Updated 22 June 2017

The benefits of breastfeeding to babies are no secret. The risks to infants of not being breastfed are less often reported, as are the advantages to mothers themselves and the disadvantages to mothers still less so. Women need to be content and well to be up to the job of mothering. When they are deciding how they want to feed their babies, mothers should be entitled to good information that includes what’s in it for them, free from misleading commercial promotion.

Advantages

Christina Simantiri

We all know breastfeeding is good for babies. It’s what a baby expects and it costs nothing. Human milk is tailor made nutrition, changing in composition from hour to hour in direct response to your baby’s needs and strengthening immune systems. Formula-fed babies suffer from more illnesses than do breastfed babies and their mothers are similarly disadvantaged.

How often do we hear about the effects of infant feeding choice that exist for a mother’s short and long-term health? The reporting of these ‘selfish’ benefits is often limited to the perk of speedier weight loss postnatally for the breastfeeding mother. Discussion of the emotional pluses, as well as other physical ones, tends to focus primarily on the baby, and the ease of bonding with a more settled child.

Mothers want what’s best for their babies, whose needs will come first. But painting a one-sided picture of breastfeeding as an ideal gold standard, a manifestation of perfection, means many mothers think it’s an unattainable ideal rather than a biological norm, i.e. something that is simply meant to happen. And what’s more, such an image makes it looks like all give and no take, which is very far from the truth. We are designed, like all mammals, to breastfeed and not doing so may have far-reaching consequences not only for babies but their mothers too.

Who tells mothers?

Following birth, immediate skin-to-skin contact and the baby’s suckling release oxytocin from the mother’s pituitary gland. This hormone signals the breasts to let down milk to the baby and simultaneously produces contractions in the uterus to expel the placenta naturally, helping prevent haemorrhage and promoting uterine involution. What does this mean with regard to a mother’s choice? When she has just given birth, if she chooses not to breastfeed she will be at risk of losing more blood and her womb will return to its normal size more slowly.

Belle Verdiglione

As long as a mother breastfeeds without substituting formula, food, or dummies for feedings, the return of her menstrual periods is delayed. Why does no one tell women that? As natural family planning for the first six months, breastfeeding according to these criteria is considered up to 99% effective when used correctly (Kennedy et al., 1992). Lactational amenorrhea is variable, with some women reporting their first postpartum menses as late as 42 months. I enjoyed 24 months with no periods following the birth of each of my three children. That alone was worth the effort expended on breastfeeding.

Natural child spacing ensures both the optimal survival of each child and its mother’s physical recovery between pregnancies. It gives a mother precious time to devote to each new baby. In contrast, the formula-feeding mother requires contraception within six weeks of the birth.

The amount of iron a mother’s body uses in milk production is much less than the amount she would lose from menstrual bleeding, increasing the risk of anaemia for the mother who does not breastfeed.

Breast cancer

Bronwyn and Ruby by Lisa Trocchi

The suppression of a woman’s menstrual cycle by exclusive breastfeeding reduces her lifetime exposure to oestrogen, which ‘feeds’ cancers.

The research on this is particularly convincing. In 2009, The American Institute for Cancer Research (a member of the International Agency for Research on Cancer, a part of the World Health Organization) released the largest review of research into lifestyle and breast cancer ever conducted, which reinforced previous findings that women can reduce their risk by maintaining a healthy weight, being physically active, drinking less alcohol, and breastfeeding their children.

In an eight-year study of over 60,000 women who had given birth, having breastfed at all provided up to a 59% reduction in the risk of developing pre-menopausal breast cancer in women with a family history of the disease (Stuebe et al., 2009). That means, for women with a family history of breast cancer, breastfeeding can reduce the odds of developing pre-menopausal breast cancer by more than half.

Another meta-study (compiling data from 47 smaller studies) concluded that a woman who breastfed for 12 months in her life reduced her risk of developing breast cancer by 4.3%. This benefit can be multiplied as a mother breastfeeds one child or several children. For example, a mother who has two children and breastfeeds each for two years can realize a 17.2% reduction in her risk of developing breast cancer later in her life (Collaborative Group on Hormonal Factors in Breast Cancer 2002).

The cumulative protective effect of lactation is one explanation for why developed countries, whose mothers breastfeed for shorter durations (or not at all) and have fewer children in their lifetimes, have higher rates of breast cancer.

A meta-analysis (Islami et al., 2015) showed a protective effect of ever breastfeeding against hormone receptor-negative breast cancers, which are more common in younger women and generally have a poorer prognosis than other subtypes of breast cancer.

