Breastfeeding

Suckling redirects here. For other uses, see Suckling perior to infant formula in most circumstances. Formula
(disambiguation).
feeding is associated with more deaths from diarrhea in
Breastfeeding is feeding of infants or young children infants in both developing and developed countries.[3][11]

1 History

An infant breastfeeding

with breast milk from female breasts (i.e. through

lactation). The sucking reex[1] enables babies to suck
and swallow milk instinctively. Some mothers express
(expel) milk to be used later when their child is being
cared for by others. This can done either by hand or by
using a breast pump.
Many health groups, such as World Health Organiza- Ilkhanate prince Ghazan being breastfed.
tion (WHO) and UNICEF support 6 months of exclusive
breastfeeding and continued partial breastfeeding for ex- Main article: History of breastfeeding
tended periods.[2][3][4][5]
Breastmilk oers benets for both mother and baby. It is
easy for the baby to digest, which promotes more frequent
eating due to faster digestion.[6] It may decrease risk of
diabetes and celiac disease.[7][8] Benets for the mother
include better uterine shrinkage, decreased risk of breast
cancer, and decreased risk of postpartum depression. It
may also be a bonding experience[9] for mother and child,
and can be less expensive than infant formula.[10] Controversially, decreased risk for obesity in adulthood and
improved cognitive development have been mooted.[3][5]

In the Egyptian, Greek and Roman empires, women usually fed only their own children. However, breastfeeding
began to be seen as something too common to be done by
royalty, and wet nurses were employed to breastfeed the
children of the royal families. This extended over time,
particularly in western Europe, where noble women often made use of wet nurses. Lower-class women breastfed their infants and used a wet nurse only if they were
unable to feed their own infant. Attempts were made in
15th-century Europe to use cow or goat milk, but these
Consensus holds that breastfeeding is benecial and su- attempts were not successful. In the 18th century, our
1

BREAST MILK

or cereal mixed with broth were introduced as substitutes

for breastfeeding, but this was also unsuccessful.
During the early 1900s breastfeeding started to be viewed
negatively by Western societies, especially Canada and
the US. These societies considered it a low class and uncultured practice.[12] This coincided with the appearance
of improved infant formulas in the mid 19th century and
its increased use, which accelerated after World War II.
From the 1960s onwards, breastfeeding experienced a revival which continued into the 2000s, though negative attitudes towards the practice were still entrenched up to
1990s.[12]

Lactation

Main article: Lactation

The hormonal endocrine control system drives milk production during pregnancy and the rst few days after
the birth. From the twenty-fourth week of pregnancy
(the second and third trimesters), a womans body produces hormones that stimulate the growth of the breasts
milk duct system. Progesterone inuences the growth
in size of alveoli and lobes; high levels of progesterone,
estrogen, prolactin and other hormones inhibit lactation
before birth; hormone levels drop after birth, triggering
milk production.[13] After birth, the hormone oxytocin
contracts the smooth muscle layer of cells surrounding the
alveoli to squeeze milk into the duct system. Oxytocin is
also necessary for the milk ejection reex, or let-down to
occur. Let down occurs in response to the babys suckling, though it also may be a conditioned response, e.g.
to the cry of the baby. Lactation can also be induced by
a combination of physical and psychological stimulation,
by drugs or by a combination of these methods.[14][15]

Breast milk

Two 25ml samples of human breast milk. The sample on the left
is foremilk, the watery milk coming from a full breast. To the
right is hindmilk, the creamy milk coming from a nearly empty
breast.[16]

Main article: Breast milk

Himba woman and child

Not all of breast milk's properties are understood, but

its nutrient content is relatively consistent. Breast milk
is made from nutrients in the mothers bloodstream
and bodily stores. Breast milk has an optimal balance of fat, sugar, water, and protein that is needed
for a babys growth and development.[17] Breastfeeding triggers biochemical reactions which allows for
the enzymes, hormones, growth factors and immunologic substances to eectively defend against infectious
diseases for the infant. The breastmilk also has longchain polyunsaturated fatty acids which help with normal
retinal and neural development.[18] Because breastfeeding requires an average of 500 calories a day, it helps the
mother lose weight after giving birth.[19]
The composition of breast milk changes depending on
how long the baby nurses at each session, as well as on
the childs age.[20] The rst type, produced during the rst
days after childbirth, is called colostrum. Breast milk is
produced soon after birth. Early in a nursing session, the
breasts produce foremilk, a thinner milk containing many
proteins and vitamins. If the baby keeps nursing, then
hindmilk is produced. Hindmilk has a creamier color and
texture because it contains more fat.[21]
Milk quality may be compromised by smoking,
caeinated drinks, marijuana, methamphetamine, heroin
and methadone.[22] However, the American Academy
of Pediatrics (AAP) states that tobacco smoking by

4.2

Timing

mothers is not a contraindication to breastfeeding.[23]

In addition, AAP states that while breastfeeding mothers should avoid the use of alcoholic beverages, an
occasional celebratory single, small alcoholic drink is
acceptable, but breastfeeding should be avoided for 2
hours after the drink.[23] However a 2014 review found
that even in a theoretical case of binge drinking, the
children would not be subjected to clinically relevant
amounts of alcohol [through breastmilk]", and would
have no adverse eects on children as long as drinking is
occasional.[24]

Process

3
more successful breastfeeding and bonding, immediate
skin-to-skin contact reduces crying and warms the baby.
According to studies cited by UNICEF, babies naturally
follow a process which leads to a rst breastfeed. Initially
after birth the baby cries with its rst breaths. Shortly after, it relaxes and makes small movements of the arms,
shoulders and head. The baby crawls towards the breast
and begins to feed. After feeding, it is normal for a baby
to remain latched to the breast while resting. This is
sometimes mistaken for lack of appetite. Absent interruptions, all babies follow this process. Rushing or interrupting the process, such as removing the baby to weigh
him/her, may complicate subsequent feeding.[25] Activities such as weighing, measuring, bathing, needle-sticks,
and eye prophylaxis wait until after the rst feeding.[23]

Books and videos advise mothers about breastfeeding.

