The 'why' behind breastfeeding your baby

Midwife, lactation consultant and mum of five, Stephanie Callaghan-Armstrong explores 'the why' behind breastfeeding your baby.

Breastfeeding is something a mum may only first think about once pregnant. Or perhaps for others they’ve grown up seeing it and had the process modelled in their community and have never considered any other way of feeding a baby. However it is for you, breastfeeding your baby (especially if it's for the first time) is definitely a journey.

There are ups and downs in every mama’s story – physically, emotionally and mentally. But with some forward planning and getting in the right headspace, hopefully a wonderful one will eventually unfold.

Recently, I was at a parent education class where the speaker asked the group of mums-to-be to share what they thought were the advantages and disadvantages of breastfeeding. As a midwife and lactation consultant, it was a great way to find out what everyone already knew and to find out what concerns were out there.

We have all heard the saying 'breast is best', but why? It can be really challenging to hear this sometimes, and it’s worth asking the question, are there times when maybe it's not 'best'? Firstly, I support the recommendation that The World Health Organisation (WHO) and New Zealand Ministry of Health hold that babies be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. And that infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age and beyond. So that being said, let’s now look at the benefits and I will attempt to help troubleshoot some of the 'cons' or perceived challenges mums-to-be may have. A disclaimer first, I wholeheartedly respect that everyone has a different journey with their baby as well as differences in support, backgrounds, cultures, conditions and preferences. This article is specifically in support of breastfeeding and offering advice and guidance for those who wish to do so.

As an International Board Certified Lactation Consultant (IBCLC) of over two decades and a midwife for a little longer, I agree that human milk is 'best' if you are able to feed it to your baby, preferably by directly breastfeeding. I have breastfed all of my four children for a total of around nine years, used donor breast milk from a generous friend for a period of time when I couldn't supply my own milk, and now, years later my daughter is a young mum and breastfeeding her baby. Safe to say we are sold on breast milk!

Breast milk is truly a wonder of this world. I often share that I used to have a list of 'what's in breast milk' that spanned the height of my clinic door. It’s the most extensive composition of nutrition you could imagine for a growing baby – developing their newborn brain and filling it with so much potential. It also helps to protect babies from disease both now and throughout life, not to mention the benefits that suckling has for the jaw, and bonding and to mum as well.

NUTRITION AND IMMUNITY 

Breast milk is made up of approximately 85-90 % water, around 7% carbohydrates, 1% protein, and 4% fats, and it’s also rich in long chain fatty acids for brain development and immunoglobulins, to name only a few. This composition may vary depending on factors such as diet, the climate and gestation of baby when they are born (your milk adjusts also for premature babies to have higher protein and salts and less sugar). Colostrum, which is the first substance produced at birth before the milk 'comes in' is the most important first food of all for babies. It’s filled with antibodies for immunity and defence against infection. It’s higher in sugars to support baby in concentrated, small amounts as they adjust to the world. If nothing else further, even for mums not wanting to breastfeed or babies being adopted, I always encourage colostrum to be given to baby if possible.

Breast milk contains antibodies too, that support baby’s gut to combat viruses, bacteria and infection and is the best food for babies with a family history of allergies or intolerances to foods. If you study epigenetics and breastfeeding, it's fascinating to understand how diet and lifestyle can help keep inherited diseases in our DNA switched off – another great reason to give colostrum and breast milk as baby's exclusive first food early in life.

FAST FOOD

Breast milk is ready to give to your baby whenever and wherever they need it, and is always at the perfect temperature and composition. Breastfeeding can also be a source of comfort, which certainly comes in handy if baby needs settling at a moment’s notice!

COST

Breast milk itself is free, a huge benefit in these financial times when families are often suddenly on one income. On a wider scale, there are proven cost savings in terms of medical care also. Statistically, breastfed babies have a lower risk of asthma, obesity, type 1 diabetes, and sudden unexpected death of an infant (SUDI). They are also less likely to have serious gastro and ear infections. Premature babies are less likely to get sick and the mortality rate is lower when baby is fed breast milk. Childhood hospitalisation is also greatly reduced. Women who breastfeed also have lifelong health benefits including a lowered risk of breast cancer, ovarian cancer, high blood pressure and Type 2 diabetes, if you feed for over a year.

PREGNANCY WEIGHT AND CHILDHOOD OBESITY

Breastfeeding assists a new mum in losing any extra pregnancy weight gained by helping metabolise fat stores your body made in pregnancy (ready to use in case there wasn't enough food around - so clever!). Research has also shown that breastfed babies are less likely to be obese as children as well as adults, as breast milk early in life creates different types of fat cells – a huge health factor of concern for today and fascinating to research!

DENTAL

Babies who are breastfed have less dental cavities, and the mechanism of suckling on the breast is optimal for developing baby's jaw and teeth, and their subsequently their speech.

OPTIMAL BRAIN DEVELOPMENT 

Breastfed babies benefit from the long chain fatty acids in breast milk. It's the perfect nutrition imaginable for a growing baby, helping develop their  newborn brain and future IQ to its full potential.

