially trained leaders. To learn more about La Leche League, call (847) 519-7730. Other local support groups may also be an option.

To prepare your nipples for breastfeeding, avoid using soap or lotion on your breasts. The breasts' natural secretions provide the best lubrication for keeping the nipple area moist and resistant to irritation. Before delivery, do not rub your nipples -- this stimulation can cause labor contractions. If you have flat or inverted nipples (those that do not protrude when stimulated), you may need special preparation for breastfeeding.


Special concerns about breastfeeding
You may fear that breastfeeding will tie you down. This is a legitimate concern because the baby will depend on you for nourishment. However, many nursing mothers enjoy a special satisfaction from this close bond with their infants. You may also find the convenience of breastfeeding may actually make life less complicated. After you've established regular breastfeeding, you can express milk that can be stored and given to your baby when you must be away.
You may be worried that breastfeeding will keep the baby's father from special moments of closeness with the baby. To combat this fear, encourage the baby's father to take advantage of other opportunities for closeness throughout the day, such as bath time and when the baby just needs to be cuddled or rocked.

Breast size and appearance don't affect the ability to produce an adequate amount of milk, so don't worry if you have small breasts or flat nipples. Remember, flat or inverted nipples may simply need specific preparation for breastfeeding. Also, breastfeeding has no permanent effect on the shape or size of your breasts. Any changes are more likely due to heredity, age, poor support or excess weight gain during pregnancy.

If you've had breast surgery such as augmentation or implants, you may have a decreased milk supply. Try it, however. If you have problems, consult your doctor or another source of support. There may be alternatives available to help you successfully nurse your baby.

If you must take medication regularly or have a chronic health problem, discuss the implications for breastfeeding with your doctor before delivery.


When breastfeeding may not be recommended
A few conditions or circumstances may interfere with breastfeeding, requiring a temporary interruption or preventing breastfeeding all together. Expressing milk during an interruption will usually ensure that you can continue breastfeeding later.
Infectious illnesses
With many infectious illnesses, your body will produce antibodies (compounds that help neutralize or destroy foreign substances in the blood) that can be passed to the baby through breast milk. In turn, these antibodies help protect the baby from the illness. Sometimes, however, certain germs can be passed to the baby through breast milk. To keep the baby from becoming ill, temporary or permanent formula feeding may be necessary.

Permanent formula feeding is a must if you have HIV (the virus that causes AIDS), AIDS or human T-cell leukemia virus type 1 (HTLV-1) and type 2 (HTLV-2). Although HTLV-1 is rare in the United States, the infection is prevalent in other parts of the world.

If you have tuberculosis (an infectious disease that affects the respiratory system), stop breastfeeding until you're doctor tells you you're no longer considered contagious. During the time you're not nursing your baby, you may want to pump and dump your breast milk to maintain your milk supply. (If you've been exposed to tuberculosis but do not have an active case of the disease, your doctor may prescribe INH and pyridoxine. Although these medications may be secreted in breast milk, no adverse effects for infants have been reported and you can usually continue breastfeeding your baby.)

If you've been infected with the herpes simplex virus type 1 (HSV-1) for the first time, your doctor may recommend interrupting breastfeeding until all the sores have healed. If at any time you develop a herpes sore on your breast, you may need to interrupt breastfeeding until it has healed. If you develop a sore elsewhere, your doctor may recommend covering it and continuing to nurse. Remember the importance of careful hand washing whenever herpes sores are present.

Infection in the breast itself is rarely a reason to stop breastfeeding. If you develop mastitis (inflammation of the breast tissue) or an abscess (collection of pus), stopping breastfeeding or pumping can actually make the condition worse. If it's too painful to nurse from the affected breast or your doctor determines that bacteria from an abscess are draining into the milk (a rare situation), you can pump the milk from that side instead and allow your baby to nurse from the other breast. Your baby will still get an adequate amount of milk. As the infection clears up or after 24 hours of antibiotic therapy, the baby can resume nursing from both breasts.
Medications
Always consult your doctor before taking any prescription or over-the-counter medication, nutritional supplement or herbal preparation while you're breastfeeding. Some medications shouldn't be taken by nursing mothers. Others should only be used if the benefit outweighs the possible risk to the baby. Considering recent research and drug recommendations, the baby's age and medical history, your health needs and possible alternatives, your doctor will help you decide if it's appropriate to continue nursing while you're taking certain medications.

Exposure to environmental contaminants
Breastfeeding after exposure to environmental contaminants such as herbicides, pesticides or heavy metals (including lead, mercury, arsenic and cadmium) is usually safe. However, it may not be recommended if the exposure was unusually heavy. If you've been exposed to an environmental contaminant, consult your doctor for details.

Substance abuse
Do not nurse your baby if you're abusing alcohol or using amphetamines, marijuana, cocaine, heroine, angel dust (PCP) or any other street drug. Remember, treatment programs are available.

Smoking
It's best not to smoke while breastfeeding your baby. After smoking, your breast milk contains nicotine. Studies of nursing mothers have associated smoking with a decreased milk supply, difficulty with let-down and early weaning. In addition, breastfed babies whose mothers smoke may be fussier, gain weight more slowly, have more respiratory infections, and have a higher risk of sudden infant death syndrome (SIDS). If you're unable to stop smoking, consider reducing some of these harmful effects by decreasing the number of cigarettes you smoke, using low nicotine cigarettes, smoking shortly after breastfeeding rather than before or during a nursing session, and never smoking around your baby.