Breastfeeding
Breastfeeding, also known as nursing, is the process whereby breast milk is fed to an infant or toddler. Infants may suckle directly from the breast, or milk may be extracted with a pump and then fed to the infant. The World Health Organization recommends that breastfeeding begin within the first hour of a newborn's birth and continue as the baby wants. Health organizations including the WHO recommend exclusively breastfeeding for six months; this means that no other foods or drinks—other than vitaminD supplement—are typically given. The WHO recommends then continuing breastfeeding with appropriate complementary foods for up to 2 years, and beyond. Between 2015 and 2020, only about 44% of infants worldwide were exclusively breastfed in the first six months of life.
Breastfeeding has a number of benefits to both mother and baby that infant formula lacks. Increased breastfeeding to near-universal levels in low and medium income countries could prevent approximately 820,000 deaths of children under the age of five annually. Breastfeeding decreases the risk of respiratory tract infections, ear infections, sudden infant death syndrome, and diarrhea for the baby, both in developing and developed countries. Other benefits have been proposed to include lower risks of asthma, food allergies, and diabetes. Breastfeeding may also improve cognitive development and decrease the risk of obesity in adulthood.
Benefits for the mother include less blood loss following delivery, better contraction of the uterus, and a decreased risk of postpartum depression. Breastfeeding delays the return of menstruation, and in very specific circumstances, fertility, a phenomenon known as lactational amenorrhea. Long-term benefits for the mother include decreased risk of breast cancer, cardiovascular disease, diabetes, metabolic syndrome, and rheumatoid arthritis. Breastfeeding is less expensive than infant formula, but its impact on mothers' ability to earn an income is not usually factored into calculations comparing the two feeding methods. It is also common for women to experience generally manageable symptoms such as: vaginal dryness, De Quervain syndrome, cramping, mastitis, moderate to severe nipple pain, and a general lack of bodily autonomy. These symptoms generally peak at the start of breastfeeding but disappear or become considerably more manageable after the first few weeks.
Each feeding may last as long as 30–60 minutes, as milk supply develops and the infant learns the Suck-Swallow-Breathe pattern. However, as milk supply increases and the infant becomes more efficient at feeding, the duration of feeds may shorten. Older infants may feed less often. When direct breastfeeding is not possible, expressing or pumping to empty the breasts can help mothers avoid plugged milk ducts and breast infection, maintain their milk supply, resolve engorgement, and provide milk to be fed to their infant at a later time. Medical conditions that do not allow breastfeeding are rare. Mothers who take certain recreational drugs should not breastfeed, however, most medications are compatible with breastfeeding. Available evidence indicates that it is unlikely that COVID-19 can be transmitted through breast milk. Smoking tobacco and consuming limited amounts of alcohol or coffee are not reasons to avoid breastfeeding.
Chestfeeding physiology
Breast development starts in puberty with the growth of ducts, fat cells, and connective tissue. The ultimate size of the breasts is determined by the number of fat cells. The size of the breast is not related to a mother's breastfeeding capability or the volume of milk she can produce. The process of milk production, termed lactogenesis, occurs in 3 stages. The first stage takes place during pregnancy, allowing for the development of the breast and production of colostrum, the thick, early form of milk that is low in volume but rich in nutrition. The birth of the baby and the placenta trigger the onset of the second stage of milk production, triggering the milk to come in over the next several days. The third stage of milk production occurs gradually over several weeks and is characterized by a full milk supply that is regulated locally, predominantly by the infant's demand for food. This differs from the second stage of lactogenesis, which is regulated centrally by hormone feedback loops that naturally occur after the placenta is delivered.Although traditionally, lactation occurs following pregnancy, lactation may also be [|induced] with hormone therapy and nipple stimulation in the absence of pregnancy.
Lactogenesis I and other changes in pregnancy
Changes in pregnancy, starting around 16 weeks gestational age, prepare the breast for lactation. These changes, collectively known as Lactogenesis I, are directed by hormones produced by the placenta and the brain, namely estrogen, progesterone, prolactin, which gradually increase throughout the pregnancy, and result in the structural development of the alveolar tissue and the production of colostrum. While prolactin is the predominant hormone in milk production, progesterone, which is at high levels during pregnancy, blocks the prolactin receptors in the breast, thus inhibiting milk from "coming in" during pregnancy.Many other physiologic changes occur under the control of progesterone and estrogen. These changes include, but are not limited to, dilation of blood vessels, increased blood flow to the uterus, increased availability of glucose, and increased skin pigmentation, which results in darkening of the nipples and areola, formation of the linea nigra, and onset of melasma of pregnancy.
From about the 16th week of pregnancy, the breasts can begin to produce milk. It's not unusual for small amounts of straw-coloured fluid called colostrum to leak from the nipples during this relatively early stage.