BONDING/MENTAL HEALTH

The skin-to-skin contact and hormone release during feeding helps with bonding with your baby. Starting with skin-to-skin time directly at birth is a first step to successful breastfeeding as baby feels warm and safe, and naturally after about 30 minutes becomes ready to latch and receive colostrum. Breastfeeding is also comforting and helps lower baby's cortisol (stress hormone) levels, plus mum's too (provided it’s going well). Oxytocin released during feeding and let downs (the milk ejection reflex) is a feel happy hormone and research shows that there are lower rates of postnatal depression in breastfeeding mums.

SO, ARE THERE ANY CONS?

We've established a number of reasons why breastfeeding is definitely an advantage if you are able to, but what are some of the disadvantages of breastfeeding that mums-to-be may be concerned about?

TIME CONSUMING?

Feeding your baby when they are newborn can take time for sure, and breastfeeding may be more time consuming than bottle feeding at first, absolutely. However, I always say to new mums that right now it's the most important job they could ever have, with lifelong benefits for them and baby, so it's worth the time it takes to establish a good milk supply and work on latching baby correctly in the beginning, however exhausting it may seem (easier said than done, I know!).

PARTNER CAN'T SHARE FEEDS?

Of course with an exclusively breastfed baby, the mum takes on the sole role of feeding, but there are so many other ways dads, partners and family members can support and take part in caring for baby! Nappy changes, skin-to-skin snuggles and baths can be super bonding ways for the other parent to be involved. If you are wanting to introduce a teat to baby so they can also feed by bottle, this is best to happen once breastfeeding and latching is well established (often after approximately one month of life).

PAIN/SORE NIPPLES

When you start to breastfeed baby there is a period where your nipples can be tender from constant feeding. Some women do experience cracked/bleeding/very painful nipples with breastfeeding and this is usually because of incorrect latching or other causes such as baby having tongue or lip tie, or maybe a high palate. Being supported and checked by your midwife or lactation consultant in the early days for correct latching and techniques that best suit you and baby helps a lot. Nipple cream or gel pads may help heal by treating the nipple tissue as you would cracked lips, and breast milk rubbed gently around the areola after feeds is healing too. Other causes of breastfeeding pain can be thrush/candida, nipple and breast infections, milk blebs or difficulties latching due to the breast anatomy or the way baby suckles. Getting professional support is the best advice as usually there are solutions and you will be soon be feeding pain-free and able to enjoy this journey. If you are unable to latch or breastfeed due to severe pain, always regularly express your breasts with a good  personal or hospital grade breast pump and don't skip feeds, so that you maintain your supply while you heal and solutions are found. Not removing milk can cause severe engorgement and mastitis and also drop your milk supply especially in the early days as your supply is still being established.

MASTITIS

Breast infections can certainly happen in the postpartum period. It is not going to happen to every new mum and there are ways to prevent mastitis and to catch it early also. Often the first symptoms of mastitis are feeling like you have the flu – a bit shivery, maybe a fever and pain and redness in an area on your breast. Mastitis doesn't always mean there is a bacterial infection, sometimes just inflammation, so early intervention to get your milk flowing and inflammation reduced can stop it in its tracks.

Regular emptying of your breasts, not skipping feeds, wearing well-fitted nursing bras, and trying to prevent cracked nipples as entry points for infection are some of the ways to reduce mastitis. High doses of vitamin C have been shown to help prevent and combat mastitis too in the early stages so antibiotics are not always necessary. Massage the area, pump for comfort, keep breastfeeding, and use hot and cold compresses to reduce inflammation. Call your midwife or see a doctor if you are concerned or getting high fevers or unwell.

UNSURE OF SUPPLY/DON'T KNOW HOW MUCH MILK BABY IS GETTING?

It is understandable that for some new parents their concern with breastfeeding is they don't know how much baby is taking each feed or if they will have enough milk. It doesn't seem so quantifiable to just let baby feed until your breasts feel softer and the baby shows signs of being full, but in fact that's really just how nature intended it.  Breastfeeding is perfect for satisfying hunger and thirst in a baby. Depending on the weather and time of day, and whether baby is having a growth spurt – they may feed more often to increase your milk supply.

Signs your baby is getting enough milk are: baby is feeding well with lots of suckles and swallows, your breasts feel softer after feeding, baby has plenty of wet nappies and the initial black meconium being passed then transitions to mustard yellow stools with 'seeds' showing healthy digestion is happening (as a breastfed baby gets a little older it's normal for them to poop anything between 7 times a day to once every 7 days) and weight gain follows the curve.

Baby's stomach capacity is smaller than we think and over-filling causes stretching and also forces not well digested milk into the small intestines too early. Baby's stomach capacity interestingly holds 3-5 mls at birth and is the size of a marble (colostrum is all baby needs small amounts of regularly), by day 3, as the milk comes in and milk supply increases, they can hold 22-27 mls which is around and the size of a ping pong ball, by day 10 it's 45-60 mls and the size of a small egg, and at 1 month it's up to 80-150 mls, the size of a large egg.