Lactation consultants in hospitals or private practice, and
volunteer organizations of breastfeeding mothers such as 4.2 Timing
La Leche League International also provide advice and
Newborn babies typically express demand for feeding evsupport.
ery 1 to 3 hours (8-12 times in 24 hours) for the rst two
to four weeks.[26]

4.1

Commencement

According to La Leche League International, Experienced breastfeeding mothers learn that the sucking patBreastfeeding can begin immediately after birth. The terns and needs of babies vary. While some infants suckbaby is placed on the mother and feeding commences as ing needs are met primarily during feedings, other basoon as the baby shows interest.
bies may need additional sucking at the breast soon after
a feeding even though they are not really hungry. Babies may also nurse when they are lonely, frightened or
in pain....Comforting and meeting sucking needs at the
breast is natures original design. Paciers (dummies,
soothers) are a substitute for the mother when she cannot
be available. Other reasons to pacify a baby primarily at
the breast include superior oral-facial development, prolonged lactational amenorrhea, avoidance of nipple confusion, and stimulation of an adequate milk supply to ensure higher rates of breastfeeding success.[27]
During the newborn period, most breastfeeding sessions
take from 20 to 45 minutes.[26] After one breast is empty,
the mother may oer the other breast.

Newborn rests as caregiver checks breath sounds

According to some authorities, increasing evidence suggests that early skin-to-skin contact (also called kangaroo
care) between mother and baby stimulates breastfeeding
behavior in the baby.[9] Newborns who are immediately
placed on their mothers skin have a natural instinct to
latch on to the breast and start nursing, typically within
one hour of birth. Immediate skin-to-skin contact may
provide a form of imprinting that makes subsequent feed- Rooming-in bassinet
ing signicantly easier. WHO reported that in addition to

4.3

Location

METHODS

4.5 Latching on

The rooting reex is the babys natural tendency to turn

towards the breast with the mouth open wide; mothers
sometimes make use of this by gently stroking the babys
cheek or lips with their nipple to induce the baby to move
into position for a breastfeeding session, then quickly
moving the baby onto the breast while its mouth is wide
open.[31] To prevent nipple soreness and allow the baby
to get enough milk, a large part of the breast and areola
need to enter the babys mouth.[32][33] Failure to latch on
In 2014, newly elected Pope Francis drew world-wide
is one of the main reasons for ineective feeding and can
commentary when he encouraged mothers to breastfeed
lead to infant health concerns.
hungry babies in church. During a papal baptism he said
that mothers should not stand on ceremony if their children were hungry. If they are hungry, mothers, feed
them, without thinking twice, he said, smiling. Because 4.6 Weaning
they are the most important people here.[28]
Main article: Weaning
Most US states now have laws that allow a mother to
breastfeed her baby anywhere. In hospitals, rooming-in
care permits the baby to stay with the mother and simplies the process. Some commercial establishments provide breastfeeding rooms, although laws generally specify
that mothers may breastfeed anywhere, without requiring
a special area. Breastfeeding in public remains controversial in many developed countries.

4.4

Position

Weaning is the process of replacing breast milk with other

food. The infant is fully weaned after the replacement
is complete. Most mammals stop producing the enzyme
lactase at the end of weaning, and become lactose intolerant. Figures vary, but worldwide, humans lose about 75
to 95 percent of birth lactase levels by early childhood,
and lactase continues to decline with age. However, the
prevalence varies widely among ethnic backgrounds. Estimates range from 2 to 5 percent in those with Northern
European ancestry to nearly 100 percent in adult Asians
and American Indians. Africans and Ashkenazi Jews
have prevalences of 60 to 80 percent, while Latinos have
a prevalence of 50 to 80 percent.[34][35]
In humans, psychological factors crucially aect the
weaning process for both mother and infant, as issues of
closeness and separation are very prominent.[36]

Illustration depicting correct latch-on position during breastfeeding.

Correct positioning and technique for latching on are necessary to prevent nipple soreness and allow the baby to
obtain enough milk.[29]
Babies can successfully latch on to the breast from multiple positions. Each baby may prefer a particular position. The football hold places the babys legs next to
the mothers side with the baby facing the mother. Using
the cradle or cross-body hold, the mother supports
the babys head in the crook of her arm. The crossover hold is similar to the cradle hold, except that the
mother supports the babys head with the opposite hand.
The mother may choose a reclining position on her back
or side with the baby laying next to her.[30]

In the past bromocriptine was in some countries frequently used to reduce the common engorgement experienced during weaning. This is now done only
in exceptional cases due to frequent side eects and
slight benets.[37] Other medications such as cabergoline,
lisuride or birth control pills may occasionally be used to
suppress lactation.

