Chapter Two: Literature Review

Breastfeeding

Attachment parenting embraces breastfeeding for at least a year, with many mothers and children continuing the breastfeeding relationship into toddlerhood or the preschool years. This extended breastfeeding is supported by historical, scientific, and anthropological evidence. The World Health Organization and UNICEF recommend all infants be breastfed exclusively for the first four to six months of life and that they should continue to be breastfed for up to and beyond two years of age (La Leche League International [LLLI], 1997). The American Academy of Pediatrics strongly recommends breastfeeding for six to twelve months (LLLI, 1997), citing the superiority of human milk in composition of fats, absorbable iron, cholesterol, proteins, and immunological benefits when compared to formula.

Breastfeeding and attachment.

     Very young infants have several behaviors through which they seek or maintain contact with their caregiver. These include grasping, rooting, sucking, and shifting position. Bowlby (1982) noted that sucking serves two purposes for infants: nutrition and attachment. He recognized both purposes as important, stating "to suppose that nutrition is in some way of primary significance and that attachment is only secondary would be a mistake. In fact, far more time is spent in non-nutritional sucking than in nutritional" (Bowlby, 1982, p. 249). According to Ainsworth, Blehar, Waters, and Wall (1978), rooting and sucking, which are food-seeking behaviors as well as attachment behaviors, tend to break from the attachment system in bottle-fed babies.
     Touch is crucial to survival and bonding. As numerous animal and human experiments have shown, infants, both animal and human, fail to thrive or die without touch (Blackwell, 2000). Breastfeeding is an obvious way to promote touch between mother and infant. The skin to skin contact intrinsic to breastfeeding is believed to promote secure attachment (Pearce, 1994). Touch helps to equalize infant body temperature and breathing and establishes a caregiving relationship between mother and child within which the two learn from each other. Furthermore, Joseph Chilton Pearce asserts, when a mother is bonded to her child and is engaged in actively mothering that child according to the child's needs, the mother will breastfeed the child on demand for two to three years. Extended breastfeeding of children until between two and six years of age is found in countless other cultures (Blackwell, 2000; Lozoff & Brittenham, 1979; Thevenin, 1987) and is increasingly common among families who practice natural or attachment parenting in this country.
     The hormonal regulation of breastfeeding is remarkable. As the baby begins to suckle the mother's body releases oxytocin and prolactin, regulating the milk release and production, but also producing feelings of warmth, love, calm, and relaxation. This hormonal release has an effect of stimulating an emotional state in the mother that promotes attachment (LLLI, 1997; Sears & Sears, 1993). It also produces bodily reactions in the mother, such as tightening contractions of the uterus, which are very beneficial in the first few days after the birth, and delaying the return of fertility, which is very important for natural child spacing.
     Breastfeeding is more conducive to quick responsive caregiving of infants (LLLI, 1997) than bottle feeding. Because an infant younger than six months has a memory span of less than a half a minute, and because bottle feeding mothers, even if immediately responding to the baby's hunger cues, must take time to prepare the bottle, they cannot immediately reinforce their child's cues. In contrast, when a breastfeeding mother recognizes her child's hunger cue, or other distress signal, her body has an immediate biological response, known as "let down," which encourages her to respond immediately to the child. The only delay to feeding is the necessary rearranging of clothing to provide the baby access to the breast. Some authors and editors are quick to point out that it is possible to bottle-feed with the consistent tender care and attention which have been demonstrated to promote infant cognitive and emotional development (Morris, 1995, editor's note; Sears & Sears, 1993). However, most individuals in our culture have observed infants seated in car seats or strollers with bottles propped up during feeding time or sitting alone holding their own bottles; this level of detachment is simply impossible with breastfeeding. The breastfeeding mother and child must physically connect in order to nurse.

Medical benefits.

