Benefits to Breastfeeding?

We hear all the time about the benefits of breastfeeding. A benefit by definition is something that is advantageous or has an advantage over something else. This language leads to the thinking that breastfeeding is better than "something" else. Now, in North America and most of the world, that something else is infant formula or artificial infant feeding. Again this language suggests to us that formula is good and acceptable but breastfeeding has advantages and benefits.

Is this how we should be thinking about breastfeeding? I would like to challenge that we should be changing this language, as language affects perceptions strongly. Is breastfeeding not what humans, like all mammals, are biologically programmed to do? Breastfeeding is the normal. If this is the case, how is it that something else has replaced the normal, expected biological act of infant feeding to the point that artificial feeding is the norm and it is an advantage, a bonus of sorts, to breastfeed?

I suggest it is partly to do with language. Be aware there is a multitude of factors that has lead to this normalization of formula feeding but right now I will focus on the language aspect. If I want to focus on language and I want to switch the normals around, so that breastfeeding is the normal, I now need to substitute the opposite from advantage or benefit to describe what the impact of not breastfeeding would be. What would be a word to describe an act that is the opposite? Harm, risk, disadvantage, damage, injury; these all could be used.

If we Google the benefits of breastfeeding we find lists that include concepts like:

•Higher IQ in breastfed children
•Higher visual acuity
•Breastfed babies get fewer ear infections
•Breastfed children are less likely to require tonsillectomies
•Breastfed babies have fewer and less severe upper respiratory infections, less wheezing, less pneumonia and less influenza
•Breastfed children may have lower cholesterol as adults
•Heart rates are lower in breastfed infants
•Less diarrhea, fewer gastrointestinal infections in babies who are breastfeeding
•Six months or more of exclusive breastfeeding reduces risk of food allergies
•Less risk of Crohn's disease and ulcerative colitis in adulthood
•Breastfeeding decreases the risk of childhood cancer
•Reduced risk of getting diabetes
•With less salt and less protein, human milk is easier on a baby's kidneys
•Fewer urinary tract infections in breastfed infants
•Less allergic eczema in breastfed infants
•Breastfed babies are leaner at one year of age and less likely to be obese later in life
•Less constipation; stools of breastfed babies have a less-offensive odour

Sounds good doesn't? Why would I think this is a not a great thing? Well, simply because when we change the language it looks a little ridiculous and raises questions for me.

•Higher IQ in breastfed children. Are humans intended to normally have a lower IQ?
•Higher visual acuity. Are the majority of humans born to need glasses?
•Breastfed babies get fewer ear infections. Are children expected to have ear infections?
•Breastfed children are less likely to require tonsillectomies. Were we given tonsils simply so a surgeon could remove them?
•Breastfed babies have fewer and less severe upper respiratory infections, less wheezing, less pneumonia and less influenza. Should children struggle with infections, breathing difficulties and influenza?
•Breastfed children may have lower cholesterol as adults. Are adults expected to have high cholesterol?
•Heart rates are lower in breastfed infants. Are infants expected to have high heart rates?
•Less diarrhea due to fewer gastrointestinal infections in babies who are breastfeeding. Are we expecting children to have gastro issues?
•Six months or more of exclusive breastfeeding reduces risk of food allergies. Do we expect humans to be allergic to common foods?
•Less risk of Crohn's disease and ulcerative colitis in adulthood. Do we expect most adults to develop bowel illnesses over time?
•Breastfeeding decreases the risk of childhood cancer. Is it normal for children to suffer cancer?
•Reduced risk of getting diabetes. Is diabetes another expected illness?
•With less salt and less protein, human milk is easier on a baby's kidneys. Is human milk easier?
•Fewer urinary tract infections in breastfed infants. Do we expect to see children with UTI's?
•Less allergic eczema in breastfed infants. Is eczema a normal infant allergy?
•Breastfed babies are leaner at one year of age and less likely to be obese later in life. Is the normal to be less lean and possibly obese?
•Less constipation; stools of breastfed babies have a less-offensive odour. Are babies expected to be constipated and have offensive odours?

With the new language these concepts could read

•Lower IQ in artificially feed babies
•Poorer visual acuity in artificially feed babies
•Artificially feed babies suffer more ear infections
•Artificially feed babies are more likely to require tonsillectomies
•Artificially feed babies have more occurrences and more severe upper respiratory infections, more wheezing, more pneumonia and more influenza
•Artificially feed babies may have higher cholesterol as adults
•Heart rates are higher in artificially feed babies
•More diarrhea and more gastrointestinal infections in babies who are artificially feed
•Six months or more of non-exclusive breastfeeding increases risk of food allergies
•More risk of Crohn's disease and ulcerative colitis in adulthood
•Artificial feeding increases the risk of childhood cancer
•Increased risk of getting diabetes
•With more salt and more protein, formula is harder on a baby's kidneys
•More urinary tract infections in artificially feed babies
•More allergic eczema in artificially feed babies
•Artificially feed babies are heavier at one year of age and more likely to be obese later in life
•More constipation; stools of artificially feed babies have a more-offensive odour

These lists are not exhaustive by any means and there could be pages more to add to the both lists depending on the language and concepts we were choosing to use, such as the impacts breastfeeding or not has on the mother herself. I was simply highlighting some examples to show how the use of language is powerful and influences our perceptions of what is normal, what is acceptable, what is beneficial and what is risky.

