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Breastfeeding and Child Health.

October 26, 2011 by David Gordon

by Kelly Reynolds Stewart

a milk jug covered with nipples

More than just cha-chas, jugs, knockers, hooters, honkers, headlights, melons, and sweater puppies

The businessman in coach class, the one in the shiny watch, complained to the steward as I nursed my three month old as the plane took off. He complained as he peeled off crisp bills to pay for his Bloody Mary. How many dollar bills do you suppose he has folded into a g-string as a reward to some darling for sliding her nipples up and down a brass pole?  A sexualized breast is worth money in this country, but a breastfeeding breast is shameful.

At the same time a young woman is funding her college career displaying her goodies, a baby is hungry to feed.  Blushing and embarrassed, its mother covers up or hides out in a bathroom stall.  Or maybe having given up entirely, she feeds the baby formula in order to spare those around her the shock and horror of her getting ‘all mammal’ and using that nipple for its intended purpose.  What the hell is up with our culture that shames breast feeding into a corner, literally?  

First let me start by saying, yes, there are reasons that some woman can’t or shouldn’t breast feed.  Also, woman have the right to decide they simply don’t like it.  This essay is not a condemnation of women that can’t do it out of medical or physical limitations.  Nor is this a condemnation of women that give way to the cultural and social pressures that discourage nursing.  This IS a condemnation of a culture that discourages woman from making the healthiest choice for their infant by withholding support and making it shameful, inconvenient and impossible.  So there.

What is it with the American love/hate relationship with the breast? We rally, walk and bumper sticker ourselves in pink to save breasts from cancer.  Entrepreneur Magazine says “breastaurants” are poised to be the fasted growing segment of the industry.  In 2010, 318,123 breast augmentations were performed. I think it’s safe to say, Americans like boobies and we want to show them off – as long as there is no baby hanging on.

Deborah Norville’s career was devastated when she posed on the cover of People magazine nursing her infant.  Tom Shales, of the Washington Post called the magazine cover 'a gross exploitation of oneself and one's child all in the name of career advancement.'

Um, pardon me, career advancement?   As I sat with a breast pump in the janitor’s bathroom during my attempt to balance career and family, I pretty clearly got the message that being a nursing mother was not something I was going to be able to exploit for career advancement.   My supervisor tapped her watch, how much time out of my day was this ‘process’ going to take, she asked.

I should have been in the best possible situation.  Hell, my job was to represent the interests of young children and support community health education for things like….wait for it… breastfeeding.  If I couldn’t figure out how to make nursing a baby and a career possible, who could?

And why does it matter?

The American Academy of Pediatrics thinks it matters.  The AAP recommends that mommies keep their mammaries out of Victoria’s Secret and in a nursing bra for the first six months of an infant’s life.  That’s a long time – especially if you are living in one of the two industrialized countries in the world that doesn’t offer a paid maternity leave (US and Australia).  Without paid leave, mothers hurry back to work and can’t breastfeed.  Most workplaces, like mine, don’t make it possible to pump breastmilk during a workday.  A mother can probably find a way to suck down half a pack of smokes and a Starbuck’s mocha during an eight-hour workday without a problem, but no one is likely to help her with a lactation situation.

The AAP six-month recommendation doesn’t come out of nowhere. Research provides pretty solid support for breastfeeding outcomes.  

Examine the following:

In the first year of life, after adjusting for confounders, there were 2033 excess office visits, 212 excess days of hospitalization, and 609 excess prescriptions for these three illnesses per 1000 never-breastfed infants compared with 1000 infants exclusively breastfed for at least 3 months. These additional health care services cost the managed care health system between $331 and $475 per never-breastfed infant during the first year of life.  Health Care Costs of Formula-feeding in the First Year of Life. Thomas M. Ball and  Anne L. Wright.  Pediatrics 1999; 103:Supplement 1 870-876.

