Milking For All It’s Worth

This week’s guest columnists are Drs. Meghan Gaddis and Camtu Nguyen, Family Practice residents at the University Hospital and Clinics here in Lafayette.

Nothing’s worse than a crying, inconsolable baby.  We face them from time to time in the Pediatric Emergency Department, and this one evening mom was equally frazzled: hair in a messy bun, bloodshot, teary eyes from nights not sleeping, clothes stained with various colors and textures.  “My baby hasn’t breastfed or taken a bottle since yesterday!  I don’t know what to do!”

Baby was 6 days old, and seemed a poor breast-feeder due to trouble latching on.  This first-time mom maybe wasn’t producing much milk with the latching difficulty, and stressing out certainly wasn’t helping her supply.  To make breast milk, breasts need stimulation from baby, and a calm mom. She was also using a breast pump to stimulate supply, but this wasn’t going well either.  She was dead set on NOT giving baby formula, because of course, “breast is best.”

However, baby looked pretty darn healthy.  Sure he was fussy, but calmed down with swaddling and a pacifier.  He looked rounded-out and well fed.  He wasn’t dehydrated, with moist eyes and mouth, and acting vigorous, and making wet diapers.

Many first-time mothers aren’t aware of the timeline of milk production.  The first milk produced immediately after birth is called colostrum.  Colostrum is thicker than later breast milk, and has a higher protein content. This “liquid gold” only comes out in teaspoonfuls at a time, but that’s all baby needs.  It provides enough calories, encourages baby to practice sucking, swallowing, and breathing, before regular breast milk comes in in quantity.  And believe it or not, newborns’ stomachs are only about the size of a cherry, so a few teaspoonfuls will fill her up just fine!

In three to five days, breast milk really comes in.  Mom’s breasts begin to feel heavy and full, and baby begins gulping and swallowing with more vigor.  Urine and poop production also ramp up with this increased intake.  Poop goes from the tarry green, sticky “meconium,” to a loose yellow stool that looks like it has oatmeal flakes, or “seeds” in it.  Isn’t this an enjoyable talk with your morning coffee?

Breast-feeding has always had a bit of a stigma.  From ancient Egypt to medieval times, nobility considered itself above breast feeding.  Queens and princesses often employed wet nurses, mothers who recently weaned their own babies, to feed their little heirs.  When 20th century technology brought ordinary people things that only royalty used to have- one’s own in-house music, indoor plumbing, ready-made meals- it also brought formula.  Now, no one had to breast-feed.

Bottle feeding is easier for moms and babies, in the beginning.  As we mentioned above, latching and sucking takes some training. While bottle feeding, like many other technologies, has the front-end convenience of ease, it begats more problems than it solves.  Bottle-fed babies more easily become obese children and adults, with higher risk of diabetes.  They have more colic (nightime cramping and fussiness) in the first few months. They’re often more constipated and spit up more.  Finally, bottle-fed babies get more stomach viruses, colds, and ear infections than their breast-fed cohort.  Then these moms come to the Pediatric Emergency Department or their doctor’s offices with their vomiting, constipated, infected, squawling progeny.

Breast feeding has many advantages for moms, as well as for babies.  Making milk burns calories, and thus moms lose weight faster.  Suckling stimulates the release of oxytocin, a hormone that shrinks the uterus to pre-pregnancy size, and reduces bleeding.  Finally, breast feeding parents have less junk to haul around.  Traveling with babies has become a modern-day caravan, with car seats, portable cribs, and diaper bags bulging with spare clothes, diapers, wipes, ointments, etc.  Add to that an assortment of bottles and nipples, formula cans, and measuring cups.  And where can I get some sterile water, please?

