Monday, June 30, 2014

“ONE BOTTLE WON’T HURT” - How Mothers Lose Their Moral Compass

We’ve all heard the mantra “one bottle won’t hurt”. It’s the mating call of the disengaged health professional or well-meaning but ultimately misinformed relative. A study published last year even suggested that giving formula to babies can help relax mothers and increase the length of time they end up breastfeeding (The Telegraph 2013). This was a huge pat on the back for supplementing mommas - and there are plenty of them about. According to the U.S. Centers for Disease Control and Prevention, one-quarter of the babies born in America in 2009 were supplemented with infant formula by two days of age, and by three months, this had increased to nearly two-thirds. With this bottle-centric backdrop it should come as no surprise that when I posted the following meme on Facebook, there was a lot of panties taking residence in buttcracksville:

However, as I have explained previously (here), one bottle does in fact hurt. It can cause irrevocable damage to your baby’s immature digestive system. Even with this pertinent truth aside, one bottle is the starting klaxon of bona fide formula feeding. It is akin to putting yourself in a giant hamster ball, standing atop a steep hill, and leaning forward. The La Leche League has issued warnings detailing how small amounts of formula can lead to such entrapment. They say:

“Unnecessary supplements sabotage milk production by reducing milk removal and stretching out feeding intervals. Problems usually start with "just one bottle a day" or "just a few bottles a week," but the more supplements that are given, the more are needed because milk isn't made when it isn't removed. It becomes a slippery slope and bottle feeding eventually seems more convenient or the baby appears to like it better.”

To explain the skinny, it's time for a patronising mini science lesson: breastmilk contains something called the Feedback Inhibitor of Lactation (FIL). Its function is to reduce production when it seems the milk isn’t needed. The amount of FIL is dependent on the amount of milk in the breast. So, when you give your baby a bottle your milk-making cells will respond by slowing down. And it is surprisingly easy to fall into this trap.

Imagine, if you will, that you are exclusively breastfeeding and visit your family doctor for a routine check-up. Your doctor recommends that you switch completely to formula feeding immediately. His rationale is that you deserve a break, and formula feeding would provide this by enabling others to feed the baby, and besides, you've breastfed long enough in his opinion. There is no medical justification for having a break but with modern formula being ‘so safe and advanced’ the doctor declares, you’d be foolish not to. Chances are you would refuse. A break would be lovely but it’s not worth surrendering your breastfeeding relationship over. Of course, a few mothers would do it with persuasion, heck, some would even do it without persuasion, but most would tell the doctor where to stick his formula.

Now suppose the doctor lures you along more gradually. Suppose he recommends a minuscule amount, say 2 ounces of formula per day, just to take the edge off your sole feeding responsibility. Two measly ounces can’t hurt and you really could do with an extra 10 minutes to blow dry your hair every morning (plus, seeing your hubby tenderly nourishing your little one would be just soooooo keyyyyyute, a message brought to you by those oh so thoughtful formula companies). So you agree.

A few days later, the doctor tells you that as your baby is growing steadily she needs 4 ounces of formula per day to maintain her steady weight gain. Again, he argues that this is such a small and harmless amount. You’ve already given your baby 2 ounces each day and she’s fine. You see no reason why you shouldn’t give her 4 ounces. Then, you say to yourself, 5 ounces isn’t that much more than 4, and for that amount I could even have a shower in peace. A few days later, the doctor informs you that he is thrilled with your baby’s weight gain and instructs you to increase the feed to 6 ounces.

Where do you draw the line? When do you decide enough is enough? Will you keep going to a full bottle a day, two bottles, or even beyond that to complete formula feeding? When mothers are asked in advance how far they imagine they would go, almost no one would say they would go to complete formula feeding. But when they are actually in the situation, the vast majority of mothers go all the way, ditching the breast forever. In my book, aptly titled, 'Breast Intentions', I explore how women turn to formula to satisfy internal intentions even moreso than external pressures. If you glance back at the doctor scenario above, you can see how mothers' expectations and beliefs about what formula will do for them influences the rewards and behaviors associated with its use - thus giving formula an addictive potential. Mothers opt into formula feeding and thus opt out of breastfeeding by justifying each step as they go along. 2 ounces won’t harm; 4 isn’t much worse than 2; if I’ve given 4, why not 6? As they justify each step, they commit themselves further to formula. By the time they are administering a bottle or two, most mothers find it difficult to justify a sudden decision to surrender the bottle.

