Breast Milk is Best
Breastfeeding the first 6 months of life | Advantages of breastfeeding | Weaning a critical time for diarrhoea transmission
Breast Milk is best. Nothing that money can buy is as good for a baby as breastfeeding.
1. Initiation of Breastfeeding within the first hour of life,
2. Exclusive Breastfeeding for six months,
3. Timely Complementary Feeding with appropriate foods, and
4. Continued Breastfeeding for Two Years and beyond.
click to enlarge
photo UNICEF, India
Breastfeeding - What's New
Facts for Feeding
Frequently Asked Questions
Breastfeeding and HIV
Health Basics insert: Breastfeeding
Breastfeeding: helping to reduce the severity of diarrhoea
Breastfeeding in emergencies
Breastfeeding prevents infection
Breastfeeding promotion: the right start
Congratulations to the mothers
Exclusive breastfeeding (letter)
Extra drinks are unnecessary
Help for breastfeeding mothers
How to feed a baby who cannot breastfeed
How to help a woman to re-establish lactation
'I do not have enough milk.'
Passport to life: breastmilk banking in India
Perspectives on human milk banking
Portugal: rediscovering breastfeeding
Promoting breastfeeding in urban communities
Promoting the benefits of breastfeeding
Training health care workers to counsel breastfeeding mothers
Women, work and breastfeeding
Zealous promotion of breastfeeding is not the answer (letter)
Feeding the Newborn and Infants - Breastfeeding: Some Basic Facts
Dr. R. K. Anand's Guide to Child Care
Worldwide Breastfeeding Partners
World Alliance for Breastfeeding Action [WABA]
The International Baby Food Action Network [IBFAN]
La Leche League International [LLLI]
International Lactation Consultant Association [ILCA]
Academy of Breastfeeding Medicine [ABM]
Breastfeeding - the first 6 months of life
Increasing optimal breastfeeding practices could save an estimated 1.5 million infant lives annually. Up to 55 percent of infant deaths from diarrheal disease and acute respiratory infections may result from inappropriate feeding practices. Optimal feeding for sustained child health and growth includes initiation of breastfeeding within the first hour of life, exclusive breastfeeding for six months, timely complementary feeding with appropriate foods, and continued breastfeeding for two years and beyond.
During the first 6 months of life, infants should be exclusively breastfed. This means that the healthy baby should receive breastmilk and no other fluids, such as water, teas, juice, cereal drinks, animal milk or formula. Exclusively breastfed babies are much less likely to get diarrhoea or to die from it than are babies who are not breastfed or are partially breastfed. Breastfeeding also protects against the risk of allergy early in life, aids in child spacing and provides protection against infections other than diarrhoea (e.g. pneumonia). Breastfeeding should be continued until at least 2 years of age. The best way to establish the practice is to put the baby to the breast immediately after birth and not to give any other fluids.
Advantages and Benefits of breastfeeding are listed below. Some or all of them may be explained to mothers using simple language.
If breastfeeding is not possible, cow's milk or milk formula should be given from a cup. This is possible even with very young infants. Feeding bottles and teats should never be used because they are very difficult to clean and easily carry the organisms that cause diarrhoea. Careful instructions should be given on the correct preparation of milk formula using water that has been boiled briefly before use.
Advantages and Benefits of Breastfeeding
1. Saves Lives. Currently there are 9 million infant deaths a year. Breastfeeding saves an estimated 6 million additional deaths from infectious disease alone.
2. Provides Initial Immunization. Breastmilk, especially the first milk (colostrum), contains anti-bacterial and anti-viral agents that protect the infant against disease, especially diarrhoea. These are not present in animal milk or formula. Breastmilk also aids the development of the infant's own immune system.
3. Prevents Diarrhoea / Diarrhea. Diarrhoea is the leading cause of death among infants in developing countries. Infants under two months of age who are not breastfed are 25 times as likely to die of diarrhea than infants exclusively breastfed. Continued breastfeeding during diarrhea reduces dehydration, severity, duration, and negative nutritional consequences of diarrhea.
4. Provides Complete and Perfect Nutrition. Breastmilk is a perfect food that cannot be duplicated. It is more easily digested than any substitute, and it actually alters in composition to meet the changing nutritional needs of the growing infant. It provides all the nutrients and water needed by a healthy infant during the first 6 months of life. Formula or cow's milk may be too dilute (which reduces its nutritional value) or too concentrated (so that it does not provide enough water), and the proportions of different nutrients are not ideal.
5. Maximizes a Child's Physical and Intellectual Potential. Malnutrition among infants up to six months of age can be virtually eradicated by the practice of exclusive breastfeeding. For young children beyond six months, breastmilk serves as the nutritional foundation to promote continued healthful growth. Premature infants fed breastmilk show higher developmental scores as toddlers and higher IQs as children than those not fed breastmilk.