Back to our mom from above, who was worried her newborn wasn’t getting enough breast milk and dehydrating.  How can you tell if baby is getting adequate fluids?  First, if your baby is crying, the fact that the little booger is hooping and hollering means she has enough fluids to be active.  If she’s making tears, that’s another good sign.  The best way to tell if baby is hydrated is if he’s making wet diapers.  At least one or two wet diapers per day means baby’s getting enough milk, for all it’s worth!

The Happiest Meal

Feeding babies manufactured formula in a bottle is a recent invention in human history. For hundreds of thousands of years, people fed their babies like every other mammal, with mother’s milk.  If mom or baby just couldn’t make it work, there were two options. One, baby died.  Two, employ a “wet nurse,” a woman who recently had a child and was still making milk, to feed baby.

For much of human history wet nursing was a respected and well-paid profession. Since medieval times wet-nursing was regulated and licensed in many countries. Then in the 19th and 20th centuries, the invention of formula that babies tolerated, along with glass bottles and rubber nipples, killed wet nursing.  The advance of technology that fostered such eager slogans as “live better electrically” and “better living through chemistry,” also led people to believe that formula could be as good for babies as breast milk, maybe even better.

Bottle feeding, like many technologies, seemed easier too.  Breast-feeding requires some initial training for babies and moms.  While most take to it readily, some don’t. But babies take bottles right away.  However, like many new inventions, the later problems with formula turn out to outweigh this temporary convenience.  Formula-fed babies have more colic, constipation, spitting up, and infections.  And now it seems formula feeding can contribute to obesity as well.

Then, these extra baby problems haunt us in the pediatric ER.  Moms come in night and day, their babies having colds, crying with passing hard poops, spitting up all over, and squawling at night from colic.  By then mom’s milk has dried up, and fretting and trying different formulas are their only options.

Changing formulas rarely helps with constipation, reflux, or colic.  But many families continue to believe the advertising that suggests formula is still as good for babies as breast milk. Theses ads are full of smiling babies in sunlit rooms. When babies have crampy guts, they give happy names to the next-try formulas; names like Gentle-ease, Total Comfort, and Good Start Gentle. There are even formulas for toddlers now, as if suddenly cow’s milk isn’t good enough anymore either.

Advertising is an attempt to change perceptions, and it’s part of why many believe the false claim that infant formula is as good for babies as breastfeeding.  As we mentioned above, formula is a relatively recent invention in human history.  Formula has only been around for about a hundred years.  For the previous thousands of years of human history, humans breast-fed like any mammal.

But breast-feeding always had a bit of a stigma.  From ancient Egypt on, nobility felt itself above breast feeding.  Queens and princesses often employed wet nurses, mothers who recently weaned their own babies, to feed their little heirs.  Then, when 20th century technology brought ordinary people the things that only royalty used to have- personal music, indoor plumbing, ready-made meals- it also brought formula.  Now, no one had to breast-feed.

Also, the formula manufacturers advertised their products as being as good as, if not better than, breast-feeding.  Formula feeding certainly seemed more convenient, and the companies promised that babies would be even healthier with their synthetic milk.  Even today there’s a misperception among consumers, and even some doctors, that recent advances make formula as good as breast milk.  Wrong.

As we mentioned above, breast milk is far healthier for babies- less constipation, colic, and reflux; fewer infections, and a smaller chance of growing up obese.  And there’s one advantage to breast feeding that formula will never erase- the benefits of breast-feeding for mothers.  These mothers lose pregnancy weight more readily, have less post-partum depression, and have lower risk of breast and ovarian cancers.  Also, breast feeding moms don’t have to haul around all those bottles and cans!

Breast-feeding does require some training for moms and babies that bottle feeding doesn’t.  Fortunately, hospitals like Lafayette General recognize the health benefits of breast-feeding, and have special nurses to help new moms and babies from day one.  Infants are also designed to survive the first few days of low milk output and training- they are born with extra “water-weight” to get them through until mom’s milk is all in. But if you and your baby are one of the few who just can’t breast-feed, there’s still formula.

Or maybe find yourself a wet nurse.