Bailey’s Golden Start Breastfeeding Curriculum for Nursing
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Describe how the course is organized and contents of this section.
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Instruct students to take a piece of paper and divide it into 4 columns (biological, psychological,
cognitive, and community).
Give them a few moments to talk with a shoulder partner at their table and jot down as many
benefits that they can think of.
Tell them to add to their lists as the discussion takes place if they think of something or if it is discussed
by another classmate.
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Bailey’s Golden Start Breastfeeding Curriculum
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Used to be that we thought it was only for FOOD --- now realize that there are HUGE advantages to
breastfeeding. Not only about growth/putting on weight.
Some say breastmilk is 10% for nutrition – 90% for protection!
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Image taken by Jennifer DeJong; Carolyn at Home, Summer 2008.
Although controversy exists surrounding some of the assertions made by lactation researchers (Labbok, 2001),
the importance of breastfeeding in the prevention of disease is well known.
The benefits of direct lactation or receiving human milk within an individual’s microsystem include a
decreased incidence of morbidity and mortality related to diarrhea (Beaudry et al., 1995; Bhandari et al., 2003;
Dewey et al., 1995; Howie et al., 1990; Kramer et al., 2003; Popkin et al., 1990); bacteremia, sepsis, and
bacterial meningitis (Cochi et al., 1986; Heinig, 2001; Hylander et al., 1998; Istre et al., 1985; Schanler et al.,
1999); upper and lower respiratory tract infections (Bachrach et al., 2003; Lopez-Alarcon et al., 1997; Oddy et
al., 2003b); necrotizing enterocolitis; otitis media (Dewey, 1995; Duncan et al., 1993; Owen et al., 1993;
Saarinen, 1982); urinary tract infections (Barone et al., 2006); diabetes mellitus (Mayer-Davis et al., 2008; Owen,
2006); cancer (Bener, 2001; Davis, 1998; Smulevick, 1999); overweight and obesity (Arenz, 2004; Armstrong &
Reilly, 2002; Dewey, 1993; Grummer-Strawn, 2004; Singhal et al., 2003; Stettler, 2002); high cholesterol (Harit et
al., 2008; Owen et al., 2002; Reiser & Seilman, 1972); cardiovascular risk (Law, Wald, & Thompson, 1994; Owen
et al., 2002; Ravelli et al., 2000; Singhal et al., 2003); asthma; and SIDS (Chen, 2004; Ford et al., 1993; Horne et
al., 2004; Mitchell et al., 1992; Scragg et al., 1993). Cognitive benefits, commonly measured by a child’s
intellectual quotient (IQ) (Anderson, Johnstone, & Remley, 1999; Caspi et al, 2007; Drane, 2000; Horwood,
Darlow, & Mogridge, 2001; Jain, Concat, & Leventhral, 2002; M. M. Smith, Durkin, Hinton, Bellinger, & Kuhn,
2003), and an enhanced analgesic effect for infants experiencing painful medical procedures have also been
reported (Carbajal, 2003; Gray, 2002; Shah, Aliwalias, & Shah, 2006).
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Infections of the tympanic membrane are common in children under the age of one. Breastfeeding decreases a child’s risk for
ear infections in the first 12 months of life (Dewey, 1995).
Prolonged breastfeeding acts as prophylaxis for recurrent or chronic otitis media (Saarinen, 1982). Duncan et al. (1993) found
that exclusive breastfeeding for at least four months protected against otitis media, and Owen et al. (1993) documented
reduced rates of otitis media with effusion in the first two years of life for children, regardless of secondhand smoke exposure
and attendance in group childcare.
Paradise (1994) concluded that breast milk protected infants with cleft palates against otitis media, and Aniannsson et al.
(1994) observed similar findings in their study of otitis media among Swedish infants receiving breast milk.
But remember, this doesn’t mean that breastfed infants never get sick!
Although the breastfed infant can get sick, statistically infections occur much less frequently and much less seriously than for
formula fed infants.
Benefits are dose related. Any amount of breastmilk is helpful, but the more breastmilk an individual receives and the longer he
breastfeeds, the greater the benefits.
The less we complicate babies’ systems with foreign proteins, the healthier they are.
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Evidence suggests a reduction in the incidence of insulin-dependent (type 1) and non-insulin
dependent (type 2) diabetes mellitus among children who were breastfed as infants.
According to Perez-Bravo et al. (1996) in their assessment of Chilean children (n = 165; 85 diabetic
and 80 non-diabetic children), exclusively breastfed infants possessed a smaller risk of developing
diabetes mellitus type 1 than those who were breastfed for a shorter duration, or who were given
cow’s milk or solid foods earlier in life.