I encourage you to keep this idea in mind when you are speaking to future parents, parents to be, parents, grandparents, health care providers, anyone you are discussing infant feeding practice with.

Good Enough

In the area of breastfeeding support, education and advocacy often times those of us in this line of work are assumed to be anti-formula and not willing or unable to support the formula feeding families. People are often shocked to find out this is not actually the case, or at least not always the case.

More and more within the education and work I do, we are discussing the non-breastfed baby. As we learn more about breastfeeding, we learn more about babies, mothers and families and the needs of babies, mothers and families.

One of the most recent headlines that started a discussion between myself and a couple of friends was that breastfeeding has a positive effect on the mental health of children and adolescents; in fact the longer the child is breastfeed the more significant the benefits are. Interestingly, in this information released was the need to look at how the non-breastfed baby can be given similar benefits.

To do this we need to ask, what is it about breastfeeding that makes for this benefit? Is it the “milk” factor? We know that the fatty acids and other non-replicable components in breastmilk are great for brain development and growth and those hormones like leptin protects against stress in infants. What about the attachment factor? We know that breastfeeding mothers look into their baby’s eyes more, they touch their baby’s more, there is more skin-to-skin contact and in fact breastfeed babies have a stronger relationship with their mothers than anyone else. Breastfeeding is a relationship builder between an infant and its mother. It is the first secure, attached relationship that a baby learns to trust. Healthy secure, attached relationships have been shown to be have a positive effect into adulthood. Are there other factors to explore yet?

We can see that it is potentially a combination of factors that lead to this finding and benefit. Exploring the factors, I am able to answer the questions that arise from the mothers that are not breastfeeding when they see a headline like “Breastfed babies have fewer behavioural problems”. They do have honest questions of “What about my baby? Breastfeeding did not work for us.” (we do not need to get into the why it did not work here). They ask to be supported as equally as a breastfeeding mother would be or sometimes they do not ask at all because they fear the reaction. They might expect to see an eyeroll when they say they need to be supported as well. They may be unsure of what reactions they will get. They may expect to hear someone say if you would have tried harder you could have breastfeed or hear the stat of how many mothers truly physically cannot breastfeed. So well this *might* be true, it is sometimes too late for that information. Can giving that info for future babies or other people they might support later help, yes, indeed it may, but it does not answer the questions that she is asking right now; the question of what about my infant that I am not breastfeeding right now.

I want to reassure these mothers that it should not be an eye roll and they deserve the information and support they need at that time. To these mothers, I say, goodness, if *I*, the one who will not say that formula feeding and breastfeeding are equal or that we should not continue the work we are doing for breastfeeding globally to have higher rates, longer durations, etc, can say that we still need to educate and support these mothers on infant feeding then more people should be able to see that. Like I mentioned, it may not be all about milk. Certainly, when you place breastmilk beside formula there are vast differences, that science cannot be disputed and formula companies will never come close to replicating breastmilk. Does that mean I would be happy if all babies had breastmilk from a bottle and were never at the breast, never held for feeds, never caressed by its mother? Certainly not. We need to educate society about the ACT of feeding infants and caring for our infants and the impact of these actions, good and bad. A question that serves food for thought that looks at just this idea; "If you had to choose one of these options, which one would you choose? 1) Would you breastfeed with formula being the substance that came out of your breasts or 2) Bottle feed breastmilk?" More questions arise around the impact of pumping breastmilk and bottle feeding vs feeding directly from the breast. Every mother will answer these questions in their own unique fashion, based on their experiences, education, situations and perceptions.

Existing are the ideal, perfect breastfeeding relationships and co-existing are the handfuls of many "good enough’s". Good enough is not necessarily a bad thing. It can be a place of peace and harmony for those mother-baby dyad’s. Do I strive for 100% of the parents I help to have the best, most wonderful breastfeeding relationships, or can it be "good enough"? It would be so wonderful and we would all be fortunate to get to 100% but is that realistic? For now, good enough is acceptable for me when it is the choice the parents. We get there when parents have been supported and educated in the decision making process, as all parents should be. It might mean breastfeeding solely, artificial feeding or mixed feedings, it might be direct breastfeeding, it might mean pumping and bottle-feeding. Every families good enough will always look different.

Where we fall short, I feel is in doing this role of educating and then supporting, period. This is where I think “good enough” is not acceptable. This is where we need to improve and this is where I plan to focus.

Kim Smith