6. Promotes the Recovery of the Sick Child. Breastfeeding provides a nutritious, easily digestible food when a sick child loses appetite for other foods. When a child is ill or has diarrhea, breastfeeding helps prevent dehydration. Frequent breastfeeding also diminishes the risk of malnutrition and fosters catch-up growth following illness.
7. Supports Food Security. Breastmilk provides total food security for an infant's first six months. It maximizes food resources, both because it is naturally renewing, and because food that would otherwise be fed to an infant can be given to others. A mother's milk supply adjusts to demand; only extremely malnourished mothers have a reduced capacity to breastfeed.
8. Bonds Mother and Child. Breastfeeding immediately after delivery encourages the "bonding" of the mother to her infant, which has important emotional benefits for both and helps to secure the child's place within the family. Breastfeeding provides physiological and psychological benefits for both mother and child. It creates emotional bonds, and has been known to reduce rates of infant abandonment.
9. Helps Birth Spacing. In developing countries, exclusive breastfeeding reduces total potential fertility as much as all other modern contraceptive methods combined. Mothers who breastfeed usually have a longer period of infertility after giving birth than do mothers who do not breastfeed.
10. Benefits Maternal Health. Breastfeeding reduces the mother's risk of fatal postpartum hemorrhage, the risk of breast and ovarian cancer, and of anemia. By spacing births, breastfeeding allows the mother to recuperate before she conceives again.
11. Saves Money. Breastfeeding is among the most cost-effective of child survival interventions. Households save money; and institutions economize by reducing the need for bottles and formulas. By shortening mothers' hospital stay, nations save foreign exchange. There are none of the expenses associated with feeding breastmilk substitutes (e.g. the costs of fuel, utensils, and special formulas, and of the mother's time in formula preparation).
12. Is Environment-friendly. Breastfeeding does not waste scarce resources or create pollution. Breastmilk is a naturally-renewable resource that requires no packaging, shipping, or disposal.
13. Breastfeeding is Clean. It does not require the use of bottles, nipples, water and formula which are easily contaminated with bacteria that can cause diarrhoea.
14. Milk intolerance is very rare in infants who take only breastmilk.
Best for baby
Reduces incidence of allergies
Economical - no waste
Antibodies - greater immunity to infections
Stool inoffensive - never constipated
Temperature always correct and constant
Fresh milk - never goes sour in the breast
Easy once established
Digested easily within two to three hours
Gastroenteritis greatly reduced
From a publicity leaflet by the TIBS support group, Trinidad.
Weaning a critical time for diarrhoea transmission
Infants are at greatest risk of diarrhoea when foods other than breastmilk are first given. This is because during weaning infants are being exposed to food-borne germs for the first time and they are losing the protection of breastmilk which has anti-infective properties.
High levels of contamination are often found in animal milks and traditional weaning foods, especially cereal gruels. Escherichia coli, which causes at least 25 per cent of all diarrhoea in developing countries, is commonly found in weaning food.
Feeding bottles and rubber teats, which are particularly difficult to clean, are often breeding grounds for germs.
The need for infants older than 6 months to receive more than just breastmilk in order to grow well, balanced against the risk that this will result in diarrhoea, has been called 'the weaning dilemma'.
It is important for health workers to work with local communities to identify and encourage safe weaning practices and to improve infants' nutrition to increase their resistance to infections such as diarrhoea.
Improved weaning practices
Complementary foods should normally be started when a child is 6 months old. These may be started any time after 6 months of age, however, if the child is not growing satisfactorily. Good weaning practices involve selecting nutritious foods and using hygienic practices when preparing them.
The choice of complementary foods will depend on local patterns of diet and agriculture, as well as on existing beliefs and practices. In addition to breastmilk (or animal milk), soft mashed foods (e.g. cereals) should be given, to which some vegetable oil (510 ml/serving) has been added.
Other foods, such as well cooked pulses and vegetables, should be given as the diet is expanded. When possible, eggs, meat, fish and fruit should be also given.
From Wikipedia, the free encyclopedia.
Breastfeeding is the practice of a woman feeding an infant (or sometimes a toddler or a young child) with milk produced from her mammary glands, usually directly from the nipples. Babies have a sucking instinct allowing them to extract the milk.
When the baby sucks, a hormone called oxytocin starts the milk flowing from the alveoli, through the ducts (milk canals) into the sacs (milk pools) behind the areola and finally into the baby's mouth
Main article: Breast milk
Throughout pregnancy a woman's body produces hormones which stimulate the growth of the milk duct system in the breasts:
* Follicle stimulating hormone (FSH)
* Luteinizing hormone (LH)
* Human placental lactogen (HPL).
