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Breast-feeding Support

Also indexed as: Nursing Mothers

Illustration

Breast-feeding can be beneficial for both baby and mother. According to research or other evidence, the following self-care steps may boost your baby’s health and increase your own comfort:

What you need to know

  • Keep up the supplements
  • Continue taking your prenatal vitamin supplement to help supply extra nutrients needed during lactation
  • Get the nutrients you need
  • Eat a balanced diet of unprocessed foods with extra calories and calcium to support lactation
  • Kick the habits
  • Reduce or eliminate sources of caffeine, alcohol, and nicotine to prevent transferring unhealthy amounts of these substances through your breast milk
  • Maximize the milk supply
  • Feed your baby frequently, and for as long as possible; help increase and maintain your milk supply by minimizing fatigue and stress
  • Perfect your positioning
  • See a lactation specialist or other knowledgeable healthcare practitioner for guidance on changing your baby’s feeding position and preventing or relieving sore nipples

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full breast-feeding support article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About breast-feeding support

Human breast milk is the best food for newborn babies. In December 1997, the American Academy of Pediatrics issued a policy statement advocating breast milk as the ideal, exclusive food for babies in the first six months of life. They also recommended that breast-feeding continue for at least 12 months or longer if mutually desired.1

In the United States, only about 50% of new mothers giving birth in a hospital breast-feed their babies. This number declines rapidly, with only about 20% of women still breast-feeding at six months.2 There is a large body of evidence on the benefits of breast-feeding for both mother and infant. With adequate support and good information on preventing some of the common problems associated with breast-feeding, a woman’s chances of successfully breast-feeding her new baby are greatly improved.

Product ratings for breast-feeding support

Science Ratings Nutritional Supplements Herbs
2Stars

Calcium

Cod liver fish oil

Docosahexaenoic acid (DHA)

Iron (for deficiency only)

Multivitamin-mineral

Garlic (to increase duration of feedings)

1Star  

Anise

Chickweed (topical application, for sore nipples)

Comfrey (topical application, for sore nipples)

Goat’s rue (to stimulate milk production)

Marigold (topical application, for sore nipples)

Stinging nettle (to stimulate milk production)

Vitex (to stimulate milk production)

3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Why breast-feed?

Breast feeding provides significant benefits for baby and mother.

Benefits for baby
Human milk contains the ideal balance of nutrients, enzymes, and anti-infective and immune supportive agents for babies.3 4 There are two kinds of breast milk: colostrum and mature milk. Colostrum, which is produced in the first few days after birth, has higher concentrations of protein and immune-enhancing agents and less sugar and fat than mature milk.5 Mature human milk differs greatly from both infant formula and either cow or goat milk. Human milk, made specifically for the nutritional needs of the newborn, is superior to all alternatives.

One significant advantage of human breast milk is its abundance of immune-protective and anti-infective agents, including immunoglobulins (primarily immunoglobulin A, or IgA), lactoferrin, Bifidobacterium bifidum, white blood cells, and other factors. These agents are known to help the newborn fight a wide variety of illnesses. Many scientific studies in the United States and other developed countries have demonstrated the health protective benefits of breast milk.

Breast-feeding has been found to help prevent: diarrhea,6 7 8 9 10 lower respiratory tract infection,11 12 13 14 ear infections (otitis media),15 16 17 18 19 20 meningitis,21 22 urinary tract infection,23 and other serious infections (botulism, necrotizing enterocolitis, bacteremia).24 25 26 27 28 In addition, breast-feeding may possibly help prevent: sudden infant death syndrome (SIDS),29 30 31 insulin-dependent diabetes mellitus,32 33 inflammatory bowel disease (Crohn’s disease, ulcerative colitis),34 35 cancer (lymphoma),36 37 allergic diseases,38 39 40 and other chronic digestive diseases.41 42 43 Breast-feeding may also enhance cognitive development.44 45

The protein composition of breast milk is perfect for growing babies and is easy for them to digest. Breast milk also provides absorbable nutrients; the iron and zinc found in human milk is extremely easily absorbed (bioavailable) compared with iron and zinc from other foods. When infants are exclusively breast-fed, 50% of the iron is absorbed. By comparison, absorption of iron from cow’s milk and iron-fortified commercial formula is much lower, only 10% and 4%, respectively.46

Breast milk is also quick, easy, and cost-effective. It’s always available and does not need to be prepared, and the cost of providing the necessary additional nutrition to a breast-feeding mother is about half the cost of commercial formula.47 48 49 And breast-feeding promotes bonding, allowing a mother and her baby to be in close physical contact, enhancing the formation of a close mother-baby bond.50