In addition, due, in part, to breastfeeding’s effect on obesity, breastfeeding also appeared to
protect against diabetes mellitus type 2 (Owen, 2006; Mayer-Davis et al., 2008).
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Nutrition in the first weeks of life may program disease risk into adulthood (Rudnicka et al., 2007).
Rudnicka et al. (2007) examined a total of 9,377 persons born during one week in 1958 in England,
Scotland, and Wales to assess the influence of initial infant feeding on cardiorespiratory risk factors in
adulthood and found that breastfeeding for more than one month was associated with reduced
waist circumference, waist/hip ratio, as well as lower odds of obesity compared with formula feeding
after adjustment for birth weight, pre-pregnancy maternal weight, maternal smoking during
pregnancy, socioeconomic position in childhood and adulthood, region of birth, gender, and
current smoking status.
With this said, the authors did not make claims to a substantial long-term protective effect of
breastfeeding for more than one month on other cardiorespiratory risk factors in adult life, writing,
“The association between breastfeeding and waist circumference, waist/hip ratio, and obesity is of
interest and needs to be replicated by other studies that have information on exclusive
breastfeeding for longer durations (> one month)” (p. 1113).
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Reduce Obesity:
Childhood obesity is an epidemic in the US.
Breastfeeding can help prevent obesity, but 1 in 3 moms stop without hospital support.
About 95% of hospitals lack policies that fully support breastfeeding moms.
Hospitals need to do more to help moms start and continue breastfeeding.
Centers for Disease Control and Prevention (CDC).
http://www2c.cdc.gov/podcasts/player.asp?f=8082868
Childhood obesity is an epidemic.
In the US, 1 preschooler in 5 is overweight; half of these are obese.
A baby's risk of becoming an overweight child goes down with each month of breastfeeding.
In the US, most babies start breastfeeding, but within the first week, half have already been given formula.
By 9 months, only 31% of babies are breastfeeding.
Hospitals can either help or hinder mothers and babies as they begin to breastfeed. The Baby-Friendly Hospital Initiative
describes The Ten Steps to Successful Breastfeeding that have been shown to increase breastfeeding rates by providing
support to mothers.
Unfortunately, most US hospitals do not fully support breastfeeding
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Risk when babies are slept with on couches….. Never do this!
Although rates have decreased worldwide, SIDS remains the leading cause of infant death from 1 to
6 months in the developed world (Heinig & Banuelos, 2006). Hypotheses proposed to explain SIDS
include deficiencies or problems related to a defect in the infant’s sleep or breathing control,
infections, reactions to immunizations, severe botulism, hypersensitivity to cow’s milk, infant thiamine
deficiency, maternal health, lower socioeconomic status, and maternal smoking status.
Because the syndrome occurs less frequently in breastfed infants, it is speculated that breastfeeding
protects against infant death (Bernshaw, 1991). McVea, Turner and Peppler (2000) reviewed the
literature regarding the risk of SIDS in bottle-fed infants compared to those who were breastfed,
conducting a meta-analysis and metasynthesis of 23 studies, and found that bottle-fed infants were
twice as likely to die from SIDS than their breastfed counterparts.
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Chen & Rogan (2004)
The Chen and Rogan study was the first time that mortality and feeding were examined in a US population.
They looked at death in the first year of life in children who were born full term and healthy and found that if
children were breastfed at all in the first 3 months, they had a 21% lower risk of dying. (This is not exclusive
BF…we don’t have that data….that would be even higher!)
Car seat laws were enforced, based on 400+ deaths over a period of three years, and yet we have little
encouragement or support for breastfeeding where 700+babies died because they weren’t breastfed.
Bartok in 2010 calculated that 911 deaths from disease and illness (respiratory, etc.) could be prevented each
year in young children if the AAP breastfeeding recommendations were followed. (Exclusive BF for the first six
months, continued breastfeeding for a minimum of one year.)
COULD ALSO ADD $13 BILLION HEALTHCARE COSTS INFO HERE FROM WBW PRESS RELEASE…
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Lymphoma, leukemia, and Hodgin’s Disease show decreased rates of occurrence in infants who had been breastfed (Bener,
2001; Davis, 1998; Smulevick, 1999). Kwan, Buffler, Abrams, and Kiley (2004) used a fixed effects model and meta-analytic
technique to quantify the evidence of an association between duration of breastfeeding and risk of childhood acute
lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML). Results of 14 case-control studies indicated a significant
negative association between long-term breastfeeding, defined as greater than six months’ duration, and both ALL and AML
risk. In addition, short-term breastfeeding, defined as less than or equal to six months’ duration, was similarly protective for both
ALL and AML.