Night time is when the highest amounts of prolactin, the milk making hormone, is released. So while I always encourage mums to regularly feed during the day and evening to encourage that stretch of sleep to be at night, feeding during the night does have the advantage of increasing and maintaining your milk supply.

For women who genuinely have a low supply there are lots of ways to help increase it. Expressing after feeds to increase stimulation to the breast and send the brain a message to make more milk is the best way to get it going. There are things called 'galactagogues' which are products, herbs and teas to help boost supply, as well as increasing protein intake and drinking lots of fluids. Rest and skin-to-skin to help you relax works wonders also. In some cases your midwife or doctor may prescribe medication. As a last resort, it’s also worth considering donor milk, a trusted friend may have extra or there are groups out there to help facilitate, usually with blood test screenings in place for safety. Even feeding some breast milk each day is very beneficial, along with formula.

FLAT OR INVERTED NIPPLES 

It can be challenging to latch baby with flat or inverted nipples, but as baby pulls the nipple out the muscles stretch and eventually you will find your nipples may stay popped out. Definitely reach out to a lactation consultant or get your midwife’s support. Pumping can help pull the nipple out as can rolling it or expressing first when breasts are very full, so that baby is easily able to compress the areola. 

In the small amount of circumstances where baby just won't latch, whether temporarily or long term, there is always the option to express and give baby expressed milk from a bottle.

Some mums prefer this anyway, but in my experience it’s more time consuming and I observe that mums wean sooner or the milk supply drops down earlier than it would have if baby was latching.

SLEEPING AT NIGHT

Often you may hear that a disadvantage of breastfeeding is that babies don't sleep as well at night as babies fed breast milk substitutes – I would say this definitely depends on the baby. It is true that breast milk digests faster and maybe babies are hungrier sooner, but also night breast milk contains melatonin (the sleepy hormone) so in fact it helps baby sleep. If baby feeds at night it can often be a 'dream feed' and they're back to sleep again fast. Keep the lights low and noise minimal to keep things calm and restful to support everyones circadian rhythm.

I encourage new mums to breastfeed 2-3 hourly from the first feed of the day till when you would want to go to bed. Babies usually have a period of cluster feeding in the evenings and this encourages them to stretch out sleeps at night – always worked a treat with my babies! Waking baby for a 'dream feed' before you go to sleep can also help encourage a longer stretch.

DIET/LIFESTYLE

Many mums are concerned that what they eat will affect baby and that breastfeeding is too restrictive for their diet and lifestyle. It’s true that you do have to be a bit more mindful of diet while breastfeeding, but many don't have any issues. I usually give a list to new mums of common foods to avoid or watch reactions for. Anything that makes you 'windy' or affects your gut, also may affect baby. Dairy and wheat are the most common allergenic foods, if baby is crying and bringing their knees up after feeds then try to reduce or find alternatives, you may be able to reintroduce these as baby gets older and their gut is more developed. Others are broccoli,  beans and legumes, chocolate (I know!), caffeine (sorry), coke or fizzy drinks with sugar, tomatoes, onions, garlic, and high quantities of things (like strawberries for example).

Not being able to drink alcohol can be perceived as a disadvantage to breastfeeding, especially after a whole nine months of pregnancy! Not drinking alcohol is the safest thing, but if you do enjoy the odd tipple, only a very small amount passes into breast milk (blood alcohol = milk alcohol). Some experts now say that breastfeeding mums can drink small amounts or low alcoholic beverages and safely breastfeed.  If you have an event,  give baby expressed milk and pump and dump in place of the usual feed (to protect supply, relieve discomfort and prevent mastitis). I hope this encourages you with your 'why' when you're going through challenging periods on your journey. Of course the best thing you can give your baby is a happy and relaxed mum, and only you can judge and know your specific situation. All the best, you're amazing!

WORKING MAMAS

Mums going back to work quite soon after birth often feel concerned about how to juggle breastfeeding and their work and wonder whether to even start because of this. Firstly, I can only reiterate the importance of colostrum as baby's first food and the early weeks of breastfeeding being so important for immunity and development for a tiny newborn – every day you breastfeed counts. There are some very good breast pumps available and many work places should be happy to provide a comfortable space for you to pump and somewhere for you to store and refrigerate your milk. If it’s not ‘the norm’ at your place of work, be the change maker for other new mums by making it mama/baby/family-friendly. Can you introduce flexible hours? Work from home with baby? Have breaks to feed baby while they’re in care?

NEED SUPPORT? Visit lalecheleague.org.nz or call PlunketLine on 0800 933 922 for a free consultation. Alternatively, your midwife may be able to recommend a lactation consultant in your area. 

Stephanie Callaghan Armstrong is a mum of five, experienced Lead Maternity Carer, Midwife and Lactation Consultant and also runs a breast pump rental and sales business with husband, Dr Mikey from The Barnstead in Coatesville. Find her at babymed.co.nz, @babylove.midwife.life and @babymednz on Instagram.

Photography: Catherine Smith