Updated: Dec 11, 2020
Let’s talk about breastfeeding.
I am super passionate about breastfeeding; its benefits, how to do it, what to do when hurdles appear etc. etc. Many times, I have stayed quiet when ‘controversial’ breastfeeding topics are mentioned to avoid conflict. However, for the sake of mothers everywhere, I will try to, as eloquently as possible (and using way to many GIF's), put onto a page why breastfeeding is important and how we as a society, as friends of breastfeeding mums, well-meaning family members, health professionals and strangers are sabotaging the breastfeeding journey of mums. As well as cover, how we can break this cycle and empower the breastfeeding women around us.
WHY IS BREASTFEEDING IMPORTANT?
Let’s start with the basics. The World Health Organisation (WHO) recommends exclusive breastfeeding (only breastmilk, no water or formula etc.) for the first six months of a baby’s life. Then at six months old complementary feeding (breastfeeding and solids) until baby is 2 years old (or beyond, if mother’s wish to).
I truly believe with adequate support virtually every mother would be able to breastfeed. I have helped many women overcome the common hurdles in breastfeeding and many of these issues, which felt like the downfall of a mother’s breastfeeding journey, required only some hands-on support and minor tweaks for things to get back on track. Breastfeeding is a skill that mothers and babies must learn and may take patience and practice. Breastfeeding may come naturally to some women however, the majority of women will need encouragement, advice, help with positioning and attachment and support from family and friends to have a successful breastfeeding journey.
Disclaimer: In this next section, I am going to present an evidence based comparison of breast milk and formula. This is in no way intended to shame anyone who has ever given their baby formula. Believing in the importance of breastfeeding does not make me anti-formula. I am, however, a strong believer in informed choice. In order to make an informed choice, one needs to be informed. This includes being aware of all the details, options, risks and benefits of whatever you are making a decision about. Whether you decide to breastfeed, mix feed or formula feed, I will be here to support you no matter what!
BREAST MILK VS FORMULA
So, is there that much of a difference between breast milk and formula? Short answer? Yes, there is a massive difference!
Let’s take a deeper look into a comparison of breast milk and formula. Whether your baby receives breast milk or formula, they will grow. Both will provide calories and hydration. Over the years formula has advanced in many ways through changes in formulation and how it is manufactured. Despite this, it is no match to the numerous health benefits of breast milk. Breast milk is a complex liquid that is uniquely designed to build our brains, digestive and immune systems. By comparison, formula is made from cow’s milk which meets the needs of a growing calve and is not safe for babies to consume. As such, cow’s milk must be rigorously processed to be made safe for babies.
“Did you know the salt (sodium) content in cow’s milk is pretty much at toxic levels for babies? In fact, in the early 1980s, cow’s milk was known to be toxic to laboratory animals such as rabbits or rats. These days, if any compound is toxic to a laboratory animal it’s not pursued in drug studies. So, by today’s standards, they wouldn’t have been allowed to make formula! Meanwhile, mother’s milk has very low concentrations of sodium.” says Professor Peter Hartmann, an internationally renowned specialist in breastfeeding and milk production, based at the University of Western Australia.
SO, WHAT IS IN BREAST MILK?
The first milk produced is called colostrum, this will coat and seal the lining of your baby’s stomach and has been dubbed ‘liquid gold’ (I will go into more depth about colostrum in upcoming blog posts). Mature milk is when your body starts to produce larger volumes of milk and will usually ‘come in’ when your baby is about three days old. From the very start, each and every drop of breast milk will contain millions of protective and beneficial components! Some of these include:
- Antibodies that protect against a wide range of illnesses
- Hormones that promote and regulate body systems such as appetite and bonding
- Stem cells which support and repair organ systems
- Infection fighting white blood cells
- Good bacteria that protect baby’s digestive system
- Oligosaccharides which are prebiotics that support a healthy gut microbiome
- Long-chain fatty acids which aid in the development of baby’s brain, eyes and nervous system
- Enzymes that support babies immune and digestive systems
- Hormones and nucleotides which develop wakeful and sleep patterns
One of the most uniquely beneficial features of breast milk over formula is that breast milk is a living, ever-changing fluid. It adapts to your baby’s individual needs, so if your baby is sick your body will produce the specific antibodies needed as well as extra white blood cells. These will travel into your breast milk and help fight infection. Amazing, right?! A somewhat demeaning comment I tend to hear is “Well so and so’s baby was breastfed and still got a cold, so it can’t be that good, can it?” Although breast milk is filled with millions of antibodies and protective substances, babies may become ill at some stage and it is not warranted to demote the benefits of breastfeeding because of this. Breastfed babies are much less likely to become ill and if they do the illness is commonly much less severe and shorter in duration.