Bener, Hoffman, Afify, Rasul, and Twefik (2008) through the Department of Medical Statistics and Epidemiology, studied patients
with ALL, Hodgkin’s lymphoma, and non-Hodgkin’s lymphoma who were equal to or less than 15 years of age. Of the healthy
control population, the mean number of months male patients were breastfed was 9.1 months; in female patients, and controls
– 8.4 months. As in Kwan et al.’s (2004) study, results indicated that a shorter period of breastfeeding (0 to 6 month duration) was
associated with an increased odds ratio for cancer development for both male and female patients, as compared to
breastfeeding longer than six months.
Additional factors associated with an elevated risk of malignancy were low age and low education of the mother.
Using a case-control study design, Altinkaynak, Selimoglu, Turgut, Kilicaslan, and Ertekin (2006) studied a population of Turkish
children (n = 137) aged 1 to 16 years to investigate cancer rates in relation to breastfeeding. They found the median duration of
breastfeeding among patients with ALL and AML to be shorter (10 versus 12 months; p = .001) when compared with healthy
children. The shortest duration of breastfeeding was noted in children with AML.
Breastfeeding for a duration longer than six months, was, again as in Bener et al.’s (2008) study, associated with increased odds
ratios for ALL, AML, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, and overall cancer occurrence.
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Within the child’s microsystem, improved individual cognitive ability, academic performance, and
mental differences of breastfed children are reported in the literature (Anderson et al., 1999; Drane,
2000: Jain et al., 2002; M. M. Smith et al., 2003).
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In a prospective study of 83 infants, Innis (2001) discovered that, in infants exclusively breastfed for
more than three months, red blood cell levels of long-chain fatty acids were related to improved
visual acuity and cognitive development. Barone et al. (2006) concurred, stating that breastfeeding
enhances the role that long-chain fatty acids have in brain development.
Similarly, in a study of 439 school-age children weighing <1500 g when born in the U.S., Smith (2002)
noted that breast milk feedings were associated with higher unadjusted test scores for each domain
of cognitive function except memory, with the greatest advantages in cognitive performance for
those who received direct breastfeedings compared to those children who did not receive any
breast milk feedings.
In addition, children who were directly breastfed demonstrated a 10.7-point advantage in overall
intellectual function and scored 10 to 14 points higher on measures of verbal ability compared with
children who never received breast milk (Smith, 2002). Finally, breastfeeding has also been reported
to mitigate the impact of congenital hypothyroidism and its negative effects on infant cognitive and
mental development (Bode, 1978; Montalvo, 1974; Sack, 1977).
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Likewise, M. M. Smith et al. (2003) found a difference of 3.6 IQ points between breastfed children and
those who did not receive any breast milk feedings for overall intellectual functioning and a
difference of 2.3 IQ points for verbal ability, after adjusting for the mother’s verbal ability, home
environment, length of hospitalization, and a composite measure of parental education and
occupation.
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All notes on this page from the March of
Dimes (November 2011):
• The preterm birth rate has increased 36
percent over the past 25 years.
• Currently, more than 500,000 U.S. infants
are born prematurely each year.
• Premature birth is the leading cause of
infant death.
In addition to monetary costs of $26 billion
dollars annually, there is the immeasurable
loss of human potential and the stress on
family relationships.
Prematurity is often associated with a wide
range of disabilities including cerebral
palsy, autism spectrum disorders, visual
impairment, and delayed motor and
intellectual development.
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Preterm infants are at high risk for infection during their hospital stay.
The earlier an infant is born, the greater the health risks. It is now
recommended that even babies born three or four weeks early (late preterm babies) receive special care.
While breastfeeding is essential to the health of all infants, babies born
prematurely benefit even more from ingredients in human milk.
Feeding premature infants foods other than human milk increases the risk of
serious infections, such as necrotizing enterocolitis, which can require
surgery and lead to lifelong disability or death.
There is compelling evidence that human milk promotes intellectual
development in all infants. In preterm infants, the link between human milk
feeding and intelligence and later school performance is even more
pronounced, especially in male infants. At present, no one knows why boys
derive more benefit from human milk compared to girls, but it is clear that all
babies benefit from receiving their mothers' milk.
Despite the importance of human milk for preterm infants being well
established, providing human milk to these medically fragile infants requires
patience, perseverance, and skill. Some mothers hand express or pump for
weeks or months in order to give their milk to their babies. Others rely on
human milk from milk banks. Those mothers able to breastfeed directly, still
require additional breastfeeding support to ensure that their babies receive
the nourishment they need.
