A few years ago I had the pleasure of attending a conference about the “Use of Human Milk and Breastfeeding Education for the Registered Nurse.” The speaker was Diane Spatz, RN PhD, an associate professor at the University of Pennsylvania and a clinical nurse specialist at the Children’s Hospital of Philadelphia. It was a fascinating day, and as usual, I learned a lot. Her most interesting lecture was her first one about the benefits of human milk. I thought I would pass this information along to all of you, as a reminder of the wonderful gift you are giving your baby!

Most women cite infection prevention as their number one reason for breastfeeding. Babies who are breastfeed have decreased incidence and severity of RSV, gastroenteritis, diarrhea, respiratory, ear and urinary tract infections. For premature babies, the benefits are life saving with a decrease in the incidence and severity of meningitis, blood infection, sepsis and necrotizing enterocolitis. ($200,000 is spent of each case of NEC alone!) These babies also have a decreased incidence of retinopathy of prematurity, SIDS, diabetes, and obesity. Their hospital stay is shorter and less expensive than formula fed preemies. Breastfeeding for these compromised babies is truly medicinal.

But do you know why that is? It is due to something called the “Enteromammary Pathway.” This is a maternal response in which anything the mom comes in contact with (microorganisms, food antigens etc.) travels thru her gut and lymphatic system causing antibodies to be produced that are then passed along thru her breast milk to protect her baby. It is for this reason that mothers of preemies are encouraged to touch everything their baby comes into contact with in the NICU. Their exposure to everything their baby is exposed to protects their baby from hospital borne illnesses.

In addition to the infection protection, breast milk has a biological specificity that is exactly what the human newborn needs. The fat content of breast milk accounts for half the calories and it adjusts throughout the feeding and the day. Amazingly, the fat content is 30% higher in mother’s who deliver preterm infants, because those babies need it! The DHA and ARA in breast milk (which have now been artificially added to formulas) enhance the babies’ visual acuity and brain maturation. Some fats are also anti-viral, anti-fungal and anti-bacterial. The lactose in breast milk enhances calcium absorption and is easily broken down to provide a constant nutrient flow to the brain. Other carbohydrates promote the growth of healthy bacteria in the gut and decrease pathogens by increasing the acidity. Protein in breast milk is low in quantity but high in quality and is primarily the easy to digest whey protein. It is also immunologic with proteins that breakdown infectious agents. Lastly, breast milk is full of antibodies, infection fighting white blood cells, hormones, vitamins and minerals that are essential for the general hydration and nutrition of your baby.

But you already knew all that didn’t you? Keep up the good work!

Mothers frequently ask me “When is the best time to give a bottle and how do we do it?” For many women, it is source of anxiety, but a necessity at some point or another. Fortunately, it is fairly easy if you do it in a controlled and timely fashion, rather than at three in the morning when you are desperate!

Obviously, my goal is to help mothers breastfeed successfully, whatever that means for them. If mothers need to give a bottle, I hope to help them give a bottle of expressed breast milk instead of formula. The most important thing to know about being able to breast and bottle feed, which many women need/want to do, is that it can be done. However, it can’t be done in the hospital, right from the get go. If you want to nurse, you have to spend the time getting breastfeeding off to a good start. This process usually takes about 3 to 4 weeks of exclusive nursing. If you do that, and nurse exclusively through the three week growth spurt, your milk supply will be well established. In addition, your baby will have learned how to nurse correctly and giving a bottle at this time will not “undo” that!

Early bottle introduction causes a host of problems for the breastfeeding family. First, these babies are usually given formula and too much of it. Babies who are nursing get only a small amount of colostrum (mother’s early milk) at each feeding, which is exactly what they need. Bottle fed babies tend to get 2-3 ounces of formula, which is much harder to digest. It prevents the meconium (baby’s first waste) from being passed quickly, suppresses their appetite and keeps them from feeding frequently, which they need to do to bring their mother’s milk in. In addition, hospital bottles have a standard size nipple, which is much smaller than a mother’s breast. Babies learn immediately to position their mouth incorrectly for breastfeeding when they are given this bottle. When they replicate that on their mom, it hurts!

So, the first few weeks should be about getting a good latch and getting your supply established. If you want to give expressed breast milk in a bottle when the time comes, you can also use this time to collect some milk to give later. There may be several opportunities for this in the early weeks. If you get engorged, you can pump just enough to make yourself comfortable, which may mean only pumping a half ounce! You may also have times when the baby takes only one side, falls into a milk coma and doesn’t take the other. In that case, pump the side he doesn’t take and save that milk. You can mix the milk from several different pumping sessions to make one bottle. When you collect a total of 3 ounces, stick it in the freezer, and you have milk for your first bottle!

Develop a plan for the first time you give your baby a bottle and have someone other than you do it. I like moms to leave the house and do something for themselves. Arrange for dinner with a friend, a haircut, or shopping to get some clothes that you fit into! The reason for this is that first of all, you probably need a little alone time after three weeks of exclusive nursing. In addition, if the baby sees, hears, or smells you, the baby may protest and wonder why you are not feeding him/her. And if the baby protests at all, the person with the bottle may quickly give up and pass the baby back to you!

It is best to time it so that you leave the house right before your baby is due to eat, and pump just before heading out the door. This gives you a few hours to do what you want, and you can nurse right when you get back. This pumped milk can be used immediately, if necessary, or goes into the freezer for the next time your baby gets a bottle. When your baby gets a bottle, it should be a bottle with a wide base and nipple, not a standard size. Thaw your frozen milk, pour it in, and have it at room temperature or a little warmer for the baby.

When done this way, bottle introduction is usually pretty uneventful. Be prepared for a mix of emotions when you come home and find out everything went fine, which is after all, what you want! Then make sure that the bottle is offered every few days, especially if you will be going back to work. If you do that, though your baby will always prefer you, he will take a bottle without difficulty when he needs to!