Lööf-Johanson et al., 2016 concluded that a total breastfeeding history >6 months and pregnancy are associated with both greater overall and breast cancer-specific survival for women diagnosed with breast cancer, having lived long enough for other causes of death to contribute substantially to mortality.

Breastfeeding also lowers a mother’s risk of developing other cancers including ovarian, uterine, and endometrial (Cramer 2012). An international study, led by Australian researchers at the QIMR Berghofer Medical Research Institute, has just (May 2017) found women who breastfed at least one child for nine months had an 11 per cent lower risk of developing uterine cancer compared to those who had never breastfed. The researchers examined data from more than 26,000 mothers and found a woman who breastfed two children for nine months each had around a 22 per cent lower risk of uterine cancer than a woman who had never breastfed her children.

If a mother does not breastfeed, it follows that she increases her risk of cancer.

Fat

Esther Edith

Production of milk is an active metabolic process, requiring the use of calories. Like any biological process, this varies from person to person, but if a mother exercises and eats a healthy diet, nature intends her to lose the extra weight she puts on during pregnancy over the few years it intends her baby to get breast milk.

The reduction in BMI associated with just six months’ breastfeeding could importantly reduce women’s risk of obesity-related disease and their costs as they age (Bobrow et al., 2013).

The findings of one study suggest that women who breastfeed have reduced amounts of abdominal fat, even decades later. Middle-aged women who consistently breastfed their children had waist circumferences that were an average of 2.6 inches smaller than women who had never breastfed (McClure et al., 2010). Since the tummy is the least healthy place for women to store fat, this is a compelling incentive to breastfeed.

Breast shape, size, and looks are altered by pregnancy and age, not breastfeeding. An entertaining book dispelling this myth is Saggy Boobs by Valerie Finigan, Pinter & Martin 2009.

A mother who does not breastfeed is at a greater risk of carrying more weight than is good for her.

Diabetes

Not breastfeeding may have persistent unfavourable effects on women’s cardiometabolic health, which is however good news for breastfeeding diabetics (Gunderson et al., 2010) and an important consideration for all since heart attacks are the leading cause of death in women. The study, however, puts it the other way round, i.e. that breastfeeding may have favourable effects. When you look at nearly all the research studies, it is the benefits provided by breastfeeding that are recorded rather than the risks mothers run by not breastfeeding. This is interesting and perhaps something that researchers should be aware of,  because they start from the assumption that formula-feeding is the norm, which, of course, from a biological perspective it should not be. 

when you look at nearly all the research studies, it is the benefits provided by breastfeeding that are recorded rather than the risks mothers run by not breastfeeding

Breastfeeding substantially reduces the risk of type 2 diabetes in later life. (Liu et al., 2010).  

Researchers (Gunderson et al., 2015) evaluated nearly 1000 mothers from diverse backgrounds who had developed gestational diabetes during their pregnancies and monitored them closely for two years after the birth. Nearly 12% had gone on to develop type 2 diabetes. Those who breastfed for more than ten months cut their risk of diabetes diagnosis by almost 60% in the two years they were followed. Of the women who only breastfed and used no formula for the first two months of the baby’s life, 8% developed diabetes, compared with 18% of the mothers who did not breastfeed and only used formula.

Heart attack and stroke

Mothers who breastfeed may reduce their risk of having a heart attack or stroke later in life, a new study has found. After adjusting the results for other risk factors, including smoking, high blood pressure and physical activity, they found mothers who breastfed their babies had a 9 per cent lower risk of heart disease and 8 per cent lower risk of stroke than mothers who never breastfed. The longer each woman breastfed her baby, the more their risk of cardiovascular disease appeared to reduce. Each additional six months of breastfeeding per baby was linked to a four per cent lower risk of heart disease and a three per cent lower risk of stroke.

And among mothers who breastfed their babies for two years or more, heart disease risk was 18 per cent lower and stroke risk was 17 per cent lower than among mothers who never breastfed.

Bones

adriana mesec maj

Calcium is necessary in the production of milk. Because women lose calcium while lactating, many assume an increased risk of osteoporosis for women who breastfed. This is controversial.

A systematic review and meta-analysis (Chowdhury et al., 2015) supports the hypothesis that breastfeeding is protective against breast and ovarian carcinoma, and exclusive breastfeeding and predominant breastfeeding increase the duration of lactational amenorrhoea. There is evidence that breastfeeding reduces the risk of type 2 diabetes. However, an association between breastfeeding and bone mineral density or postpartum weight change was not evident.

Wiklund et al., 2012 found that lactation is associated with greater maternal bone size and bone strength later in life.

Women who breastfed had higher adjusted total body bone mineral content, total hip bone mineral density, and lower fat mass than did parous non-breastfeeders (Paton et al., 2003). Chantry et al., 2004 concluded that breastfeeding may be protective to the bone health of adolescent mothers.