The easiest time to quit formula is before you start

It’s easy for a mother to tell herself that she’s not going to make a habit of using formula. But the easiest time to quit any bad habit is before you start. If you can’t give up the first ounce, you’ll never have it so easy again. Mothers who resist early on, questioning the validity of the doctor’s recommendation, are much less likely to become entrapped (Tavris and Aronson 2007).

Look, I’m telling you this because I’ve learnt the hard way, not because I’m one of those infallible sorts who wouldn’t know a bad habit if it bitchslapped them in the face. I fell into the formula trap with my first child (story here) and clawed myself back out of it. I’ve spoken to countless mothers who dabbled with the bottle only to fight with nipple confusion, diminished supply and the health issues inherent with formula use. And every time, every fricken time people!, they wished they’d never picked up that darn bottle in the first place.

Not all mothers are able to claw themselves out of the formula trap. Through a chain reaction of behaviour and subsequent self-justification they find themselves at a markedly different infant feeding destination to their original aspirations. This is what leads to the dramatic feelings of guilt and despair which choke their mothering experience. In one study for example, the most common reason for weaning at any age was a "perceived lack of supply". But it was revealed that these early weaners consistently introduced supplemental feedings in the first 2 weeks, whereas those mothers still nursing at 6 weeks gave no supplements at all. If that isn’t enough to convince you to step away from the bottle, I will leave you with some statistical truths:

  • “The highest level of breastfeeding problems is experienced by mothers using a combination of breast and formula feeding” (National Childbirth Trust).

  • “Infants still breastfeeding at 4 or 9 weeks were far more likely to have been unsupplemented than those no longer being breastfed” (Journal of Paediatrics).

  • “Supplementing with formula before 2 weeks is significantly likely to lead to termination of breastfeeding by 8 weeks” (Journal of Paediatrics).

  • “At four to six months most mothers who had given their baby milk other than breastmilk were mainly giving infant formula” (National Childbirth Trust).

  • “Mothers who supplement before 3 months are significantly more likely to discontinue breastfeeding before the first 12 months” (Journal of Public Health and Nutrition).

  • “Mothers who believed that the baby prefers formula were more likely to stop breastfeeding within the first 2 weeks postpartum” (Journal of Paediatrics).

  • “Combination feeding is associated with shorter overall breast-feeding duration” (Journal of Paediatrics).

  • “Use of supplementary formula has a negative influence on breastfeeding duration” (World Health Organization;Centers for Disease Control and Prevention).

  • “In infants given formula, as soon as regular formula feeds started, the breastfeeding frequency and suckling duration declined swiftly” (Journal of Paediatrics).

  • The list goes on...

In a nutshell: the trick of avoiding the formula trap is to be fully aware of it - recognize the potential habit before it has a chance to become established. That way you can take avoiding action, abstaining from buying formula “just in case” and staying clear of those who may attempt to sway you.

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Monday, June 23, 2014

First Facebook, Now Apple – Sexualizing Breastfeeding

Earlier this month, Mark Zuckerberg hoist his white boxers onto a pole and waved them in defeat. He, and his fratboy team at Facebook HQ, finally conceded that breastfeeding wasn’t sexual. Good. Glad we sorted that out lads.

Technology had, at last, given breastfeeding moms a high five. This was great timing, as I was about to launch a new breastfeeding cellphone app: an interactive version of The Timeline of a Breastfed Baby! A dynamic on-the-go breastfeeding resource for busy moms who needed accessible support at their fingertips. The dudes at Google swiftly approved the app for their Android market. Thanks guys. Next stop – Apple.

Now, Apple are notorious for being elitist pearl-clutching brand-guardians. Any company can create and submit an app to appear in their app store, but Apple has the ultimate say on which apps make it. The basics of the their vetting process boil down to a technical pre-application check of your binary, a review by an Apple employee along with revisions to the app if necessary, followed by acceptance or an appeal of a rejection, and the summons of a pound of flesh.

A lot of hoops to jump through, but, if I say so myself. I’m quite good at hoop jumping, so confidently, I submitted my app and waited. Apple's response?

Apple need to 'free the nipple' already.

