Why Breastfeeding is Important—Plus More Tips For the First Few Weeks
If there’s one thing to read before you have a baby, it’s inarguably Dr. Harvey Karp’s Happiest Baby on the Block—and really, you can just watch the corresponding DVD. It’s predicated on the theory that human babies are born months prematurely, before their heads become too big to pass safely through the vaginal canal—and that ideally, they really should spend another trimester in vitro while their nervous systems evolve. (Think about how helpless a human baby is compared to say, a baby horse, who is immediately up and on his feet.) The goal of Dr. Karp’s very simple program is to create an experience for your newborn that’s as similar to the womb as possible, which is a loud, cramped, constantly in-motion place. It’s called the 5 S’s, and when it comes to baby soothing, it’s magic. (And the best part is that guys generally do baby soothing better than women, making it very empowering for new dads.) A pediatrician in Los Angeles, Dr. Karp, who is also on the board of the Environmental Working Group, is one of those forward-thinking, open-minded doctors who is both reasonable and concerned, wise and fair. We asked him a bunch of questions about the importance of breastfeeding, what sort of toxins should be avoided (he pops in throughout our non-toxic nursery guide), and what type of formula he’d give his own child. The one thing he wanted to stress above all things, though, is that it’s all hard, particularly as our society has evolved: “No woman has ever had to do as much, on her own, as the modern mother,” he explains. “We don’t have the same family structure or the same neighborhood structure anymore—people don’t live near their parents and siblings, the next door neighbor kids don’t stop by to babysit. It’s really hard, and every woman needs to cut herself a break.” Well, that’s a subject for another piece.
(Meanwhile, Dr. Karp’s follow-up book and DVD, the tantrum-eliminating Happiest Toddler on the Block is just as compelling, and he has both a guide to great sleep for years 0-5 and a white noise CD as well. And if you’re feeling exhausted post-baby, make sure you read Dr. Serralach’s piece on Postnatal Depletion.)
Why is breast milk so important?
Breast milk has been crafted by mother nature over millions of years—mammals have been around for a long, long time. Each mammal has its own type of breast milk, depending on the needs of the baby. Little horses and cows have to have strong bones because they have to run and support the weight of their bodies. And so their milk has tons of calcium and phosphorus. It’s hard to imagine, but in the ’50s and ’60s, when we didn’t realize that, we would give premature babies cow’s milk formula—and there was so much phosphate it dropped the amount of calcium in the blood and they would have seizures. In the ’70s, when I was doing my medical training, we used to make formula from evaporated milk, Caro syrup, water, and vitamin drops. It’s only recently that formula makers have gotten really good.
Meanwhile, reindeer, seals, and whale babies make breast milk that is very high in fat because their babies need to build their fat layer very quickly to protect them from the cold. In humans, our breast milk has very high levels of certain types of sugars that are used in brain development, and certain types of fat, since our species gets its survival advantage through our brains.
Breast milk is important because it’s perfectly designed for the growing body, adrenal glands, and brain—it has exactly the right amount of protein, and the right sugars and fats to promote rapid growth. This is wild, but when a baby is born, its head is already about 60% of the size of an adult head. By the time your child is one, its head is about 80% of the size of your head. That growth is really fueled by the fats and sugars in breast milk.
What are the other advantages of breast milk for a baby?
Breast milk also prepares a baby for the food they’re going to eat later on, as they taste flavors through breast milk that will start familiarizing them with the flavors of food.
It’s also less allergy-provoking than other foods. Colostrum, which is what comes in the first few days before the milk comes in, is filled with antibodies and white blood cells that carry the mother’s immunity and literally coat or paint the intestine. In fact, some people call colostrum white blood because it’s so rich in white blood cells it’s almost as rich as blood.
Breast milk also has factors that promote good bacteria, which is why moms who nurse will notice that their baby’s poop doesn’t smell bad until they start giving formula and food. It’s not stinky because the breast milk is actually supporting acidophilus in the baby’s intestine, which is probiotic. It’s called lactobacillius acidophilus: Lacto means milk, bacillus means bacteria. Acidophilus means to love acid. The reason the name is important is because when a baby drinks the milk, there’s so much sugar in it that not all of the sugar is digested, and some of these sugars are then fermented in the intestine, like what happens with champagne or vinegar. So after it’s consumed, it turns into gas, which is no big deal (it causes rumbles, which is nothing to be alarmed about), and then vinegar-like fermented acid. This is great because stomach acid kills bacteria, meaning that the process keeps bad bacteria out of a baby’s body. Breast milk essentially gives your baby probiotics.
