It used to be a common refrain: Breast-feeding is great to try, but if you decide against it, don't sweat it.
Nobody's saying that anymore.
"Breast-feeding isn't just a nice thing to do," says Dr. Lawrence Gartner, a pediatrician and chairman for the American Academy of Pediatrics (AAP) task force on breast-feeding. "It actually has a major impact on the mother's and child's health."
Be prepared. It may not come as naturally as one might think of something that's supposed to be natural. So it's wise to learn as much as you can about breast-feeding beforehand and line up the skilled support you might need if a problem does arise.
But above all, be ready to enjoy. Women who have been there say it's definitely worth it.
"There's such a warm connection," says Lisa Powers, of New York. "You feel so important in their life. It's so tender and loving. I can't imagine what it would be like to just sit and give her a bottle." Powers' daughter, Alexa, is 7 months old.
The decision to breast-feed is a personal one, but the benefits overwhelmingly tip the scale in favor of it.
"Everything you hear about the health benefits, there's actually 10 times the evidence that the public is really aware of," says Laura Best-Macia, a board-certified lactation consultant in New York.
Babies derive a host of benefits, not just while they're breast-feeding, but perhaps all the way into adulthood.
While they're breast-feeding, babies show a marked reduction in almost all viral and bacterial illnesses, including diarrhea, ear infections and respiratory infections, such as pneumonia and meningitis. That's because breast milk contains not only the mom's antibodies, but also hundreds of compounds that alter the growth of bacteria and viruses.
Researchers also have discovered long-term benefits for breast-fed babies: a lower incidence of childhood middle-ear infections, chronic illnesses such as diabetes, allergies and, most recently, even obesity. Schoolchildren who were breast-fed also were found to have IQs about eight points higher.
There's even evidence that bonding between mothers and babies is enhanced with breast-feeding. When mothers nurse, the letdown reflex triggers the release of oxytocin, which sends signals to her brain that produce relaxation, mothering behavior and maternal attachment. Skin-to-skin contact appears to produce the same effect in the baby's brain.
Among the greatest medical benefits to moms is a reduction in the risk of getting at least two types of cancer -- pre-menopausal breast cancer and ovarian cancer -- as well as reduced incidence of osteoporosis and hip fractures. Researchers believe that prolonged production of estrogen and other hormones while you breast-feed may trigger protective mechanisms.
"The longer you breast-feed and the more children you breast-feed, the greater the benefits to the mother," says Dr. Gartner.
Acknowledging the benefits to mother and baby, the AAP recommends that mothers nurse their babies for at least a year -- exclusively for the first six months and then gradually introducing solids. In fact, experts encourage women to go as long as they and their babies want, into the second and third year.
If you don't breast-feed for that long, though, combining breast-feeding with formula is still preferable to formula alone, experts say. And something is better than nothing.
"We know that the benefits of breast-feeding are dose-related, so a baby that's breast-fed for three months has less protection than a baby that's breast-fed for six months," says Best-Macia, who is also president of Wellcare Inc., a group of lactation consultants. "But any amount of breast-feeding is beneficial, even if it's two days in the hospital."
Of course, there is plenty that can stand in the way of a woman's decision to nurse her baby.
Besides the difficulty women may have in learning proper technique, it takes more time and commitment -- you can't just hand off your baby to anyone who can hold a bottle. If you're going to work outside the home, you'll have to pump, which requires all sorts of logistical considerations. And, breast-feeding may make it difficult for some new mothers to lose those last few pounds.
Powers says she was stunned by the pervasive negativity toward breast-feeding where she lives on the Upper East Side. "I think it's a very selfish, vain attitude. They think, 'Give the kid a bottle. I don't want it to interrupt my life. I want to be able to have my freedom. I won't do it in public. I want my body back.' "
Breast-feeding definitely wasn't the easy choice for Powers. Alexa stopped breast-feeding as soon as they left the hospital, and it took a month of frustration and sleepless nights before Powers realized that Alexa had poor sucking skills. After another month working with Best-Macia, however, Alexa finally got the hang of things.
There have been some personal trade-offs, too. For instance, hanging on to those last 10 pounds has bothered Powers, who is a personal trainer, "probably more than the average woman," she concedes. "But I'm still choosing to do it -- it's that important. I have to put my feelings about my body aside and do this for my daughter."
Many couples also may worry that if dads can't give a baby a bottle, they'll feel left out of the bonding process. But there are other ways they can enjoy some one-on-one time with their babies, such as being the one who regularly bathes the baby, Best-Macia says.
"I think we really underestimate the role of the father if we think that all he can do is imitate the role of the mother by feeding the baby," she says. "Bathing, especially if babies are in the bathtub with the father, can be a very fun and happy time. ... It's similar to a breast-feeding counterpart because fathers have skin-to-skin contact with their babies."
Technique Is Everything
Despite the benefits of breast-feeding, only a relative few mothers stick with it for the time recommended by experts. About 60% of women start breast-feeding in the hospital, but the number drops to 20% by the time the baby is 6 months old.
One of the biggest reasons women abandon nursing is the gamut of difficulties they may experience getting started, such as inadequate milk supply or sore nipples. But many of these difficulties, often the result of improper positioning and latching technique, could be avoided if women had the support and instruction they need to get off to the right start.
"I think mothers should be patient with themselves. They're learning a new skill," says Best-Macia. "A baby that's positioned and latched well right from the beginning will avoid a lot of the difficulties you hear about," she says.