5 Methods
5.1 Exclusive breastfeeding
Exclusive breastfeeding is dened as an infants consumption of human milk with no supplementation of any
type (no water, no juice, no nonhuman milk and no foods)
except for vitamins, minerals and medications.[23] Exclusive breastfeeding has reduced infant deaths in developing countries by reducing diarrhea and infectious diseases. It also reduced HIV transmission from mother to
child, compared to mixed feeding.[38][39][40][41]

5.3

Expressed milk

Measuring how many calories a breastfed baby consumes

is complex, although babies normally attempt to meet
their own requirements.[42] Babies that fail to eat enough
may exhibit symptoms of failure to thrive.
La Leche League says that mothers most often asked
question is, How can I tell if my baby is getting enough
milk?" They advise that for the rst few days, while the
baby is receiving mostly colostrum, one or two wet diapers per day is normal. Once the mother starts producing
milk, usually on the third or fourth day, the baby should
have 6-8 wet cloth diapers (5-6 wet disposable diapers)
per day. In addition, most young babies have at least two
to ve bowel movements every 24 hours for the rst several months.[43]
La Leache League oers the following additional signs
that indicate a baby is receiving enough milk The baby:
Averages at least 8-12 feedings per 24-hour period.
Determines the duration of feeding, which may be
10 to 20 minutes per breast or longer.
Swallowing sounds are audible.
Manual breast pump

Gains at least 4-7 ounces per week after the fourth

day.

5.3 Expressed milk

Is alert and active, appears healthy, has good

color, rm skin and is growing in length and head A mother can express (produce) her milk for storage
and later use. Expression occurs with massage or a breast
circumference.[43]
pump. It can be stored in freezer storage bags, containers
made specically for breastmilk, a supplemental nursing
system, or a bottle ready for use. Using someone other
5.2 Mixed feeding
than the mother/wet nurse to deliver the bottle maintains
the babys association of nursing with the mother/wet
nurse and bottle feeding with other people.
Breast milk may be kept at room temperature for up to six
hours, refrigerated for up to eight days or frozen for six to
twelve months.[45] Research suggests that the antioxidant
activity in expressed breast milk decreases over time, but
remains at higher levels than in infant formula.[46]

Formula and pumped breastmilk, side-by-side. Note that the formula is of uniform consistency and color, while the milk exhibits
properties of an organic solution, separating into the creamline
layer of fat at the top, milk and a watery blue layer at the bottom.

Mothers express milk for multiple reasons. Expressing

breast milk can maintain a mothers milk supply when she
and her child are apart. A sick baby who is unable to nurse
can take expressed milk through a nasogastric tube. Some
babies are unable or unwilling to nurse. Expressed milk
is the feeding method of choice for premature babies.[47]
Viral disease transmission can be prevented by expressing
breast milk and subjecting it to Holder pasteurisation.[48]
Some women donate expressed breast milk (EBM) to
others, either directly or through a milk bank. This allows mothers who cannot breastfeed to give their baby
the benets of breast milk.

Predominant or mixed breastfeeding means feeding Babies feed dierently with articial nipples than from
breast milk along with infant formula, baby food and even a breast. With the breast, the infants tongue massages
water, depending on the childs age.[44]
the milk out rather than sucking, and the nipple does not

go as far into the mouth. Drinking from a bottle takes

less eort and the milk may come more rapidly, potentially causing the baby to lose desire for the breast. This
is called nursing strike, nipple strike or nipple confusion.
To avoid this, expressed milk can be given by means such
as spoons or cups.[44]

METHODS

babies varying appetites. Breasts can respond to the demand and produce larger milk quantities; mothers have
breastfed triplets successfully.[53][54][55]
Tandem nursing occurs when a woman gives birth while
breastfeeding an older child. During the late stages of
pregnancy, the milk changes to colostrum. While some
children continue to breastfeed even with this change,
others may wean. Breastfeeding a child while pregnant
with another may be considered a form of tandem feeding for the nursing mother, as she provides nutrition for
two.[56]

Exclusively expressing, exclusively pumping, and

EPing are terms for a mother who exclusively feeds
her baby expressed milk. With good pumping habits,
particularly in the rst 12 weeks while establishing the
milk supply, it is possible to express enough milk to feed
the baby indenitely. With the improvements in breast
pumps, many women exclusively feed expressed milk, expressing milk at work. Women can leave their infants in 5.6 Induced lactation
the care of others while traveling, while maintaining a
supply of breast milk.[49]
Induced lactation, also called adoptive lactation, is the
process of starting breastfeeding in a woman who did not
give birth.[57] This usually requires the adoptive mother to
take hormones and other drugs to stimulate breast development and promote milk production. In some cultures,
breastfeeding an adoptive child creates milk kinship that
built community bonds across class and other hierarchal
bonds.[57]

5.7 Re-lactation

Expressed breast milk (EBM) or infant formula can be fed to an

infant by bottle

Re-lactation is the process of restarting breastfeeding.[57]

In developing countries, mothers may restart breastfeeding after a weaning as part of an oral rehydration treatment for diarrhea. In developed countries, re-lactation
is common after early medical problems are resolved, or
because a mother changes her mind about breastfeeding.

