Guest: Dr. Jean Rhodes, RN, PhD
Host: Dr. Linda Austin – Psychiatrist
Announcer: Welcome to an MUSC Health Podcast.
Dr. Linda Austin: I am Dr. Linda Austin. I am talking with Dr. Jean Rhodes, who is Manager of the MUSC Lactation Consultation Services. Dr. Rhodes, we had been talking about some of the benefits of lactation to the mother, but let’s talk about the baby. Now, many of us have heard it’s said that there are important antibodies in breast milk that really help the baby, how does that work?
Dr. Jean Rhodes: Well, the immune protection afforded to an infant by its mother is in milk, is extremely complex, and there are, I think at last count about 50 different substances in human milk that help protect a baby from infection. There is a whole science on to itself, but there are live cells in mother’s milk that when a baby takes in its mom’s milk, it is taking in white blood cells from the mother’s body that are in all of our blood streams. They are white blood cells that get into the baby’s body to help the baby immediately begin to fight infections, so there is that. There are immunoglobulins in human milk that help fight infection in the baby system. There are also growth hormones that help the baby’s lungs and GI system begin to protect itself from bacterial and viral invasion from the outside world because that’s where they are most susceptible and for folks who know anything about premature babies, you may hear that their lungs are particularly vulnerable as they are because the lung system is immature, but also the stomach and GI system are underdeveloped in preterm babies and mother’s milk can be of tremendous benefit in any infant, but particularly to preterm babies. So, there are many, many factors that are in mother’s milk that work in different ways to either attack bacteria, viruses, and fungi or to help shore up the baby system so that it begins to make its own immunity.
Dr. Linda Austin: For babies who are in the neonatal intensive care unit, I know that sometimes donor milk is used. Is there any advantage or disadvantage of that over mother’s own milk?
Dr. Jean Rhodes: No, we always prefer to have mother’s own milk when it’s available and when the mother is healthy. As I mentioned before, there are some cases where if a mother has HIV that she is not recommended to breastfeed, but in general, mother’s own milk is far superior partly because it can be used as fresh milk. Mother can pump or can breastfeed her baby even if it’s able to breastfeed in the NICU, and the baby is getting the milk that is most potent in terms of its immune properties. Donor milk is milk that has been expressed by other women, usually pooled and that’s been frozen both right after being expressed by the donor mother and then after it’s pasteurized, which is a heat process, it’s frozen again. So, it goes through several processes, heat and cold that do affect some of the immune properties and the nutrients in donor milk. So, mother’s own milk, especially fresh milk is always best. Also we know that mother’s milk contains antibodies to what the mother is exposed to. So when a mother goes to visit her baby in the neonatal intensive care unit, she is going to be in the baby’s environment, sitting at the baby’s bedside, interacting with the doctors and nurses, and during that time, her body will begin to make antibodies to the germs, which are everywhere, in every environment even though the NICU is very, very clean and we do our utmost to prevent infection there, there are always germs in the air and the mother’s body begins to make antibodies to those so that when she pumps her milk, her milk will have antibodies that are specific to the baby’s environment there in the NICU and this can be very, very important in terms of helping her baby fight the germs that the baby is going to be exposed to.
Dr. Linda Austin: As well as then when baby comes home, presumably it’s a same home that the mother has been exposed to as well.
Dr. Jean Rhodes: Exactly, it’s a same kind of idea, right, it has been germs in the home environment. So, mother’s milk is not only species-specific, but is infant-specific and that milk is made for that baby and the environment that the baby is in.
Dr. Linda Austin: How about the long-lasting impact on a child’s health?
Dr. Jean Rhodes: Well, we know that lactation can impact certain health conditions such as diabetes. It can reduce a child’s risk of diabetes as an adult as well as cardiac disease and hypertension. We also know that breastfeeding can help prevent some of the cancers; leukemia is one example, which may occur not during the time of breastfeeding, but several years down the road and probably one of the most significant findings in the last few years is that lactation helps prevent obesity and in this country, obesity is a huge epidemic and what we know is that babies that are breastfed and the longer they are breastfed, they have a reduced risk of obesity as both children and adults.
Dr. Linda Austin: Any idea what the mechanism is of that?
Dr. Jean Rhodes: Well, we think that it probably is at least twofold; one would be just the nutritional components of human milk and the way in which the body metabolizes those, and it may be that the body is more efficient and sets up the infant and child’s body for the future to be more efficient in terms of digestion. For instance, we know that babies that are breastfed have many fewer allergies and also asthma, but those are things that are kind of an inflammatory response many times and nutrition in the components of breast milk seem to diminish the risk of those allergies, but the other thing that happens in lactation is that a baby breastfeeds until the baby is finished. The baby doesn’t have to take a certain amount, prescribed amount, that’s in the bottle, which is what happens with bottle-feeding and now you keep feeding the baby until the bottles are gone and if the baby has only taken half, then usually you do your utmost to get your baby to finish taking the bottle. With breastfeeding, babies finish eating when they are full and that’s how learns behavior that can last them a lifetime. They learn to stop eating when they are satiated, when they have had enough to eat unlike bottle-fed children who don’t develop that same sense of knowing when to stop.
Dr. Linda Austin: Do you have any recommendations about how long in months or years a mother should or may breastfeed?
Dr. Jean Rhodes: The American Academy of Pediatrics recommends that women breastfeed their infants exclusively for the first six months of the infant’s life and then to continue for the infant’s first year of life. So, their recommendations have changed over the last few years to extend it out to a year, recommending that every baby receive mother’s milk for the first year of life. After that, the American Academy of Pediatrics and Lactation Consultants, I believe in general, recommend that the mother and infant continue to breastfeed as long as it’s mutually beneficial. So, there really isn’t an upper limit that is set on how long a woman should breastfeed.
Dr. Linda Austin: There must be some upper limit.
Dr. Jean Rhodes: You know, I always say by the time they are walking down the aisle, it’s probably not appropriate. That’s such a difficult question. Our culture is a bottle-feeding culture. We are not comfortable for the most part in seeing women breastfeed children once they can begin to walk and talk, but there are many cultures across the world where it’s very common for women to breastfeed a child, at least into the third year of life and there are others where it may be longer up until five years of age. We are not used to that and we are uncomfortable with it. So, it’s unusual in this country for a woman to breastfeed beyond, say two to three years, but I don’t think I am the person to say when a woman should stop.
Dr. Linda Austin: As long as by the time he gets married, he stopped.
Dr. Jean Rhodes: Or school age, but -- I mean, I do think it’s something that you have to see and really reflect on how you are feeling.
Dr. Linda Austin: Dr. Rhodes, thank you so much for talking with us.
Dr. Jean Rhodes: You’re welcome.
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