Once baby turns six months old and complementary solids feeding begins, the beneficial properties of breast milk don’t just fade away. During this active stage of crawling and walking, babies will explore the world by putting everything into their mouths! Breast milk is propped full of protective features that have been designed to support a growing baby safely explore their surroundings.
SO, WHAT IS IN FORMULA?
The exact ingredients in powdered formula will vary by brand and by country. Most formula is made with highly processed skim cow’s milk. Added to this are stabilisers and emulsifiers that help the oils mix with water when making up the feed. Here is a typical list of ingredients found in formula:
- Lactose and other sugars such as corn syrup or maltodextrin
- Plant-based oils such as palm and sunflower oil
- Fatty acids derived from fish oil
- Vitamins and minerals from plant and animal sources
- One or two enzymes or amino acids
- Probiotics in some formulas
“Scientists have shown there are more than 1,000 proteins in breast milk– and the best formula companies are looking at increasing just one or other of them,” explains Professor Hartmann. “What’s more, people have only just been able to synthesise some of the many oligosaccharides found in breast milk. So, copying a couple of proteins and oligosaccharides is not going to get you breast milk!"
“As far as cow’s milk is concerned, excess protein has to be added to bring the number of amino acids up to the level that baby needs,” he continues. “But that excess protein will be metabolised and broken down into components that can be converted into fat.”
“That’s one of the problems with formula – babies do too well on it. Parents often think they’re doing fine because they’re growing like mad – but actually, that may not be good for the long-term health of formula-fed infants. So, formula companies are now trying to bring down protein levels in their milk to prevent babies from getting too big” says Professor Hartmann.
In the first 6 months of life, babies gut struggles to absorb anything besides breastmilk. Even one formula feed can cause injuries to the gut that can take weeks to recover from. A quick note about cow’s milk. Cow’s milk contains concentrations of minerals and protein too high for a newborn’s immature kidneys to process. This can cause severe illness during fever, heat stress and diarrhoea. Cow’s milk lacks the needed quantities of vitamin C, iron and other nutrients babies need to thrive. Some babies may even develop iron deficiency anaemia because cow’s milk protein irritates the lining of the stomach and intestines, causing blood loss into the stools. Babies should not receive any cow’s milk for the first year of life.
MUM AND BABY: HEALTH BENEFITS
Breast milk is not just food. It is a designed protective substance that will reduce the risk of your baby experiencing diarrhoeal illnesses, colds and flu, ear infections and thrush. Compared to formula fed babies, exclusively breastfed babies are half as likely to die from sudden infant death syndrome.
If your baby is born premature, breastmilk will help protect your baby from sepsis, infections, necrotising enterocolitis and chronic lung disease. The more breastmilk your baby consumes, the lower the risk of disease. Each additional 10 ml a day, per kg of a baby’s weight, reduces the risk of sepsis by 19%. And the risk of necrotising enterocolitis (NEC), a potentially fatal bowel condition, is also up to ten times lower in premature babies who have breast milk compared to those who are formula-fed. So, every drop counts!
Breast milk is not only nutrition for your baby but health professionals see it as a medical intervention. Many hospitals that have neonatal intensive care units have breast milk banks so that premature babies can have access to breast milk and avoid formula top ups in the case where mother’s milk hasn’t come in yet. But, I digress! I have a lot more to say about breastfeeding and premature babies but will save it for another post.
In the first six months of your baby’s life, their brain is rapidly developing and will almost double in size during this time. A study done in the US revealed that toddlers who had been exclusively breastfed had 20-30% more white matter (connecting and transmitting signals between different areas of the brain) than toddlers who were formula fed.
Research shows that children who received breast milk as babies are less likely to suffer from leukaemia and lymphoma. Breastfed babies also tend to have better eyesight, straighter teeth and less likely to suffer from obesity and diabetes as an adult.
Breastfeeding also has many advantages to mums. Initiating breastfeeding immediately after delivery encourages your uterus to contract and the expulsion of the placenta, protecting you from losing too much blood. Oxytocin (the love hormone) is released when you have skin to contact with your baby and also while breastfeeding. Studies have shown that oxytocin has an antidepressant effect. Oxytocin will help you feel less anxious and reduce stress for as long as you breastfeed.