Re-lactation is most easily accomplished with a newborn or with a baby that was previously breastfeeding; if
5.4 Shared nursing
the baby was initially bottle-fed, the baby may refuse to
suckle. If the mother has recently stopped breastfeeding,
Main article: Wet nurse
she is more likely to be able to re-establish her milk supply, and more likely to have an adequate supply. Although
Wet nursing was common throughout history. It re- some women successfully re-lactate after months-long in[57]
mains popular in some developing nations including in terruptions, success is higher for shorter interruptions.
Africa, for more than one woman to breastfeed a child. Techniques to promote lactation use frequent attempts to
Shared breastfeeding is a risk factor for HIV infection breastfeed, extensive skin-to-skin contact with the baby,
in infants.[50] A woman who is engaged to breastfeed and frequent, long pumping sessions.[57] Suckling may be
anothers baby is known as a wet nurse. Shared nurs- encouraged with a tube lled with infant formula, so that
ing can sometimes provoke negative reactions in the the baby associates suckling at the breast with food. A
Anglosphere.[51][52]
dropper or syringe without the needle may be used to

5.5

Tandem nursing

Feeding two children at the same time who are not twins
or multiples is called tandem nursing. Appetite and feeding habits of each baby may dier, so they may feed at
the same or dierent times, which may involve feeding
them simultaneously, one on each breast.
Breastfeeding triplets or larger broods is a challenge given

place milk onto the breast while the baby suckles. The
mother should allow the infant to suckle at least ten times
during 24 hours, and more times if he or she is interested.
These times can include every two hours, whenever the
baby seems interested, longer at each breast, and when the
baby is sleepy when he or she might suckle more readily.
In keeping with increasing contact between mother and
child, including increasing skin-to-skin contact, grandmothers should pull back and help in other ways. Later
on, grandmothers can again provide more direct care for

6.1

For the baby

the infant.[58]

that national authorities in each country decide which inMilk-producing drugs, such as domperidone, may be fant feeding practice should be promoted by their maternal and child health services to best avoid HIV transmisgiven.
sion from mother to child.[65]
These techniques require the mothers commitment over
Some pollutants in the mothers food and drink are passed
a period of weeks or months. However, even when lactaincluding mercury (found
tion is established, the supply may not be large enough to to the baby through breast milk,
in some carnivorous sh),[66] caeine,[67] and bisphenol
breastfeed exclusively. A supportive social environment
[68][69]
improves the likelihood of success.[57] As the mothers A.
milk production increases, other feeding can decrease.
Parents and other family members should watch the 6.1.1 Growth
babys weight gain and urine output to assess nutritional
adequacy.[58]
The average breastfed baby doubles its birth weight in 5 to
A WHO manual for physicians and senior health workers
citing a 1992 source states: If a baby has been breastfeeding sometimes, the breastmilk supply increases in a
few days. If a baby has stopped breastfeeding, it may take
1-2 weeks or more before much breastmilk comes.[58]

6 months. By one year, a typical breastfed baby weighs

about 2 times its birth weight. At one year, breastfed
babies tend to be leaner than formula-fed babies, which
improves long-run health.[70]

The Davis Area Research on Lactation, Infant Nutrition

and Growth (DARLING) study reported that breastfed
and formula-fed groups had similar weight gain during
5.8 Extended breastfeeding
the rst 3 months, but the breastfed babies began to drop
below the median beginning at 6 to 8 months and were
Main article: Extended breastfeeding
signicantly lower weight than the formula-fed group between 6 and 18 months. Length gain and head circumferExtended breastfeeding means breastfeeding after the age ence values were similar between groups, suggesting that
of 12 or 24 months, depending on the source. In Western the breastfed babies were leaner.[71]
countries such as the United States, Canada, and Great
Britain, extended breastfeeding is relatively uncommon.
For example, in the United States overall, only 22.4% of 6.1.2 Immunity
babies are breastfed for 12 months.[59] In India, mothers
commonly breastfeed for 2 to 3 years.[60]
During breastfeeding, approximately 0.25-0.5 grams per
day of secretory IgA antibodies pass to the baby via
milk.[72][73] This is one of the most important features
of colostrum.[74] The main target for these antibodies are
6 Health eects
probably microorganisms in the babys intestine. The
rest of the body displays some uptake of IgA,[75] but this
6.1 For the baby
amount is relatively small.[76]
Early breastfeeding is associated with fewer nighttime
feeding problems.[61] Early skin-to-skin contact between
mother and baby improves breastfeeding outcomes, increases cardio-respiratory stability and decreases infant
crying.[62] A 2007 review for the U.S. Agency for Healthcare Research and Quality (AHRQ)[63] and a 2007 review for WHO[64] found numerous benets. Breastfeeding aids general health, growth and development in the infant. Infants who are not breastfed are at mildly increased
risk of developing acute and chronic diseases, including
lower respiratory infection, ear infections, bacteremia,
bacterial meningitis, botulism, urinary tract infection
and necrotizing enterocolitis. Breastfeeding may protect
against sudden infant death syndrome, insulin-dependent
diabetes mellitus, Crohns disease, ulcerative colitis,
lymphoma, allergic diseases, digestive diseases and may
enhance cognitive development.[23]

Infections Breast milk contains several anti-infective

factors such as bile salt stimulated lipase (protecting
against amoebic infections) and lactoferrin (which binds
to iron and inhibits the growth of intestinal bacteria).[77][78]
Infants who are exclusively breastfed for the rst six
months are less likely to die of gastrointestinal infections than infants who switched from exclusive to partial
breastfeeding at three to four months.[79]

Vaccination Maternal vaccinations while breastfeeding is safe for almost all vaccines.
Additionally,
the mothers immunity obtained by vaccination against
tetanus, diphtheria, whooping cough and inuenza can
protect the baby from these diseases, and breastfeeding
Exceptions include periods when the mother is taking cer- can reduce fever rate after infant immunization. Howtain drugs, has active untreated tuberculosis or is infected ever, smallpox and yellow fever vaccines increase the risk
with human T-lymphotropic virus. WHO recommends of infants developing vaccinia and encephalitis.[80][81]