Snootypants Apple - makers of ipads, iphones and iattutude problems - didn’t like the app. Turns out, they just don’t like boobs being associated with kids. Presumably, these guys would only know a breast if it poked them in the eye at a strip joint. In their rejection email, they linked to their resolution center with the following spiel:

3.6: Apps with app icons and screenshots that do not adhere to the 4+ age rating will be rejected

We found that your app icons, screenshots, and/or Application Description includes content that is not appropriate for all age groups, as required by the App Store Review Guidelines.


They included the following screenshot...

Brace yourself, the offensiveness will put your retina into shock:

Consider my wrists slapped. Back to the drawing board.

In an attempt to discover what would pull the bothersome wedgie from Apple's ass-crack I searched for other breastfeeding apps available via Apple. Here I noticed something piss-boilingly sad: most had a 12+ rating that warned of, and I quote, “Mild Sexual Content”. It appears, the boys at Apple don’t think anyone below the age of 12 can cope with viewing a nursing mother (yet strangely, I know plenty folk under the age of 1 that have no issue with it).

Well, Apple could swiffle on an ipod shuffle if they thought I was going to label my breastfeeding app as sexual. This would feed right into the warped perception of breasts as pornographic by default. So, instead, I chose the only other category that seemed remotely relevant: “Infrequent/Mild Medical/Treatment Information” which automatically lifted the age limit of my app to 12+. Hoop well and truly jumped, pole-vaulted and Zumba'd around.

I submitted my application again, and waited. And waited. And whatya’ know, this time Apple rejected the app again! They told me they were not happy that the images featured breastfeeding and that people would *OMFG* see them when they browsed the app store. So, let's recap: breatsfeeding images would be permitted ONLY if their viewing was restricted to people over 12 years old, and ONLY if they were inside the app and not darkening the app store shelves like porno on the top shelf of a dodgy service station. After all, some poor DFF or male widower could clamp their eyes on the flesh of a young woman nursing her child, and throw a wobbler. Seems the boys at Apple don’t think anyone above the age of 12 can cope with inadvertently viewing breastfeeding, and such people should be protected from this obscenity (a view only adopted in Technology-Land; for those of you living IRL, the law does not recognise a need for protection from breastfeeding, just, you know, FYI).

Back to the proverbial drawing board again.

Finally, I replaced the main menu with a different background, not showing breastfeeding. And finally, Apple begrudgingly placed the app in their app store, where it is now free to offend anybody, as long as they have two dollars and have been on the planet no shorter than 12 rotations around the sun:


Would this offend you?

The App details:

  1. The (Entire) Timeline of a Breastfeed Baby, PLUS:
  2. Stunning pro-breastfeeding images on every page.
  3. Notifications: I can send news, messages, and links directly to your phone. It’s like having your very own pocket Alpha Parent harassing you.
  4. The app is designed to work on cellphones and ipads. The blog is not. Thus the app is smoother and more effective to navigate.
  5. Has a direct one-click connection to The Alpha Parent facebook page, for all your bitching needs.
  6. Updated in line with the latest lactation research.
  7. Works on every device there is. So for Apple, it works on the iphone 3, 4, 5 and all ipads.
  8. Functions globally.
  9. Rock bottom cost to you: $0.99 in Apple or $1.00 in Google Play (I don’t believe in milking my Alpha mammas – that’s your babies’ domain!)

Not offended? Get your ass over here then! 

Want this bad boy for yourself? Support the app!

Monday, June 16, 2014

How Breastfeeding Changes Your Brain

‘Motherhood changes you forever’ - the cliché your own mother forewarned you. And she was right. Motherhood, and specifically breastfeeding - the most central physiological act of mothering during infancy, changes you because it literally alters your brain - structurally, functionally, and in many ways, irreversibly. I am about to explain how the act of nursing sets apart mothers who breastfeed from those who don’t – on a neurological scale.

Breastfeeding mothers and their babies are attuned to each other on a deep biological level. In fact, a breastfeeding mother and her baby are sometimes referred to as a ‘dyad’ – two individuals so closely linked they are considered one unit. Her body nourishes him; his feeding determines her milk production. Scientists call this ‘limbic regulation’. It’s a remarkable natural phenomenon whereby the mother is neurologically and chemically in sync with her baby, and her baby to her. Michael Merzenich, the San Francisco University brain plasticity expert, has described breastfeeding as a kind of temporary breakdown of identity for both mother and child that powerfully affects both their brains. “At that point, the baby and the mother are unified” (Merzenich 1994). Glassy eyed, who, me?

