CHAPTER 1 * * * Choosing to Breastfeed KEY POINTS Breastfeeding Virtually every mother can breastfeed. Breastfeeding: *is healthier for both mothers and babies than formula-­feeding. *promotes attachment between mom and baby. *gives your baby the best start in life. *is convenient. *is less expensive. *is something only you can do for your baby. The American Academy of Pediatrics recommends exclusive breastfeeding for about six months, and continued breastfeeding, after solids are added, at least through your child''s first birthday.

Congratulations--­you''re pregnant or perhaps contemplating pregnancy! Chances are you''re experiencing a flood of emotions and preparing for a new life with your baby. You are probably also pondering some decisions, both big and small. Where will the baby sleep? Will I stay at my job? Who will watch my baby if I go back to work? Among the most important decisions you''ll make is whether to breastfeed your new baby. The decision to breastfeed is intensely personal and one that has important ramifications for your baby''s health as well as yours. But like most women, you probably have questions about what breastfeeding entails, exactly how to nurse your child, and whether breastfeeding will fit into your lifestyle, schedule, and circumstances. Breastfeeding has both long-­ and short-­term benefits for both you and your infant, including preventing many illnesses and chronic diseases. Ultimately, only you will be able to determine whether breastfeeding is right for you, but the information in this book is designed to help you make that decision. DOES BREASTFEEDING MAKE SENSE FOR ME? The act of breastfeeding--­one of nature''s most rewarding and beneficial processes--­can sometimes seem intimidating when you face a host of other commitments and hear a great deal of conflicting advice.

In the following chapters, you will find clear answers to many of your questions, solutions to your problems, and information about the array of breastfeeding support services--­hospital nurses, lactation specialists, pediatricians, obstetricians, family physicians, and breastfeeding support groups--­that are in place to help mothers breastfeed their infants successfully. In addition, there are a number of resources available online for breastfeeding families. There has been an enormous amount of research demonstrating how beneficial breastfeeding is for babies. We now know that nursing your child not only strengthens the quality of your relationship with her but also improves her health, enhances her brain development, and provides her with precisely the type of nourishment she needs at each critical stage of her development. The benefits of human milk so greatly exceed that of any alternative method of infant feeding, in fact, that health organizations around the globe have united to promote this natural source of nutritional and emotional sustenance for babies. The World Health Organization (WHO), for example, encourages women to breastfeed exclusively for six months (nothing but human milk) and to continue to breastfeed for at least two years to take advantage of human milk''s ability to provide the best nutrition and protection against infection. Exclusive breastfeeding for about six months has also been recommended by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the Academy of Breastfeeding Medicine, and the Academy of Nutrition and Dietetics. Exclusive breastfeeding means no water, formula, other liquids, or solids.

Breastfeeding should then be continued at least through the child''s first birthday, and thereafter as long as mutually desired by the mother and baby. Complementary solids, often called "baby foods," should be introduced around six months of age. As you prepare for motherhood, you will want answers to all of your questions about breastfeeding. You will want to consider how it is possible to combine breastfeeding with work outside the home, how you can fully involve your partner in parenting a breastfed infant, and how to adjust if breastfeeding doesn''t begin smoothly. You will need to understand how breastfeeding works so you can feel assured that certain behaviors are normal or recognize any difficulties. Finally, you will want to find knowledgeable breastfeeding support services in your area. As pediatricians, we want to share all we know to help you reach your breastfeeding goals. With this guide, we will provide information, encouragement, and support as you learn this vital new skill.

We will show you how many millions of women--­working outside the home or not, married or not, first-­time or experienced mothers--­have provided the best start for their babies through breastfeeding, and how you can, too. DID MY MOTHER BREASTFEED? When you were an infant you may not have been breastfed, though your mother may have been, and your grandmother was even more likely to have been breastfed. Breastfeeding, like many other aspects of nurturing children, has passed in and out of fashion according to parental and societal trends and the accumulation of reliable research. Of course, few alternatives were available to mothers a century ago. In the early 1900s, the majority of American women breastfed their infants, and over half of babies were still being breastfed beyond the first year of life. Mothers who could not breastfeed, chose not to breastfeed, or weaned early used a wet nurse, fed animal milk to their babies, or fed mixtures of flour, rice, and water called "pap." The newborns'' chances of survival decreased significantly as a result. During the decades that followed, however, glass bottles and rubber nipples became more widely available and pasteurization and vitamin supplementation more commonplace.

As a result, alternatives to breastfeeding became more practical and prevalent, though almost nothing was known about how these artificial infant feedings affected children''s long-­term health and development. During World War II, as more women worked outside the home, formula-­feeding rose even more and continued to increase through the 1950s and 1960s. By 1966, only 18 percent of babies were being breastfed at the time they left the hospital, and this percentage dropped sharply soon after the babies arrived home. In the early 1970s in the United States, breastfeeding rates hit a record low. At about this time, however, medical research began to uncover a wealth of information about the advantages of mother''s milk for infant health and development. Scientists noted that formula-­fed babies were more prone to developing diseases. They suffered from more ear and respiratory infections, were more prone to diarrheal illnesses, and experienced more allergies. Such findings, along with the mid-­seventies movement toward a more natural childbirth and parenting experience, caused breastfeeding rates to begin to climb again.

In 1982, nearly 62 percent of newborns were fed their mother''s milk after birth. Among babies born in 2013, this number increased to more than 81 percent. Unfortunately, work conflicts and lack of support continue to cause many mothers to give up nursing quite early. Based upon the 2013 National Immunization Survey, only about 52 percent of American newborns were receiving any human milk by their sixth month, dropping to about 31 percent by their first birthday. Only 44 percent were exclusively breastfed for the first three months of life. More important, only 22 percent of infants were exclusively breastfed for the first six months, despite the fact that six months of exclusive breastfeeding is recommended by every major medical association. Studies show that while most mothers start out breastfeeding, many don''t reach their own breastfeeding goals, and too many babies start receiving formula even before they are discharged from the hospital. There are a variety of factors that contribute to this, including lack of knowledge, help, or resources.

This book will help you to be armed with the information you need to be successful and to make sure that your hospital, health care providers, family, and workplace can be your support system. Research continues to reveal the fascinating ways in which the content of human milk changes to suit the baby at every stage of development, continuing to provide precisely the developmental, psychological, and health benefits a baby needs through the first year and beyond. Today, mothers are not forced to choose between only two alternatives--­breastfeeding their babies or giving them formula. They may opt to breastfeed their babies directly; provide them with bottles of human milk that they have expressed and stored for later use; provide donated, processed human milk from a milk bank when their own milk production is insufficient or their milk cannot be used; or use commercially produced formula available in supermarkets and pharmacies as either a supplement to their own milk or a replacement for breastfeeding in the rare case that breastfeeding is not possible. The option you choose at any particular time will depend on your circumstances and the needs of you and your baby. However, before you make your decision, you owe it to your baby to learn how breastfeeding benefits you both, and the advantages and disadvantages of each option. While the best outcomes for health and well-­being result from exclusive breastfeeding, alternatives can also provide benefits. Consider the support services (lactation specialists, breastfeeding support groups, and online information), efficient aids to breastfeeding (breast pumps, human milk storage cont.