8
6.1.3

HEALTH EFFECTS

Mortality

increased cognitive development in childhood, although

the cause may be increased motherchild interaction
Babies who are not breastfed are almost six times more rather than nutrition.[64] Studies show that babies brain
likely to die by the age of one month than those who re- development is highly developed over other babies that
ceive at least some breastmilk.[82]
are not breast feed.Export to Bibliographic Management
Software (EndNote, ProCite, Reference Manager, RefWorks, BibTeX, etc.)
Diabetes Infants exclusively breastfed have less chance
of developing diabetes mellitus type 1 than those with
a shorter duration of breastfeeding.[63] Breastfed infants
6.2 For the mother
appear to have a lower likelihood of developing diabetes
mellitus type 2 later in life.[63][64][83]
Breastfeeding aids maternal physical and emotional
health.
Childhood obesity The protective eect of breastfeeding against obesity is consistent, though small, across
many studies.[63][64][84] A 2013 longitudinal study re- 6.2.1 Maternal bond
ported less obesity at ages two and four years among inHormones released during breastfeeding help to
fants who were breastfed for at least four months.[85]
strengthen the maternal bond.[17] Teaching partners how
to manage common diculties is associated with higher
Allergic diseases (atopy) In children who are at risk breastfeeding rates.[90] Support for a breastfeeding
for developing allergic diseases (dened as at least one mother can strengthen familial bonds and help build a
parent or sibling having atopy), atopic syndrome can be paternal bond.[17][91]
prevented or delayed through 4-month exclusive breastfeeding, though these benets may not persist.[86]
6.2.2 Fertility
Necrotizing enterocolitis in premature infants
Main article: Postpartum infertility
Breastfeeding may reduce the risk of necrotizing
enterocolitis (NEC).[63]
Exclusive breastfeeding usually delays the return of fertility through lactational amenorrhea, although it does not
Other long-term health eects Breastfeeding by a provide reliable birth control. Breastfeeding may delay
mother who eats gluten-containing foods reduces the risk the return to fertility for some women by suppressing ovuof celiac disease.[87]
lation. Mothers may not ovulate, or have regular periods,
Breastfeeding may decrease the risk of cardiovascular during the entire lactation period. The non-ovulating pedisease in later life, as indicated by lower cholesterol and riod varies by individual. This has been used as natural
C-reactive protein levels in breastfed adult women.[64] contraception, with greater than 98% eectiveness durBreastfed infants have somewhat lower blood pressure ing the rst six months after birth if specic nursing be[92]
later in life, but it is unclear how much practical bene- haviors are followed.
[63][64]
t this provides.
In a 1998 study it was suggested that breastfed babies have
a better chance of good dental health than formula-fed
infants because of the developmental eects of breastfeeding on the oral cavity and airway. It was thought that
with fewer malocclusions, breastfed children may have
a reduced need for orthodontic intervention. The report
suggested that children with a well rounded, U-shaped
dental arch, which is found more commonly in breastfed
children, may have fewer problems with snoring and sleep
apnea in later life.[88]

Hormonal Breastfeeding releases benecial hormones

into the mothers body.[73] Oxytocin and prolactin hormones relax the mother and increase her nurturing
response.[93] This hormone release can help to enable
sleep. Breastfeeding soon after birth increases the
mothers oxytocin levels, making her uterus contract
more quickly and reducing bleeding. Pitocin, a synthetic hormone used to make the uterus contract during
and after labour, is structurally modelled on oxytocin.
Syntocinon, another synthetic oxytocic, is commonly
used in Australia and the UK rather than Pitocin.[94]

Intelligence It is unclear whether breastfeeding improves intelligence later in life. Several studies found
no relationship after controlling for confounding factors
like maternal intelligence (smarter mothers were more
likely to breastfeed their babies).[63][89] However, other
studies concluded that breastfeeding was associated with

Mothers who successfully breastfeed are less likely to develop postpartum depression.[95]
Weight loss It is unclear whether breastfeeding causes
mothers to lose weight after giving birth.[63]

9
Long-term For breastfeeding women, long-term 8 Ocial recommendations
health benets include reduced risk of breast cancer,
ovarian cancer, and endometrial cancer.[23][63]
Support for breastfeeding is universal among major
health and childrens organizations. WHO states, Breast
milk is the ideal food for the healthy growth and devel6.3 Concerns
opment of infants; breastfeeding is also an integral part
of the reproductive process with important implications
Infants that are otherwise healthy uniformly benet from for the health of mothers..[102] WHOs guidelines recbreastfeeding. No known disadvantages stem from ommend continue[d] frequent, on-demand breastfeedbreastfeeding.[96] However, extra precautions should be ing until two years of age or beyond.[103][104]
taken or breastfeeding be avoided entirely in circum[105][106]
the US Centers for
stances including certain infectious diseases, or use of The European Commission,
[107]
Disease
Control
and
Prevention
(CDC), UNICEF,
[97]
certain medications. In some cases it may not be fea[108]
Save
The
Children
and
the UK National
AAP,
[98]
sible for the mother to continue breastfeeding.
Health Service[109] (NHS), Australian Department of
Health,[110] Health Canada, Canadian Paediatric Society,
Dietitians of Canada, and Breastfeeding Committee for
6.3.1 HIV
Canada,[111] recommend exclusive breastfeeding for six
months following birth and continued nursing for an addiMain article: Breastfeeding by HIV infected mothers
tional eighteen months or more.[3][112] Save the Children
states, Six months of exclusive breastfeeding increases a
The central concern about breastfeeding in the presence childs chance of survival at least six-fold.[113]
of maternal HIV is whether or not it risks the child
becoming infected. Factors such as the viral load in Authorities generally advise avoiding bottle feeding until
[114]
the mothers milk complicate breastfeeding recommen- the baby is 46 weeks old and is nursing successfully.
dations for HIV-positive mothers.[99]

