Breast Feeding: Benefits and Guidelines
Guest: Dr. Carol Wagner - Pediatrics
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Carole Wagner who is Professor of Pediatrics and an expert in the area of infant nutrition. Dr. Wagner, let’s imagine I’m a new mother; I’ve just had a baby. I’m trying to make a decision between breastfeeding versus formula or, maybe, some combination of the two. What sorts of issues do I need to think about in making that decision?
Dr. Carol Wagner: I think that most women, 90 percent of them, have made a decision before they deliver. Ten percent are undecided at the time of delivery.
Dr. Linda Austin: So I’m on the slow side here?
Dr. Carol Wagner: Yes. So what I want you to know is that human milk is designed for the human baby and in our culture we’ve lost some of the fine art of breastfeeding. So, for a woman who has never known anyone in her social circle who has breastfed, it can be a really overwhelming decision. What I want moms to think about is that human milk is alive, it’s bioactive, and it has infection-fighting properties. It has growth factors. And it has a special blend of fats and protein that are unique, that are not copied by formula.
Dr. Linda Austin: Now, when you say alive, do you mean it has living cells in it?
Dr. Carol Wagner: Yes. It also has the ability to send signals through cells and through growth factors to the baby’s GI tract, so it’s a signaling mechanism. It’s a communication mechanism on how the baby’s GI tract should grow. So it’s very important.
We consider human milk to be liquid gold and any amount of breast milk is better than none at all. That’s not to say that there’s anything inherently wrong with formula but it’s not alive; it’s inert, and it does not have the ability to signal the immune system and the baby’s GI tract. It also has a very different blend of fats, although they try to copy, and that can make a difference as far as a lifelong immunity.
Dr. Linda Austin: How long, optimally, should a woman breastfeed.
Dr. Carol Wagner: We recommend exclusive breastfeeding through the first six months and then, with the introduction of complimentary foods, which means baby foods, starting at about six months. And I say ‘about’ because some babies mature differently. So, one baby may be ready for solid, shows interest and reaches for foods by five months, or five and a half months. With that baby, we would recommend continuing breastfeeding and to start those foods.
We typically recommend one food at a time so that you can tell if the baby will have an allergy to that type of food. Most people will start with a rice base mixed with breast milk. Then, Academy Breastfeeding Medicine (ABM) recommends breastfeeding continued through at least the first year. Now, that can be pretty daunting, especially for a woman who is working, or a woman who has a lot of responsibilities, to be able to maintain her milk supply when she’s away from her baby. So, we have better techniques of pumping and storing milk today than we did even 10 years ago, and that does make a difference. But having a baby to breast is a lot easier than pumping and that’s really important.
So, for you, as the new mom, I would want to know what your experiences are with breastfeeding. Have you had another child and after two or three days, was it a horrible experience? Did you have a lot of pain? I would want to know all of these things because that’s going to influence your decision. If a woman tried breastfeeding and didn’t have good results, it’s our fault, not hers. We know much more about latch than we used to. Breastfeeding shouldn’t be painful. If it is, it’s because the latch is just not right between the baby and the mom.
If a mom has the expectation that it will fail, that certainly plays a role. If the father of the baby isn’t supportive of breastfeeding, that can impact on her success. Or, if grandmother isn’t supportive, that plays a very large role.
Dr. Linda Austin: Are there special nutritional issues that a woman should think about for herself when she is breastfeeding?
Dr. Carol Wagner: That’s a very good point. A mom should eat a well-balanced meal. She should eat the foods that she ate during her pregnancy. There may be some babies who are very sensitive to, like, a spicy meal, particularly in the first month or so after delivery and if that baby was born a bit early. But, for the most part, what a woman ate during her pregnancy is very well tolerated during lactation.
She should have, really, the food groups and fruits and vegetables, just like you would with a normal, what we consider the optimal, diet and she should continue her prenatal vitamin. She should take that daily. But the prenatal vitamin is not going to provide the amount of vitamin D that her growing baby will need. The American Academy of Pediatrics recommends that all breastfeeding babies receive 400 international units (IU) a day of vitamin D. That is because many women in the United States are vitamin D deficient, so their milk is going to be vitamin D deficient.
Dr. Linda Austin: Any other special nutritional supplements that the mother needs?
Dr. Carol Wagner: She should avoid excessive caffeine because that will sometimes impact on her milk production and it can also be given to the baby in the milk. But, really, for the most part, her general diet, if she grew the baby during pregnancy and that baby is healthy, then her diet was clearly a success and she should continue that diet.
Dr. Linda Austin: How about alcohol?
Dr. Carol Wagner: That’s a good question. We recommend that alcohol exposure should be limited. But, if a woman is going to have a glass of wine, she should feed her baby first. The alcohol level in her milk will peak an hour after she’s had the glass of wine and it will then fall in the ensuing two to three hours. They’ve studied this in China where part of the birth celebration process is that the women actually have a significant amount of alcohol everyday, not that I’m promoting it. But they looked at levels and what they found was by four hours, there was a minimal amount of alcohol in the mother’s milk.
If a woman is going to have more than a glass of alcohol in four hours then we have to think about her ability to parent because that could impact on the care that she gives. If she is celebrating and chooses to do that then she should have another care provider there and consider pumping and dumping her milk at that point if she’s drinking more than that drink in a four hour-period.
Dr. Linda Austin: How about other concerns, about medications, prescription medications as well as over-the-counter medications, and recreational drugs, like marijuana, and so forth, any comments about that?
Dr. Carol Wagner: There are many medications that I prescribe that and, for the most part, prescribed medications are safe for the breastfeeding mother’s infant diet. There are a few exceptions. Psychiatric medication, like thorazine, or that kind of thing, would not be good for the baby. On the other hand, there are really thousands of women who have breastfed who have been on SSRIs (Selective Serotonin Reuptake inhibitors), antidepressants of that class, and it’s really considered safe. But you have to look at the individual baby and you look for signs of sleepiness. If a woman was on that medication during her pregnancy then the levels that the baby will be exposed to through her milk are much less. So, it’s actually not considered an absolute contraindication to breastfeeding.
However, each baby and mother is unique and so you have to look at the baby and the behavior. We recommend that the mom take her medication immediately after breastfeeding so that the peak level of that medication will be less.
As far as over-the-counter medications, Tylenol and Motrin are well tolerated. One of the medications that a mother may be prescribed is a diuretic and that may cause her milk to dry up. Another medication is an oral contraceptive. That will impact on her milk production and we recommend other forms of birth control, particularly in the first two months. Someone women will choose to use an intrauterine device, an IUD. The lactating mother can even have an impact from the Mini-Pill.
Over-the-counter medications, like Tylenol or Motrin, are fine. But cold medications, decongestants, that kind of thing, phenylephrine equivalents, those can decrease the amount of milk that’s produced.
Recreational drugs, we don’t recommend and, you know, alcohol is occasionally thought to be permissible, but cocaine is an absolute contraindication. It can cause impaired blood flow to the baby’s GI tract and other brain dysfunction.
Dr. Linda Austin: Thanks so much for talking with us today.
Dr. Carol Wagner: Oh sure.
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