New Pathways

When you breastfeed, you are relating to this little person in a way you have never related to anyone else in your life. The process of a baby suckling at the breast actually forges new neurochemical pathways in the mother’s brain that create and reinforce maternal behaviour. This process is aided by chemical imprinting and huge increases in oxytocin. These changes result in a motivated, highly attentive, and aggressively protective brain that compels the breastfeeding mother to alter her responses and priorities in life (Hahn-Holbrook 2011). This hormonal cascade makes mom want to respond to her baby and helps her to interpret his needs effectively (Rapley and Murkett 2012).

When a mother nurses, not only do her blood oxytocin levels increase, but her body makes more receptors, permanently increasing her feelings of love - and her ability to feel loved. Mom's sensitivity to oxytocin’s power is one of the most fundamental ways she changes as a new mother. In humans, we have oxytocin receptors snuggled within our breast tissue. As Sweden’s Karolinska Institute, Kerstin Uvnas-Mobery, the global authority on oxytocin, found in a series of experiments, breastfeeding women tend to be less reactive to stress hormones, less physically tense, less suspicious, and less bored. They are also calmer and more sociable when tested for these traits than mothers of comparable ages who are not breastfeeding (Uvnäs-Moberg & Petersson 2005).

But the accolades don't stop there! In another study, this time conducted by Margaret Altemus, a psychology professor at Cornell University, 10 lactating and 10 non-lactating women were stressed by being forced to engage in one of my favourite past times – pounding a treadmill for no particular reason. The research team found the lactating women released only HALF the amount of stress hormones, compared to those not nursing (Altemus 2010). Other studies back this up. It appears that oxytocin not only lowers blood pressure but also inhibits the release of the stress hormone glucocorticoid. Glucocorticoids are one reason why prolonged stress can damage the hippocampus. Meanwhile, prolactin, dubbed ‘the parenting hormone’, dampens fear and anxiety by inhibiting the amygdala (the part of the brain responsible for fear responses) (Kirsch 2005). Zen! The two hormones are elevated each time baby suckles at the breast reaching blood levels of eight times the norm (Ellison 2006). In other words: breastfeeding moms’ antistress systems are frequently activated and they are buffered. Oxytocin is Mother Nature’s weapon against stress, an innate mechanism that mammal mothers enjoy so that stress doesn’t interfere – and least not too much – with mental function. As Stanford biologist Robert Sapolsky, an international expert in stress (would you want his job?) has remarked: “Somehow mammals have worked this out, because cognition is a good thing to have when you have small dependents” (Sapolsky 2014).

Breastfeeding mothers respond to stress less with the banal ‘fight-or-flight’ model (commonly seen in men) and more with an alternative one that has been named ‘tend-and-befriend’ - with friendliness rather than anger. This ‘female model of the stress response’ is again, thanks to lactation’s triggering of oxytocin (Taylor 2000; McCarthy 1995). Throughout most of human history, women have had to watch out not just for themselves but for the sprogs they most likely had in tow. Their bodies knew they had little people to care for purely because of the signals produced through sustained lactation. A consequence of this biology is that each gender has evolved differently in the matter of psychological responses to stress. Formula feeding mothers respond to stress like men, in a more ‘fight or flight’ manner, due to their low exposure to oxytocin relative to lactating mothers. This in part explains why breastfeeding mothers are significantly less likely to abuse their babies (Strathearn 2009; On this touchy topic, see also: 'Why the Way You Feed Your Baby is MY Business').

Dr Kerstin Uvnas-Moberg, a world authority on oxytocin, has studied the changes between these two defence mechanisms, where she refers to the 'tend and befriend' approach as 'calm and connection'. In her book 'The Oxytocin Factor' she compiled two striking lists:

For breastfeeding moms, it's an upward spiral. The longer and more often their baby suckles, the more it triggers the prolactin-oxytocin response in the mother’s brain, forging more connections. Pretty soon, the mother forges enough receptors that she can feel her breasts tingling and leaking at the sight, sound, or merely passing thought of nursing her baby. As one Warwick University study discovered:

“Breastfeeding causes a massive increase in communication between the neurons, co-ordinating a ‘swarm’ of oxytocin factories producing intense bursts of the hormone”. To illustrate, take a gander at the virtuous circle depicted in the diagram below:

When a baby grasps its mother’s breast with tiny hands and sucks on her areola, it triggers explosive bursts of oxytocin and prolactin, prompting bursts of dopamine, in the mother’s brain. Prolactin is detected by a sensitive area on each milk-making cell and has the effect of priming them, or switching them on. Breast milk then begins to flow. These ‘receptors’ are much, MUCH stronger in lactating mammals than non-lactating mammals (Tzanou et al 2007). When these receptors are stimulated they make the mother want to protect her baby and hold him close.