The longer you breastfeed the more health benefits you will receive. Breastfeeding reduces your lifelong risk of type 2 diabetes and heart disease. Each month you continue to breastfeed the risk of breast, ovarian and uterine cancers reduces.
- Breastfeeding is free! Even if you buy breastfeeding accessories you are unlikely to exceed the amount spent on formula - on average $3500 per year
- Saves time! There is no need to wash, sanitise and prepare bottles
- Babies experience the flavour of foods you eat as you breastfeed and when you introduce solids they are more likely to enjoy a wide variety of foods
- Environmental benefits such as no factory emissions, packaging or transportation
RISKS OF FORMULA – DEVELOPING COUNTRIES
In many countries, the protection of breastfeeding and the defence against a ‘formula feeding culture’ is a life or death matter. For mother’s in developing countries, formula feeding carries an increased risk of infection, illness and death. Mother’s face many challenges in ensuring safe formula feeds such as; limited access to clean water, education on safe dilution and quantity of formula feeds and access to feeding equipment, like bottles, that can be adequately washed.
Optimal nutrition during the first two years of a child’s life will lower the rate of mortality, morbidity and the risk of chronic disease. Malnutrition is linked to 45% of child deaths per year. Exclusive breastfeeding has the ability to save the lives of over 820,000 children under the age of five each year. The impact of optimal breastfeeding is especially critical in developing countries. However, formula fed babies in developed countries are also at an increased risk of mortality – about 25% increased risk revealed in recent studies.
RISKS OF FORMULA – BREASTFEEDING SUCCESS
Let’s firstly discuss the basics of milk production. Breastfeeding works on a simple supply = demand system. The first six weeks after baby is born is a crucial time where the milk supply must be established. Introducing a bottle of formula during this crucial time (or at any time really) can have a devastating effect on a mother’s milk supply.
There is something called the ‘top up trap’ which is a vicious cycle of one top up feed of formula given to baby, perhaps because you are doubting your supply. This then leads to baby experiencing an over-full feeling and dozing off to sleep for 4-5 hours, normally baby would have fed once or twice during that time. Your breasts are then signalled to make less milk and baby wakes up from their formula induced slumber very hungry. You are tired and feel like you are not making enough for baby so you give another top up feed of formula. By this time the milk making cells in your breasts are signalling your body to make less milk and so the ‘top up trap’ continues.
Perceived low milk supply is one of the most common concerns new mums have. It warrants a whole blog post but in the meantime, commonly low milk supply is only perceived. Often normal newborn behaviour is mistaken as signs of hunger and mothers begin to doubt their supply. If you ever feel you are not making enough milk I beg of you to contact a lactation educator or consultant before topping up with formula. Unfortunately, the top up trap is a sure-fire way to sabotage your breastfeeding journey before it has even started. In an upcoming blog, I will give you all the information you need to recognise normal newborn behaviour, feeding cues and teach you how to know if your baby is getting enough breastmilk.
BREASTFEEDING - STATISTICS
The Australian National Infant Feeding Survey results revealed that 96% of mothers initiated breastfeeding at birth. Unfortunately, things go downhill from there. At three months of age, only 39% of babies are exclusively breastfed and by five months of age, only 15%. I truly believe that virtually every mother (there is a very, very small percentage of women who cannot breastfeed due to medical or surgical reasons) who wishes to breastfeed can do so with access to adequate support. However, often mothers are being failed by the system, receiving incorrect information tainted by personal bias, no formal lactation education and poor management. This topped with the lack of support from family, friends and society makes for a very hostile environment for breastfeeding mums.
BREASTFEEDING - THE LAW
In Australia breastfeeding mothers have the legal right to breastfeed anywhere and anytime. A hungry baby should never be expected to wait nor should mothers be made to feel uncomfortable for feeding their babies while they shop, have brunch or catch up with friends in the park. Breastfeeding is the normal and natural way to feed babies. Confrontation about breastfeeding in public can be very unsettling for a mother and can serve as a roadblock to breastfeeding. This can have a severe, negative impact on a mother’s mental wellbeing. Navigating motherhood is hard enough without feeling that you cannot meet the most basic needs for your baby when out and about.
BREASTFEEDING CRITICISM - FAMILY
Sadly, I often see breastfeeding criticism from the parents or in-laws of the new mum. Sometimes family members will feel that you making choices about feeding that are different to their own choices, as a way of attacking or shaming them. For the most part, this is simply not true. All parents try to make the best decisions for their family with the information and guidelines available to them at the time. There are many things our parents or in-laws did, twenty, thirty years ago that have since been found to be against best practice and safety guidelines. This is normal as medical practice advances and high-quality research is being produced.
