The birth of a baby is a time filled with excitement, joy and maybe even a little trepidation but in the midst of all this excitement, you may face a decision about whether or not to breastfeed your baby. If your personal circumstances allow it, breastfeeding will provide your little one with the best start to life nutritionally and will also bring other important benefits to mum and baby. Indeed, breastfeeding will meet all of your baby’s nutritional needs for around the first six months of life. In Australia, The National Health and Medical Research Council (NHMRC) recommends that infants are breastfed exclusively for around the first six months of life to achieve optimal health, growth and development, but adds that any amount of breastmilk is beneficial to a mother and her baby. The NHMRC also says that when solid foods are introduced gradually at around six months of age, breastfeeding should continue until 12 months and beyond and for as long as the mother and baby pair desire. As there is so much information to wade through when a new baby joins the family, we thought we would take the time to explain a little bit about breastfeeding.
There are various benefits to a lactating mother associated with breastfeeding. It provides a convenient and inexpensive source of food and fluid for your baby that does not need any preparation or storage and which is always available. Breastmilk delivered from the breast is always at the right temperature and is safe to consume anywhere, anytime and without the need to sterilise bottles. The regular close interaction and skin-to-skin contact during breastfeeding also encourages a close mother-infant bond. Breastfeeding also helps the uterus contract back to normal size, helps to regain pre-pregnancy body weight and is also associated with a reduced risk of breast and ovarian cancer.
If mum is breastfeeding and remains amenorrheic, this can also preserve maternal iron stores and so improve maternal iron status, as well as provide a method of natural birth control during the first months following birth (of course, seek advice about contraception to cover the first months following birth from a qualified medical practitioner). For more information on breastfeeding advice, visit the Australian Breastfeeding Association (ABA) website and a book published recently called ‘The Newborn Baby Manual’ by Renee Kam.
Breastfeeding your little one will give them the best start during their first year of life, when growth is greater than at any other time across the lifespan. The benefits of breastfeeding to your baby include such things as improving visual, psychomotor and cognitive development. Breastmilk also contains many factors that help your little one to settle, protect him or her against infection and support development of the innate immune system. Several studies have also shown that the risk or severity of a number of health conditions are reduced in breastfed babies, including gastrointestinal infections.
One of the unique factors of breastmilk is that it not only changes within one feed but also during the course of lactation, to reflect a baby’s needs. The first ‘breastmilk’ is called colostrum, which is a protein and essential fatty acid rich, yellowish and thick fluid produced during late pregnancy and during the early days after birth. Although it is only produced in small amounts, its protein content is very high and it is rich in antibodies (immune system proteins), which are important for infection protection. Colostrum is also a rich source of fat-soluble vitamins such as vitamins A and E and minerals. Due to these benefits, it is recommended that if possible, a baby receives colostrum rather than infant formula at this time.
Around day three or so after a baby’s birth, a mothers’s milk ‘comes in’ and changes to a thinner whiter appearance.
Once a mother’s milk has ‘come in’ and a mother’s breasts begin to feel firmer and fuller, at the start of the feed a baby receives milk that is lower in fat and calories and is thirst quenching. As the feed progresses and the breast drains, the baby receives milk that is high in fat and calories.
Breastmilk is nutritionally complete because it contains all the nutrients a baby needs during the first six months of life, including fat, carbohydrate, protein, vitamins, minerals and water to help your baby grow, develop and reach their full potential. Many of the nutrients in breastmilk are absorbed and used easily by your baby. All of this makes it nature’s perfect first food for a new baby’s developing body.
About half of the energy from breastmilk comes from fat (3.5 grams per 100ml of breastmilk). Most of the fat in breastmilk comes from the essential omega 3 and 6 fats, including the omega 3 fat called docosahexaenoic acid (or DHA) and the omega 6 fat called arachidonic acid (or ARA). These play an important role in brain and eye development. Fat in breastmilk is released in small drops, with the amount of fat increasing as the breast empties and the feed continues. So, there is more fat in breastmilk produced from softer, emptier breasts as feeding progresses, compared with breastmilk produced at the beginning of a feed from firmer breasts. So let baby continue feeding on the milk from softer breasts so that he or she can get all the important nutrients breastmilk provides during the course of one feed.