Benefits for mother
Breast-feeding a new baby has many important health benefits for the mother as well. Breast-feeding immediately after childbirth causes the release of a hormone called oxytocin, which causes the uterus to contract. This results in less postpartum (after pregnancy) blood loss and a more rapid return of the uterus to its pre-pregnancy size.51 While breast-feeding, most women will not immediately resume their ovulation and menstrual periods. Delaying the return of ovulation may extend the time between pregnancies.52 53 Women who breast-feed for at least six months lose weight more quickly than women who continue breast-feeding for less than three months.54 And, while breast-feeding can cause a short-term loss of bone density, it also seems to improve the body’s ability to rebuild bones postpartum.55 In addition, women who have breast-fed their babies may have fewer osteoporosis-linked hip fractures after they’ve passed through menopause.56 Breast-feeding has also been associated with a lower risk of ovarian cancer and a reduced risk of breast cancer in premenopausal women.57 58

Dietary changes that may be helpful

Pregnant and breast-feeding women should choose a well-balanced and varied diet that includes fresh fruits and vegetables, whole grains, legumes, and fish. Many doctors recommend limiting intake of refined sugars, white flour, fried foods, processed foods, and chemical additives.

The caloric needs of a breast-feeding woman are even higher than during pregnancy. An extra 400 to 500 calories per day above pregnancy requirements are needed. Most women should consume approximately 2,800 calories per day to meet the energy needs of breast-feeding.66 Therefore, under most circumstances, doctors discourage dieting (i.e., calorie restriction). Weight loss following pregnancy usually occurs naturally, particularly if a woman can engage in moderate exercise. Breast-feeding uses up fat stores, and is a natural way to lose weight.

A woman should continue to take prenatal vitamins in order to meet the nutrient requirements of breast-feeding. Especially important is continued intake of calcium and calcium-rich foods.

Breast milk contains essential fatty acids. The fat composition of breast milk varies with a woman’s diet. If a woman consumes foods that provide essential fatty acids (e.g., vegetable oils such as canola oil, corn oil, and safflower oil; nut and seed oils; and fish), the breast milk she produces will contain higher quantities of essential fatty acids.67

Drinking to quench thirst is enough to support a healthy milk supply.68 Women are frequently instructed to drink extra fluids to increase milk supply. This is a common misunderstanding, however, and excessive fluid intake should be avoided.69

Lifestyle changes that may be helpful

It is best to avoid all unnecessary medications, herbs, and nutritional supplements when breast-feeding. Most prescribed and over-the-counter medications, when taken by a breast-feeding mother, are considered safe for the infant. However, a doctor should always be consulted before any medication is taken. There are a few medications that mothers may need to take that may make it necessary to interrupt breast-feeding temporarily.

Caffeine
Caffeine, which is considered a drug, is excreted into breast milk. It is estimated that an infant receives 1.5 to 3.1 mg of caffeine after the mother drinks a cup of coffee (a cup of coffee typically contains 60 to 50 mg of caffeine). Because this amount is fairly low, a morning cup of coffee is not likely to cause any problems. However, if the mother is a heavy caffeine user, caffeine can accumulate in the infant.70 Infants have immature livers that are unable to adequately process caffeine. A baby who is irritable and sleeping poorly may be reacting to caffeine in the mother’s diet. A woman can switch to decaffeinated coffees and teas to effectively reduce the amount of caffeine her baby receives through her milk.

Alcohol
Alcohol reaches maternal milk in concentrations similar to those in the mother’s blood.71 It is therefore best for breast-feeding mothers to minimize or eliminate alcohol consumption. It is commonly believed that drinking beer can increase a woman’s milk supply. In fact, drinking beer intake does increase secretion of prolactin (the hormone that stimulates production of breast milk) in both men and women.72 However, research has shown that infants breast-fed after their mothers drank alcoholic beer consumed less milk than when their mothers drank non-alcoholic beer.73

Smoking
Breast-feeding mothers should not smoke. Nicotine passes to the baby through the breast milk and can cause feeding problems and illness, especially in newborns. Babies should also be protected from the dangers of second-hand smoke. Second-hand smoke has been shown to increase the risk of SIDS (sudden infant death syndrome)74 75 76 77 78 and colic in newborns.79

Initiating the breast-feeding relationship
There are many reasons why women decide not to breast-feed or discontinue breast-feeding earlier than the recommended six months. These include a lack of family, societal, or medical support;80 misinformation or lack of education about breast-feeding;81 marketing of commercial formulas to new mothers;82 and the difficulties often encountered in returning to work or school.83 In addition, there are some common difficulties that could interfere with a healthy breast-feeding relationship. These include fear of not having enough milk to nourish the baby, sore nipples, engorgement, and mastitis (inflammation of the breast, frequently caused by infection).