For those of you that are inclined to think this breastfeeding stuff is some sandal wearing warm hearted fuzzy hippie crap, those are numbers.  Less visits to the doctor and fewer health care services. Those numbers translate into money.  For the employer that rolls eyes at the idea of accommodating a nursing mother, those few minutes she spends each day with a breast pump could save you on sick days.  A fewer days that the employee calls in absent due to a snotty-nosed kid.

Speaking of money and healthcare, everybody got their panties all wadded up about Obama Care.  As it so happens, I would have really appreciated a little Obama Care while I was shamefully milking myself in the janitor’s bathroom at a branch of the largest non-profit community charity in America.

H.R. 3590 and H.R. 4872 Section 4207 requires an employer with over 50 employees to provide reasonable break time for an employee to express breast milk for one year after the child's birth. Don’t worry, the employer is not required to compensate an employee for any work time spent for such purpose but they do have to provide a place, other than a bathroom, for the employee to do the deed.

These small changes could improve some pretty paltry statistics, at least a bit.  According to the Centers for Disease Control and Prevention,  approximately 75 percent of mothers start breastfeeding after birth, but less than 15 percent of those moms are breastfeeding exclusively six months later.  

That is likely because six months into this parenting trip, a mother has been exposed to a mind numbing amount of unsolicited opinion and garbage misinformation about breastfeeding.  Fifty-seven percent of respondents told BabyTalk Magazine they disapprove of public breastfeeding. With the nasty looks and clucking tongues it’s no wonder so many say ‘screw it’ and buy a can of formula.

I am going to assume the origin of the problem and intolerance stems from ignorance, as it often does.  Perhaps a little science-y goodness will create a little awe for this mammalian function.

Here are a few upsides of being a mammal, reasons we should think our branch of the taxonomic tree is pretty special.

Breastfeeding lowers risk for childhood obesity – The CDC Research to Practice Study published in July 2007 cites a good many studies that link breastfeeding to lower rates of obesity. The report admits the difficulty in teasing out the reasons for the connection.  Multiple theories exist including better self-regulation and differences in concentrations of insulin and leptin in breastfed babies.  So no, nobody knows exactly why, but that doesn’t mean the connection doesn’t exist.  (www.cdc.gov/nccdphp/dnpa/nutrition/pdf/breastfeeding_r2p.pdf )
 
Long ingredient list – In this case a long ingredient list is a good thing. Human milk lots of good stuff, including interferon, white blood cells, antibacterial and antiviral agents. All those ingredients unique to breastmilk reduce the risk of just a few diseases like: celiac disease, diabetes, multiple sclerosis, sudden infant death syndrome, childhood cancer, autoimmune thyroid disease, appendicitis, osteoporosis, cardiovascular disease, helicobacter pylori infection, Crohn's disease, colitis, juvenile rheumatoid arthritis, obesity, tonsillitis, allergies, atopic disease, and asthma. (The full report can be found at http://exterminatingangel.com/worpress-archives/wp-content/uploads/2011/10/Outcomes_of_breastfeeding_June_2007.pdf )
 
Milk production will adjust to the needs of the infant – The human body is amazingly adaptive. The more milk an infant demands, the more the mother’s body can produce.  A mother can nurse twins or even triplets.  I didn’t say it was easy, only that it is possible.  What part of having twins or triplets would be easy anyway?
Breast milk boosts IQ – Researchers believe that a breastfed infant can benefit by as many as 8 extra points over babies who aren't breast fed. The reasons aren’t entirely clear.  I don’t know about you, but I think we are all better off with a few extra points.  
It’s easy and it’s cheap – Some people disagree with me on the easy part.  Perform this experiment to appreciate my opinion:  First, pull up your shirt and then put it down.  Now scrub out twelve bottles and nipples with a bottle-brush and sanitize them. Which seemed easier?   
As for cheap, not using formula can save you between $1,000 and $3,000 per year.  That’s money you’ll want to put in your pocket because you’ll need to spend on other things later.  Things like Legos, prom dresses, braces and sports equipment.

Nonsense and Bullshit

So that was the good stuff, here is the most common bullshit. People get really defensive of their choice not to breastfeed.  While defending their choice, they sometimes spout non-sense that contributes to even more backward ideas about the matter.  Relax, it was your choice, remember.

