What is breastfeeding?

In my foundational maternal child health class last week, we had a great presentation from one of the leaders of breastfeeding research and promotion. She went through a list of everything that breastfeeding provides:

- Breastfeeding is the baby's first immunization. It continues to protect the baby, through antibodies produced by the mother, as long as the baby/child is breastfed. Breastfed babies get fewer ear infections, less diarrhea, on and on and on.

- Breastfeeding is oral rehydration. Oral rehydration is the simple but lifesaving technique for saving children (and adults) when they have diarrhea - a very common killer. When someone has diarrhea, you make a solution of salts and sugars in water (not just water - you want to maintain electrolyte balance) and have them drink it. It's even more successful when you add a little bit of protein. That's breastmilk. In developing countries, babies and children with diarrhea have a readymade oral rehydration solution in breastmilk.

- Growth and development. She discussed all the ways breastfeeding promotes healthy growth and normal neurological development. Perhaps the most interesting part of this, for me, was the possible contribution of breastfeeding to "epigenetics". Epigenetics is a new field that looks to explain, for example, why identical twins have different health outcomes, even when those health outcomes are strongly linked to genetics. Epigenetics is how environmental factors act upon ("epi" = upon) the genes you're born with. For example, breastfeeding colonizes the gut with a particular kind of flora; how the gut is colonized in infancy may affect how genes are expressed there for the rest of your life. Really interesting!

- Reduced cancer and chronic disease. Again, this may be linked to epigenetics. In terms of chronic disease, obesity and formula feeding have sometimes been linked as well, with the theory that bottle-fed babies are, by nature, overfed. Bottle nipples flow very quickly - in fact, babies don't have to do much sucking at all to get the liquid out and can end up eating a lot more than they're actually hungry for, whereas breastfed babies must actually work for their meal. There's also a tendency to want the baby to "finish" the bottle. Could it be that bottlefed babies always get just a little more than they need - and set that habit for life? It's a theory worth exploring.

- Maternal health and survival. Women who breastfeed return to (and maintain) their prepregnancy weight faster than women who don't. Women who breastfeed also have a lower risk of breast cancer and diabetes later in life. There is a dose-response relationship - the more breastfeeding time, the less risk.

- Birth spacing and fertility. I would not myself depend on lactational amenhorrhea (not getting your period while you're EXCLUSIVELY breastfeeding) for birth control, but in some parts of the world that's all there is. If you can encourage a mom to exclusively breastfeed, she will probably not become pregnant again as quickly and will have a better chance of surviving her next pregnancy (and her children will benefit, as close birth spacing has an adverse affect on them as well).

- Family savings. Breastmilk is free, although it is important to note that breastFEEDING does have a cost, in time and in a small amount of increased calories needed, to the mother. But the health costs associated with not breastfeeding can overwhelm those costs anyway.

The thing I loved about her presentation was that she finished up with "Oh, and also, breastfeeding provides nutrition." Oh wait, right! Along with all these benefits - it's also the baby's food! How often do public health professionals, or the public at large, think of breastfeeding as just what the baby eats? There's so much more!

I know a lot of my classmates got excited about breastfeeding out of that presentation. I've seen a lot of breastfeeding education, but I had never seen it presented so effectively as something that affects almost every area of maternal and child health. And I haven't covered even a third of what she talked about in terms of the benefits - what's above are mostly examples. If anyone out there is interested I can forward you some of the slides.