6.3.2

Medications

It is safe for breastfeeding mothers to take many over-thecounter drugs and prescription drugs. Certain painkillers,
psychiatric drugs and herbal supplements carry more risk.
The maternal health benets must be weighed against the
risk of infant drug exposure. The report recommends
consulting the NIH database 'LactMed' for up-to-date
information.[80][81]

9 Decision factors
Main article: Breastfeeding diculties
The majority of mothers intend to breastfeed at birth.
Many things can disrupt this intent. Even though many
mothers are educated about the health benets of breastfeeding, fewer than 25% of US mothers do so.[115] Multiple factors aect the mothers decision breastfeed.

Smallpox and yellow fever vaccines are also a concern.

9.1 Workforce

Financial considerations

Breastfeeding is cheaper than alternatives, but it is not

free of cost. The mother generally must eat more food
than otherwise. In the US, the extra money spent on food
(about US$13 each week) is usually about half as much
money as the cost of infant formula.[100]

Work is the most common cited reason for not

breastfeeding.[116] In 2012 Save the Children examined
maternity leave laws, ranking 36 industrialized countries
according to their support for breastfeeding. Norway
ranked rst, while the US came in last.[117] Maternity
leave in the US varies widely, including by state, despite
the Family Medical Leave Act (FMLA), which guarantees most mothers up to 12 weeks unpaid leave. The majority of US mothers resume work earlier.

Breastfeeding represents an opportunity cost, as the

mother must spend hours each day breastfeeding instead
of other activities, such as paid work or home production (such as growing food). In general, the higher the 9.2 Birth procedures
mothers earning power, the less likely she is to save
money by breastfeeding.[101]
Routine mother/baby separation, delayed initiation, vigBreastfeeding reduces health care costs and the cost of orous routine suctioning, medications and delivery mode
caring for sick babies. Parents of breastfed babies are less all interfere. A substantial number of hospital and facillikely to miss work and lose income because their babies ities employed procedures and policies that interfere with
are sick.[100]
lactation.[118]

10

9.3

Knowledge and social support

Mother Absent examples, mothers may opt out

of nursing,[119] although classes, books and personal
counseling (professional or lay) can help compensate. Some women fear that breastfeeding will negatively impact the look of their breasts.However, a
2008 study found that breastfeeding had no eect
on a womans breasts, other factors did contribute
to drooping of the breasts, such as advanced age,
number of pregnancies and smoking behavior.[120]

DECISION FACTORS

9.6 Demographic/socioeconomic status

Race, ethnicity and socioeconomic status aect choice
and duration in the US. A 2011 study found that on average, US women who breastfed had higher levels of education, were older and were more likely to be white.[125]
The reasons for the persistently lower rates of breastfeeding among African American mothers are not well understood, but employment may play a role. They tend to
return to work sooner than white mothers, and are more
likely to work in unsupportive environments.

Although return to work is associated with early discon Partner Partners may lack knowledge of breast- tinuation, a supportive work environment may encourage
feeding and their role in the practice.
mothers to continue.
Low-income mothers are more likely to have unintended
Practitioner Primary physicians and nurses have pregnancies.[125] Mothers whose pregnancies are uninlittle training in lactation and lactation support and tended are less likely to breastfeed.[124]
are often unprepared to provide the information that
mothers need.[119] The Surgeon Generals Call to Action to Support Breastfeeding attempts to educate
9.7 Social acceptance
practitioners.[121]
9.7.1 Public nursing

9.4

Technique

Main article: Breastfeeding in public

Pain caused from mis-positioning the baby on the breast

or a tongue-tie in the infant can cause pain in the mother Negative perception of breastfeeding in social settings
to feel discomfort when breastfeedand discourage her. These problems are generally easy to has led some women
[126]
ing
in
public.
Public
breastfeeding is forbidden in
[122]
correct (by re-positioning or clipping the tongue-tie).
some jurisdictions, not addressed by law in others, and
a granted legal right in others. Even given a legal right,
some mothers are reluctant to breastfeed,[127][128] while
9.5 Health
others may object to the practice.[129]
IOM reported that breast surgery, including breast implants or breast reduction surgery, reduces the chances
that a woman will have sucient milk to breastfeed.[123]
Women whose pregnancies are unintended are less likely
to breast feed their babies.[124]

Property owners and/or nearby individuals have objected

to or forbade the practice. Responses by mothers ranged
from acquiescence to nurse-ins (where mothers gather
to nurse at the scene) to legal action. Some businesses
apologised after the fact.[130]
In 2006, many readers of Babytalk magazine complained
after the August cover depicted a baby nursing at a bare
breast. In a subsequent reader poll, one-quarter of 4,000
respondents objected to the cover. In a 2004 American
Dietetic Association survey, 43% of the 3,719 respondents believed mothers ought to have the right to breastfeed in public.[131]
In some public places and workplaces, rooms for mothers
to nurse in private have been designated.
In a 2006 survey, over half of the respondents believed
that women should not be allowed to breastfeed in public.