The milk sugar called lactose is the main carbohydrate in breastmilk and there are around 7 grams per 100ml of breastmilk. This is more than in most other mammalian milk types. The lactose in breastmilk is an important source of energy for a baby and his or her developing brain. Lactose also enhances calcium absorption and promotes the growth of lactobacilli in the gut (good bacteria). It is worth noting that it is extremely rare for babies to have the genetic disorder that means they cannot digest lactose. In fact, babies of all races are well adapted to digest lactose and will only experience temporary or secondary ‘lactose intolerance’ if there is some sort of gut damage, which will need medical attention and which will subside with treatment. Otherwise, a baby consuming large amounts of breastmilk may experience lactose overload but this can be managed with the help of a Hong Kong qualified and experienced breastfeeding counselor from the Baby Friendly Hospital Initiative Hong Kong Association or the Department of Health Family Health Service. Breastmilk also contains other carbohydrates called oligosaccharides (sugar chains), which give protection against infection and help to develop healthy gut function.
There are around 1.3 grams of protein per 100ml breastmilk, which is around one third of the total protein of other mammalian milk. Most of the protein in human breastmilk comes as either whey protein or casein protein. The combination of whey and casein (or their ratio) is also different compared to other mammalian milk: there is more whey compared to casein protein in breastmilk. The combination of whey and casein in human milk also change dynamically over time, which cannot be replicated exactly by infant formula.
As your baby’s digestive system matures, more milk casein protein appears in human breastmilk. Casein protein is classified into different groups, including alpha-casein, beta-casein and kappa-casein. Beta-casein is classified further as A1 or A2 beta-casein types. Human breastmilk contains only the A2 type and not the A1 type and unlike cows’ milk, human breastmilk contains very little of the other casein protein groups. So, most of the casein in human breastmilk is A2 type beta-casein (however, some cows’ milk proteins may pass into a mother’s breastmilk from her own diet).
Breastmilk contains all of the essential vitamins and minerals your baby needs during his or her first six months of life, unless your own stores are compromised, when a GP or healthcare professional may advise supplementation. Having said that, Vitamin D needs a special mention: if a mother has good Vitamin D levels during pregnancy, her breastfed baby will continue to receive enough Vitamin D provided he or she receives sufficient casual exposure to sunlight. This can be achieved by taking him or her out for walks, but sensible sun protection strategies need to be followed and always avoid high ultraviolet (UV) light times. Sun protection recommendations do vary with latitude and UV index but as a general rule, if the UV index is less than three, sun protection is not needed unless in alpine regions or outside for extended periods or one is near a highly reflective surface, such as snow or water.
Breastmilk also has many unique factors which play an important role in the development of the gastrointestinal system and protection against infection. These include antibacterial factors like lactoferrin and lysozyme, immunoglobulins (or antibodies) which are directed against a number of microorganisms that can threaten a baby, white blood cells which can destroy germs and oligosaccharides and nucleotides, which help to promote healthy gut and immune function.
Breastmilk contains other bioactive factors that can help digestion and absorption of nutrients. For example, there are enzymes in breastmilk itself that help a baby to digest breastmilk fully and hormones that act as messengers by carrying signals between body cells. There are also proteins in breastmilk that stimulate the development of a baby’s intestinal lining (epidermal growth factors) and improve vitamin and mineral availability (lactoferrin), so that he or she is better able to digest and absorb nutrients and are less easily infected by foreign proteins. There are also many other bioactive factors unique to human milk, which cannot be replicated in infant formula because of its complexity
Breastmilk has a high water content and supplies enough water to keep your baby hydrated. So breastfed infants do not need extra fluids even in hot weather, provided they have access to the breast.