There are other cool things about breast milk, too. Not only does it change from the first day, but it also changes during a feeding. At the beginning, the baby is getting more watery milk, which has more sugar. This satiates their initial thirst and need for calories. And then the baby starts to get the hind milk, which has more fat in it. That makes the baby feel more sleepy and ready for a nap.
After that initial, antibody-rich colostrum, there continue to be antibodies, white blood cells, enzymes, and all sorts of other factors that boost a baby’s immune system in breast milk. It is most robust in the first days and first months when babies are the most vulnerable.
One other benefit is that we know that breastfed babies have a reduced risk of Sudden Infant Death Syndrome (SIDS). We don’t know why, but breastfeeding cuts the risk of SIDS by 50%.
What are the benefits of breastfeeding for the mom?
For the mom, there are many benefits:
1. It immediately helps moms in terms of recovery from the delivery as breastfeeding releases Oxytocin, which causes the uterus to constrict, shrink, and close off bleeding. This reduces the size of the uterus and promotes healing. It also inhibits menses or ovulation so it’s a natural way of spacing out births—in some cultures, it’s really breastfeeding that prevents a mom from getting pregnant three months after she’s had her baby.
2. Creating breast milk consumes an awful lot of calories—if you’re feeding your baby 25 ounces a day, that’s equivalent to 500 calories, or running 5-6 miles. It helps a lot of moms recover their weight, post-baby.
3. Perhaps most importantly, breastfeeding has been associated with reductions in breast and ovarian cancer. This is especially related to the length of breastfeeding, as the longer you breastfeed, the more protection you receive. We don’t really know at what point there are diminishing returns because there are so many factors. We believe that one contributing factor is that you’re reducing the amount of periods you’re experiencing, so you’re less exposed to those hormones.
4. Breastfeeding releases oxytocin (the love hormone) and also prolactin, a hormone released from your pituitaries. This is what makes you a little forgetful and in a fog, which helps you forget the stress of delivery. These both help boost the relationship that’s building between you and the baby. It’s important to note that you don’t need to breastfeed to get the oxytocin release: Fathers, and women who adopt and never breastfeed, all get the oxytocin release. Another great way to facilitate this is through skin-to-skin contact, i.e., holding a naked baby on your bare chest.
What are the primary reasons some women who want to breastfeed struggle?
There’s a belief that because breastfeeding is natural, it should come naturally, but the truth is that it doesn’t mean either of you know what’s your doing. It’s not that it’s overly complex, but it’s easy to make mistakes, and it’s easy to avoid mistakes with some help and preparation. It’s important to get help if you’re having challenges, and to recognize that every woman, forever, has had breastfeeding help. There was always an experienced woman right there to guide her: Women shouldn’t feel like it’s an intuitive kind of thing. If you’re having challenges, reach out to a lactation consultant, your doctor, La Leche League, an experienced friend… The longer you go with problems, the harder it is to get it back on track.
The main reasons for issues are generally technical, either that you have flat nipples, or that you’re putting the baby on incorrectly which is giving you cracked or sore nipples. And sometimes the baby has tongue tie, which can create painful or sore nipples. And if you have a premature baby, or a baby through a C-Section, it’s not uncommon for the baby to not suck strongly at the beginning. And so parents become concerned and lose confidence.
Dr. Derrick Jelliffe, who used to teach at UCLA, always said: “Breastfeeding is a confidence game.” Your belief in yourself builds your persistence and tenacity and helps you get through the tough times at the beginning. The more you doubt yourself, the more you can get into a spiral of dejection and hesitance until you’re too demoralized to try.
If you believe you have flat nipples, you want to work on this before you have the baby. There are breast shields that you wear underneath your bra that allow the nipple to protrude and start stretching—it’s important to elongate the nipple before the baby is born.
If you have flat nipples, immediately after the baby is born, ask to use a breast pump in the hospital, as they’ll suck the nipples out and elongate them—this will also help you jumpstart your breast milk if you have twins, or a baby is otherwise ill or not able to suck as strongly, or not being brought to you. Also, if you have a C-Section, know that it usually takes a day longer for milk to come in—if you get on the pump, you can speed that process up. If you pump in the hospital, it’s only 3-4 times a day for 5-10 minutes—don’t worry if nothing comes out as you are really just “priming” the breast to get it all started. The milk flow will increase in 3-4 days.
The other factor that causes a lot of new moms to stress unnecessarily is that they believe that as soon as the baby is born, they need to nurse. Babies are interested immediately after they’re born, and then they’re not interested for another 18 hours or so. They are born with an extra pound of food and water in their bodies—they’re like camels, and so they don’t need a lot of sustenance at the beginning. In those first few days, you just have colostrum, which comes out a drip at a time. The baby sucking is what brings the milk in. (And once the milk comes in, nursing becomes infinitely easier.) Babies will lose about 7-10% of their body weight—and then hunger will start to drive their appetite. By the third day, they’re getting really hungry, and thus, very interested.
