All About Breastfeeding

Breastfeeding provides many benefits for both infants and mothers, but it is not without challenges.

National and international organizations recommend breastfeeding; however, the exact guidelines vary a bit.

“In general, they all agree on some basic concepts, which is breast milk is best for the baby, and most groups do recommend exclusive breastfeeding until 6 months of life,” says Lovya George, MD, neonatologist and medical director of the NICU at The University of Kansas Health System. "After 6 months, they recommend continued breastfeeding along with complimentary foods into the second year or longer, as mutually desired by mother and baby."

Dr. George explained that the most recent figures in 2020 showed about 85% of moms do initiate breastfeeding. Michelle Finn, lactation consultant and lactation team lead at The University of Kansas Health System, says that in the Kansas City metro area there is about a 90% initiation rate of breastfeeding.

"Most parents desire to breastfeed," Finn says. "It is both an individual and a family decision. As a society, it is important that we ensure the institutional supports are in place, making breastfeeding an easier choice for those who desire it. I really encourage families to take it 1 day at a time, 1 week at a time, setting their own goals along the way."

There are physical, mental and emotional benefits of breastfeeding for both mom and baby. Dr. George explains that breast milk is more easily digestible than formula. Additionally, there are components in breast milk that cannot be replicated in formula.

“For example, 1 of the carbohydrates in breast milk is the human milk oligosaccharides, and this is such an important component because it, other than providing nutrition, it also helps decrease gut inflammation, helps the growth of beneficial bacteria in the gut, and gut health is so important to overall health,” says Dr. George.

That gut health is especially important to premature and pre-term infants who may spend time in the NICU. One of their biggest complications is necrotizing enterocolitis, or an inflammation of the gut.

“Infants who are fed mom's breast milk are 6 times less likely to have NEC compared to babies who have had formula,” says Dr. George.

Treatment for illness

The first substance nursing mothers produce is colostrum – a thick, sticky, yellow fluid in very limited quantities. It provides a highly concentrated level of antibodies.

“It’s kind of like the first vaccine for babies,” Dr. George says of colostrum.

The breast milk that comes after colostrum is also powerful. It has white blood cells, enzymes, antiviral proteins and antibacterial properties. It is also adaptive.

“One of the most unique aspects of breast milk is that each mother's breast milk is tailor-made for her baby. So anytime the baby is sick, mother's breast milk changes to provide specific antibodies to the baby,” says Dr. George. “So every mother's milk is uniquely made for their baby, and that is something that formula just cannot replicate.”

Reduced risk of SIDS

Sudden infant death syndrome (SIDS) affects about 1,500 babies in the US annually. There are many ways to help protect against SIDS, including safe sleep practices and breastfeeding. Finn says research shows 4 months of exclusive breastfeeding reduces the risk of SIDS by up to 50%.

Health benefits for mom

There are both long-term and short-term health benefits for the breastfeeding parent. Over the course of a lifetime, women who breastfeed have a reduced risk of breast cancer, cardiovascular and heart disease, ovarian cancer, osteoporosis and stroke.

In the short term, early breastfeeding can help the uterus return to its prepregnancy size. It also reduces the risk of postpartum hemorrhage.

"Sometimes you'll hear you're more likely to lose weight faster," says Finn. "The research is a bit more squishy there, but we do know that breastfeeding is a fat mobilizer. It takes probably 600-800 calories a day to make a full milk supply. So if you can eat a varied diet and move a little bit every day and you breastfeed, you're more likely to get back to that prepregnancy weight."

Although the rates for initiating breastfeeding are high in the US, they aren't sustained. If you look at the 6-month mark, only 25% are exclusively breastfeeding and about 50% are doing any breastfeeding.

“There is this rapid decline that happens around the 1–3-month time frame, which is when a lot of moms are returning to work,” says Dr. George. "There's just a lot of barriers in terms of lack of parental leave, accommodations for pumping at work and things like that.”

Finn agrees that returning to work is a key tipping point for most breastfeeding parents.

"You need that flexibility in your workplace, to be able to have a private place, to be able to express milk," she says. "You need that support from your employer, your child care provider and at home."

Additionally, Finn pointed out that we would benefit from more regulations around breast pumps. Although some have gotten more convenient, like wearable models, they aren’t necessarily efficient. Low quality breast pumps can quickly compromise a milk supply or even cause injury.

“I do see that oftentimes, if the pump is not as efficient as it needs to be, as moms, we're real quickly blaming ourselves before questioning the breast pump,” Finn says.

Other challenges may come up if a mom is confused about what medication she can take while breastfeeding. Finn says that most medications are compatible with breastfeeding.

Finally, there can be psychological challenges. While breastfeeding is generally shown to be beneficial for mental health, there can be issues when it doesn’t go as planned.

“Sometimes people have had such a heck of a time with their first and they just really are struggling with the idea, psychologically, of investing themselves (in breastfeeding),” Finn says. “We all want to just be successful, right? And we all want to be good parents. You can be a good parent whether you're breastfeeding or not. So I think it's just important that we have those conversations, educate as we need, and then fully support that family in their informed decision making.”

“The biggest thing to remember is a happy and healthy mom is the best thing for the baby,” says Dr. George. “We need to support moms in whatever areas of their life that we can to help attain those mental health goals as well.”

Ultimately, Dr. George says there needs to be more work put into education and providing support for families.

"Breastfeeding is natural, but it's not always easy," she says.

For some who struggle with breastfeeding or need the flexibility, expressing breast milk with a pump and then feeding it in a bottle is the option. And Dr. George agrees that it is a great one.

When it comes to the benefits of breast milk, getting it directly from mom is best. Next would be pumped milk that has not been frozen. After that would be frozen and thawed milk.

But pumped milk, or donor milk from a milk bank, is still superior to formula from a health standpoint.

Helping parents and babies on their breastfeeding journey is incredibly important to the health system.

“We are a designated Baby-Friendly facility, which means we uphold World Health Organization and UNICEF standards," says Finn.

Lactation consultants are available through a monthly breastfeeding class.