Breastfeeding: History,

Health, and Society

February 8, 2008
 Overview
• Culture and history of breastfeeding
• AAP policy
• Proven health benefits
• Baby-Friendly hospitals
• Breast vs. Formula
• Breastfeeding in society
• Resources
 Breastfeeding Around the
World
• In ancient Greece and Rome, women fed their
own infants. This was an activity considered
below royalty, so they began the practice of
hiring wet nurses
• In India, traditionally, breastfeeding was not done
until the fifth day so that the baby would not
ingest colostrum.
• Cuba’s constitution has a provision for
breastfeeding mothers to take “mandatory paid
vacation” from work to feed their infants, six
weeks before and six weeks after the birth; plus
continuing breaks during the workday.
• Primary feeding method in developing countries-
economical
• Japan was the first developed nation to promote
 Historical Attitudes About
Breastfeeding
1750-1820
• Babies not breastfed until 2 or 3 days old
• Frequent pregnancy left many women
feeble and unable to nurse- wet nurses
were preferred over animal milk
• Tight corsets inhibited health breast
development and made breastfeeding
very difficult for some women
• Infants in orphanage hospitals were fed
directly from a goat’s udder
 Historical Attitudes About
Breastfeeding
1820-1870
• Breastfeeding becomes popular again
• Impress upon fathers and other children
what a mother’s role is.
• Mothers were encouraged to breastfeed on
a schedule (which actually inhibits natural
supply and demand)
• Others encouraged to feed right after birth
• Baby food first marketed in 1850s and
encouraged milk substitutes which led to
trend towards bottle feeding
 Historical Attitudes About
Breastfeeding
1870-1920
• “Liberated” and “progressive” mothers of
the 1880s saw breastfeeding as out-of-
date
• Mrs. Panton: “Let no mother condemn
herself to be a common or ordinary ‘cow’
unless she has a real desire to nurse…”
• By 1914, trend switched toward
breastfeeding again. People worried that
becoming too lackadaisical about
breastfeeding would be bad for future
generations of women and children
 Historical Attitudes About
Breastfeeding
1920-1946
• Truby King- “Breastfed is Bestfed.”
• Believed in strict feeding schedules,
quantities, and allowing the infant to
“cry it out.”
• Warned against over-feeding
• By 1930, it was proven that infants
ate varying amounts in a supply-
demand pattern
 Historical Attitudes About
Breastfeeding
1946-1981
• Freudian concerns
– Biting the nipple
– Time of weaning
– Separation trauma
• Bottle-feeding increasingly accepted
• 1970s
– Physical and emotional benefits of breastfeeding for
mother and child
– New mothers increasingly want to feed their children
naturally
 Historical Attitudes About
Breastfeeding
1981-2007
• Breastfeeding regarded as the most
natural and healthiest way of feeding
infants (see AAP)
• However, contemporary U.S.
generally adopts a “no-guilt” policy
for women who choose to, or must,
feed formula for personal reasons
 Breastfeeding Continues to
Increase Into the New
Millennium
• Breastfeeding increasing among populations that
historically do not breastfeed (young, black,
uneducated, WIC participants)
• Low SES mothers most concerned with
convenience and uncomfortable embarrassment
related to breastfeeding
• Breastfeeding remains high in educated, high SES
families
• Baby-friendly hospitals are increasing acceptance
and knowledge of breastfeeding practices among
all SES
• High SES mothers may have more control over
their environments and more opportunity to
breastfeed while employed
• Working mothers wean earlier than stay-at-home
moms, but changing workplace policies are
American Academy of
Pediatrics
• “Although economic, cultural, and political
pressures often confound decisions about
infant feeding, the AAP firmly adheres to
the position that breastfeeding ensures
the best possible health as well as the best
developmental and psychosocial outcomes
for the infant. Enthusiastic support and
involvement of pediatricians in the
promotion and practice of breastfeeding is
essential to the achievement of optimal
infant and child health, growth, and
development.”
 “Baby-Friendly
Hospitals”
• Designation by WHO given to
hospitals that promote breastfeeding
over formula feeding because of
health and psychological benefits:

• Particularly in developing countries

because of high infant-mortality
associated with formula feeding.
 Baby-Friendly Hospital
Protocol:
1. Have a written breastfeeding policy that is routinely
communicated to all health care staff.
2. Train all health care staff in skills necessary to implement
protocol
3. Inform all pregnant women of the benefits and
management of breastfeeding
4. Give newborns no food or drink other than breast milk
unless medically indicated
5. Help mothers initiate breastfeeding within ½ hour of birth
6. Show mothers how to breastfeed and maintain lactation
even if separated from the infant
7. Practice rooming in- allowing mother and child to stay
together 24 hours a day
8. Encourage breastfeeding on demand
9. Give no artificial teats or pacifiers to breastfeeding
infants
10. Foster the establishment of breastfeeding support groups
and refer mothers to them upon discharge from the
hospital
 Health Benefits
• Infant
– Essential nutrients provided naturally
– Colostrum rich in anti-bodies needed to build immune system
– Protects against common infection (upper-respiratory, ear infections,
gastroenteritis, otitis media, asthma)
– Lower incidence of SIDS,
– Lower risk of diabetes and obesity
– Lower risk of certain types of cancer, including leukemia
– Improved cognitive development
• Mother
– Decreased risk of ovarian cancer
– Decreased risk of pre-menopausal cancer
– More weight loss after pregnancy/return to normal weight
– No ovulation while breastfeeding
– Psychological and physical attachment to child: strengthens attachment
bond
 Other Benefits
• Bonding experience for mother and
infant
• Skin-to-skin contact is good
stimulation for baby
• Economical- It’s free! (Formula costs
more than $120/month)
 Breast Milk or Formula?
• Research and the AAP strongly
advise breastfeeding for obvious
health (and economical) reasons.
• However, in modern society,
extenuating medical circumstances
and/or convenience compel doctors
and mothers to consider formula or a
combination of breast milk and
formula
• Many mothers pump their breast
milk so that it is available even when
 When Pediatricians and
Mothers Consider Formula
• Persistent difficulties in latching on
and/or sucking
• Maternal medical condition that
could be passed through breast milk
(HIV/AIDS)
• Low milk production- not enough to
satisfy supply/demand
• Failure to thrive/ low weight
• Uncomfortable with exposure or act
of breastfeeding
 A Personal Choice
• Consider your comfort level and
lifestyle when deciding to breastfeed
or use formula
• Combining breast and formula is an
option for many mothers
• Commercially-made formula is
nutritionally complete
• There appears to be no difference
between attachment and adjustment
of infants who were breastfed and
infants who were bottle-fed.
 Breastfeeding in Society
• Public or private?
– One Viewpoint
• “I just don’t like the idea of whipping my breast out in public.”
• Breastfeeding is a private event between mother and child, should be done
in private; or in restrooms when in public. Mother should not expose herself
in public
– Opposing Viewpoint
• “As long as I’m discrete about it…You don’t eat your dinner in the bathroom,
why should my child?”
• Discrete breastfeeding in public while covering yourself is ok
• Especially for children who are slow feeders, mother doesn’t miss out on
social events

• Especially first-time mothers may feel guilty if they can’t

breastfeed exclusively
• Supporters of “breast-only” feeding may judge others who choose
to formula feed, or combine breast and formula, contributing to
the “good mother, bad mother” stereotypes

• http://www.youtube.com/watch?v=rrnxtiYmXig
 Resources
• La Leche League International
www.lalecheleague.net
• The American Academy of Pediatrics
www.aap.org
• INOVA Fair Oaks Women’s Center
www.inova.com/inova_fair_oaks_hospital
• The Birthing Inn at INOVA Loudoun
www.thebirthinginn.org