By making choices about breastfeeding, when to introduce solids or any other decision, that is different to that of your parents or family members, make it clear that you respect their advice and are grateful they care however this is the current recommendation for feeding, weaning, safe sleep etc. Hopefully, family members will not only respect your choices but also be a source of support and encouragement.
RESPONSE TO COMMON BREASTFEEDING CRITICISM
I am going to share my thoughts and responses to some of the most common breastfeeding criticisms I hear. I find it so beyond sad that mothers have to worry about the judgement they face for breastfeeding their babies, not only from family members but also from strangers. I know I and many others are the type of person to avoid conflict as much as possible. However, when it comes to criticism about something like breastfeeding which may happen frequently, it can lead to relationship breakdown.
No matter who you are to a breastfeeding mum; friend, aunty, mother in law, brother, cousin, father or even a stranger walking down the street, I encourage you to read these responses and challenge your feelings about breastfeeding. Trust me, it will make you a better person.
Before we get into these responses I wanted to add this video. It is a slightly cringeworthy American hidden camera show, but the message is on point. Enjoy!
Now to the criticisms and responses:
“It is selfish of mums to be breastfeeding in public/they are making others uncomfortable”
To put this simply, you are the selfish one.
A mother breastfeeding in public is simply not about you. A mother’s priority is meeting the needs of her baby. If a baby is hungry and needing to be fed while mum is out and about, her first thought should never have to be how will it make others feel. Mothers have the right to breastfeed wherever they are. If for some reason you still feel uncomfortable at the sight of a mother feeding her baby, simply look the other way, it’s easy.
“Fine, you can breastfeed but I don’t need to see it/just be more modest.”
I often hear complaints of women ‘whipping’ out their breasts to feed or ‘shoving’ them in people’s faces. I am very sorry you have been victim to such violence (note sarcasm).
I have honestly never seen a woman purposefully expose themselves while breastfeeding for the purpose of making others uncomfortable. Note: a mum breastfeeding in your vicinity does not count as ‘shoving’ it in your face, by the way. Majority of women are just trying to feed their baby in peace, not start a riot or make a statement.
When it comes to modesty and discrete feeding, the problem is these are completely subjective terms. What counts as modest? Covering your entire body in a blanket so no distinguishable features of breastfeeding are remotely visible? Or is it fine if the baby’s head is covering most of the breast? Is it okay if a little bit of skin is showing? What happens if the baby pops off and pulls the cover down and everything is exposed?
Breastfeeding can be tricky sometimes. Then, try adding the pressure of getting baby latched on under a cover with the fear of judgement if something was to be exposed. Not fun, right? Breastfeeding covers can work great, but it is a mother’s choice whether to use them or not. Some babies may find it extremely uncomfortable to feed underneath a cover, especially in summer. Also, eye contact while breastfeeding is important, it aids in vital brain connections being created for baby.
In saying this, it is okay to expect that mums won’t fully expose themselves while breastfeeding. However, as I’ve said above, it can be hard to get a baby latched on without worrying about modesty and covers. Let’s give mums a little bit of grace and just look away if something is exposed instead of judging or getting riled up.
“I suppose breastfeeding is fine but my kids shouldn’t have to see it.”
I have supported women to breastfeed who are struggling partly because they have never seen a woman breastfeed before. It should be normal for mums to be surrounded by other mums breastfeeding or to grow up seeing your mum, aunties etc. breastfeed. Letting your child see breastfeeding should be a gift. One day your daughter will have the confidence in the normalcy of breastfeeding or your son will be able to support the breastfeeding women in his life. Once again it comes down to the fact that breastfeeding is natural and normal.
“But breasts are sexual, what about the poor men!”
Okay cool I get it, breasts are used in an intimate context yet so are our mouths and nobody complains when we use our mouths to eat or talk. Breastfeeding is not a sexual activity and breasts are not genitalia. Men who grow up around breastfeeding women or who support breastfeeding women will attest to the fact that it is not a big deal.
It is completely possible to differentiate between seeing breasts in the context of breastfeeding and seeing breasts in a sexual context. I find the idea that men are so enslaved by their sex drive they cannot control themselves, quite disturbing. I truly feel if you have an issue with seeing a mum breastfeed, the issue is with you.
