Breastfeeding is the best way for mothers to ensure a healthy future for their infants
Modern science has failed to produce a milk that has the unique properties of breast milk, and it is unlikely that such a proprietary food will be formulated in the foreseeable future.
The flow of breast milk is stimulated by the act of sucking, and varies in its composition and volume according to the infant’s requirements which may differ from day to day. The supply of milk depends on environmental factors as well as maternal malnutrition which must be extreme before the milk is affected. However, the disturbing decline in breast feeding throughout the world in recent years has stimulated various promotion groups.
In the UK less than 30 per cent of mothers are still breast feeding at one month, and only six per cent at three months. These figures are disappointing and could be greatly increased by education in schools, and improved advice and support during and after pregnancy.
ADVANTAGES OF BREAST FEEDING: A number of the advantages of breast feeding arise from the intrinsic properties of breast milk.
Lactoferrin and immunoglobulins — breast milk contains an iron-binding protein (lactoferrin) which in the presence of immunoglobuins (IgA, AgM, IgG) and bicarbonate, prevents replication of enteropathogenic stains of E.Coli. Lactoferrin interferes with the availability of iron to these bacteria which require it for replication. Some of the immunoglobuins are absorbed intact during the newborn period and confer passive immunity against extraintestinal infections, particularly those affecting respiratory tract.
Acidity — the stools of breast-fed infants are more acid than their bottle-fed counterparts and contain acetate buffer. It is known that Gram-negative bacteria cannot survive in a medium containing acetate buffer at a pH of less than 5.0, and therefore the colonic environment of breast-fed babies presents and hostile environment to Gram-negative enterpathogenic organisms.
Immune protection — the anti-viral factors, lymphocytes, polymophs, macrophages and lysozyme present in breast milk also protect against infections.
Solute content — the content of protein, phosphorus and sodium are much lower in breast milk. And since nice immature kidneys have a limited capacity to excrete solutes, breast-fed babies are less likely to develop the serious complication of hypernatraemmic dehydration during an episode of acute gastroenteritis.
Protein and amino acids — the relatively low concentrations of protein and amino acids in breast-milk provide the optimum requirements for the physical and neurological development of the infant. Excess of certain amino acids, such as phenylalanine, is a potential cause of brain damage, particularly in pre-term infants.
Unsaturated fatty acids — breast milk is very rich in unsaturated fatty acids, such as linoliic acids, which are essential for normal brain development. Obesity is more common in bottle fed infants; in the short term, fat infants are more susceptible to respiratory infections; in the long term they are more likely to grow up to be obese adults with the dangers of coronary thrombosis and diabetes mellitus.
Enzymes and digestion — breast milk contains many enzymes such as lipase, alkaline and acid oxaloacetic transaminase, amylase, aldolases and phosphohexose isomerase. These enzymes compensate for the immature digestive system of the newborn.
Reduced susceptibility to disease — the following conditions are much less common in breast fed infants:
* Allergic disorders Dental caries.
* Hypocalcaernic convulsions constipation.
* Necrotizing enterocolitis.
Other advantages include the way in which the infant is fed.
Hygiene — breast feeding is more hygienic.
Emotional factors — the ‘bonding’ process between mother and child is facilitated by breast feeding and probably plays an important role in the development of the child.
There are specific problems associated with bottle feeding.
Milk plugs — bottle-fed babies may occasionally develop intestinal obstruction due to milk plugs.
Cot deaths — approximately 3000 ‘cot deaths’ occur each year in Great Britain, and these tragedies are very rare in breast-fed babies.
There are advantages to the mother who breast feeds.
The act of sucking stimulates release of prolactin from the anterior pituitary gland of the mother. There is evidence that prolactin stimulates milk secretion as well as having an anovulatory (contraceptive) effect. The ‘figures’ of mothers who breast feed tend to improve more rapidly post-natally than their bottle feeding counterparts. Last, but not least, breast feeding is less expensive.
PRACTICAL ASPECTS OF BREAST FEEDING: In early pregnancy the nipples and breasts should examined to assess whether breast feeding will be possible, and this opportunity should be used to discuss breast feeding, not only with the mother but with the father too, if possible. As pregnancy proceeds retractile nipples should be regularly expressed by pressing on the areola with thumb and finger so as to mimic the baby’s suck. Retracted nipples can be protected with Waller shields or manually expressed. Throughout pregnancy it is most important that the mother eats a mixed diet, ideally including a pint of milk per day.
As soon after birth as possible — in the labour ward — physical contact and sucking should be encouraged since this is of great importance for ‘bonding’ between mother and child. Afterwards the infant should be placed next to the mother’s bed and allowed to feed on ‘demand’. Newborn babies are individuals in their own right and therefore vary in their needs, and some may not ‘demand’ for 12 to 24 hours after birth. Except for pre-term or small-for-dates babies they should be left undisturbed.
In the event of the mother being unwell in the immediate postnatal period, the infant should be given expressed milk or, if that is not possible, boiled water.
‘Demand’ and frequent feeding should be encouraged until milk flow is established, which is usually between four and seven days. Thereafter the infant usually settles into a pattern of feeding every three to five hours. After each feed the mother should express any residual milk as this ensures an adequate supply for the next feed. The act of feeding should be a relaxed and enjoyable experience, and it is important that the infant and mother are recently positioned:
* There should be eye-to-eye contact.
* The nipple should reach the back of he tongue to stimulate the sucking reflex.
* The breast should not obstruct the baby’s nose.
* The baby’s upper lip should not fold over his nostrils.
* The baby should be held comfortably to avoid the mother developing ‘breast lag’ or stretched sore nipples.
When a pattern of breast feeding has been established, feeds should be limited to a maximum of ten minutes each breast, continued advice and support in the home by a midwife is as important as the hospital experience.
Supplements must be avoided for three important reasons.
* The mother’s confidence may suffer.
* Even a single artificial feed may permanently alter the bacterial flora of the intestine and so nullify the protective effects of breast feeding against enteric infection.
* Because the neonate’s intestine is permeable to intact foreign proteins, supplements can trigger allergies in susceptible infants.
Breastfeeding is the best way for mothers to ensure a healthy future for their infants 