By the fifth or sixth month of pregnancy, the breasts are sufficiently developed to produce milk. Near the time of birth, the breasts may begin to secrete a thick, yellowish fluid called colostrum (or "beestings"), which is the first milk the infant receives. It contains important antibodies from the mother's body providing "immunological protection." Colostrum has no fat and little sugar – these substances appear three to four days after birth when the suckling action of the infant further stimulates the breast to produce mature breast milk.
After the colostrum the breast produces milk on a basis of supply and demand in response to how often a child feeds and how much milk he or she consumes. The production, secretion and ejection of milk is called lactation. Some breastfeeding advisers recommend at least one feeding every four hours to prevent premature termination of lactation.
The exact integrated properties of breast milk are not entirely understood, but the nutrient content after this period is relatively consistent and draws its ingredients from the mother's food supply. If that supply is found lacking, content is obtained from the mother's bodily stores. The exact composition of breast milk varies from day to day, depending on food consumption and environment, meaning that the ratio of water to fat fluctuates. Foremilk, the milk released at the beginning of a feed, is watery, low in fat and high in carbohydrates relative to the creamier hindmilk which is released as the feed progresses. The breast can never be truly "emptied" since milk production is a continuous biologic process.
The let-down reflex
The let-down reflex, also known as the milk ejection reflex, is the stimulation of the muscles of the breast to squeeze out the milk by the release of the hormone oxytocin. Breastfeeding mothers describe the sensation differently, with some feeling slight tingling and others not feeling anything different.
The reflex is not always consistent, especially at the start of the breastfeeding process. The thought of nursing or the sound of any baby can stimulate the process, causing unexpected leakage. Commonly both breasts can give out milk when one infant is feeding, but this and other problems often settle after two weeks of feeding. One major cause of difficulties during breastfeeding is when the mother is in a stressed or anxious state of mind.
Causes of a poor let-down reflex:
* Sore or cracked nipples
* Separation from the infant
* A history of breast surgery
When a mother has difficulties breastfeeding she may try different methods of assisting the let-down reflex, including:
* Feeding in a familiar and comfortable location
* Massage of the breast or back
* Warming the breast with a cloth or shower
The benefits of breastfeeding are both physical and psychological. Nutrients and antibodies are passed through to the baby and the process of breastfeeding releases hormones into the woman's system. The bond between the baby and its mother is also strengthened during breastfeeding.
Benefits for the infant
Breast milk consumption has been linked to a decreased risk for several infant conditions including Sudden Infant Death Syndrome (SIDS). The sucking technique required of the infant encourages the proper development of both the teeth and other speech organs.
Numerous health benefits of breastfeeding have been medically documented. According to the American Academy of Pediatrics' policy statement on breastfeeding and the use of human milk, "Extensive research, especially in recent years, documents diverse and compelling advantages to infants, mothers, families, and society from breastfeeding and the use of human milk for infant feeding. These include health, nutritional, immunologic, developmental, psychological, social, economic, and environmental benefits."
Breast milk helps to lower the risk of or protect against:
* Urinary tract infections
* Chest infections and wheezing
* Ear infections
* Attention-deficit hyperactivity disorder
Recent studies show that children who have been breastfed on average score higher on IQ tests than those babies who have not been breastfed.
Benefits for the mother
Breastfeeding has also been shown to be beneficial to the mother. The act of breastfeeding releases hormones which have been found to both relax the mother and cause her to experience nurturing feelings toward her infant. Breastfeeding as soon as possible after giving birth increases levels of oxytocin which encourages a more rapid contraction of the uterus and in turn decreases postpartum bleeding. Breastfeeding can also allow the mother to return to her pre-pregnant weight as the fat stores accumulated during pregnancy are utilized in milk production. Frequent and exclusive breastfeeding delays the return of menstruation and fertility (known as lactational amenorrhea) allowing for improved iron stores and the possibility of natural child spacing. Breastfeeding mothers experience improved bone re-mineralization postpartum, and a reduced risk for both ovarian and pre-menopausal breast cancer.
The maternal bond is strengthened through breastfeeding, with the hormonal releases giving the mother positive feelings of nurture towards the child. Building upon this bond is very important as studies show that up to 80% of mothers suffer from some form of postpartum depression, though most cases are very mild. The partner can support the mother in a variety of ways and is seen as an important factor in successful breastfeeding . This can also help to establish the paternal bond in fathers.
The relationship between the partner and the child can also be greatly affected by the act of breastfeeding. While some partners may feel left out when the mother is feeding the baby, others may see the whole process as a chance to bond as a family. Breastfeeding, possibly alongside birth-related health problems, takes a lot of time. This may add pressure to the partner and the family, with them having to work harder, caring for the mother and performing tasks she would otherwise do. However, as they are often very willing to show their supportiveness, this pressure can help to strengthen the family bonds.
If looking after the child while the mother is away, the father may find it impractical or inappropriate to feed expressed breast milk to the infant. This may remove the choice of the mother of whether to breastfeed her child or not.