The invention of formula was hypothesized as a way

Famille dun Chef Camacan se prparant pour une Fte (Fam- for western culture to adapt to negative perceptions of
[132]
The breast pump oered a way for
ily of a Camacan chief preparing for a celebration) by Jean- breastfeeding.
Baptiste Debret shows a woman breastfeeding a child in the back- mothers to supply breast milk with most of formula feedground.
ings convenience and without enduring possible disapproval of nursing.[133]

11

Sign for a private nursing area at a museum

9.7.2

Conation with sex

International Breastfeeding Symbol

9.8.1 Marketing of infant formula

Western society tends to perceive breasts in sexual terms

instead of for their main biological purpose, to nourish
infants.[115] This view led many to object to breastfeeding
because of the implicit association between infant feeding
and sex. Many women feel embarrassed to breast feed
in public.[127] These negative cultural connotations may
reduce breastfeeding duration.[127][134][135]

Advocates oppose marketing of infant formula, especially

in developing countries. They are concerned that mothers who use formula will stop breastfeeding and become
dependent upon substitutes that are unaordable or less
safe.[138][139] Through eorts including the Nestl boycott, they have advocated for bans on free samples of infant formula and for the adoption of pro-breastfeeding
codes such as the International Code of Marketing of
Breast-milk Substitutes by the World Health Assembly
9.7.3 Maternal guilt and shame
in 1981 and the Innocenti Declaration by WHO and
[138]
Maternal guilt and shame is often aected by how a UNICEF policy-makers in August 1990.
mother feeds her infant. These feelings result from
her inability to behave according to her denition of
a good mother. These feelings aict both bottle- 10 See also
and breast- feeding mothers, although for dierent reasons. Bottle feeding mothers may feel that they should
be breastfeeding.[136] Conversely, breastfeeding mothers 11 References
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Some may see breastfeeding as, indecent, disgusting, an- [1] Berger, Kathleen (2014). Invitation to the Life Span (secimalistic, sexual, and even possibly a perverse act.[115]
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Advocates use nurse-ins to show support for breastfeed978-1429283526.
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women with education on breastfeedings benets as well [2] Nutrition in the First 1,000 Days: State of the Worlds
Mothers, 2012 (PDF). Retrieved October 26, 2013.
as problem-solving skills.[136]

9.8

Advocacy

International board certied lactation consultants (IBCLCs) are health care professionals certied in lactation management. They work with mothers to solve
breastfeeding problems and educate families and health
professionals. Exclusive and partial breastfeeding are
more common among mothers who gave birth in IBCLCequipped hospitals.[137]

[3] Infant and young child feeding Fact sheet N342.

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(2003). Perceptions of the Woman Who Breastfeeds: The Role of Erotophobia, Sexism, and At[99] Moland, K, Blystad A (2008). Counting on Mothers
titudinal Variables. Sex Roles 49 (7/8): 379388.
Love: The Global Politics of Prevention of Mother-todoi:10.1023/A:1025116305434.
Child Transmission of HIV in Eastern Africa. In Hahn R,
Inhorn M. Anthropology and Public Health: Bridging Dif[116] Galson SK (July 2008).
Mothers and children
ferences in Culture and Society. Oxford University Press.
benet from breastfeeding (PDF). Journal of
p. 449.
the American Dietetic Association 108 (7): 1106.
doi:10.1016/j.jada.2008.04.028.
PMID 18589012.
[100] Breastfeeding and the Use of Human Milk
Retrieved 25 August 2012.
[101] Cohen, Lloyd R.; Wright, Joshua D. (2011). Research
Handbook on the Economics of Family Law. Edward El- [117] State of the Worlds Mothers 2012-Final
gar Publishing. p. 185. ISBN 9780857930644.
[118] Breastfeeding-related maternity practices at hospitals
[102] Up to what age can a baby stay well nourished by just beand birth centersUnited States, 2007. MMWR Morb.
ing breastfed?". WHO. July 2013. Retrieved 7 February
Mortal. Wkly. Rep. 57 (23): 6215. June 2008. PMID
2015.
18551096.