For more information about the March of Dimes Prematurity Awareness
Campaign, visit their website at http://www.marchofdimes.com/. For more
information about International Board Certified Lactation Consultants or to
locate an IBCLC in your area, visit www.uslca.org.
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Some of the problems that preterm infants may encounter are:
Feeding difficulties
Hypoglycemia
Jaundice
Excessive weight loss
Respiratory distress
Apnea
Necrotizing entercolitis (NEC)
Unable to maintain body temperature (low brown adipose tissue stores)
Infection
Slow weight gain
Intracranial hemorrhage
Bonding issues
Chronic lung disease
Risk of re-hospitalization
What are some underlying maternal variables that researchers have indicated as precursors/factors that impact prematurity?
Diabetes
Pregnancy-Induced Hypertension
Preeclampsia
OBESITY
Isn’t it interesting that it can be a never-ending cycle?
Maternal Obesity – can lead to pre-term labor – can lead to moms not breastfeeding because of delayed milk production --- can
lead to formula feeding --- which can lead to, any guesses? CHILDHOOD OBESITY
Maternal Obesity --- can lead to difficulty with childbirth --- which can lead to a mom having a c-section --- which can lead to delayed
milk production --- which can lead to formula feeding --- which can lead to, any guesses? CHILDHOOD OBESITY
For the premature infant born before 38 weeks gestation, Blaymore et al. (2002) found that breastfeeding reduced the severity of
symptoms of upper respiratory tract infections (URI) for up to seven months following hospital discharge. Among very low birth weight
(VLBW) infants, Hylander et al. (1998) noted decreased rates of infection among infants receiving human milk.
Schanler et al. (1999) found similar findings, reporting the beneficial outcomes of feeding fortified human milk versus preterm formula to
premature infants.
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Image used with permission from Marissa Funkhouser, Summer 2012.
Ask the students: Do you notice the ventilator tubing on the mom’s shoulder? As the nurse, what are
you assessing during these kangaroo cares, and what do you expect the infant’s vital signs to be?
Get in pairs and discuss.
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Image taken by Christian DeJong; Jennifer
and Carolyn DeJong, Spring 2008.
GROUP WORK: Give students 5 – 10
minutes to answer the following
question.
Aside from the apparent health benefits of
breastfeeding for infants and children,
research supports maternal health benefits
within the lactating mother’s microsystem,
as well. The individual health benefits for
mothers include decreased postpartum
bleeding (Chua, 1994), enhanced infant
bonding (Dettwyler & Stuart-Macadam,
1995; Ekstrom & Nissen, 2006), effective
child spacing through lactational
amenorrhea (Rosner & Schmlman, 1990),
earlier return to pre-pregnancy weight with
a reduction in postpartum weight retention
(Dewey, 1993), decreased risk of breast
cancer (Byers, 1985; Chilvers, 1993;
Katsouyanni et al., 1986, 1996; Layde et al.,
1989; Lubin, 1982; McTiernan, 1986;
Newcomb et al., 1994; Romieu, HernandezAvila, Lazcano, Lopez, & Romero-Jaime,
1996; Rosero-Bixby, 1987; Sisking, 1989; Tao,
1988; Yang, 1992; Yoo et al., 1992; Yuan, Yu,
Ross, Gao, & Henderson, 1988), decreased
risk of endometrial cancer (Newcomb &
Trentham-Dietz, 2000; Rosenblatt, 1995),
and decreased risk of ovarian cancer
(Gartner et al., 2005).
Question: While taking the history of a
pregnant woman she tells you she has
had a right-sided mastectomy as a
result of cancer treatment. She is
undecided about breastfeeding.
What information could you give her
specific to her situation?
Note: Some health professionals
recommend that we do not use the word
“BENEFITS” when talking about what is
supposed to be the NORM.
In this case, it is not a “BENEFIT” or an
“ADVANTAGE” – instead, those who do
NOT breastfeed are functioning at a lower
level than NORMAL (and are at a
significant disadvantage – functioning at a
BELOW average level… They are not
meeting their full potential).
Section Two: Objectives 2-5
ANSWER: Breastfeeding will help you
to protect your remaining breast from
developing cancer, and
breastfeeding your baby will reduce
her risk of getting breast cancer in the
future.
Either way --- what does the literature report?
LAPTOPS AVAILABLE? ALLOW THEM TO LOOK
ONLINE NOW.