Recommendations and research
"Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months after birth. [...] It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired."
– The American Academy of Pediatrics (AAP) 
"A vast majority of mothers can and should breastfeed, just as vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother's milk be considered as unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed milk from the infant's own mother, breastmilk from a healthy wet-nurse or a human-milk bank, or a breastmilk substitute fed with a cup, which is a safer method than a feeding bottle or a teat – depends on individual circumstances"
– WHO Global Strategy for Infant and Young Child Feeding. Geneva, World Health Assembly, May 2002, page 10 
"If we allow the 'breast versus bottle' argument to be reduced to a simple issue of nutrition, we ignore the much greater potential breastfeeding has to enhance the lives of parents and children."
– Gill Rapley, deputy programme director of the UNICEF UK Baby Friendly Initiative 
Contraindications and complications
It is not uncommon for a mother and child to have difficulties breastfeeding, with some women unable to feed their child at all. Others find it too problematic or choose not to attempt or continue breastfeeding for personal reasons.
When first born the child must learn how to feed. Though babies have a natural sucking reflex they may occasionally resist feeding from the breast, often due to external factors. It is important for the baby to be fed soon after birth in order to quickly establish the routine and to become accustomed to feeding from the breast. Other causes of breast refusal include:
* Overhandling after birth
* Formula feeding, sometimes without the knowledge of the mother.
* Poor feeding technique
* The use of artificial teats leading to "nipple confusion"
* The presence of thrush in the mouth of the baby
* Distractions or interruptions during feeds
* Long separations from the mother
* Breathing difficulties, often caused by a common cold
* Pain or discomfort; for example, due to recent surgery or medical procedures (such as circumcision  
In later stages teething is a significant hindrance to breastfeeding and is seen by many as the ideal time to wean the infant.
Medical conditions of the infant
Reasons for the inability of an infant to feed include:
* Difficulties latching onto the breast
* Poor sucking reflex
* Poor stamina
* Medical conditions such as cleft palate
* Hypoglycemia or Hyperglycemia
Premature babies have difficulties because their sucking reflex is still underdeveloped and because they tire during feeds.
Medical conditions of the mother
Damage to the breast tissue can cause problems or totally prevent manageable breastfeeding, especially women with history of breast surgery or infection. Cancer (particularly breast cancer) and chemotherapy treatments have also been shown to cause difficulties. Many women with previous surgeries, abscesses and cancer can breastfeed successfully.
Infectious diseases such as HIV, AIDS, or active, untreated tuberculosis can be passed onto the infant. A HIV-positive mother breastfeeding an infant can, in some countries, be investigated for child abuse – a 1998 case in the U.S. resulted in the HIV-positive mother being reported to social services for her continued breastfeeding and non-treatment of the child for HIV . The presence of herpes lesions on the breast is also contraindicative to breastfeeding.
Mastitis, the inflammation of the mammary glands caused by the blocking of the milk ducts, can cause painful areas on the breasts or nipples and may lead to a fever or flu-like symptoms.
Negative effects upon the infant
Breastfeeding can be harmful to the infant if the mother:
* is taking certain medications that suppress the immune system
* is taking certain medications which may be passed onto the child through the milk and are found to be harmful. However, the vast majority of medications are compatible with breastfeeding.
* has had excessive exposure to heavy metals such as mercury
* uses potentially harmful substances such as caffeine, tobacco, alcohol, cocaine, heroin and amphetamines
Health and diet
Since the nutritional requirements of the baby must be satisfied solely by the breast milk in exclusive breastfeeding it is important for the mother to maintain a healthy lifestyle, especially with regards to her diet. If the baby is large and grows quickly, the fat stores gained by the mother during pregnancy can be quickly depleted, and she may have trouble eating well enough to keep developing sufficient milk. The diet usually involves a high calorie, high nutrition diet which follows on from that in pregnancy. Some breastfeeding advisers suggest mothers avoid certain gas producing food, such as beans, if the baby starts to develop colic or gas.
Breastfeeding mothers must use caution if they regularly consume nicotine through tobacco smoking. In addition to reducing the milk supply, heavy use of cigarettes by the mother (more than 20 per day) has been shown to cause vomiting, diarrhea, rapid heart rate, and restlessness in breastfeeding infants. Research is ongoing to determine whether the benefits of breastfeeding out-weigh the potential harm of nicotine in breast milk. The effects of a smoky environment are thought to have links to Sudden Infant Death Syndrome (SIDS). Breastfeeding mothers who smoke are counselled not to do so during or immediately before feeding their child, and are encouraged to seek advice to help them to reduce their nicotine intake or to quit.