Breast development throughout pregnancy may result in significant Areola and Areolar gland enlargement, erectile nipples or nipple sensitivity.
Lactogenesis II
The third stage of labor describes the period between the birth of the baby and the delivery of the placenta, which normally lasts less than 30 minutes. The delivery of the placenta causes an abrupt drop off of placental hormones. This drop, specifically in progesterone, allows prolactin to work effectively at its receptors in the breast, leading to an array of changes over the next several days that allow the milk to "come in"; these changes are known collectively as Lactogenesis II. Colostrum continues to be produced for these next few days, as Lactogenesis II occurs. Milk may "come in" as late as five days after delivery; however, this process may be delayed due to a number of factors as described in the [|Process] "Delay in milk 'coming in'" subsection below. Oxytocin, which signals the smooth muscle of the uterus to contract during pregnancy, labor, birth and following delivery, is also involved in the process of breastfeeding. Oxytocin also contracts the smooth muscle layer of band-like cells surrounding the milk ducts and alveoli to the newly produced milk through the duct system and out through the nipple. This process is known as the milk ejection reflex, or let-down. Because of oxytocin's dual activity at the breast and the uterus, breastfeeding mothers may also experience uterine cramping at the time of breastfeeding, for the first several days to weeks.Lactogenesis III
and oxytocin are vital for establishing milk supply initially; however, once the milk supply is well established, the volume and content of the milk produced are controlled locally. Although prolactin levels are higher on average among breastfeeding mothers, prolactin levels themselves do not correlate to milk volume. At this stage, production of milk is triggered by milk drainage from the breasts. The only way to maintain milk supply is to drain the breasts frequently. Infrequent or incomplete drainage of the breasts, decreases blood flow to the alveoli and signals the milk-producing cells to produce less milk. Breast pumps are often used to drain the breasts when the infant is not feeding.A condition called Mastitis sometimes occurs in this stage, resulting from incomplete milk drainage. The Academy of Breastfeeding Medicine recommends against trying to "empty" the breasts, whether through pushing the baby to feed more or through over use of a breast pump, to prevent causing milk oversupply.
Breast milk
The content of breast milk should be discussed in two separate categories: the nutritional content, and the bioactive content, i.e., the enzymes, proteins, antibodies, and signaling molecules that assist the infant in ways outside of nutrition.Nutritional content
The pattern of intended nutrient content in breast milk is relatively consistent. Breastmilk is made from nutrients in the mother's bloodstream and bodily stores. It has an optimal balance of fat, sugar, water, and protein that is needed for a baby's age-appropriate growth and development. That being said, a variety of factors can influence the nutritional makeup of breastmilk, including gestational age, age of infant, maternal age, maternal smoking, and nutritional needs of the infant.The first type of milk produced is called colostrum. The volume of colostrum produced during each feeding is appropriate for the size of the newborn stomach and is sufficient, calorically, for feeding a newborn during the first few days of life. Produced during pregnancy and the first days after childbirth, colostrum is rich in protein and Vitamins A, B12 and K, which support infants' growth, brain development, vision, immune systems, red blood cells, and clotting cascade. The breast milk also has long-chain polyunsaturated fatty acids which help with normal retinal and neural development.
The caloric content of colostrum is about 54 Calories/100mL. The second type of milk is transitional milk, which is produced during the transition from colostrum to mature breast milk. As the breast milk matures over the course of several weeks, the protein content of the milk decreases on average. The caloric content of breastmilk is reflective of the caloric requirements of the infant, increasing steadily after 12 months. The caloric content of breastmilk in the first 12 months of breastfeeding is approximated to be 58-72 Calories/100mL. Comparatively, the caloric content after 48 months is approximately 83-129 Calories/100mL.
When a mother has her full milk supply and is feeding her infant, the first milk to be expressed is called the foremilk. Foremilk is typically thinner and less rich in calories. The hindmilk that follows is rich in calories and fat.
If the mother is not deficient in vitamins, breast milk normally supplies the baby's needs, except for Vitamin D. The CDC, National Health Service, Canadian Paediatric Society, the American Academy of Pediatrics, and the American Academy of Family Physicians all agree that breast milk alone does not provide infants with an adequate amount of Vitamin D, thus they advise parents to supplement their infants with 400 IU Vitamin D daily. Providing this quantity of Vitamin D to breastfeeding infants has been shown to reduce rates of Vitamin D insufficiency. However, there was insufficient evidence in the most recent Cochrane Review to determine if this quantity reduced rates of Vitamin D deficiency or rickets. Term infants typically do not need iron supplementation. Delaying clamping of the cord at birth for at least one minute improves the infants' iron status for the first year. When complementary foods are introduced at about 6 months of age, parents should make sure to choose iron-rich foods to help maintain their children's iron stores.