Friday, April 13, 2012

Defending the Boob

I'll start off right now by saying this post isn't for everyone.  It has boobs in it. 

Lactating ones.

I realize that half of you stopped reading after the last line, but to be fair, I've probably gained a few weird fetish dudes by now so I'm sure it all balances out somehow. 

In any event:  My name is Jen and I am an extended breastfeeding Mom.

As their biological mother, I chose to breastfeed all three of my kids.   I did this as I believe this is the best start that I can give them. I am not here to make you feel bad if you didn't;  we are fortunate enough to live in an area of the world that allows us options.   However, it's my blog and right now we are all about the boobies. 

It's sad in this day and age that you have to defend your choices as a mother, no matter what direction you take.   I am very lucky to have been able to breastfeed my twins up until now.  I struggled with my eldest for 6 months before giving up and switching him to formula. I wish I had known then what I know now (and had gotten a decent pump!)  The babies are now almost 14 months old and we are still going strong.   When Wyatt was born, I was open to any an all options for him in particular;  if it turned out that he needed to be tube or bottle fed pumped milk, then I would have done that.  We were very pleased when he was able to breast feed; not only would it provide the best dietary option and boost his immunity, but the increased resistance would give his oral-facial muscles a better start. 

As part of the 31 for 21 Blogging Challenge that I participated in last October, I put out this Factoid Friday:  7 Good Reasons to Breastfeed Your Baby with Down syndrome.  Babies with Down syndrome commonly have feeding problems;  I came across a study from Italy where 57% of babies with DS born in the four university hospitals were bottle fed (Pisacane, etc, 2003)  Depression and frustration were two of the most common cited reasons.  Feeding difficulties was the most common.  Only 30% of the children admitted to the NICU were breastfed.  I've run into similar studies from South America.  My advice to any new DS parent facing their options would be to do the research.  If you can do it, do it for the 7 Reasons that I've listed.

Now that the babies are 13+ months, I've now moved into very uncharted waters.  I'm now part of a new category:  the extended breastfeeder.  I have had (mostly well meaning) folks ask me "how long are you going to keep that up?" and the like.  (Also, "why are you still feeding both of them?", like I can pick one of them?) The stereotype, of course, is the "crunchy" mom who breastfeeds until the kid is in middle school... and yes, I have been asked that as well. Both Wyatt and Zoe are eating a variety of solid foods.  When I am at home, they continue to receive breast milk (they are supplemented with homogenized milk when I am working and there is not enough pumped milk in the fridge).  Why am I still doing this?

Really, it's more like: why the hell wouldn't I be?

There is no medical explanation as why I should cease breastfeeding my twins;  those 7 reasons still apply.  Between my insane work schedule and, well, life, any close, quiet snuggle time I get with the babies is important.  So what is the issue then, other than a vague societal idea that it is somehow weird and unnecessary?

To be honest, I did think about quitting.  It would be easier in some respects.  Pumping at work can be a drag, when all I want to do on my break is close my eyes for a few minutes or possibly eat something at a comfortable pace.  I might also want a glass of wine or two (or three) some evening at home. Then there is Zoe, who now has a mouthful of teeth.  Sharp, needle-like teeth.  I probably don't need to expound on that one. 

Ultimately, for me, it comes down to Wyatt.  Yes, he is eating solids, well above what is "expected" of a child with Down syndrome at his age.  However, is solid food and cow's milk the best I can do for him and his special needs?

It is true that after 6 months, with any baby, supplementary feeding is recommended.  However, that does not mean that breast milk ceases to be of any nutritional value.  In fact, once you are over the year point, it is the exact opposite.  In 2005, Mandel determined that milk from mothers who had been breastfeeding for over a year showed "significantly increased fat and energy contents, compared with milk expressed by women who have been lactating for shorter periods."  To further expound on this, Dewey (2001) found that "Breast milk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins."  In fact, when analyzed, 448 ml of breast milk (in ages 12-23 months) provides (of the daily requirement):
  • 29% of energy
  • 43% of protein
  • 36% of calcium
  • 75% of vitamin A
  • 76% of folate
  • 94% of vitamin B12
  • 60% of vitamin C
    After the first year then, breast milk continues to be a valid form of nutrition for a toddler.  What else can it do?  Building on our previous 7 reasons:

    "1)  Breastfeeding provides antibodies and protection from illness"

    After the first year, breast milk continues to provide immunity and fight infection.  In fact, it has been shown that breast fed toddlers have less infections and a reduced severity of illness (Gulick, 1986). Also, breast milk has an increased amount of antibodies in the second year (Goldman, Goldblum, Garza, 1983) which increases even further at the time of weaning (Goldman, 1983).  It would seem that extended breastfeeding is a beneficial practice for the health of any child, especially one who is statistically prone to infection and illness due to his genetic make up.