Heavy alcohol consumption is known to be harmful to the infant, causing problems with the development of motor skills and decreasing the speed of weight gain. However, there is no consensus on how much alcohol may be safely consumed and it is generally agreed that small amounts of alcohol may be occasionally consumed by a breastfeeding mother. Unfortunately, it is unknown what level is safe. Some believe that a single daily glass of wine is sufficient to cause distress to some fetuses. Levels of alcohol in breast milk peak 30 to 90 minutes after one drink of moderate alcoholic content. Considering the known dangers of alcohol exposure to the developing fetus, many medical professionals believe it is prefereable to err on the side of caution with alcohol exposure to a baby and have breastfeeding women restrict or eliminate their alcoholic intake.
Excessive caffeine consumption by the mother can cause irritability, sleeplessness, nervousness and increased feeding in the breastfed infant. Moderate use (one to two cups per day) usually produces no effect. Breastfeeding mothers are advised to avoid or restrict caffeine intake. Contrary to popular belief, this also applies to Meditteranian babies.
The recreational use of marijuana in conjunction with breastfeeding is a controversial issue. The AAP Committee on Drugs lists marijuana in their table of Drugs of Abuse for Which Adverse Effects on the Infant During Breastfeeding Have Been Reported yet they reference only one study in the literature and this study reports no effect.  There is a lack of research on the effects of marijuana on the breastfed infant. Withdrawal from marijuana can cause some mild unpleasant affects, however these disappear in a few weeks, and the mother's body almost free of the active ingredient in just a few days.
Feeding options and requirements
Exclusive breastfeeding is generally defined as feeding a baby nothing but breast milk. Predominant or mixed breastfeeding is the practice of feeding breast milk along with some form of substitute — infant formula or baby food, depending upon the age of the child.
Exclusively breastfed infants feed, on average, 8–12 times a day. The requirements vary greatly between children, with newborns consuming in the range of one to three ounces and babies after the age of four weeks consuming around four ounces per feed. Each baby is different and as it grows this amount will increase. It is important to recognise the signs of a baby's hunger and it is advised that the baby should dictate the number, frequency, and length of each feed, based on the assumption that it knows the amount of milk it needs. The supply of milk in the breast is determined by the frequency and length of these feeds or the amount of milk expressed.
One criticism of breastfeeding is the difficulty in accurately monitoring the amount of food taken by the baby. This, however, is largely discounted because the baby will feed as per its own requirements.
Expressed breast milk (EBM) or infant formula can be fed to an infant by bottle When direct breastfeeding is not possible the baby may still be fed breast milk. By expressing (artificially removing and storing) her milk, a mother can allow her child to be fed while she is not present or does not have the opportunity to do so herself. With expression through manual massage or the use of a breast pump the woman can draw out her milk and keep it in a bottle ready for use. This bottle may be refrigerated for up to eight days or frozen for up to four months, though research suggests that antioxidant activity in breast milk decreases over time .
Expression can be used to prolong the lactation when required. This is most common if the mother and child are separated for an extended period. In cases of the baby being unable to feed, expressed milk can be fed through a nasogastric tube.
Expressed milk can also be used to assist a mother who is experiencing difficulty breastfeeding, because of a newborn causing grazing and bruising or because of an older baby growing teeth and biting.
Some women donate their expressed breast milk (EBM) to other people, either directly or through the hospital. Though some dislike the idea of feeding their own child with another person's milk, others appreciate the ability to give their baby the benefits of breast milk.
Infant formula has been heavily marketed and promoted to many new mothers as the preferred option to breastfeeding. In 1979 the International Baby Food Action Network (IBFAN) was formed to help raise awareness of such practices.
The World Health Organization recommends that all mothers be encouraged to breastfeed, and hospitals that are accredited by the World Health Organization are tolerant of formula feeding but do not offer it to healthy infants who can breastfeed.
Tandem, extended, and shared breastfeeding
Feeding two infants simultaneously is called tandem breastfeeding. The most common need for this is after the birth of twins whereby both babies are fed at the same time. It is not necessarily the case, however, that the appetite and feeding habits of both babies are the same. This leads to the complication of trying to feed each baby according to their individual requirements while also trying to breastfeed them both at the same time.
In cases of multiple births with three or more children it is extremely difficult for the mother to organise feeding around the appetites of all of the babies. The mammary glands can produce a high quantity of milk, according to the demand placed upon them, and many mothers have been able to successfully feed their infants . It is common, however, for the woman to look to other alternatives.
Tandem breastfeeding is also convenient if a woman gives birth to a newborn while still feeding an older baby or child. Under these circumstances it is possible for the newborn baby to miss out on the beneficial colostrum.
Although some may find it controversial, some women breastfeed their offspring for as many as three to seven years from birth. This is referred to as extended breastfeeding.
In developing nations within Africa and elsewhere, it is sometimes common for more than one woman to feed a child. This shared breastfeeding has been highlighted as a source of HIV infection amongst infants born HIV-negative .