     Medical benefits of breastfeeding exist for both mothers and infants. Breastfeeding Does Make a Difference, a 12-page brochure from La Leche League International (1992) with 20 medical journal references, documents many of these health advantages. Breastfeeding infants are less likely to suffer from respiratory, ear, or gastrointestinal infections. Formula fed babies are five times more likely to suffer from lower respiratory infections and twice as likely to require hospitalization for those infections than breastfed infants. Formula feeding has also been associated with immune system disorders, while breastfeeding is known to provide immunological benefits, not only through the colostrum in the first days of life, but also throughout the breastfeeding relationship (LLLI, 1992). In fact, when a breastfeeding child has an infection the child passes that infection to his mother through her mammary glands and the mother's body creates antibodies to the infection which are then fed back to the child in her milk during the next nursing session (Bumgarner, 2000). Breastfeeding has been shown to offer long-term protection from intestinal disorders such as Crohn's disease and ulcerative colitis and children who have been breastfed longer than six months are much less likely to develop certain types of childhood cancers (LLLI, 1992). Breastfeeding also lowers the risk of Sudden Infant Death Syndrome. Additionally, children who were breastfed have a lower risk of developing insulin dependent diabetes and are less likely to develop severe allergies than children with a history of formula feeding (LLLI, 1992). Mothers who breastfeed for a duration longer than 25 months are 33% less likely to develop pre-menopausal breast cancer than mothers who did not breastfeed. Breastfeeding has also been shown to provide protection against ovarian cancer and urinary tract infections and nursing improves bone strength (Radetsky, 1999; LLLI, 1992).
     The purely nutritional benefits of breast milk over cow's milk or soy product formulas are formidable. The proteins in human milk are very different from those in cow's milk, and despite mechanical or chemical manipulation, formula is less easily digested than breast milk (LLLI, 1992). The composition of nutrients in human milk change over the course of a single nursing session (Morris, 1995) with the type of suckling by the infant affecting the fat content so that a thirsty infant drinks milk that is lower in fat while and hungrier child, who nurses for a longer duration, consumes more of the fattier hindmilk (Sears & Sears, 1993). The vitamins and minerals in breast milk are perfectly balanced and more readily available to the baby than those same nutrients in formula. Additionally, amino acids, such as taurine, and fats, such as DHA, along with enzymes and hormones in breast milk, which have been identified as very important to human development, have been missing from baby milk substitutes (LLLI, 1997).
     Human breast milk may have wider medical applications as well. Dr. Catharina Svanborg of Sweden's Lund University is leading a team of researchers who stumbled upon the discovery of a component of human breast milk which seems to cause all types of cancer cells to commit suicide. While studying the well-documented anti-bacterial components of breast milk, one of her students, Anders Håkansson, noticed the cancer cells he was using as a contrast to the bacteria were behaving strangely. Perhaps this helps to explain why the risk of childhood lymphoma among bottle-fed babies is nine times higher than for breastfed babies. The researchers discovered that alpha-lactalbumin, an abundant protein in human breast milk, when mixed with stomach acid and one other component of breast milk, which has not yet been made public, kills cancer cells and pneumococcus bacteria (Radetsky, 1999).

Economic Benefits.

Breast milk is free. Although some mothers may need to increase their own nutritional intake, the cost of food for the mom is negligible compared to the cost of baby milk substitutes. In 1997, formula-feeding would have added approximately $30 per week or $1500 per year to the family grocery bills (LLLI, 1997). Our federal budget is affected along with the budgets of individual families. Low income mothers and children in the United States are eligible to receive food supplements under the Department of Agriculture's Women, Infants, and Children (WIC) program. These supplements include formula along with juice, eggs, milk, cheese, and other staples. In 1986 the Department of Agriculture reported that 29 million dollars would be saved annually if WIC mothers breastfed their babies for only one month. In 1996 the Colorado WIC program calculated a projected savings of 111.6 million dollars per year if only 50% of the mothers in WIC nationwide would follow American Academy of Pediatrics recommendations and breastfeed their children for five to six months (LLLI, 1997). In developing countries the economic impact of breast vs. bottle feeding has been even more dramatic.

Attitudes toward breastfeeding.

The medical, emotional, and economic benefits of breastfeeding are well documented, but in our culture, sadly, approximately 80% of children are not breastfed after six months of age. Why is this? Possibly it is the result of poor education with regards to infant nutrition, popular culture's absence of breastfeeding images, or commercialism and the influence of formula companies in the hospitals and obstetrician's offices across the land. The UN's World Health Organization has stated clearly that media commercials and free samples through hospitals, OB/Gyns, pediatricians, and direct mailings are unacceptable, yet formula companies continue to engage in such tactics. Meanwhile, the US television and film industries demonstrate little positive breastfeeding presence, likely due in part to the practicalities of needing a breastfeeding pair rather than professional actors with someone else's pretty baby. The average television-viewing teenager or adult has seen several hundreds of homicides on television, but has never tuned in and seen a baby being nursed. It therefore falls to the schools to help to correct the lack of information and the discomfort around the topic of breastfeeding. It will only be after young people truly understand the many irreplaceable benefits of breastfeeding that our nation's babies will begin to receive their own mother's milk as their birth right.
A 1983 study of Canadian secondary students by Donelda Ellis demonstrated a lack of understanding of the nature of breastfeeding and the proliferation of attitudes which would compromise breastfeeding success. There were 409 participants in this survey of eighth through twelfth graders in British Columbia. The volunteers were recruited from Home Economics classes and three-quarters of the sample was female. Common false beliefs among the teens included thinking breastfeeding was an instinct when in fact it is a socially learned behavior, and thinking breast size was related to a woman's ability to breastfeed. Eighteen percent of the students interviewed lacked the knowledge that breastfeeding was the healthiest way to feed an baby. The students' attitudes about breastfeeding in certain locations were also assessed. The considerable majority of the students felt breastfeeding was inappropriate in public. For example, only 35% felt it would be reasonable for them to nurse in their own home if both male and female guests were present and only 13% felt nursing an infant in a shopping mall was acceptable (Ellis, 1983). False ideas about the nature of breastfeeding can be corrected through education, but the attitudes about the social appropriateness of nursing are the most detrimental to breastfeeding success and will be harder to change. Kaplowitz and Olson (1983) discovered pamphlet-based education for expectant mothers about the nature and benefits of breastfeeding was effective at increasing knowledge about breastfeeding, but ineffective at improving the women's attitudes towards breastfeeding and failed to increase the occurrence or length of breastfeeding among the educated mothers.

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