For example, in one study Best-Macia did at St. Vincent's Hospital in New York, the breast-feeding problems among women who were discharged from the hospital dropped by half after labor and delivery nurses learned how to teach proper breast-feeding techniques.
An easy way to learn breast-feeding is by holding the baby in the so-called football or clutch position.
Find a comfortable position with back support and with your knees higher than your hips. Place your baby on his side on pillows at breast level, with his nose to your nipple and his neck straight. For feeding on the left breast, place your left arm along your baby's back and support your baby's head with your left arm.
Place your fingertips behind his ears and the heel of your hand across his shoulder blades. Supporting your breast in your free hand, lightly tickle your baby's lips with your nipple until he opens wide, aim your baby's lower lip toward the areola so he takes in more breast near the lower lip, and push with the heel of your other hand across your baby's shoulder blades to bring him onto the breast quickly and deeply.
Let your baby nurse at the first breast for as long as he likes, then put him on the other side until he stops nursing by himself. At each new feeding, alternate the breast you begin with, Best-Macia says.
Don't force a newborn to switch sides during feedings, she says. The fat content changes as the breast is drained. So, if you switch too early, your baby may not get the higher-fat milk that comes at the end. Your milk supply will adjust to the baby's needs.
Some common mistakes include improperly aligning the baby so that only the head is turned sideways, pushing the breast into the baby's mouth instead of bringing the baby onto the breast and latching the baby too high.
"Women can't see the bottom part of the areola where the lower lip is, and that's really the part that the baby needs," says Best-Macia.
Part of the problems women have stem from the fact that they're not exposed to other nursing mothers and, even if they are, the examples aren't always useful. Newborns need to be positioned differently than older babies -- they don't have the same neck stability as older babies -- and many women don't use proper technique.
"If you're just in a random group of breast-feeding mothers, the likelihood is that at least half of them aren't using proper technique," Best-Macia says. That isn't a big deal for the woman who's still able to breast-feed, but for the woman who's having problems, "it's not the best learning opportunity."
Some women may not be able to breast-feed for some medical or surgical reason, but that number is very small -- somewhere between 2% and 3%, says Dr. Gartner. Women who have a history of sexual abuse also may find it too emotionally difficult. However, immunizations and most medications are safe to take during lactation.
If you had a previous bad experience with breast-feeding, you shouldn't assume that it will happen again, experts say. Lisa Stein, of Evanston, Ill., developed a serious infection that sent her into the hospital and prevented her from breast-feeding her first child. Stein was apprehensive of a repeat performance when her second baby was born in October.
So far, the experience has been like night and day. "I had a few problems up front, mostly psychological because of the fear," she says. "I had a little cracking and bleeding, but I brought a lactation consultant in on the third day, worked with her for a week, and now it's going great."
Getting on the Right Track
The key to a successful breast-feeding experience is getting off to a good start, says Marsha Walker, a certified lactation consultant in Weston, Mass., and immediate past president of the International Lactation Consultants Association. Here are Walker's suggestions for new moms:
Set realistic expectations: Expect to breast-feed eight to 10 times in 24 hours for about 20 minutes to 30 minutes each time. Your baby will let you know when she's hungry (don't wait until she's crying), and she'll typically bunch her feedings together several times in the morning, late afternoon and evening. Eventually, by about four weeks to six weeks, a more regular pattern will emerge (breakfast, midmorning snack, lunch, midafternoon snack, dinner and nighttime snack). To avoid being overloaded, divvy up household chores and set aside some time each day for yourself.
Make sure you're stimulating an abundant milk supply: Offer frequent feedings and make sure the baby's swallowing. Since that may be hard to gauge in the early days, listen for a little puff of air from the nose when your baby exhales. Effective feeding is characterized by rhythmic sucking followed by a short pause. Supplements, including water, sugar water, formula and pacifiers, aren't recommended since they can interfere with early milk production.
Line up a support network: Take a prenatal breast-feeding class. Find out if your hospital or birthing center has a formal policy to encourage breast-feeding (for instance, the AAP recommends nursing within the first hour). Get telephone numbers of sources who can help once you're at home, such as a breast-feeding hotline, private lactation consultants or your local La Leche League, which offers mother-to-mother support groups. Referrals of local lactation consultants are provided by the International Lactation Consultants Association at (919) 787-5181.
Pain is a sign that something isn't right. Often the culprit may be positioning, latching on or your baby's sucking skills, which can be remedied with the help of a skilled mother or a lactation consultant. Red patches on the breast and fever are signs of an infection, which require antibiotics. Draining the breasts completely will help to prevent infections.
Optimize the transition back to work: Although you'll probably feel bad leaving your baby, experts say nursing can actually help you feel connected to your baby even though you're apart. To get ready for the separation, start pumping and bottle-feeding your baby about a week, or so, before your first day back. Introduce a bottle initially when the baby's not hungry so frustration isn't compounded by hunger. If giving a bottle is unsuccessful, a flexible plastic cup might work. Electric pumps with a double-collection kit, which can be rented as well as purchased, are easier to use and more efficient than manual pumps. Massaging and compressing the breasts while pumping are also helpful.
Make sure you marshal the support you need at work. "Typically what the mom needs is a gatekeeper -- it could be her supervisor, a secretary ... someone who makes sure that she's enabled to pump, typically two to three times a day, and that co-workers are supportive," Walker says. Find a day-care center that will respect your choice to breast-feed. She even suggests spending time there each week, just hanging out so that your body will make antibodies to germs your baby will be exposed to.