See also: wet nurse
There are many texts available to new mothers to assist in the establishment of breastfeeding. The baby will usually indicate hunger by crying or moaning and fussing. When the baby's cheek is stroked, the baby will move his or her face towards the stroking and open his or her mouth, demonstrating the rooting instinct. Breastfeeding can make the mother thirsty and can last for up to an hour – it is therefore common for the mother to require a drink during the process.
Feeding and positioning
While for some people the process of breastfeeding seems natural there is a level of skill required for successful feeding and a correct technique to use. Incorrect positioning is one of the main reasons for unsucessful feeding and can easily cause pain in the nipple or breast. By tickling the baby's cheek with the nipple the baby will open its mouth and turn toward the nipple, which should then be pushed in so that the baby has a mouthful of nipple and areola – the nipple should be at the back of the baby's throat. Inverted or flat nipples can be massaged to give extra area for the baby to latch onto. Many women choose to wear a nursing bra to allow easier access to the breast than normal bras.
The baby may pull away from the nipple after a few minutes or after a much longer period of time. Sometimes the baby will relatch on the same breast or mother may offer the other side. The fat content of the milk increases as the breast empties. Babies should be permitted to "finish the first breast first" before offering the second breast and without a time limit on feeding from either breast.
The length of feeding is quite variable. Regardless of the duration, it is important for the breastfeeding woman to be comfortable.
* Upright: The sitting position with the back straight.
* Mobile: The mother carries her nursling in a sling or other baby carrier while breastfeeding. Doing so permits the mother to incorporate breastfeeding into the varied work of daily life, such as shopping, working in the garden, housework, hiking, etc.
* Lying down: Good for night feeds or for those who have had a caesarean section.
o On her back: Mother is usually sitting slightly upright; particularly useful for tandem breastfeeding.
o On her side: The mother and baby lie on their sides.
* Hands and knees: The mother is on all fours with the baby underneath her.
There are many positions and ways in which the feeding infant can be held. This depends upon the comfort of the mother and child and the feeding preference of the baby – some babies tend to prefer one breast to another. Most women breastfeed their child in the cradling position.
* Cradling positions:
o Cradle hold: The baby is held with its head in the woman's elbow horizontally across the abdomen, "tummy to tummy", with the woman in an upright and supported position
o Cross-cradle hold: As above but the baby is held with its head in the woman's hand
* Football hold: The woman is upright and the baby is held securely under the mother's arm with the head cradled in her hands
* Feeding up hill: The baby lies stomach to stomach with the mother who is lying on her back; this is helpful for babies finding it difficult to feed
* Lying down:
o On its side: The mother and baby lie on their sides
o On its back: The baby is lying on its back (cushioned by something soft) with the mother on her hands and knees above the child
When tandem breastfeeding the mother is unable to move the baby from one breast to another and comfort can be more of an issue. This brings extra strain to the arms, especially as the babies grow, and many mothers of twins recommend the use of more supporting pillows. Favoured positions include:
* Double cradle hold
* Double clutch hold
* One clutched baby and one cradled baby
* Lying down
Breast and nipple pain
Breastfeeding may hurt some women, sometimes related to an incorrect technique, but usually eases over time. Milk ducts can block up on occasion, leading to breast engorgement, and should be addressed with massage and by encouraging the baby to suck from that side to keep it as empty as possible until the problem goes away.
Fair skinned mothers are most likely to experience cracked nipples, but it can happen to anyone. The baby's rough tongue can also cause grazes and the suction can cause bruising. If breastfeeding is endured for the initial six weeks then this usually becomes easier. Mothers determined to breastfeed their babies can buy or hire breast pumps to extract the milk.
Weaning is the process of gradually introducing the infant to what will be its adult diet and withdrawing the supply of milk. The infant is considered to be fully weaned once it no longer receives any breast milk (or bottled substitute) and begins to eat baby food. This often leads to lactose intolerance.
History of breastfeeding
In the early years of the human species, breastfeeding was as common as it was for other mammals feeding their young. There were no alternative foods for the infants, and the mother, along with other lactating females, would have no choice but to breastfeed the children. This process is still seen in many developing countries and is known as shared breastfeeding.
The Egyptian, Greek and Roman empires saw women only feeding their own children. However, breastfeeding began to be seen as something too common to be done by royalty and wet nurses were employed to feed the children of the royal families. This was extended over the ages, particularly in western Europe, and saw women of noble birth (or who married into nobility) making use of wet nurses.
According to some Brahminical literature, breastfeeding in 2nd century India was commonly practiced but not until the fifth day, allowing the colostrum to be discarded and the true breast milk to flow.
Alternatives first became popular in the late 15th century with many parents substituting cow or goat's milk for their own breast milk. This was particularly necessary for those families working the land whereby time could not easily be taken out to regularly breastfeed the child. Such trends soon faded when the problems associated with these milks started to show, and by the mid to late 16th century breastfeeding once again became the preferred feeding method for most families. Italian Hieronymus Mercurialis wrote in 1583 that women generally finished breastfeeding an infant exclusively after the third month and entirely after around 13 months.
