A Well-Kept Secret
Breastfeeding's Benefits to Mothers
Alicia Dermer, MD, IBCLC
Old Bridge NJ USA
From: NEW BEGINNINGS, Vol. 18 No. 4, July-August 2001, p. 124-127
Very few people are unaware
of the benefits of breastfeeding for babies, but the many benefits
to the mother are often overlooked or even unknown. From the effect
of oxytocin on the uterus to the warm emotional gains, breastfeeding
gives a mother many reasons to be pleased with her choice. These documented
effects are outlined in this excerpt from Breastfeeding Annual
International 2001, a recently published anthology which was edited
by Dia Michels, co-author of the classic breastfeeding advocacy book,
Milk, Money, and Madness. Both books are available from LLLI.
One of the best-kept secrets
about breastfeeding is that it's as healthy for mothers as for babies.
Not only does lactation continue the natural physiologic process begun
with conception and pregnancy, but it provides many short and long-term
health benefits. These issues are rarely emphasized in prenatal counseling
by health care professionals and all but ignored in popular parenting
literature. Let's look at all the benefits breastfeeding provides
mothers and speculate as to why so few are finding out about them.
Physiologic Effects of Breastfeeding
Immediately after birth,
the repeated suckling of the baby releases oxytocin from the mother's
pituitary gland. This hormone not only signals the breasts to release
milk to the baby (this is known as the milk ejection reflex, or "let-down"),
but simultaneously produces contractions in the uterus. The resulting
contractions prevent postpartum hemorrhage and promote uterine involution
(the return to a nonpregnant state).
Bottle-feeding mothers
frequently receive synthetic oxytocin at birth through an intravenous
line, but for the next few days, while they are at highest risk of
postpartum hemorrhage, they are on their own. As long as a mother
breastfeeds without substituting formula, foods, or pacifiers for
feedings at the breast, the return of her menstrual periods is delayed
(Lawrence and Lawrence 1999). Unlike bottle-feeding mothers, who typically
get their periods back within six to eight weeks, breastfeeding mothers
can often stay amenorrheic for several months. This condition has
the important benefit of conserving iron in the mother's body and
often provides natural spacing of pregnancies.
The amount of iron a mother's
body uses in milk production is much less than the amount she would
lose from menstrual bleeding. The net effect is a decreased risk of
iron-deficiency anemia in the breastfeeding mother as compared with
her formula-feeding counterpart. The longer the mother nurses and
keeps her periods at bay, the stronger this effect (Institute of Medicine
1991).
As for fertility, the lactational
amenorrhea method (LAM) is a well-documented contraceptive method,
with 98 to 99 percent prevention of pregnancy in the first six months.
The natural child-spacing achieved through LAM ensures the optimal
survival of each child, and the physical recovery of the mother between
pregnancies. In contrast, the bottle-feeding mother needs to start
contraception within six weeks of the birth (Kennedy 1989).
Long-Term Benefits of Breastfeeding
It is now becoming clear
that breastfeeding provides mothers with more than just short-term
benefits in the early period after birth.
A number of studies have
shown other potential health advantages that mothers can enjoy through
breastfeeding. These include optimal metabolic profiles, reduced risk
of various cancers, and psychological benefits.
Production of milk is an
active metabolic process, requiring the use of 200 to 500 calories
per day, on average. To use up this many calories, a bottlefeeding
mother would have to swim at least 30 laps in a pool or bicycle uphill
for an hour daily. Clearly, breastfeeding mothers have an edge on
losing weight gained during pregnancy. Studies have confirmed that
nonbreastfeeding mothers lose less weight and don't keep it off as
well as breastfeeding mothers (Brewer 1989).
The above finding is particularly
important for mothers who have had diabetes during their pregnancies.
After birth, mothers with a history of gestational diabetes who breastfeed
have lower blood sugars than nonbreastfeeding mothers (Kjos 1993).
For these women who are already at increased risk of developing diabetes,
the optimal weight loss from breastfeeding may translate into a decreased
risk of diabetes in later life.
Women with Type I diabetes
prior to their pregnancies tend to need less insulin while they breastfeed
due to their reduced sugar levels. Breastfeeding mothers tend to have
a high HDL cholesterol (Oyer 1989). The optimal weight loss, improved
blood sugar control, and good cholesterol profile provided by breastfeeding
may ultimately pay off with a lower risk of heart problems. This is
especially important since heart attacks are the leading cause of
death in women.
Another important element
used in producing milk is calcium. Because women lose calcium while
lactating, some health professionals have mistakenly assumed an increased
risk of osteoporosis for women who breastfeed. However, current studies
show that after weaning their children, breastfeeding mothers' bone
density returns to prepregnancy or even higher levels (Sowers 1995).
In the longterm, lactation may actually result in stronger bones and
reduced risk of osteoporosis. In fact, recent studies have confirmed
that women who did not breastfeed have a higher risk of hip fractures
after menopause (Cummings 1993).
Non-breastfeeding mothers
have been shown in numerous studies to have a higher risk of reproductive
cancers. Ovarian and uterine cancers have been found to be more common
in women who did not breastfeed. This may be due to the repeated ovulatory
cycles and exposure to higher levels of estrogen from not breastfeeding.
Although numerous studies have looked at the relationship between
breastfeeding and breast cancer, the results have been conflicting.
