Trends and practices

August 1, 2011

From the dawn of civilization women have entertained the use of special feeding flasks, wet nurses, and mixed concoctions of animal milk as alternate methods to nurture infants. Uninformed concerns about maternal beauty, nobility, and the etiquette of the wealthy fueled many of these practices. In the mid-1900s, when most advances in science were perceived as beneficial, the “scientifically” prepared formulas were marketed as medical and commercial solutions to the problems of infant feeding. “Scientific motherhood” coupled with the impact of urbanization and industrialization led to a worldwide downward trend in breast-feeding. This impact was especially harmful to the breast-feeding practices of mothers in developing countries. Modified “formulas” that were closer to human milk in nutrient quantity were still very different in quality and lacked immune factors. In developed countries, there were negligible differences in mortality between breast-fed and artificially fed infants; however, the evidence became increasingly clear regarding the prevention of infant and later illness among those breast-fed. In developing countries, artificially fed infants had an associated higher morbidity and mortality than breast-fed infants, primarily caused by infection and malnutrition. Poor access to clean water along with inadequate preparation, dilution, and storage of “formulas” are large contributors to these outcomes.

Global trends toward increasing breast-feeding have been noted since the late 20th century. Data from the International Breastfeeding Compendium suggest that in the unindustrialized countries, most children are breast-fed for a few months. This is due in great part to the strong work of mother support groups, more educated women, and available evidence as to the benefits of breast milk, along with control of the marketing of artificial formula preparations.

In the United States, a national health initiative, Healthy People 2000, was outlined in 1978. It defined clear targets for improved maternal and child health measures and included improving breast-feeding rates as a priority.

    Target (%)  
1978 1998 2010
In early postpartum 30 64 75
At 6 months <5 29 50
At 1 year <5 16 25

The international community has similar objectives; however, the baseline rates are lower in many developing countries, with slow but steady advances toward the target rates. Studies confirm that the rate of breast-feeding is higher for married, well educated, higher socioeconomic status women. Maternal employment outside the home and non-Anglo American ethnicity were related to higher rates of bottle-feeding. Many of these women, well informed about the benefits of mother’s milk, chose not to breast-feed because it was “too difficult” and “there were too many rules.” The most frequent reasons cited for stopping breast-feeding by women who started at hospital discharge were (1) not enough milk, (2) felt tired, and (3) infant’s pediatrician told mother to stop. Asking for help from lactation consultants, mother and father support networks, and trained health professionals allows access to practical guidance and accurate information and should be sought before making any decision to stop nursing. Nursing is a flexible practice that should be tailored to fit the lifestyle needs of you and your baby. Most problems, typically experienced in the first 2-3 weeks of breast-feeding, have simple solutions. Proper positioning and feeding on demand can lead to avoidance of many of the common problems that affect milk supply and breast health such as engorgement, sore nipples, and blocked ducts. Positioning is the single most important factor for getting breast-feeding started well. This refers to (1) the physical alignment of mother and infant, (2) the way the mother holds the infant, (3) the position of the mother’s hand as it supports her breast, and (4) the position of the baby’s mouth, lips, and tongue—often called the “latch-on”— around the areola and nipple. Addressing problems early is also important to prevent outcomes such as infant failure to thrive, mastitis, yeast infections, and maternal discouragement, all of which require professional attention. Recommendations for routine breast care involve washing the breast following each nursing session with only lukewarm water, if at all; and massaging a small amount of expressed milk onto the nipple and areola following every feed.

Milk banking and pumping are notable options in expressing breast milk that provide optimal infant nutrition while the mother is not physically able to nurse due to health problems, employment demands, physical absence, or simple fatigue. Special instructions are available in the cited references regarding these practices and the storage of expressed milk.

SEE ALSO: Lactation, Pregnancy

Category: Breast-Feeding