    "2)  Breastfeeding improves mouth and tongue co-ordination which will aid in speech and language development"
    Breastfeeding provides a variety of "positive effects on the development of an infant's oral cavity, including improved shaping of the hard palate resulting in proper alignment of teeth and fewer problems with malocclusions." (Palmer, 1983). In terms of both motor skills and early language development, another study found "The proportion of infants who mastered the specific milestones increased consistently with increasing duration of breastfeeding." (Vestergaard, etc,1999).  Therefore, extended breastfeeding would only continue to enhance speech and language development.

    "3)  Breastfeeding promotes increased brain growth due to DHA, a fatty acid that is not found in most formulas or cow's milk." 

    Extensive research in this area has shown that there is a direct relationship between breastfeeding and cognitive ability.  Of particular note is a study from 2002, whereby "a significant positive association between duration of breastfeeding and intelligence was observed in 2 independent samples of young adults, assessed with 2 different intelligence tests." (Mortenson, etc, 2002).  Extended breastfeeding then, would further aid any child's cognitive development;  ostensibly providing a boost to one who was developmentally delayed.

    "4)  Breastfeeding provides the opportunity for extra sensory stimulation as there is more skin to skin contact"

    Many studies have shown that breastfeeding enhances motor skills and overall development.  In fact, "The psychomotor and social development of breast-fed babies clearly differs from that of bottle-fed ones and leads at the age of 12 months to significant developmental advantages of the psychomotor and social capabilities." (Baumgartner, 1984).  As the senses develop the more they are stimulated, it would be easy to infer that the more one is breastfed, the more developed the senses would become.  It is obvious how this would be helpful to a child with Down syndrome.

    "5)  Breastfeeding fosters closeness"
     "6)  Breastfeeding enhances mothering skills"

    I think this quote says it best;

    "A major reason for practicing sustained breastfeeding in industrialized countries in the face of social disapproval has been the belief that it provides a closer bond between mother and child. These children are often said to be more secure and more independent. They continue to remember this close bond and their mothers believe that it continues in some sense, even into adolescence, easing the difficulties in the mother-child relationship during this period." (Grenier, 1995)  

    The strong bonds created with breastfeeding appear to last well into childhood, at least by our perceptions.  Ferguson found "significant associations between the duration of breastfeeding and maternal and teacher ratings of conduct disorder obtained at six, seven and eight years" (Ferguson, et al, 1987). 
    "7)  Breastfeeding reduces the risk of Type 2 diabetes"

    Breastfeeding your child reduces his or her chances of developing Type 2 diabetes.  What is not commonly known is that extended breastfeeding decreases the mother's chance of developing Type 2 DM as well.  According to the Journal of the American Medical Association:  "increased duration of breastfeeding was associated with reduced risk of type 2 diabetes".  In fact, for each year of lactation, a woman decreases her chances by 15%.  (Stuebe, etc, 2005).  With that in mind, if a woman has two children and breastfeeds them both for two years, she has reduced her chances of developing Type 2 diabetes by 60%.  Other diabetes related finds of note:  suppressed lactation actually increases the chances of diabetes. Also: "lactation was associated with improved glucose tolerance, fasting glucose, and total area under the glucose tolerance curve. In an analysis stratified by use of insulin during pregnancy, fasting glucose levels were significantly lower in the lactating group." (Stuebe, etc, 2005)

    As it turns out there is also some evidence that extended breastfeeding reduces the mother's risk of certain cancers, rheumatoid arthritis, and osteoporosis.

    Contrary to popular belief then, extended breastfeeding (past the first year) has valid benefits for both mother and baby. I must admit, although it can be tricky (mainly due to other people), it provides a quiet time that I can spend with both my babies at once.  They make eye contact with me, they make eye contact with each other.  Occasionally, one will poke at the other, but that is the story with any siblings.  It's also easy and free, which scores bonus points as well.  I won't know for sure if it will make the difference between Wyatt taking this course or another in high school.  I will know that when I do get a chance to cool it for a bit, I can rest easy knowing that I did my very best for him and his sister.  Which is all any of us aspire to do, really.