Early cessation or not breastfeeding at
all is associated with an increased risk
of maternal postpartum depression
LECTURE:
Faster Postpartum Recovery:
Birth spacing: Delayed postpartum
ovulation during exclusive
breastfeeding supports birth spacing
(lactational amenorrhea)
prevention of hemorrhage (how? Oxytocin
increases uterine contractions therefore
reducing maternal blood loss)
Relaxation due to bonding and stress reduction
(how? Again Oxytocin contributes to feelings
of relaxation and attachment)
History of lactation reduces risk of developing
Note: lactational amenorrhea is only
effective IF “exclusive” breastfeeding.
Don’t promise this if they are not
breastfeeding exclusively or they may
be surprised with another pregnancy
before they are ready!
type 2 diabetes
ovarian cancer
breast cancer – even on 1 breast if the other
has already been removed secondary to
breast cancer
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Image taken by Jennifer DeJong; Christian and Carolyn, Spring 2008.
During lactation and the act of breastfeeding, the hormones oxytocin and prolactin are released from the pituitary. This
biological event enhances a mother’s capacity to relax and feel nurturing toward her baby (Dettwyler & Stuart-Macadam,
1995). Researchers’ interest in supporting and analyzing variables related to maternal-infant bonding is evident in the literature.
In a study of Swedish mothers, Ekstrom and Nissen (2006) found that breastfeeding mothers who were cared for by midwives and
nurses who had completed a lactation education program (n = 540) perceived stronger maternal feelings for their infants than
mothers who had received standardized care. With support from professionals who participated in a breastfeeding counseling
program, mothers’ self-esteem and their ability to bond and care for their infants was strengthened.
Ekstrom and Nissen (2006) also showed that at three days postpartum, those mothers who had received the intervention thought
their understanding of their infants was better; they perceived more strongly their infants as their own; and they enjoyed more
breastfeeding and resting with their newborns. In addition, at nine months’ observation, mothers in the intervention group
perceived their newborns to be more attractive than other infants, conversed more with their infants, and perceived more
strongly that their infants were their own than did the mothers in the control group. Finally, mothers in the intervention group felt
significantly more confident with their infants. This finding led Ekstrom and Nissen (2006) to conclude that a breastfeeding training
program for midwives and postpartum nurses improved the maternal-infant bond by increasing positive feelings toward the
newborns.
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Within the mother’s microsystem, ffrequent breastfeeding can delay the return of fertility through lactational amenorrhea. The
lactational amenorrhea method (LAM) for full breastfeeding women has received worldwide approval across various cultures
and socioeconomic levels as a means of natural suppression of fertility (Hight-Laukaran et al., 1997; Labbok et al., 1997).
However, many providers question its reliability (WHO, 1999). Sooi-Ken Too (2002, citing Labbok, 1990) writes, “The reluctance
and skepticism may be because breastfeeding is seen as a traditional method or ‘old wives’ tale lacking the rigour of the
medical model of contraception” (p. 302).
The efficacy of lactational amenorrhea has been studied extensively as an effective contraceptive method (Clubb & Knight,
1996; Hight-Laukaran et al., 1997; International Medical Advisory Panel, 1996; Kennedy, 1988; Labbok, 1990; Labbok et al.,
1997; Newton & Newton, 1967; Ramos, Kennedy, & Visness, 1996; Rodriguez-Garcia & Frazier, 1995; Van Look, 1996; Walton,
1994; WHO, 1999). According to a study by Rosner and Schulman (1990) on birth intervals among breastfeeding women (n =
236) and formula-feeding women (n = 30) not using contraceptives, analyses indicated that mothers who breastfed had
longer birth intervals than those who did not.
For mothers who breastfed, there was a significant positive correlation between duration of breastfeeding, the length of
lactational amenorrhea, and total birth interval. Ramos et al. (1996) reported LAM to be 99% effective when used correctly
during the first six months postpartum; after 12 months, the effectiveness dropped to 97%. In this study, LAM provided as much
protection from pregnancy as barrier methods and intrauterine devices (Ramos et al., 1996). Caution is advised for mothers
who do not exclusively breastfeed, however, as lactational amenorrhea cannot be advised for mothers who give the
occasional bottle of formula or for those who go for greater than five hours between breastfeeding sessions.
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According to Ogden et al. (1999-2004), U.S. women of reproductive age are alarmingly heavy, with 52% of women overweight,
29% obese, and 8% with BMI index scores (BMI: in kg/m2) more than 40. In North America, a BMI greater than 25 is considered
“obese” and cause for concern.
