Spilled Milk: An Objective Profiling of Baby’s Milk Options – Part 1: Breast Milk

I find it very hard to find articles that are both well-researched and objective regarding the mixed vs exclusive breast vs exclusive formula debate in the online mommy community. Most of the time, even a well-researched article will weigh itself more heavily in favor of one choice over the others (and so also only include sources that come from the same school of thought – providing an imbalanced argument, regardless of how useful the information is). As such, this series will be a balanced profiling of different milk options based on objective, medically and scientifically based sources. I will mostly be compiling research with regards to what these choices are, and will leave the rest to my readers to decide for themselves.

Note that at the end of this series, I will be creating a handy little chart comparing all the options for you!

breastfeeding

Enter a caption Matt Daigle for this International Breastfeeding Symbol

 

Breastmilk

You hear it all the time, and everywhere “breastmilk is best for babies” (sometimes followed by “up to 2 years”). In the Philippines, this is the disclaimer at the end of every single baby/toddler formula commercial. And it is such for a reason: Breastmilk is most often seen as the “superior” choice – the healthiest, freshest, most nutrient-packed choice. The WHO (World Health Organization, not the band…), for example, suggests babies should be exclusively breastfed up to 6 months, for optimal (long-term) health benefits. For the purposes of this post, we will look at the following with regards to breastmilk:

  1. Composition 
  2. Top 5 Benefits of Breast Milk
  3. Pros and cons of direct feeding
  4. Pros and cons of exclusive pumping and/or supplementing with donated milk

#1 CompositionBreastmilk comes in what I’m calling “stages.” In each “stage,” its makeup changes.

  1. Stage 1: Colostrum
    • This is the “first liquid”. It’s yellow in color, thicker than regular milk, and produced the first few days postpartum. It’s made up of antibodies, “immunologic components such as secretory IgA, lactoferrin, leukocytes, as well as developmental factors such as epidermal growth factor1. The components in colostrum are said to expedite cell growth, and strengthen the immune system. Epidermal Growth Factor (EGF), for example, is a strong protein that facilitates healing, skin/tissue/intestinal growth, and more.
    • According to the US Department of Health & Human Services, colostrum has low lactose content, and is higher in sodium, chloride, and magnesium. These components prove that its purpose is primarily immunological – to get baby hydrated, immunized, and ready for the outside world!
  2. Stage 2: Transitional Milk
    • When your milk starts to come in (lactogenesis II), you will observe that the colostrum is replaced with a thinner substance. It may, for up to a few weeks, retain a yellow color, though. This milk is “transitional”. It has many of the same properties as colostrum, but also begins exhibiting characteristics of more mature milk (increased lactose, and so on). This milk is continuously undergoing dramatic changes as it comes.
  3. Stage 3: Mature Milk
    • This is the point at which milk is called “Human Milk,” and typically occurs from week 5 or 6 postpartum onward. This milk is even more difficult to characterize than the two before it as it depends as well on mom’s height, weight, diet, lifestyle. However, there is enough understanding of the general components all human milk has, which include the following:
      • Proteins (both whey and casein) and Growth Factors
        • Proteins and growth factors are responsible for facilitating and regulating growth, as well as: enhancing cell growth and cell repair (ex: healing wounds, strengthening intestines, etc), facilitating digestive processes (and the creation of digestive enzymes integral to those), providing supplemental oxygen (MIND-BLOWING what fits in these boobies, I tell you), and strengthening the survival and outgrowth of brain cells and neurons.*
      • Lactose (which, despite being a sugar, also supports brain development, and is a prebiotic – aka stimulates gut health)
      • Compounds containing nitrogen (including: creatine, amino acids, and nucleotides; which build muscles)
      • Fat high in palmitic acids (which have mild antioxidant properties) and oleic acids (which facilitate wound healing, and is known to have a beneficial effect on autoimmune diseases, cancer, and so forth)2
      • Carbohydrates and sugars (in the form of lactose, for example)
      • Micronutrients
        • Vitamins A, B1, B2, B6, B12, D, and iodine (which, it should be noted, are affected by diet, and is one of the reasons mothers are encouraged to continue taking their Prenatal Vitamins)

Now, on the Top 5 Benefits of feeding breastmilk exclusively to babies for at least the first 6 months*:3 

  1. General health and fitness of baby (“infant morbidity”)
    • Because of human milk’s “super composition” (as seen above), exclusively breastfed babies have lower risk of both infectious and chronic disease incidence (aka they don’t get sick as much, and they have a better chance of not experiencing: asthma, obesity, cancer, diarrhea, and more)
  2. Life expectancy of baby (“infant mortality”)
    • Related to #1: there’s a linkage between lower risk of SIDS or even terminal illness later in life, and breastfeeding
  3. Mommy Health
    • Immediate latching post-delivery stimulates oxytocin release, which contracts the uterus and helps it shrink
    • Breastfeeding delays the restart of the menstruation cycle (which, let’s face it, is pretty awesome…haha)
    • There are links between breastfeeding and lower risk of breast cancer
  4. Child development
    • This one is still a bit hazy for me, but research suggests that despite parental (particularly maternal) intelligence, babies who are breastfed score higher on intelligence tests (but don’t start your Tiger Mommy days fresh out the womb! Breastfeeding your baby is not going to be the single magic touch to make them successful, intellectual contributors to society in their adulthood.)
  5. Financial benefit
    • Well, it’s cheap. Particularly when you are direct latching for extended periods, you save plenty on not just formula, but bottle paraphernalia too!

So what are the pros and cons for direct feeding? This is where I will diverge a bit and speak a little from experience as I think in addition to scientific “factors” here, there are practical/experiential ones that come into place as well.