    Long live the boobies.  To my twins at least, they're like no udder. 

    Baumgartner, C. Psychomotor and social development of breastfed and bottle-fed babies during their first year of life. Acta Paediatrica Hungarica 1984; 25(4):409-17. 

    Dewey KG. Nutrition, Growth, and Complementary Feeding of the Breastfed Infant. Pediatric Clinics of North American. February 2001;48(1).

    Ferguson, D. M. et al. Breastfeeding and subsequent social adjustment in six- to eight-year-old children. J Child Psychology and Psychiatry 1987; 28:378-86.

    Gulick EE. The effects of breastfeeding on toddler health. Pediatr Nurs. 1986 Jan-Feb;12(1):51-4.

    Goldman AS et al. Immunologic components in human milk during weaning. Acta Paediatr Scand. 1983 Jan;72(1):133-4.

    Goldman AS, Goldblum RM, Garza C. Immunologic components in human milk during the second year of lactation. Acta Paediatr Scand. 1983 May;72(3):461-2.

    Mandel D, Lubetzky R, Dollberg S, Barak S, Mimouni FB. Fat and Energy Contents of Expressed Human Breast Milk in Prolonged Lactation. Pediatrics. 2005 Sept; 116(3):e432-e435.

    Mortensen EL, Michaelsen KF, Sanders SA, Reinisch JM. The Association Between Duration of Breastfeeding and Adult Intelligence. JAMA. 2002;287:2365-2371.

    Nursing Beyond One Year by Sally Kneidel, NEW BEGINNINGS, Vol. 6 No. 4, July-August 1990, pp. 99-103.

    Palmer, B. The Influence of Breastfeeding on the Development of the Oral Cavity: A Commentary. Journal of Human Lactation. 1998;14(2):93-98

    Pisacane A, Toscano E, Pirri I, Continisio P, Andria G, Zoli B, Strisciuglio P, Concolino D, Piccione M, Lo Giudice C, Vicari S.  Down syndrome and breastfeedingActa Paediatr. 2003;Dec;92(12):1479-81.

    Stuebe A., Rich-Edwards J., Willett W,  Manson J, Michels M, Duration of Lactation and Incidence of Type 2 Diabetes.  JAMA 2005;294(20):2601-2610.

    Sustained breastfeeding, complementation, and care by Ted Greiner, Food and Nutrition Bulletin, 16(4):313-319, 1995

    Vestergaard M, Obel C, Henriksen TB, Sorensen HT, Skajaa E, Ostergaard J. Duration of breastfeeding and developmental milestones during the latter half of infancy. Acta Paediatr. 1999 Dec;88(12):1327-32.


    1. YES! I love breastfeeding my son, aged 14 month and have no intention of weaning him, despite friends and family comments. I gave up pumping this week as I was having trouble filling a bottle, so he has homo milk during the day while I'm at work, but it's boobie milk before bed and during the night. People tell me that I should be night weaning him (he wakes at least once or twice a night) but I'm not interested. If he wants breast milk and I'm around, it's all his.

    2. Breastfed my oldest two well beyond a year and Dominic until about 11 months which is when the doctors decided he was to be nil by mouth. For me it was convenience as well as knowing it was the best start. I didn't want to get up and make bottles, I wanted to pop the baby in bed with me and go back to sleep. Breastfeeding is perfect for the lazy mother (not saying it's easy at the beginning... god no! Elliot was in SCBU and tube fed and getting him to latch on after all of that was a nightmare of epic proportions, plus at one point my milk all but dried up, but I persevered with the dogged determination of a slightly crazed sleep deprived woman and we got there in the end!).

      1. It's easier in some respects, that is for sure!

    3. I wish I had breastfed longer, especially now in retrospect. Good for you, Jen!!

      1. Don't beat yourself up about it. You did the best you could.

    4. I don't want to live in a place where an educated mother does what she thinks is best for her kids -- and she's chastised for it. Thanks for speaking up Jen. Your kids are lucky to have you.

    5. I stopped when they got those razor sharp teeth...not after the first bite and scream, but when I got the evil grin before the second bite and scream!!!

      1. Yes! Zoe has been trained away from that (flicks to the nose!) but Wyatt now has teeth and I'm gently telling him no! (If I yelp even, he starts to wail inconsolably!)


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