These hormonal interactions create the notorious ‘breastfeeding bond’, switching off negative emotions and switching on pleasure circuits that produce feelings of exhilaration and attachment (Domes et al 2007; Hurlemann et al 2010). The hormonal exchange works as follows: The nursing response of the oxytoxin circuits is reinforced by the feeling of pleasure created by bursts of dopamine - the pleasure and reward chemical. Dopamine is jacked up in the mother’s brain by estrogen and oxytocin. The mother’s blood pressure drops, she feels peaceful and relaxed, and she basks in waves of oxytocin-inspired loving feelings for her baby. This neurological mechanism explains one of the ways that breastfeeding reduces the risk of a mom developing postpartum depression (Figueiredo et al 2013;  Figueiredo et al b 2013; Hahn-Holbrook et al 2013). Think of it like walking through a forest the same way again and again, each time making a clearer trail – this is what’s happening in mom’s brain. Circuits that activate as she breastfeeds, become stronger and respond more readily.

More Powerful Than Cocaine

Let’s explore this feel-good mechanism in even more detail. In one study, mother rats were given the opportunity to press a bar and get a squirt of cocaine or press a bar and get a rat pup to suck their nipples. Which do you think they preferred? Those oxytocin squirts in the brain outscored a snort of cocaine every time.

To give you another example of oxytocin's potency, male prairie voles given a shot of the stuff are converted from roving-eyed bachelors into nurturing husbands and fathers (Ellison 2006).

Enhanced Empathy

In one Yale University study, a team of researchers examined new mothers – half who were breastfeeding, and half who were formula feeding. Two to four weeks after giving birth, the mothers had their brains scanned using a swanky ‘functional magnetic resonance’ (fMRI) machine while they listened to recordings of their babies' cries. Why their cries? I can think of better stuff to put on my ipod. Why not their cute baby gurgles? Or their babbles? Well, the focus on crying was strategic: as I have discussed elsewhere, responding promptly and lovingly to a baby’s cry is an important part of helping that baby develop trust, a feeling of safety, of worthiness, and of mental well-being. The results of this Yale experiment revealed that the brains of the breastfeeding mothers showed a significantly stronger response to the sound of their babies' cries than did the brains of the formula feeding mothers. Greater activity was revealed in several brain regions, including the superior frontal gyrus, striatum and amygdala. The researchers hypothesised that high activity in these regions contributes to breastfeeding mothers’ ability to understand how their babies are feeling and respond in an appropriate way (Kim et al 2011). In other words: breastfeeding mothers are more attentive than their formula feeding peers. Mammaries: 1. Man-Made Powder: 0. 

The amazing hormonal cascade induced by lactation doesn’t end there. Lactation also facilitates learning and memory specifically for social information. Breastfeeding mothers show improved memory for human faces, in particular happy faces (Rimmele et al 2009; Guastella 2008). They also show improved recognition for positive social cues (Unkelbach 2008; Marsh 2010) and improved recognition of fear in others (Shofty 2010).

Not breastfeeding stunts
maternal brain circuits
To examine how important this process is, let’s take a look at rats again. Female rats inhibited from producing oxytocin after giving birth do not exhibit typical maternal behaviour (Van-Leengoed 1987). They show a marked delay, and in some instances avoidance, of pup carrying, pup manipulation, nest building, autogrooming, and time spent on the nest with the pups. At the end of 1 hour, two out of the six mothers had not yet picked up a single infant. Consider that human mothers who formula feed are literally inhibiting their oxytocin production, lack of lactation is literally stunting their maternal brain circuits. Contrast this with mothers who breastfeed, they have been found to exhibit more behaviors that create a close relationship to their baby, such as singing a special song to them, bathing and feeding them in a special way, or thinking about them more (Odent 2011). Quite simply, the more oxytocin you have, the more loving and attentive you are to your baby. The reserve is equally true.