First, the pros: 

  1. Direct latching is a wonderful bonding experience with your baby triggers all the right “affection” hormones
  2. Some research suggests direct latching also encourages an exchange of other bodily fluids between mom and baby that tell the mother’s breasts what to produce more of when, say, baby is lower in immunity and coming down with a cold, for example
  3. Baby gets to regulate his or her own diet (that is, eat exactly as much as he or she needs to be satiated), preventing issues of over-feeding
  4. It’s cheap and lightweight — direct latching mamas have the benefit of not needing to carry so much along with them for a short day out (no clunky bottles and coolers with milk, and so on)

And the cons…

  1. You don’t really know how much baby is getting at one time so it’s difficult to gauge if it is in fact enough. This is particularly problematic in the first few weeks of life when babies are content to just sleep if they get too tired trying to drink. We ran into this problem and our baby was dehydrated for a couple of days. We had to supplement with both pumped milk and formula for a whole week just to make sure we were all clear. I’ve even heard this problem cause much more serious issues with other babies whose mothers did not notice the dehydration but whose milk had yet to come in, causing long-term health defects in the baby.
  2. The movement for support of direct latching in many “Baby Friendly Hospitals” has become a source of stress and unnecessary pressure for already tired moms who may even be suffering other issues such as PPD (postpartum depression).
  3. Some women find it too painful to bear – particularly if baby’s palate or tongue are shaped differently, or mom’s nipples are inverted. A lactation consultant can help, but can sometimes be too expensive or else unavailable depending where you are in the world.

Women who experience the cons and for those reasons, or many others, might want to try exclusive pumping instead, can of course do so and still achieve the goal of feeding human milk to their little ones exclusively for at least the first 6 months. However, it’s good to be aware of the pros and cons of that style as well:

Pros of exclusive pumping/exclusive bottle-feeding of breastmilk:

  1. Full control and knowledge of what goes into your baby (you can monitor how much baby is eating, and you never have to worry about baby getting dehydrated)
  2. If you’re a pump-and-store (fridge/freezer) mama, then the good news is that the important proteins in human milk that accelerate cell growth, healing, and brain development remain intact so your baby’s getting some of the best benefits of human milk even if it’s coming from a bottle
  3. Freedom to go back to work – particularly useful if this was something you really wanted to do, or something your family really needs

exclussive pumping

Cons of exclusive pumping/exclusive bottle-feeding of breastmilk:

  1. You miss out on that initial bonding experience (but to be fair, pumping-and-feeding is still a bonding opportunity as well. Any mommy who’s pumped in their lives knows that is not an easy task) 
  2. As with anything that isn’t served fresh-on-the-spot there’s risk of contamination. (This risk can be alleviated by safe, hygienic pumping and storage practice)
  3. Clunky and high maintenance: you lug a lot around with you everywhere!
  4. To say pumping and direct feeding yield exactly the same amount of benefits is misleading. It’s likely, based on the research, that your baby will get more of the benefits of fresh direct latching than any other form of human milk consumption. Particularly because, despite #2 in the Pros above, other key elements in breast milk that are incredibly beneficial often diminish in the storing process (such as immunological cells and lipids)


A little personal anecdote: 
To end this, I’d like to share a summary of our personal experience. Our baby is now 8.5 months old and he was primarily exclusively breastfed for the first 6 months (save emergencies that warranted up to 3 formula bottles a week when they’d happen). We direct latched 90% of the time and gave a bottle 10% of the time until he was 4 months old. Then I had to go back to work and we transitioned him to bottle feeding in the day and direct latching in the night. After 1 month of that, he started refusing the breast and we went to exclusively bottle feeding. Since he’s turned 6 months, my own breastmilk supply has suffered (from the stress and schedules of work, mostly), so we’ve introduced a little more formula along with his solids now too so he is a truly mixed fed baby. In his life so far, he has only had a cold and cough once (despite frequent air travel), and is a hardy, good-natured little boy hitting all his milestones (praise God!). I am sharing this story to basically let all you mamas know out there: do what is best for you and your baby. Examine your options and make your own choices. At the end of the day, you are the parent. And you need to arm yourself with the right information, and then trust yourself to make the right decision thereafter. As good as it is to exclusively breastfeed your babies, sometimes that’s not possible. So just do your best, and don’t beat yourself up for the occasional compromises you’re going to have to make for the benefit of your family. While breastmilk is constantly touted as superior, I was fed formula milk exclusively from 6-12 months, and I am fine. My mother was fed formula milk exclusively all the way, and she is also fine. Our babies will be fine as long as we make good, educated choices, and continue to do what’s best for them – not just with what we feed them, but beyond that too. 🙂  

Sources:

  1. Ballard O, Morlow A. “Human Milk Composition: Nutrients and Bioactive Factors.” Pediatric Clinics of North America, Volume 60, Issue 1, Pages 49-74
  2. Sales-Campos H, Souza PR, Peghini BC, da Silva JS, Cardoso CR. “An overview of the modulatory effects of oleic acid in health and disease” Mini Rev Med Chem 2013 Feb;13(2):201-10
  3. Leon-Cava N, Lutter C, Ross J,  Martin L. Quantifying the benefits of breastfeeding: A summary of evidence. Pan American Health Organization. June 2002

Notes:

*There are quite a few, heavily jargony “growth factors.” Read about them here.
*”Exclusive Breastfeeding” 
still includes occasional formula supplementation in emergency settings (ie first week of life waiting for milk to come in, or a few bottles of formula a week in emergencies).

 

 

 

One thought on “Spilled Milk: An Objective Profiling of Baby’s Milk Options – Part 1: Breast Milk

  1. Pingback: 2016 In Review – foster & fit

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