Lactation has higher energy requirements than pregnancy, utilizing approximately 500 calories per day, and although weight loss
is highly variable among breastfeeding mothers, some studies indicate that breastfeeding for at least six months can assist
lactating mothers to lose weight (Dewey, 1993). Baker et al. (2008) aimed to uncover whether breastfeeding reduced postpartum
weight retention (PPWR) in a Danish population where exclusive breastfeeding is common and breastfeeding duration is long due
to extended maternity leave practices and a culture that supports breastfeeding. Results of 36,030 six-month and 26,846
eighteen-month postpartum interviews, after adjusting for maternal pre-pregnancy
BMI and gestational weight gain (GWG), indicated that breastfeeding was associated with lower PPWR in all categories of prepregnancy BMI. These results suggest that, when combined with GWG values of approximately 12 kg, breastfeeding as
recommended could eliminate weight retention by six months postpartum in many women. Researchers caution that mothers
who are overweight or obese and who do not initiate breastfeeding, who breastfeed for short periods of time and then
terminate, or who have reduced physical activity may not return to their pre-gravid weights during the first six months postpartum
(Dorea, 1997).
In addition, lactating women who intentionally increased their physical activity by exercising for 45 minutes four days a week and
restricting their caloric intake by 500 calories per day lost four times more weight and fat mass than the control group who
exercised no more than once a week for 10 weeks (Dugdale & Eaton-Evans, 1989). Most professionals, however, recommend that
mothers restrict caloric intake to no lower than 1500 calories a day to lose weight and postpone weight-loss measures until
lactation is well established (Barbosa, Butte, Villalpando, Wong, & Smith, 1997; Dugdale & Eaton-Evans, 1989; Lovelady, Garner,
Moreno, & Williams, 2000; McCrory, 2001).
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Image used with permission from Ashley Terhune; Marissa Funkhouser’s Mom’s Group, Summer 2012.
Breast cancer affects 1 in 8 women in the U.S. (Spencer-Cisek, 1998). Although the evidence of a
reduced risk of breast cancer among women who have ever breastfed is far from universal with
several studies showing no protective effect (Coogan, Rosenberg, Shapiro, & Hoffman, 1999;
Lipworth, Bailey, & Legoretta, 2000; Parker, Rees, Leung, & Legoreta, 1999; Purwanto, Sadjimin, &
Dwiprahasto, 2000), there is still accumulating evidence suggesting that increasing the duration of
lifetime breastfeeding reduces the risk of premenopausal breast cancer in the mother (Labbok, 2001;
Newcomb et al., 1994).
There is a weak, yet protective, effect against breast cancer with prolonged lactation (Byers, 1985;
Chilvers, 1993; Katsouyanni et al., 1986; Layde et al., 1989; Lubin, 1982; McTiernan, 1986; Newcomb et
al., 1994; Romieu et al., 1996; Rosero-Bixby, 1987; Wang et al., 1992; Wu, 1996; Yoo et al., 1992; Yuan
et al., 1988).
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There are some indications that lactation may be protective for only pre-versus post-menopausal breast cancers (Byers, 1985;
McTiernan, 1986; Newcomb et al., 1994; Yoo et al., 1992), that maternal age at first lactation may be significant (Brinton et al.,
1995; Newcomb et al., 1994), and that duration of lactation is important (Byers, 1985; Chilvers, 1993; Katsouyanni, 1996; Layde et
al., 1989; McTiernan, 1986; Newcomb et al., 1994; Romieu et al., 1996; Rosero-Bixby, Oberle, & Lee, 1987; Tau, 1988; Yang et al.,
1993; Yoo, 1992). In cancers that affect post-menopausal women, the protective effect of breastfeeding is less certain. A
longer duration of lactation has been found to be protective in some studies (Layde et al., 1989; Romeiu et al., 1996; Yoo et al.,
1992) as carcinogens may be excreted and removed through the very act of breastfeeding.
According to Enger, Ross, Henderson, and Bernstein (1997); Romeiu et al. (1996); and Siskind (1989), a long duration (13 to 25
months) of breastfeeding the first child was found to offer protection to both premenopausal and post-menopausal women.
Similarly, Hollander (1996), in her case-control study of Mexican women (n = 349), found long-term breastfeeding of the first
baby to substantially reduce a woman’s odds of getting breast cancer. The relative risk fell from 0.7 among those women who
had breastfed their first infant for 1 to 3 months to 0.2 for those women who had done so for longer than 12 months. The results
were roughly the same for pre-menopausal and post-menopausal women, and the findings remained unchanged in analyses
adjusting for confounding factors (Hollander, 1996). In a population-based case control study of five counties in New Jersey,
2203 women were studied to ascertain lifetime total breastfeeding duration. A three times lower risk of developing breast
cancer was found in women who breastfed between 37 to 60 months, or a 3 to 5 years, lifetime total (Brinton et al., 1995).