Dry nursing, the feeding of flour or cereal mixed with broth or water, became the next alternative in the 19th century but once again quickly faded. Around this time there became an obvious disparity in the feeding habits of those living in rural areas and those in urban areas. Most likely due to the availability of alternative foods, babies in urban areas were breastfed for a much shorter length of time, supplementing the feeds earlier than those in rural areas.
Though first developed by Henri Nestlé in the 1860s, infant formula received a huge boost during the post World War II "Baby Boom". The aggressive marketing campaigns when business and births decreased saw Nestlé and other such companies focus on non-industrialised countries, while government strategies in industrialised countries attempted to highlight the benefits of breastfeeding.
Breastfeeding in Japan
Traditionally Japanese babies were born at home and breastfed with the help of breast massage. After World War II Western medicine was taken to Japan and the women began giving birth in hospitals, where the baby was usually taken to the nursery and fed formula. In 1974 a new breastfeeding promotion by the government helped to boost the awareness of its benefits and the uptake has seen a sharp increase. Japan became the first developed country to have a Baby-friendly hospital and has since gone on to have another 24 such facilities.
Publicity, promotion and law
In response to public pressure, the health departments of various governments have recognised the importance of encouraging women to breastfeed. The required provision of baby changing facilities was a large step towards making places more accessible for parents and in many countries there are now laws in place to protect the rights of a breastfeeding mother when feeding her child in public.
The World Health Organisation (WHO), along with grassroots non-governmental organisations like the International Baby Food Action Network (IBFAN) have played a large role in encouraging these governmental departments to promote breastfeeding. Under this advice they have developed national breastfeeding strategies, including the promotion of its benefits and attempts to encourage mothers, particularly those under the age of 25, to choose to feed their child with breast milk.
Government campaigns and strategies around the world include:
* National Breastfeeding Week in the UK
* The Department of Health and Ageing Breastfeeding Strategy in Australia
* The National Women's Health Information Center in the U.S.
However, there has been a long, ongoing struggle between corporations promoting artificial substitutes and grassroots organisations and WHO defending breastfeeding. The International Code of Marketing of Breast-milk Substitutes was developed in 1981 by WHO, but organisations, including those networked in IBFAN, claim that, in particular, Nestle took three years before it initially implemented the code, but in the late 1990s and early 2000s was again violating the code.
In many countries, particularly those with a generally poor level of health, malnutrition is the majority cause of death in children under 5, with 60% of all those cases being within the first year of life . International organisations such as Plan International and La Leche League have helped to promote breastfeeding around the world, educating new mothers and helping the governments to develop strategies to increase the number of women exclusively breastfeeding.
Traditional beliefs in many developing countries give different advice to women raising their newborn child. In Ghana babies are still frequently fed with tea alongside breastfeeding . This reduces the benefits of exclusive breastfeeding and the drink can inhibit the absorption of iron, important in the prevention of anemia.
In 1981, 118 countries voted in favour of the International Code of Marketing of Breast-milk Substitutes, but the USA voted against, on the grounds that it was a violation of freedom of speech guaranteed by the First Amendment of the Constitution of the USA, since due to corporate personhood, corporations have the same human rights as individual humans. 
Breastfeeding in public
When in public with a breastfed baby it is often difficult to avoid the need to feed the infant. The public reaction at the sight of breastfeeding can make the situation uncomfortable for those involved. There are numerous laws around the world that have made public breastfeeding legal and companies disallowed from prohibiting it.
In the U.S. the "Right to Breastfeed Act" (HR 1848) was signed into law on September 29, 1999 affirming the right of a woman to breastfeed her child anywhere on federal property. However, not all state laws have affirmed the same right in their respective public places. Nowhere is breastfeeding in public illegal.
A survey reported by the UK Department of Health stated that most people (84%) find breastfeeding in public acceptable as long as it is done discreetly . Contrastingly, 67% of mothers are worried about general opinion being against public breastfeeding. To combat these fears in Scotland, a bill  (pdf) safeguarding the freedom of women to breastfeed in public was introduced, and is currently making progress  in the Scottish Parliament. The proposed legislation sets up a fine of up to £2500 for preventing breastfeeding in legally permitted places.
In Canada, the Canadian Charter of Rights and Freedoms affords some protection under gender equality. Although Canadian human rights protection does not explicitly include breastfeeding, a 1989 Supreme Court of Canada decision (Brooks v. Canadian Safeway Ltd.) set the precedent for pregnancy as a condition unique to women and that thus discrimination on the basis of pregnancy is a form of sex discrimination. Canadian legal precedent also allows women the right to bare their breasts, just as men may. In British Columbia, the British Columbia Human Rights Commission Policy and Procedures Manual protects the rights of female workers who wish to breastfeed.