Breastfeeding hurts – Just because it’s natural doesn’t mean it’s easy in the beginning. Pain early on is common, this should be a temporary situation.  If you find yourself, banging your head against the back of the rocking chair while nursing to distract yourself from the pain, find a lactation consultant.  This is what they do.  
 
Breastmilk doesn’t have enough vitamin D – A baby stores around two-months worth of vitamin D during a full term pregnancy. After about six months, a little outside exposure to natural sunlight, on a regular basis, gives the baby all the additional vitamin D needed.  Think about leaving the house and going on a walk instead of watching all the crap on your DVR.  
 
Breastmilk does not contain enough iron – Breastmilk contains enough iron and other nutrients for the baby’s needs for the first six months without any other food. I am guessing a formula company started this rumor.
It is easier to bottle feed than to breastfeed – This is just an opinion. As I said before,  I would rather pull up my shirt than wash, dry and sanitize a sink full of bottles.  Call me lazy if you must.
 
Breastfeeding ties the mother down – I don’t know if you noticed, but having a baby ties a mother down.  Things aren’t really going to lighten up for you for about 18 to 20  years.  The sink full of bottles you have to wash, the crazy diaper bag filled with more bottles, ear infections and the cost of the formula is going to tie you down too.  Again, I’d just prefer to pull up my shirt and be done with it.
 
Modern formulas are almost the same as breastmilk – Nope. Formulas and breastmilk additives have come a long way, but pharmaceutical formula is still a formula.  It contains no antibodies, living cells, enzymes or hormones that I mentioned before.  It doesn’t vary and change with the growth and needs of the baby.  
 
If the mother has an infection or is taking medication she should stop breastfeeding – There are only a very few medical circumstances that require a mom to stop nursing.  She may feel like stopping, but that something different entirely.  Ask a doctor or lactation consultant about anything you are prescribed or are taking.  Also, learn how to read a pharmaceutical label.

So, if breastfeeding makes for healthier, smarter kids. Healthier kids turn into healthier adults. Healthy adults require less healthcare services and are more productive people.  Most of corporate America has acknowledged that looking out for health has a financial upside.  Companies offer healthcare discounts and incentives to quit smoking and get your butt to the gym.  Companies encourage employees to adopt healthy habits that produce better outcomes for the whole group. Everyone benefits from greater productivity and lower healthcare costs.

So, um, where are the incentives to breastfeed a baby? Where are the insurance premium discounts, the free seminars, products and services? My company will reimburse me for Nicotine gum, but they will not reimburse me for a breast pump or the ten minutes I spend in the janitor’s closet with it.  Surely a healthy baby with fewer ear infections and a decreased likelihood of chronic disease would create a lesser burden on resources.

Several states have begun to acknowledge the importance of encouraging breastfeeding and have pretty unique laws to support it. For example,
•    Puerto Rico mandates shopping malls, airports, government centers have accessible breastfeeding and diaper changing areas that are not also bathrooms.
•    Handling breastmilk is a pain, it’s a body fluid and can potentially transmit disease, so many daycares don’t want the trouble.  Louisiana prohibits any child care facility from discriminating against breastfed babies.
•    Maryland exempts the sale of property that is manufactured for the purpose of breastfeeding from the sales and use tax.
•    New York created a Breastfeeding Mothers Bill of Rights. They also created a law that allows a child under the age of one to accompany the mother to a correctional facility if the mother is breastfeeding at the time she is committed.

So there are little shining lights of support for breastfeeding, but we need more.  Breastfeeding is a choice.  Just one of a million that a parent makes on behalf of their child.  It’s a great choice, it’s a healthy choice.  As a culture we need to do what to support parents that are trying to make decisions in the long term interest of their child’s health.  We need to invest in breastfeeding as health strategy.  If only we spent as much on breastfeeding support programs each year as we do on the Sports Illustrated Swimsuit Edition.  

Filed Under: Kelly Reynolds Stewart.

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