Life-threatening gynecological cancers may be reduced for women with a breastfeeding history. According to Rosenblatt
(1995) and, more recently, Newcomb and Trentham-Dietz (2000), mothers with a history of lactation have a decreased risk of
developing endometrial cancer compared to mothers who have never breastfed. Similarly, Gartner et al. (2005) reported a
decreased rate of ovarian cancer among women who had ever breastfed.
The potential role lactation has in the prevention of cancer is important. Because the choice to breastfeed is a modifiable
variable for most childbearing women, understanding the role that lactation could contribute to a greater understanding of
cancer prevention has important public health implications (Freudenheim et al., 1997).
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Maternal Health Benefits to Breastfeeding:
Relaxation due to bonding and stress reduction.
Oxytocin contributes to feels of relaxation and attachment.
Early cessation or NOT breastfeeding at all is associated with an increased risk of maternal
postpartum depression.
Birth spacing HERE too: if you don’t have one child on top of the other --- less stress!
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And just the thought of it makes babies happy!
Photo Bucket at http://i31.photobucket.com/albums/c355/Candor7/gif_breast_feeding-2.gif
Downloaded 2/9/12
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Instruct students to take a piece of paper and divide it into 4 columns (biological, psychological,
cognitive, and community). Give them a few moments to talk with a shoulder partner at their table
and jot down as many benefits that they can think of. Tell them to add to their lists as the discussion
takes place if they think of something or if it is discussed by another classmate.
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DID YOU KNOW:
There are 4000+ different species of mammals
Milk of 350+ of these mammals has been collected and studied.
Humans are mammals
Mammals = MAMMARY gland (1st fill in the blank)
Each species’ milk is unique (2nd fill in the blank) and is intended for the offspring of that particular
species.
Breastmilk it impossible to REPLICATE (3rd fill in the blank) and infants who don’t receive breastmilk can
not grow and develop to reach their potential.
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Image taken by Brad DeJong; Jennifer and Carolyn golfing, Spring 2008.
Bird image taken by Jennifer DeJong; Eagle Lake bird’s next, Spring 2012.
Because of a high water content, we must feed our babies often, and they need to have easy
access to breast.
The very high sugar (fill in the blank) content is for a large and complex brain that needs a lot of
energy to grow.
Unfortunately, human mothers don’t typically follow biology, they follow culture, which tells them
they can’t feed their baby every time they cry! Humans are supposed to be “Carriers ” and feed
their babies frequently according to the composition of their milk.
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Image from WIC/USDHHS
The composition of breastmilk is relatively
constant with minimal fluctuations caused by
maternal diet (fill in the blank).
Unlike the nutrition received by the fetus
through the placenta, the nutrition received by
breastfed infants is not dependent on the status
of maternal metabolism.
The mechanisms that cause breastmilk to be
synthesized are insulated from variations in
maternal nutritional intake, ensuring that
sufficient milk of adequate composition is
available to the infant even during inadequate
food intake by the mother.
Components of Breastmilk:
There have been around 130 different oligosaccharides (short chains of sugar molecules)
identified in human milk. These important sugars comprise up to 1.2% of mature human milk,
compared to only 0.1% of bovine milk. Their role is to protect the infant from infections (fill in the
blank).
• antimicrobial agents
• anti-inflammatory agents
• immunologic stimulating agents
Immune-regulating substances include:
immunoglobulins
lactoferrin
lysozymes
maternal immune cells
Section Two: Objectives 2-5
cytokines
hormones
oligosaccharides
nucleotides
antioxidants
long-chain fatty acids
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Formula is “a food,” the other is a food plus protection…..
Human milk provides continuous protection
Human milk is a living tissue very similar to blood
Even a mother’s own milk is different than if her child were to receive donor breast milk.
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The level of cholesterol in breastmilk remains constant (10-20mg/dL) (fill in the blank) despite dietary
manipulation of the mother's cholesterol intake. There is negligible cholesterol in artificial infant
formula.
Cholesterol is required to build and maintain cell membranes. Amongst other important tissues it is
involved in laying down the myelin sheath which covers the axons of nerve cells in the rapidly
growing brain and spinal cord. Multiple sclerosis, a problem of myelinization, is much more prevalent
in countries where artificial infant feeding is common.
The high level of cholesterol in breastmilk appears to have a 'programming' effect on infants,
protecting them from detrimental effects in later life. Adults who were artificially-fed have significantly
higher total cholesterol levels and incidences of coronary heart disease than adults who were
breastfed.