It’s at this point that you want to get help because little baby bodies tend to be tight. Their arms and legs are flexed up since they’ve been packaged like a little peanut for so long, and their jaw muscles get tight as well, which means that they don’t open their mouths enough—it’s not fun when they’re just on the tip of the nipple. It really helps to have someone show you how to get the baby’s mouth fully open and on the breast. The tongue is what causes the most trauma—you want it open like a big fish mouth and you want the nipple up high on the palate and away from the tongue.
Also keep in mind that when the milk comes in, you will likely feel extra-engorged. This is because you’re swelling not only with milk, but also with blood. The blood vessels expand and it’s sometimes very painful. It’s as though the workmen have come in to build the factory—once the milk is coming in, the engorgement reduces and you will stop feeling so full.
If you have a really spirited baby who is flipping out and crying, it can become incredibly unnerving for a new mom and dad. Sometimes you can put them on the breast and they’ll immediately calm down, but much of the time, it doesn’t happen. Generally, you need to calm them down and bring them back to the breast. That’s where the 5 S’s—watch the DVD, because you learn it better by watching—come in hand. Shush the baby, swaddle the baby, and then bring them back to the breast.
Sucking is one of your five S’s—safe to assume that you’re a fan of pacifiers? Any specific pacifiers that are better than others?
Pacifiers are fine, but in general, it’s best to avoid them until the breastfeeding goes well. Once it’s going well, pacifiers are fine. If your baby gets one in the hospital, I wouldn’t flip out about it—sometimes they’ll give a baby a pacifier who is really upset. But you absolutely do not want to use bottles until breastfeeding is established, as they do confuse the way they suck. Bottles create more nipple confusion than pacifiers. The best one is a clear silicon rubber—the shape really doesn’t matter. But silicon is the safest. In general, you always want to use products that are BPA-free. It’s also important to note that pacifier use at night has been shown to reduce a baby’s chance of SIDS.
What’s the safest material for a bottle? Anything you recommend in particular?
You want to avoid using a bottle for the first two or three weeks—and then you want to start a bottle, otherwise it will be too late. You can give pumped breast milk, or even breast milk with a little boiled water added to it if you need to stretch your supply. Don’t give bottled water as it’s not pristine—it’s better to fully disinfect it by boiling it. (Note: Do not give more than one bottle of diluted breast milk per day.)
Giving a bottle just once a day is a really nice way to let other caregivers nurture the baby.
Glass bottles with a silicon nipple are best, as glass is the most inert. Interestingly, the one exception to this is with preemies, as white blood cells stick to the glass. With preemies, you actually want to use non-BPA plastic.
For those who supplement with formula, anything specific to look for? Any brands that you like in particular? Anything ingredient-wise to avoid?
Thank god for formula. It really is great to know that there is something that can sustain our babies if we can’t do it ourselves. If you look on the container, it has 25 ingredients, most of them you can’t pronounce. Those ingredients are primarily nutrients and minerals and vitamins.
If you were to label breast milk, you’d have 100’s of ingredients. Formula doesn’t have the complexity of breast milk, which is why the latter is always ideal if possible. When it comes to formula choice, the only thing I usually recommend is going with an established company that’s been around for 30 or 40 years. There’s a lot of sophistication that goes into making formula. Even though I’m a big fan of organic, and love to support new start-ups, I get concerned about companies that are new who don’t have the track record of safety. I just feel more confident in the companies that know what they’re doing—the food you give a young baby is critical.
What about making your own formula? There’s a certain goat milk recipe that some advocate—worth trying?
That’s a disaster. It’s never going to be good. Goat’s milk is very low in folic acid, cow’s milk is very low in iron, and too high in phosphate. Stick with the known entities.
What about other toxins in a baby’s environment? How concerned are you with organic cotton, for example?
Organic cotton is a great choice in so much as it’s about creating a better earth for our children, but conventional cotton doesn’t add to a toxic load for the family. Don’t stress about that.
Can you explain what white noise is, and why it’s effective?
So one of the things I discuss in The Happiest Baby on the Block is how incredibly loud it is in the womb. But the sound is coming through water—it’s like ducking your head in a bath.
There are actually two types of white noise, which have completely opposite effects on the nervous system.
High-pitched white noise is the noise of sirens. This sound actually calms crying.
Low-pitched white noise is the sound of a train, plane, or car—this is what puts you to sleep. And, I may be a little biased, but the best rumbly white noises are definitely the specially engineered sounds on our Happiest Baby CD/download.