Women who had breastfed for 13 months or longer were half as likely to develop rheumatoid arthritis as those who had never breastfed. Those who breastfed for between one and 12 months had a 25% decreased risk (Pikwer et al., 2008).

Yazici et al., 2011 found that changes of bone metabolism during lactation had no effect on postmenopausal bone mineral density. Consequently, it could be suggested that long breastfeeding duration is not a risk factor for low bone mass later in life.

Baby blues

As someone with an anxious frame of mind, my years breastfeeding stand out for me, in spite of the challenges of parenting young children, as the calmest. Breastfeeding is pleasurable: it’s a great biological design. “Breastfeeding does not deplete mothers, nor does it cause depression,” says health psychologist Kathleen Kendall-Tackett.

Anna Bondarieva

Breastfeeding mothers exhibit a less intense response to adrenaline (Altemus et al.,1995). Breastfeeding compels a mother to relax. For a start she is sitting or lying down. With an increase in maternal levels of natural opiates during lactation, the release of oxytocin (the hormone of love) followed by a release of prolactin (the milk-making and calming hormone), there comes a letting go, followed by a blissful serenity that helps her slow down to adopt this new pace of life, to cope and enjoy mothering. All this is quite apart from the personal satisfaction and peace of mind a mother may have from doing what is best for her child.

Breastfeeding might well protect against negative moods and stress. Breastfeeding mothers had more positive moods, reported more positive events, and perceived less stress than formula-feeders (Groër, 2005).

To make her life easier, a mother will often have her baby in her arms and babies who are carried cry and fuss less (Hunziker et al., 1986).

sleeping-like-a-baby
Adriana mesec maj

Exclusively breastfeeding mothers appear to get more sleep than their mixed- and exclusively formula-feeding counterparts (Kendall-Tackett, Cong, & Hale, 2011). Maintenance of breastfeeding, as well as deep restorative sleep stages, may be greatly compromised for new mothers who cope with infant feedings by supplementing in an effort to get more sleep. Advising women to avoid nighttime breastfeeding to lessen their risk of depression is unwise. In fact, if women follow this advice, it may actually increase their risk of depression.

A mother who feels that breastfeeding is the only thing that is working well in her life does well to continue if she chooses to take medication to treat her depression. Most antidepressants prescribed nowadays are compatible with breastfeeding, though not all those prescribing them are aware of this.

Alzheimer’s

Mothers who breastfeed may have a decreased risk of Alzheimer’s disease in later life (Fox et al., 2013). The link may be down to breastfeeding’s action in restoring insulin sensitivity and glucose tolerance, which is significantly reduced during pregnancy. More research is needed to investigate the relationship between breastfeeding physiology and cognitive health.

The above list of advantages and disadvantages is not comprehensive. Talk to any mother who has breastfed her child comfortably and she will tell you particular reasons that made the experience especially important for her.

From a mother’s perspective, what all this illustrates is that breastfeeding is a precious gift she gives to herself as well as to her baby and that mothers who do not breastfeed are not reaping those same rewards.

References

Altemus, M., Deuster, P, Galliven, E., Carter, C., & Gold, P. (1995). Suppression of hypothalmic-pituitary-adrenal axis responses to stress in lactating women. J Clin Endocrinol Metab 80: 2954-2959.

Bobrow, K., Quigley, M., Green, J., Reeves, G., & Beral, V. (2013). Persistent effects of women’s parity and breastfeeding patterns on their body mass index: results from the Million Women Study. International Journal of Obesity (2005)37(5), 712–717. http://doi.org/10.1038/ijo.2012.76

Chantry, C. et al. (2004). Lactation Among Adolescent Mothers and Subsequent Bone Mineral Density Arch Pediatr Adolesc Med. 158:650-656.

Chowdhury, R., Sinha, B., Sankar, M., Taneja, S., Bhandari, N., Rollins, N., … Martines, J. (2015). Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatrica (Oslo, Norway : 1992), 104(Suppl 467), 96–113. http://doi.org/10.1111/apa.13102.

Collaborative Group on Hormonal Factors in Breast Cancer (2002) Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet 360, 187–95.

Cramer, D. (2012). The Epidemiology of Endometrial and Ovarian Cancer. Hematology/Oncology Clinics of North America, 26(1), 1–12. http://doi.org/10.1016/j.hoc.2011.10.009

Doan, T., Gardiner, A., Gay, C. et al. (2007). Breastfeeding increases sleep duration of new parents. Journal of Perinatal & Neonatal Nursing 21(3), 200–206.