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Practice (1st fill in the blank)
coating (2nd fill in the blank)
Breastmilk contains all five types of immunoglobulins, (antibodies) including IgM, IgG, IgA, IgD and IgF.
However, the primary immunoglobulin in human milk sIgA which provides mucosal immunity and prevents from
tissue invasion and damage.
Formula fed children take years to make protective levels of sIgA.
sIgA is present in human milk for the duration of breastfeeding
Epidermal Growth Factor and Insulin-Like Growth Factors are highly concentrated in colostrum (along with
sIgA) All help to protect the infant gut and prepare it for the larger volumes of mature milk.
Early supplementation undermines this gut priming by stressing the mucosa with inflammatory antigens of
foreign proteins (cow and soy)
Large volumes of supplementation also are associated with inflammatory-infectious problems like NEC.
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Babies are not intended to grow from this, but to be protected.
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Image used with permission from Shannon Mcgregor on July 25, 2012; Marissa Funkhouser’s Mom’s
Group, Summer 2012.
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In-Class Activity: If possible, pass out copies of The Surgeon General’s Call to Action to
Support Breastfeeding or have students retrieve a laptop and find the risks within the report
on the internet. Source: http://surgeongeneral.gov
WHO DO CLIENTS TRUST TO PROVIDE THEM WITH THE INFORMATION THEY NEED?
You
WHO DO CLIENTS ASSUME HAS THE MOST UP-TO-DATE INFORMATION?
You
WHO DO CLIENTS BELIEVE KNOW THE RISKS OF VARIOUS HEALTH CHOICES?
You
WHO DO CLIENTS TRUST TO TELL THEM THE TRUTH ABOUT ADVERTISING?
You
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Outcome
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Excess Risk (%)
Among full-term infants
Acute ear infection (otitis media) 100
Eczema (atopic dermatitis) 47
Diarrhea and vomiting (gastrointestinal infection) 178
Hospitalization for lower respiratory tract diseases in the first year 257
Asthma, with family history 67
Asthma, no family history 35
Childhood obesity 32
Type 2 diabetes mellitus 64
Acute lymphocytic leukemia 23
Acute myelogenous leukemia 18
Sudden infant death syndrome 56
Among preterm infants
Necrotizing entercolitis 138
Among mothers
Breast cancer 4
Ovarian cancer 27
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Women who breastfeed have higher bone density later in life, although there is no evidence of
fewer hip fractures.
LAM (Lactational Amennorrhea) exclusive BF (feed at least every 4 hours) during 1st 6 mos. pp
Lower blood pressure may be related to higher oxytocin levels in women who breastfeed.
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We need to think twice before feeding babies foreign proteins.
There can be consequences when babies are not fed breastmilk.
Most babies do fine with only breastmilk in the early days.
Few babies require additional supplementation.
Few babies need to be fed away from their mother’s breast.
Our job is to support best practices for women and their babies.
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Image used with permission of Becky Kiefer on July 25, 2012; Facebook Photo, Summer 2012.
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Lecture:
Health professionals agree that human milk provides the most complete form of nutrition for infants, including premature and sick
newborns. However, there are rare exceptions when human milk is not recommended. Under certain circumstances, a physician
will need to make a case-by-case assessment to determine whether a woman's environmental exposure or her own medical
condition warrants her to interrupt or stop breastfeeding.
Breastfeeding is NOT advisable if one or more of the following conditions is true:
An infant diagnosed with galactosemia, a rare genetic metabolic disorder
The infant whose mother:
Has been infected with the human immunodeficiency virus (HIV) – although in Africa they are debating this!
Is taking antiretroviral medications
Has untreated, active tuberculosis
Is infected with human T-cell lymphotropic virus type I or type II
Is using or is dependent upon an illicit drug
Is taking prescribed cancer chemotherapy agents, such as antimetabolites that interfere with DNA replication and cell
division
Is undergoing radiation therapies; however, such nuclear medicine therapies require only a temporary interruption in
breastfeeding
For additional information, visit American Academy of Pediatrics' Breastfeeding and the Use of Human Milk or read: American
Academy of Pediatrics Committee on Drugs. (2001) The transfer of drugs and other chemicals into human milk. Pediatrics 108:776789. Available online at http://pediatrics.aappublications.org/cgi/content/full/108/3/776
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Herpes: not a lot of transmission noted if mom doesn’t feed while active lesion in place
Encourage moms with past breast reduction—try to “go for it”, but don’t promise full milk supply.
Hx. of unsuccessful BF: encourage to try again, we don’t know what will happen, we won’t let your baby get
into trouble, etc.
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