Many mothers choose to purchase pumping equipment or express milk ("milk" themselves) by hand so that they can carry a small bottle of milk with them if they plan to be out at mealtimes. This allows them the advantages of breastfeeding while avoiding possibly uncomfortable situations. Unfortunately, breastfed babies can have trouble transitioning to a bottle, so this may not work for everyone.
Recent global uptake
The following table shows the uptake of exclusive breastfeeding. Sources: WHO Global Data Bank on Breastfeeding and UNICEF Global Database Breastfeeding Indicators
Country Percentage Year Type of feeding
Armenia 20.8% 1997 Exclusive
0.7% 1993 Exclusive
Benin 16% 1997 Exclusive
13% 1996 Exclusive
Bolivia 53% 1994 Exclusive
59% 1989 Exclusive
Central African Republic 4% 1995 Exclusive
Chile 97% 1993 Predominant
Columbia 95% (16%) 1995 Predominant (exclusive)
19% 1993 Exclusive
Dominican Republic 10% 1991 Exclusive
14% 1986 Exclusive
Ecuador 96% 1994 Predominant
Egypt 68% 1995 Exclusive
Ethiopia 78% 2000 Exclusive
Mali 12% 1996 Exclusive
8% 1987 Exclusive
Mexico 37.5% 1987 Exclusive
Niger 4% 1992 Exclusive
Nigeria 2% 1992 Exclusive
Pakistan 25% 1992 Exclusive
12% 1988 Exclusive
Poland 17% 1995 Exclusive
1.5% 1988 Exclusive
Saudi Arabia 55% 1991 Exclusive
Senegal 7% 1993 Exclusive
South Africa 10.4% 1998 Exclusive
Sweden 61% 1993 Exclusive
55% 1992 Exclusive
98% 1990 Predominant
Thailand 4% 1996 Exclusive
99% (0.2%) 1993 Predominant (exclusive)
90% 1987 Predominant
Zambia 23% 1996 Exclusive
13% 1992 Exclusive
Zimbabwe 38.9% 1999 Exclusive
17% 1994 Exclusive
12% 1988 Exclusive
Lactation without pregnancy
Although not widely known in developed countries, women who have never been pregnant are able to lactate and therefore breastfeed as well. If their nipples are stimulated in a breastfeeding manner for a while (such as a breast pump or an actual baby suckling), eventually the breasts will begin to produce milk which can be used to feed a baby. For this reason, adoptive mothers, usually initially in conjuction with some form of supplementation, are able to breastfeed their infants. There is also anecdotal evidence of male lactation.
* Attachment parenting
* List of child related articles
* Breastfeeding, Biocultural Perspectives; Editors Patricia Stuart-Macadam & Katherine A. Dettwyler.
* La Leche League (1995). The Breastfeeding Question and Answer Book.
* Mercurialis, H. (1583). De Morbis Puerorum.
* Minchin, M. (1985). Breastfeeding matters, Almo Press Publications, Australia. ISBN 0-86861-810-1
* Moody, J., Britten, J. and Hogg, K. (1996). Breastfeeding your baby, National Childbirth Trust, UK. ISBN 0-72253-635-6
* Royal College of Midwives (1991). Successful Breastfeeding: A Practical Guide for Midwives, Royal College of Midwives, London.
* Stuart-Macadam, P. and Dettwyler, K. (1995). Breastfeeding: Biocultural Perspectives (Foundations of Human Behavior), Aldine de Gruyter. ISBN 0-20201-192-5
* 4woman.gov – Breastfeeding resource page
* ADC Online journals
* Breastfeeding NHS – UK NHS Breastfeeding strategy
* Plan International
* La Leche League International – An international organization whose mission is to help mothers worldwide to breastfeed through mother-to-mother support, encouragement, information, and education and to promote a better understanding of breastfeeding as an important element in the healthy development of the baby and mother
* Circumcision, Breastfeeding, and Maternal Bonding – Claimed effects of circumcision on breastfeeding
* WhyQuit.com – Anti-smoking site with numerous links in the "Known Breastfeeding Risk Factors" section
* AskDrSears.com – Advice from two pediatricians
* Baby Milk Action – Supports mother's rights to breastfeed
* Breastfeeding at LifeTips – Detailed articles and FAQs
* Plus-size-pregnancy.org – Private research site FAQ
* U.S. Food and Drug Administration (FDA) "Breast-Feeding Best Bet for Babies"
* National Childbirth Trust – The NCT is U.K. based organistion for new parents that promotes the benefits of breast feeding.
* BBC Health – health information from the BBC
* Papers written by Ted Greiner
* Human Milk Secretion: An Overview
* Canadian Breastfeeding Rights - from Canadian Infant Feeding Action Coalition
* WHO - Infant and Young Child Feeding Practices