Breastfeeding basics for mom and baby (2014)

New moms, a lactation consultant, and a pediatrician weigh in on the basics of breastfeeding. Cristina Mutchler reports.

Posted: Jul 9, 2018 4:45 PM
Updated: Jul 9, 2018 5:14 PM

An international resolution promoting breastfeeding was at the center of negotiations between delegates from the United States and other countries during this year's meeting of the World Health Assembly (the decision-making body of the World Health Organization), held in the spring.

Some US delegates reportedly wanted to water down the resolution, while others wanted to maintain strong language, leading to a debate on the floor, seen in an online webcast.

In the end, "delegates at this year's World Health Assembly unanimously renewed their commitment to invest and scale up nutrition policies and programmes to improve infant and young child feeding. We are not in a position to comment on exchanges between different delegations," WHO spokesman Tarik Jašarević wrote in an email.

Despite the controversy, in the medical world, breastfeeding is not such a contentious topic.

"WHO recommends breastmilk as the best source of nourishment for infants and young children. Exclusive breastfeeding for the first six months is one of the most effective ways to ensure child health and survival," Jašarević said.

"If all infants under the age of six months were exclusively breastfed, we estimate that about 820,000 child lives would be saved every year," he said. "Today, however, globally, only 40% of infants under six months of age are exclusively breastfed."

The countries that breastfeed the most and least

Responding to the account of the WHO resolution, US Department of Health and Human Services spokeswoman Caitlin Oakley said in a statement that the US "has a long history of supporting mothers and breastfeeding around the world and is the largest bilateral donor of such foreign assistance programs."

"The United States was fighting to protect women's abilities to make the best choices for the nutrition of their babies," she said. "Many women are not able to breastfeed for a variety of reasons, these women should not be stigmatized; they should be equally supported with information and access to alternatives for the health of themselves and their babies."

President Donald Trump tweeted similar sentiments on Monday, posting that the US "strongly supports breastfeeding but we don't believe women should be denied access to formula. Many women need this option because of malnutrition and poverty."

The original WHO resolution called for increased commitment by member countries to specifically protect, promote and support breastfeeding practices for mothers who wish to breastfeed, said Aunchalee Palmquist, an assistant professor in the Department of Maternal and Child Health and the Carolina Global Breastfeeding Institute at the University of North Carolina at Chapel Hill.

The resolution also outlined specific ways that may be achieved, she said, including supporting the Baby-Friendly Hospital Initiative, a toolkit that assists hospitals in giving mothers "the information, confidence, and skills necessary to successfully initiate and continue breastfeeding their babies or safely feed with formula," according to its website.

"A major risk of formula feeding in low-income settings is that the formula is available without the other safety precautions," Palmquist said.

"It is often sold over the counter -- or in emergencies distributed as blanket donations -- as if it's as safe as breastmilk, when that is not the case," she said. "Many parents and infant caregivers feed their infants formula without any understanding of how dangerous it can be for their infant or what practices need to be in place to make it safer."

Those risks include creating the formula precisely as instructed, storing it safely and cleaning and sanitizing bottles so the infant doesn't get sick.

A UNICEF report published in May found that more than one in five babies is never breastfed in high-income countries, whereas one in 25 babies is never breastfed in low- and middle-income countries.

Among the high-income countries, Ireland, France and the United States had the three lowest breastfeeding rates, according to that report.

In the US, 83% of babies start out being breastfed, but only 25% are exclusively breastfed six months later, according to the US Centers for Disease Control and Prevention. Breastfeeding rates are significantly lower for black infants.

In comparison, among the low- and middle-income nations, the UNICEF report showed that nearly nine in 10 babies were breastfed, even in the countries with the lowest breastfeeding rates for that group. The percentage of babies ever being breastfed was above 88% in all of those countries, reaching above 99% in Bhutan, Nepal and Sri Lanka.

The country-by-country differences in breastfeeding rates could be due to cultural norms, having the ability to breastfeed while in the workplace or having access to safe and affordable alternatives to breast milk, among other factors.

"There are major political, economic and social factors that shape breastfeeding patterns in global settings," Palmquist said.

For instance, "mothers who must return to work shortly postpartum face enormous challenges in establishing lactation and continuing to breastfeed as recommended," she said. "They may have to work away from their infants and rely on others to care and feed their infants. They may also not have the support of skilled breastfeeding counselors and other health care providers who can assist them with breastfeeding difficulties."

Breastfeeding can come with short- and long-term benefits for both mom and baby, especially in low-income settings, Palmquist said.

"In settings where there is high poverty and weak public health infrastructure -- for example that ensures clean water, sanitation, routine child immunizations -- exclusively breastfeeding in the first six months of life is not only a primary source of food security for infants, it gives them immunological protection against infections and malnutrition," Palmquist said.