This is largely due to flaws in study design and lack of uniform definition
of breastfeeding, resulting in difficulty comparing the data. (In
some studies, breastfeeding has been defined as having breastfed at
least once a day, while in others it is defined as exclusive breastfeeding,
using no supplements or artificial nipples.) Despite this, it is now
estimated that breastfeeding from six to 24 months throughout a mother's
reproductive lifetime may reduce the risk of breast cancer by 11 to
25 percent (Lyde 1989; Newcomb 1994). This phenomenon may also be
due to suppressed ovulation and low estrogen, but a local effect relating
to the normal physiologic function of the breast may also be involved.
This was suggested by a study in which mothers who traditionally breastfed
on only one side had significantly higher rates of cancer in the unsuckled
breast (Ing, Ho, and Petrakis 1977).
In two studies, there appeared
to be an increase in flare-ups of rheumatoid arthritis in breastfeeding
mothers (Jorgensen 1996; Brenna 1994). However, in another study,
overall severity and mortality of rheumatoid arthritis was worse in
women who had never breastfed (Brun, Nilson, and Kvale 1995). There
have been no other studies showing any detrimental health effects
to women from breastfeeding. Bottom line: Breastfeeding reduces risk
factors for three of the most serious diseases for women-female cancers,
heart disease, and osteoporosis-without any significant health risks.
Psychological Issues for Breastfeeding Mothers
How do you measure the
peace of mind of having a healthy baby who is developing optimally?
Where do you factor in the financial burden of formula prices and
increased medical costs?
Public health agencies
advocate for breastfeeding because of its well-documented health advantages
to babies, but they fail to convey to individual mothers and families
the potential emotional impact of this very crucial infant-feeding
decision. In Western society, the decision about breast or bottle
is still seen very much as a personal choice based on convenience.
The potential stress of living with a child with recurrent illnesses,
or the loss of the unique bond that comes from breastfeeding, are
often omitted from the decision-making process.
There is much more to breastfeeding
than the provision of optimal nutrition and protection from disease
through mother's milk. Breastfeeding provides a unique interaction
between mother and child, an automatic, skin-to-skin closeness and
nurturing that bottle-feeding mothers have to work to replicate. The
child's suckling at the breast produces a special hormonal milieu
for the mother. Prolactin, the milk-making hormone, appears to produce
a special calmness in mothers. Breastfeeding mothers have been shown
to have a less intense response to adrenaline (Altemus 1995).
This calming effect is
hard to measure in a society largely unsupportive of breastfeeding
such as the United States, where breastfeeding beyond the early weeks
is not the norm. Mothers who try to breastfeed in this climate often
experience physical and emotional problems. These problems result
from a lack of breastfeeding role models among family and friends,
and are compounded by the easy availability of formula and a lack
of access to knowledgeable and supportive health care professionals.
Even if a mother overcomes
physical problems, she may still encounter negative comments, such
as "Are you still nursing?" or "Your milk may not be strong enough-why
don't you add formula?" Or her employer may make it impossible for
her to continue breastfeeding on returning to work. Or she may be
harassed for breastfeeding in public. No wonder that few mothers get
to fully experience the relaxing effects of breastfeeding.
New motherhood is a time
fraught with emotion. The baby blues are common, often exacerbated
by lack of support and a sense of isolation. The role of breastfeeding
in postpartum emotional upheavals has not been well studied, but breastfeeding
mothers with depression need treatment just as much as any other mother.
Such women present a unique challenge to health care professionals.
Since medications may pass into breast milk, many physicians believe
the safest solution is to wean the child. However, in most cases of
depression, women do better if they continue to breastfeed. Unfortunately,
too often physicians insist that mothers wean their child in order
to take antidepressant medicines.
A review of the literature,
however, has demonstrated that several antidepressants pose minimal,
if any, risk to the nursing child. A mother who feels that her nursing
relationship with her child is the only thing going right in her life
can now continue to breastfeed while receiving appropriate medications
for her depression.
Why Don't More People Know How Good Breastfeeding Is?
Clearly, breastfeeding
is good for mothers both physically and emotionally. And yet,
many mothers decide to breastfeed based solely on the benefits
to the baby. Breastfeeding in the context of a bottle-feeding
society tends to be perceived as inconvenient and uncomfortable.
Often, mothers see
breastfeeding as martyrdom to be endured for their baby's health.
If they stop early, they may feel guilty about depriving the
baby of some health benefits, but their guilt is often soothed
by well-meaning people who reassure them that "The baby will
do just as well on formula." Perhaps if they knew that continuing
to breastfeed is also good for their own health, some mothers
might be less likely to quit when they run into problems.
Many mothers are
not being told how good breastfeeding is for their health. Whether
out of ignorance or due to the influence of the artificial baby
milk industry, many health care providers fail to inform mothers
of the facts. It's time for this well-kept secret to come out.
As word spreads about these little-known facts, more mothers
will not merely choose to breastfeed briefly to provide early
disease protection for their baby, but will continue to breastfeed,
providing optimal outcomes both for their children and for themselves.
|
Alicia Dermer, MD, IBCLC,
is Clinical Associate Professor in the Department of Family Medicine
at the University of Medicine and Dentistry of New Jersey-Robert Wood
Johnson Medical School in New Brunswick, New Jersey. She has a special
interest in wellness and health promotion. As part of this interest,
she has gained expertise in breastfeeding education and promotion.
She successfully sat for the certifying examination of the International
Board of Lactation Examiners in 1995. She lectures extensively on
the subject of lactation, is actively involved in health care professional
and lay education about breastfeeding, and has several publications
on the subject.
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