16

12 FURTHER READING

[119] Woods NK, Chesser AK, Wipperman J (2013). Describ- [135] Battersby, S. (2010). Understanding the Social and Culing adolescent breastfeeding environments through focus
tural Inuences on Breast-Feeding Today. Journal of
groups in an urban community. J Prim Care Community
Family Health Care 20 (4): 128131. PMID 21053661.
Health 4 (4): 30710. doi:10.1177/2150131913487380.
[136] Taylor EN, Wallace LE (2012). For Shame: Feminism,
PMID 23799673.
Breastfeeding Advocacy, and Maternal Guilt. Hypatia 27
[120] Ireland, Jae (20 July 2011). Will My Breasts Be Ruined
(1): 7698. doi:10.1111/j.1527-2001.2011.01238.x.
After Breastfeeding?". LiveStrong.com. Retrieved 27 Jan
[137] US Surgeon General Breastfeeding Executive Summary
2013.
[121] Benjamin RM (2011). Public health in action: give [138] Milking it Joanna Moorhead, The Guardian, May 15,
2007
mothers support for breastfeeding. Public Health Rep
126 (5): 6223. PMC 3151176. PMID 21886320.
[139] Baby health crisis in Indonesia as formula companies push
[122] Ballard J, Chantry C, Howard CR. Guidelines for the
products, The Guardian, Zoe Williams in Jakarta, 15 Feb.
evaluation and management of neonatal ankyloglossia and
2013.
its complications in the breastfeeding dyad. ABM Clinical Protocol #11.
[123] Breast Surgery Likely to Cause Breastfeeding Problems.
The Implant Information Project of the Nat. Research
Center for Women & Families. February 2008.
[124] Family Planning - Healthy People 2020. Retrieved
2011-08-18.
[125] Oce of the Surgeon General (US); Centers for Disease Control and Prevention (US); Oce on Womens
Health (US) (2011). Call to Action to Support Breastfeeding (PDF). Surgeon Generals Call to Action. PMID
21452448.
[126] Boyer, K., & Geographies of Care. (March 01, 2011).
The way to break the taboo is to do the taboo thing breastfeeding in public and citizen-activism in the UK. Health
and Place, 17, 2, 430-437.
[127] Wolf JH (2008). Got milk? Not in public!". International breastfeeding journal 3 (1): 11. doi:10.1186/17464358-3-11. PMC 2518137. PMID 18680578.
[128] Breastfeeding Legislation in the United States: A General Overview and Implications for Helping Mothers.
LEAVEN 41 (3): 514. 2005.
[129] Jordan, Tim; Pile, Steve (eds.) (2002). Social Change.
Blackwell. p. 233. ISBN 0-631-23311-3.
[130] Barsch, Sky (2006-11-14). Woman alleges she was
kicked o Burlington ight for breast-feeding. Burlington Free Press. Retrieved 2007-01-24.
[131] Eyeful of breast-feeding mom sparks outrage. Associated Press. 2006-07-27. Retrieved 25 November 2011.
[132] Hausman, B. L. (January 01, 2007). Things (Not) to Do
with Breasts in Public: Maternal Embodiment and the
Biocultural Politics of Infant Feeding. New Literary History, 38, 3, 479-504.
[133] Boyer, K. (January 01, 2010). Of care and commodities:
breast milk and the new politics of mobile biosubstances.
Progress in Human Geography, 34, 1, 5-20.
[134] Harmon, A. (2005, June 7). 'Lactivists Taking Their
Cause, and Their Babies, to the Streets. The New York
Times. Retrieved November 1, 2013

12 Further reading
Baumslag, Naomi; Michels, Dia L. (1995). Milk,
money, and madness: the culture and politics of
breastfeeding. Westport, Conneticut: Bergin & Garvey. ISBN 9780313360602.
Cassidy, Tanya and Abdullahi El Tom, eds. Ethnographies of Breastfeeding: Cultural Contexts and
Confrontations (Bloomsbury Academic; 2015) 255
pages; Scholarly essays on a variety of topics such
as networks of milk sharing through Facebook,
public-health guidelines on infant feeding and HIV
in Malawi, and dilemmas involving breastfeeding
and bonding for babies born from surrogate mothers.
Halili, Hassan Kamal; Che, Musa Norsuhaida (June
2014). Womens right to breastfeed in the workplace: legal lacunae in Malaysia. Asian Women
(Research Institute of Asian Women (RIAW)) 30
(2): 85108. doi:10.14431/aw.2014.03.30.2.85.
Hausman, Bernice L. (2003).
Mothers milk:
breastfeeding controversies in American culture.
New York, New York: Routledge.
ISBN
9780415966573.
Huggins, Kathleen (2010) [1987]. The nursing mothers companion (6th ed.). Boston, MasISBN
sachusetts: Harvard Common Press.
9781558327207.
Palmer, Gabrielle (2009) [1988]. The politics of
breastfeeding: when breasts are bad for business
(3rd ed.). London: Pinter & Martin. ISBN
9781905177165.
Pryor, Gale (1997). Nursing mother, working
mother: the essential guide for breastfeeding and
staying close to your baby after you return to work.
Boston, Massachusetts: Harvard Common Press.
ISBN 9781558321175.

17
Weiss, Robin (2010). The better way to breastfeed: the latest, most eective ways to feed and
nurture your baby with comfort and ease. Beverly, Massachusetts: Fair Winds Press. ISBN
9781592334223.
Wiessinger, Diane (2010) [1988]. The womanly art
of breastfeeding (8th ed.). London: Pinter & Martin. ISBN 9781905177400.

13

External links

Breastfeeding at DMOZ
Human Milk Secretion: An Overview US National
Institute of Health
Breastfeeding Resources La Leche League International
Breast-Feeding Content Resources WHO reports on
Breast Feeding
Health risks of not breastfeeding US Department of
Health & Human Services
The World Alliance for Breastfeeding Action
(WABA) is a global network of individuals & organisations concerned with the protection, promotion &
support of breastfeeding worldwide.
Breastfeeding: NHS Choices
Center for Disease Control and Prevention Breastfeeding CDC
LactMed, a database of the safety of drugs to which
breastfeeding mothers may be exposed, by the U.S.
National Library of Medicine

18

14

14
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14.2

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19

K6ka, Parenting82, ZroBot, Summertime30, Bongoramsey, BirthRoutes, Jeanpetr, Abbypeck, Ganesh Paudel, Bluemarie0428, Eponymous, Jamesgoldy, Saritbronstein, Tradimus, Pleonastic, L Kensington, Deutschgirl, Gsarwa, XRiamux, SBaker43, Dylan Flaherty, Fultonm92, Spicemix, Rp2488, Will Beback Auto, Margaretaker, Falito, ClueBot NG, Nature0rNurture, Sarah0227, Mother18, Mirisaamali,
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File:Blausen_0118_Breastfeeding_CorrectLatch-On_02.png Source:
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