Breast Milk Better, but...

Along with choosing the baby's name and the nursery colors, pregnant women face another difficult choice: to breastfeed or bottlefeed their babies.

In Third World countries, the choice can have deadly implications if water is not clean enough to wash bottles in or mix with formula. In developed nations, women may find it impossible to balance the needs of the workplace with the demands of breastfeeding.

Poll medical professionals and the answer is simple: breastfeeding is best for mother and baby. Polls of bottlefeeding women show that, they too feel breastfeeding is the optimum way to feed a baby.

Why then, don't more women do it?

Two reasons, says Robert Baker, M.D., professor of pediatrics at SUNY at Buffalo, N.Y., and a member of the Committee on Nutrition for the American Academy of Pediatrics.

"The reasons women give for not breastfeeding are mostly convenience, convenience and modesty," he says, repeating the first reason, for emphasis. "With bottlefeeding, you can pick up a bottle and anyone can do it, anyone can feed the baby."

That's particularly important for working women, he says, who leave their baby in the care of other people for the day.

"Particularly, working mothers find it inconvenient," he says. "They have to pump their breast milk, and that gets cumbersome."

Some women cite modesty as another reason. "They just don't like to do it," Baker says.

Medically, answer is simple

When weighing the pros and cons from a medical standpoint Baker says, "the pros for breastfeeding go on and on."

There are some medical concerns, however, chief among them the need for vitamin D.

The American Academy of Pediatrics released recommendations on April 7, 2003 calling for vitamin D supplementation for babies and children, including breast-fed babies in the first 2 months. The AAP report, titled "Prevention of Rickets and Vitamin D Deficiency: New Guidelines to Vitamin D Intake" advocates giving babies 200 IU (International Units) of vitamin D daily. Public health officials are concerned about an upswing in rickets, a disease caused by a lack of exposure to sunlight or a vitamin D deficiency in which the bones soften.

"Vitamin D in breast milk is extremely low," Baker says. "People might say, 'Well, if breast-milk is the perfect baby food why is it lacking in vitamin D?' What people don't understand is that our environment is changing rapidly, more rapidly than it ever has."

Children are not exposed to the sun as much - indeed, parents try to protect children from too much sun exposure because it is dangerous. Sunscreens, which block harmful rays, also block the sun's ability to provide vitamin D.

Another concern is that environmental toxins can be passed to the baby through breast milk. "There are other things we worry about, but we don't know if things in the environment affect the baby," says Baker, citing women who eat a high-fish diet and thus ingest mercury as an example.

"There is this potential worry that there might be something out there," he says.

But when analyzing what is known, breastfeeding is better than bottlefeeding.

"It's amazing formula companies do as well as they do," Baker says, pointing out that formula companies have spent years making their product as close to breast milk as possible.

Immune system ingredient

"But there are always things they're missing," he says. One key ingredient that can't be duplicated in bottle milk is the immunologic factors in breast milk. That's not so much of a concern in developed countries, where infection is limited and water sources are clean. But it's terribly important in Third World countries.

Breastfeeding also gives some protection against allergies. Baker notes that two studies, one a double-blind placebo controlled study that looked at children for 18 months and another one that followed them until 18, did show breastfeeding had a small but definite protective effect against allergies.

"It's true, but not a huge difference," he says.

Researchers are still studying growth patterns of babies; the World Health Organization is conducting studies to establish new growth curves based on breast-fed babies. Current growth curves are based on babies fed a mixture of breast and bottle, Baker says, noting that breast-fed babies tend to be heavier in the first six months of life, but bottle-fed babies are heavier in the second sixth months.

One concern all mothers have is getting their baby to understand the notion that nighttime is for sleep, preferably uninterrupted sleep. Breast-fed babies tend to quiet more easily, Baker says.

"When my children were small, I would get them and bring them to my wife in bed, and she would breastfeed them and she was barely awake," he says, adding that was much easier than getting up and warming a bottle. But he also realizes that for a woman without a supportive partner, the situation might not have been the same.

When to stop

For women who do choose to breastfeed, they still have to make yet another decision: How long should they breastfeed?

"There is an argument about that," Baker says. Most medical professionals recommend breast milk for the first year, but the question becomes how long should one exclusively feed breast milk. When should you introduce a complementary food, such as cereal?

"I would be flexible about it; it's about 4 to 6 months, preferably closer to 6 months," Baker says. "Some kids just aren't going to make it past 4 months. But by 6 months all babies should be on complementary feeding."

Too often, women find themselves back in the workforce in just six or eight weeks after having had the baby, and trying to breastfeed and meet a deadline or make a meeting all on little sleep is a challenge to say the least.

"I'm a strong supporter of breastfeeding," Baker says. "It's better for the baby and for the mother. As a society, we should be making it easier for women to breastfeed. Women are going to work; we should make it easier for them to breastfeed."

External Source American Academy of Pediatrics

This article was reviewed June 2006, by Edith D. Gurewitsch, M.D., Assistant Professor, Department of Gynecology and Obstetrics in the Division of Maternal Fetal Medicine, Johns Hopkins Hospital, Baltimore, MD.

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