I asked some of the men in my life and some new dads their thoughts on breastfeeding:
“I am in awe of my wife, the fact that she can provide all the food our baby needs to grow is amazing” – Joel B.
“It really sucks that when we go to Coles, people find it okay to stare at my partner even though she is covered up” – Luke S.
“I think breastfeeding is the best thing ever! It is the food God provided for a new baby. No better recipe ever! I do appreciate modesty and have no problem with a mum feeding anytime and anywhere” – My dad (thanks dad)
“Being married to a midwife has opened my eyes to the importance of breastfeeding and I feel lucky to have this knowledge and do my bit in supporting women who breastfeed and changing the culture.” – Stefan (my husband)
“Your baby is eating way too much/too often/is just using you as a dummy”
On demand feeding and cue based feeding is the gold standard in breastfeeding. For the first 12 weeks of life on demand and unrestricted breastfeeding is the way the body regulates and establishes milk supply. Beyond this time babies will normally settle into a more predictable routine. Telling a mother, she is feeding too much or too often can sabotage her breastfeeding journey as this attitude may encourage feelings of perceived low milk supply, or even overfeeding which are simply not true.
Some important things to note include milk carrying capacity. Mothers will all have unique milk carrying capacity in their breasts. Some babies will need to feed more often due to a smaller volume of milk at each feed. When we follow babies feeding cues (will discuss in an upcoming blog), assess their output, weight and temperament we can ascertain if baby is getting enough milk. This is a slightly tricky concept to wrap your mind around, but I will explain more soon.
Another thing to think about is the composition of breast milk. Breast milk is made up of foremilk; watery milk (for hydration) and hindmilk; fattier, high calorie milk. No switch gets flipped in the body for the milk to change from one to the other. It depends on the length of the feed, time since the last feed etc. etc. This is why cue based feeding is so important. Let’s say baby fed for 15 minutes and 2 hours later feeds again for 35 minutes. We cannot say how much foremilk or hindmilk a baby received with each feed. We cannot measure the volume of milk a baby has received and as such we must trust in a mother’s supply and encourage on demand and cue based feeding to help establish breastfeeding.
Let’s talk about cluster feeding. This seems to be the downfall of women’s confidence in their milk supply. However, cluster feeding is normal newborn behaviour! I repeat cluster feeding is normal newborn behaviour! Your body is very much in tune with your baby’s needs and cluster feeding is a mechanism to maintain supply. Seemingly constant feeding during fussy periods can be very tiring. But take heart in knowing you are maintaining your supply and possibly supporting your baby through a growth spurt!
Breasts aren’t used as a dummy. Dummies were created to be an artificial breast. Babies feed for a whole range of reasons; hungry, thirsty, they are too hot or cold, tired, for comfort, the list goes on! Feeding babies to respond to their cues is a way to comfort a new baby and increase breastfeeding success. Newborn babies can’t manipulate parents or be given too much attention in those early days. Routine will naturally come later and is not designed to be utilised when establishing breastfeeding.
HOW CAN YOU HELP?
So, you have made it through this whole post (thank you so much) and are wondering how you can help. Although every mum’s breastfeeding journey is different, everyone needs support and encouragement at some stage.
Attend a preparing to breastfeed class with your partner. It is especially hard to learn new skills in the sleep deprived days after a new baby arrives. Encourage your partner to reach out for help if needed and be their biggest cheerleader!
For friends and family:
Make breastfeeding women in your life feel comfortable! Bring them snacks and drinks, offer a comfortable seat or the TV remote. Don’t assume she wants to be alone! Motherhood can be lonely, ask her if she would like some privacy, if not stay and chat! Offer genuine encouragement and support.
For mothers, mothers in law, aunties, grandmothers:
New mums are highly influenced by your opinions! Keep your words kind, provide encouragement and support. Offer to make a meal or help with older children. Your kindness will make all the difference.
For when you’re out and about:
If you ever hear someone being anything other than kind to a breastfeeding mum, come to their defence! Accepting breastfeeding as the natural way for mums to feed their babies will go a long way in creating a more safe and supportive environment for new mums. So, next time you are at a café or browsing the isles in Target and see a mum breastfeeding give her smile or say a kind word.
Thank you for reading all the way through. It was really important to me to lay down this foundation. It is imperative that we protect, promote and support breastfeeding. You can look forward to upcoming blog posts that will cover everything you need to know about breastfeeding from attachment and positioning to how to increase milk supply and how to deal with blocked ducts.