Dørheim, S., Bondevik, G., Eberhard-Gran, M., & Bjorvatn, B. (2009). Sleep and Depression in Postpartum Women: A Population-Based Study. Sleep 32(7), 847–855.

Fox, M., Berzuini, C., Knapp, L. (2013). Maternal Breastfeeding History and Alzheimer’s Disease Risk. Journal of Alzheimer’s Disease DOI 10.3233/JAD-130152.

Freudenheim, J., Marshall, J., Graham, S. et al., (1994) Exposure to breastmilk in infancy and the risk of breast cancer Epidemiology 5, 324-331.

Groër, M. (2005). Differences Between Exclusive Breastfeeders, Formula-Feeders, and Controls: A Study of Stress, Mood, and Endocrine Variables. Biological Research For Nursing 7: 106-117

Gunderson, E et al (2010). Duration of lactation and incidence of the metabolic syndrome in women of reproductive age according to gestational diabetes mellitus status: a 20-Year prospective study in CARDIA (Coronary Artery Risk Development in Young Adults). Diabetes 59(2):495-504.

Gunderson, E. (2014). Impact of Breastfeeding on Maternal Metabolism: Implications for Women with Gestational Diabetes. Current Diabetes Reports14(2), 460. http://doi.org/10.1007/s11892-013-0460-2.

Gwinn, M., et al. (1990). Pregnancy, breast feeding, and oral contraceptives and the risk of epithelial ovarian cancer. J Clin Epidemiol 43: 559-68

Hunziker, U., Barr, R. (1986). Increased carrying reduces infant crying: a randomized controlled trial Pediatrics 77(5):641–8

Islami, F., Liu, Y., Jemal, A., Zhou, J., Weiderpass, E., Colditz, G., … Weiss, M. (2015). Breastfeeding and breast cancer risk by receptor status—a systematic review and meta-analysis. Annals of Oncology, 26(12), 2398–2407. http://doi.org/10.1093/annonc/mdv379

Kendall-Tackett, K., Cong, Z., & Hale, T. (2011). The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation, 2(2), 22–26.

Kennedy, K., Visness C (1992) Contraceptive efficacy of lactational amenorrhoea Lancet 25;339(8787):227–30

Liu, B., Jorm, L., & Banks, E. (2010). Parity, Breastfeeding and the Subsequent Risk of maternal Type 2 diabetes. Diabetes Care.33(6): 1239–41.

Lööf-Johanson, M., Brudin, L., Sundquist, M., & Rudebeck C. (2016). Breastfeeding associated with reduced mortality in women with breast cancer. Breastfeeding Medicine, 11(6): 321-327

McClure, C. & Goldberg, N. (2010). Presentation, American Heart Association’s Cardiovascular Disease Epidemiology and Prevention Annual Conference, San Francisco.

Paton, L. et al (2003). Pregnancy and lactation have no long-term deleterious effect on measures of bone mineral in healthy women: a twin study. Am J Clin Nut 77: 707–14.

Peters, S,  Yang, L., et al. (2017). Breastfeeding and the risk of maternal cardiovascular disease: a prospective study of 300 000 Chinese women. 

 

Pikwer, M,, Bergström, U,, Nilsson, J.,  et al (2008). Breast-feeding, but not oral contraceptives, is associated with a reduced risk of rheumatoid arthritis. Ann Rheum Dis. ard.2007.084707v1

Salari, P., & Abdollahi, M. (2014). The Influence of Pregnancy and Lactation on Maternal Bone Health: A Systematic Review. Journal of Family & Reproductive Health, 8(4), 135–148.

Stuebe, A., Willet, W., Xue, F., et al (2009). Lactation and incidence of premenopausal breast cancer: a longitudinal study Archives of Internal Medicine 169, 1364–1371.

Wiklund, P,, Xu ,L, Wang, Q. et al. (2012) Lactation is associated with greater maternal bone size and bone strength later in life. Osteoporos Int. (2012). Jul;23(7):1939-45. doi: 10.1007/s00198-011-1790-z. Epub 2011 Sep 17.

World Cancer Research Fund and American Institute for Cancer Research. (2007). Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective Washington, DC: AICR, 2009.

Yazici, S., Korkmaz, U., Erkan, M., Korkmaz, N., Erdem Baki, A., Alçelik, A., … Ataoğlu, S. (2011). The effect of breast-feeding duration on bone mineral density in postmenopausal Turkish women: a population-based study. Archives of Medical Science: AMS, 7(3), 486–492. http://doi.org/10.5114/aoms.2011.23416

Zinaman, M., Hughes, V., Queenan, J. et al (1992). Acute prolactin and oxytocin responses and milk yield to infant suckling and artificial methods of expression in lactating women. Pediatrics 89 (3): 437–40.

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