A new mother should try to breast-feed her baby as soon as possible after delivery, ideally within the first hour of life.84 An infant should be fed on demand. A hungry infant will first get fussy, with increased activity and rooting (a reflex wherein the infant appears to be searching for the breast with his or her mouth) or mouthing behavior. Crying is a late sign of hunger. To get into the habit of feeding their babies, new mothers are often instructed to follow a schedule of breast-feeding every four hours around the clock. However, these imposed schedules, if followed beyond the first few weeks of life, often lead to frustration and confusion. The only infant who needs to be breast-fed on such a schedule is the infant who does not demand to be fed. Feeding on demand is the best way to increase milk supply. Most infants will empty the breast in 10 to 15 minutes. Some doctors advise gradually increasing the duration of breast-feeding over the first week of life. If this regimen is followed, it is important to breast-feed for at least five minutes on each side to get the benefit of the let-down reflex (which promotes the release of milk from the storage ducts in the breasts).85

Infants need no additional foods or liquids, if exclusively breast-feeding. Early introduction of these items may make successful breast-feeding difficult. Most breast-fed infants will not require any supplemental vitamins or minerals to meet daily requirements until at least six months of age.86 Vitamin D may be required for infants whose mothers are vitamin D-deficient or those infants not exposed to adequate sunlight. Iron may be required for infants with low iron stores or anemia.87

Anxiety over milk supply
Breast milk is made on demand. The more often a baby feeds, the more milk will be produced. If breast-feeding sessions are frequent and long enough, the milk supply will rarely be inadequate. Parents can be reassured that their infants are receiving enough milk if they have six or more wet diapers a day while exclusively breast-feeding. If a parent still feels anxious about the adequacy of the nourishment provided by breast-feeding alone, weekly weighing may allay fears. A weight gain of 0.38 pound (190 grams) per week is evidence of sufficient nourishment and growth.

Some low-birth-weight infants will require intensive care and ventilation in the hospital. Mothers of these infants often have difficulty continuing to produce breast milk. These mothers must rely on expressing breast milk manually because their babies cannot effectively breast-feed. Pumping milk is much less efficient than breast-feeding. Due to the inadequacy of pumping milk, milk production can decline. In low-birth-weight infants in an intensive care setting, skin-to-skin holding over a four-week period postpartum has increased a mother’s milk supply.88 In contrast, women who did not participate in skin-to-skin holding of their low-birth-weight infants did not experience an increase in milk production. These findings may have implications for all mothers experiencing a diminishing milk supply. In addition, some doctors will prescribe a day of rest to busy mothers whose milk supply seems to be lessening.89 Spending a day in close and relaxed contact with one’s newborn, with its associated increase in frequency of feedings, can effectively increasing milk supply.

Stress and fatigue can greatly inhibit the let-down reflex, lessening the production of milk. In a clinical trial involving mothers of premature infants, mothers who listened to an audiocassette tape based on relaxation and imagery techniques increased milk production by more than 60%, compared with mothers not listening to the tape.90 Whether relaxation techniques would increase milk supply in the mothers of full-term infants is not known.

Vitamins that may be helpful

Docosahexaenoic acid (DHA), an omega-3 fatty acid present in cod liver oil and other fish oils, is important for normal development of the brain and eyes. Studies have shown that higher concentrations of DHA in mothers’ milk are associated with better visual acuity in the infants.91 Other studies have suggested that DHA improves the development of infants, although not all research agrees.92 Because DHA in the mother’s diet passes into the breast milk,93 some doctors advise nursing mothers to supplement their diet with cod liver oil or another fish-oil supplement. Women wishing to use this or any supplement while breast-feeding should consult their doctors and use only under the supervision of a qualified healthcare practitioner.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Numerous herbs are used traditionally around the world to promote production of breast milk.94 Herbs that promote milk production and flow are known as galactagogues. Stinging nettle (Urtica dioica) enriches and increases the flow of breast milk and restores the mother’s energy following childbirth.95 Vitex (Vitex agnus castus) is one of the best-recognized herbs in Europe for promoting lactation. An older German clinical trial found that 15 drops of a vitex tincture three times per day could increase the amount of milk produced by mothers with or without pregnancy complications compared with mothers given vitamin B1 or nothing. Vitex should not be taken during pregnancy.96 Goat’s rue (Galega officinalis) also has a history of use in Europe for supporting breast-feeding. Taking 1 teaspoon of goat’s rue tincture three times per day is considered by European practitioners to be helpful in increasing milk volume.97 Studies are as yet lacking to support the use of goat’s rue as a galactagogue. In two preliminary trials, infants have been shown to nurse longer when their mothers ate garlic than when their mothers took placebos.98 99 However, some infants may develop colic if they consume garlic in breast milk.

For sore nipples, some healthcare practitioners may recommend a warm, moist poultice of herbs with demulcent (soothing) properties. Demulcents are traditionally used to aid healing and soothe any irritated tissue. Examples of herbs traditionally used as demulcents to relieve sore nipples are marigold (Calendula officinalis), comfrey (Symphytum officinalis), and chickweed (Stellaria media). To prepare a poultice, the dried herbs are moistened with boiling water and wrapped within two layers of gauze. The poultice is then applied to the breasts. Application of a hot water bottle over the poultice will keep the poultice warm longer. Any residue should be washed from the breast before the baby breast-feeds. Individuals wishing to use herbs during breast-feeding should do so only under the supervision of a qualified healthcare practitioner.

The safety of using anise during pregnancy and breast-feeding is unknown, though it is very likely safe and has traditionally been used to support breast-feeding in some cultures.100

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

References:

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