"In addition to reducing risk for chronic diseases and sudden infant death syndrome, breastfeeding is associated with a reduction of ear infections, upper respiratory infections and gastrointestinal infections when compared with formula feeding. This is because human milk contains immunological components that protect infants from infection, through passive immunity," she said.

"Breastfeeding also reduces the risk that mothers will become impoverished by their dependence on formula to feed their infants; formula is expensive and not always available to families in low-income settings," she said.

'Mothers require more than just encouragement to breastfeed'

In the US, the American Academy of Pediatrics policy on breastfeeding is one of its most accessed policies. It recommends to exclusively breastfeed in the first six months of an infant's life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age.

"Medical contraindications to breastfeeding are rare," the policy's abstract states.

In the United Kingdom last month, the Royal College of Midwives published a new position statement on infant feeding.

"Exclusive breastfeeding for the first six months of a baby's life is the most appropriate method of infant feeding. Breastfeeding should continue alongside complementary foods for up to two years," the position statement recommends.

UNICEF and WHO also recommend exclusive breastfeeding from within an hour of birth until the baby is 6 months old. Thereafter, nutritious complementary foods should be added to a child's diet while continuing to breastfeed for up to 2 years or beyond.

For mothers who are unable to breastfeed for medical reasons, such as having the human immunodeficiency virus or not producing enough milk, it is recommended to consult with a trained health care professional for support and guidance.

"Mothers require more than just encouragement to breastfeed," Palmquist said. "They need to have support at all levels of society, including multilevel support for policies and practices to protect, promote and support this basic human right."

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 312712

Reported Deaths: 7223
CountyCasesDeaths
DeSoto21445257
Hinds20264414
Harrison17785308
Rankin13548278
Jackson13401246
Madison10055217
Lee9959173
Jones8361163
Forrest7638152
Lauderdale7191240
Lowndes6361144
Lamar620686
Lafayette6164118
Washington5318133
Bolivar4796132
Oktibbeha460698
Panola4550105
Pearl River4493145
Marshall4393103
Warren4371121
Pontotoc419372
Monroe4089133
Union408876
Neshoba4022176
Lincoln3944110
Hancock376886
Leflore3487125
Sunflower335590
Tate332084
Pike3290105
Scott314973
Alcorn311268
Yazoo310269
Itawamba299277
Copiah296065
Coahoma293979
Simpson293888
Tippah287468
Prentiss278960
Marion268780
Leake265573
Wayne262241
Adams261882
Grenada260085
Covington256281
George246748
Newton246161
Winston226881
Tishomingo225467
Jasper220748
Attala214173
Chickasaw206957
Holmes188672
Clay184654
Stone181833
Clarke177879
Tallahatchie177840
Calhoun169732
Yalobusha162936
Smith162134
Walthall133845
Greene130333
Lawrence128323
Montgomery126742
Noxubee126734
Perry125838
Amite122842
Carroll121728
Webster114532
Jefferson Davis106932
Tunica104626
Claiborne102230
Benton99025
Humphreys96133
Kemper95328
Franklin83423
Quitman79916
Choctaw76018
Wilkinson66830
Jefferson65428
Sharkey50217
Issaquena1686
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Alabama Coronavirus Cases

Cases: 529446

Reported Deaths: 10930
CountyCasesDeaths
Jefferson763031516
Mobile40850804
Madison34622501
Tuscaloosa25701451
Montgomery24289585
Shelby23367247
Baldwin21035307
Lee15822169
Calhoun14469313
Morgan14266279
Etowah13806352
Marshall12185222
Houston10533280
Elmore10029205
Limestone9948150
Cullman9640193
St. Clair9589239
Lauderdale9407239
DeKalb8814185
Talladega8199175
Walker7214277
Autauga6914108
Jackson6801111
Blount6635136
Colbert6288134
Coffee5498117
Dale4820111
Russell438438
Chilton4258111
Franklin424782
Covington4111117
Tallapoosa4004150
Escambia393076
Chambers3555123
Dallas3543151
Clarke350661
Marion3105100
Pike310177
Lawrence299798
Winston273672
Bibb260463
Marengo249064
Geneva247676
Pickens233659
Barbour230756
Hale222276
Butler215869
Fayette212062
Henry188744
Cherokee184145
Randolph179241
Monroe177040
Washington167039
Macon158850
Clay155156
Crenshaw151957
Cleburne148341
Lamar141534
Lowndes138553
Wilcox126729
Bullock122941
Conecuh110129
Perry107526
Coosa106928
Sumter104332
Greene92334
Choctaw60424
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