Introduction to Breast-Feeding

Breast-feeding is a personal decision a mother needs to make carefully, taking full into account the benefits and burdens it will bring to both mother and baby.  Breast-feeding offers many benefits.  It helps babies get the proper nutrition and can help mothers recover from pregnancy and delivery.  Importantly, breast-feeding can promote a “bond” between mother and baby.  It is estimated that approximately 62% of mothers breast-feed their children.  Expecting mothers planning to nurse should discuss breast-feeding with a physician, nurse, or certified lactation consultant before giving birth.  A healthy baby can benefit from breast milk, bottled milk or a combination of the two. 

Main Menu:

• Physical Breast Changes During Pregnancy and Nursing
• Benefits and Risks to Breast-Feeding
• Breast Engorgement (swelling)
• Breast Mastitis (infection)
• Common Breast-Feeding Problems
• Additional Resources on Breast-Feeding 

Physical Breast Changes During Pregnancy and Nursing

During pregnancy, the breasts increase in size and become more tender, especially in the first half of pregnancy.  The most rapid period of breast growth is during the first eight weeks of pregnancy.  As the pregnancy progresses, the breasts become firmer and more nodular to prepare for lactation.  The Montgomery’s gland surrounding the areola (the pigmented region around the nipple) becomes darker and more prominent, and the areola itself darkens.  The nipples also become larger and more erect as they prepare for milk production.  The blood vessels within the breasts enlarge as surges of estrogen stimulate the growth of the ducts and surges of progesterone cause the glandular tissue to expand.  Prolactin, a hormone produced by the pituitary gland, starts the growth of the mammary glands and triggers production of milk (lactation).

After childbirth, estrogen and progesterone levels decrease and the production of prolactin declines.  The breasts will usually begin to produce milk three to five days after a woman has given birth.  During these few days before milk is produced, the body produces colostrum, a liquid substance that contains antibodies to help protect the infant against infections.  Some physicians believe that colostrum also decreases an infant's chances of developing asthma and other allergies.  Within a few days, the infant's own immune system will develop and he or she will not need colostrum.

The other hormone responsible for milk production, oxytocin, triggers the delivery of milk that prolactin has produced.  When an infant suckles at the mother’s breast, it brings milk out of the nipples.  This suction signals the body to make more milk (using prolactin) and deliver more milk (using oxytocin).   The body also produces a variety of other hormones (insulin, thyroid, cortisol) that are useful to the infant.  A woman’s body will continue to produce milk until she stops breast-feeding, and even then, it may take several months for milk production to completely stop.

Benefits and Risk of Breast-Feeding

The American Academy of Pediatricians and the National Association of Pedriatic Nurses Associates and Practitioners recommend breast-feeding as much as possible during the baby’s first year.  Breast milk is extremely nutritious and contains carbohydrates, proteins, and fats essential for a baby’s health.  Breast milk also contains antibodies that help prevent infections and allergies.

Studies have shown that breast-feeding may help protect against infant ear infections, allergies, diarrhea, eczema, bacterial meningitis, and other serious illnesses.  Research has also shown that breast-feeding reduces infant anemia (iron deficiency in the blood) and stomach or intestinal infections. 

Breast-feeding also offers benefits to nursing mothers.   Breast-feeding releases hormones which cause the uterus to shrink after delivery and also decreases bleeding.  Mothers who breast-feed typically have an easier time losing weight after pregnancy.  According to the American Academy of Pediatrics, breast-feeding also helps build a woman’s bone mineral density and helps prevent osteoporosis after menopause.

While most mothers are able to breast-feed, in some cases, breast-feeding is not possible.  Infant problems that may complicate or prevent breast-feeding include:

• Premature birth or small size at birth
• Birth defects such as a cleft lip or cleft palate
• Digestive problems such as breast milk jaundice (a liver disease caused by a mother's breast milk) or galactosemia (milk intolerance)
• Problems with sucking
• Frail or weak physical condition

Certain conditions or diseases may also prevent a woman from breast-feeding.  Breast cancer, certain breast infections, or another type of cancer may prevent a woman from breast-feeding her baby.  Women who are HIV positive, have AIDS, have heart disease, are malnutritioned, or have untreated tuberculosis may be recommended not to breast-feed.  Sometimes, previous radiation therapy or surgery may complicate breast-feeding.   In rare cases, women do not have enough milk to breast-feed.  Click here to learn more about breast cancer and breast abnormalities during pregnancy and lactation.

If a mother does decide to breast-feed her children, she should understand that breast-feeding is a major responsibility that requires her to maintain excellent nutrition and health.  Women who breast-feed should eat well-balanced, nutritious meals.  Generous portions of whole grain breads and cereals, fruits and vegetables, and dairy products with an abundance of calcium are recommended.  Most physicians agree that it is safe for breast-feeding mothers to consume small amounts of caffeine (equivalent to one to two cups of coffee per day), though larger amounts of caffeine may interfere with a baby’s sleep or cause him or her to become fussy. 

Alcohol should be avoided by breast-feeding mothers because it can be passed through the breast milk to the baby.  An occasional drink (no more than two ounces of alcohol) is probably safe but women should ask their physicians before consuming any alcohol or over the counter medications, including Tylenol. 

Side effects or complications of breast-feeding may include:

• Sore nipples
• Breast swelling (engorgement)  
• Fatigue
• Poor let-down reflex (milk-ejection reflex): a sometimes stinging or painful sensation while the milk is being expelled
• Blocked milk ducts
• Mastitis (breast infection)

Additional References and Resources

• The American Academy of Pediatrics provides information on breast-feeding at http://www.aap.org/
• To learn more about breast engorgement (swelling), please visit http://www.imaginis.com/breasthealth/breastfeeding/engorgement.asp
• To learn more about breast mastitis, please visit http://www.imaginis.com/breasthealth/breastfeeding/mastitis.asp
• To learn more about common breast-feeding problems, please visit http://www.imaginis.com/breasthealth/breastfeeding/problems.asp

Updated: June 29, 2008