The breastfeeding mother has a brain that is literally marinating in oxytocin and dopamine making her feel loved, deeply bonded, and physically and emotionally satisfied. Just check out the smorgasboard of other psychological and physiological changes that oxytocin brings about in breastfeeding moms:

Enhanced Smarts

In the same way that lactation gives breastfeeding mothers the edge over formula feeding mothers on the attentiveness front, it also makes them smarter than their bottle wielding peers. By ‘smart’ I’m not talking about Hawkingesc quantum physics – nope - the smarts of a breastfeeding mother mean much more than that. I’m talking about the kinds of smarts that translate into enhanced perception, efficiency, resiliency, motivation and social skills. This is a topic I explore in depth in my book when I speak of breastfeeding mothers as ‘positive deviants’. Breastfeeding is nature’s academic plan for mothers. Harvard psychiatrist Dr John Ratey explains: 

“When a mother gives birth, you want her to be really smart, as smart as she can be. You want her to know about the territory around her and remember things about her kids, and be in a prime state to function” (Ratey 2003).

When Dr Ratey examined the brains of mothers in late pregnancy, he found that their normal rate of cell replacement had slowed down and brain size had shrank - an event which may explain the oh-so-dopey ‘mommy brain’ fog of the third trimester. However, once mom has given birth and breastfeeding begins, cell replacement resumes and increases. Compared to those not breastfeeding, Dr Ratey found that lactating moms had more glial cells, which support the neurons by importing energy and exporting waste products.

Let me give you an example of these cells in action: breastfeeding mothers are more sensitive to the sounds of their own babies, and more skilled in interpreting what they mean. A breastfeeding mom’s pricked-up ears (as discussed in that crying experiment we spoke of earlier) make her more perceptive and aware – in a word, smarter – about her child. This perceptional ability becomes part of her general feeling of extraordinary attachment to this new being. Strong attachment itself can help make her smarter about the rest of the world, in part by keeping her brain elevated.

Then there's the sensory aspect: a mother’s skin as she nurses her baby, is her most direct and loving means of communication, just as her suckling baby talks back with lips and hands, egging her on, before he knows a single word. Katherine Ellison, author of The Mommy Brain has extensively researched this area. She has noted that:

“Studies on animals strongly suggest that breastfeeding re-plots the map of the brain. When my baby son lay on my chest, he had direct impact on my sensory hormunculus. With repeated input from suckling and nestling, my chest, which used to be a purely aesthetic part of my personal repertoire, had acquired a leading role in the nurturing of another human being – and also in the way I was imagining myself, interpreting the world, and learning to behave”.

A decade ago, two neuroscientists, Judith Stern at Rutgers University and Michael Merzenich at the University of California, provided stunning evidence of this impact when they showed that in the cortex of a mother rat, the area devoted to the trunk, or chest, had actually doubled in size while that rat was breastfeeding. Both Stern and Merzenich have little doubt that the same kind of thing happens in humans:

“It is probable that human lactation results in substantial representational remodeling in most or all of more than 10 different somatosensory representational areas, as well as in a number of motor and 
premotor zones” (Stern and Merzenich 1994).

The brains of breastfeeding mothers are buffered against stress.
Another boffin known for his scientific brilliance, anatomist Vincenzo Malacarne, has noted that breastfeeding is an especially powerful cognitive experience because it involves, in his words, “learning under high stakes conditions, which is just the sort of learning that drives changes in the brain”. In his work he discovered how lactation increases synapses in the part of the brain’s cortex that deals with attention and complex tasks. This however, he did not find surprising: “In breastfeeding, you are relating to another person like you never related to anyone before. In a sense, you are one person, and it’s pretty educational to have another human being extending into the makeup of your own self” (Ellison 2006). Indeed, breastfeeding forces moms to use certain talents up-close, constantly and repetitively. And, unlike the mental challenges of studying or working at a job, it’s much harder to check out for any length of time when you’re on the spot for nourishing. Add to this the fact that breastfeeding reduces stress via oxytocin, and opportunities for learning are improved even further. Have you ever tried to learn something new when you're under stress? Breastfeeding strikes the perfect balance between keeping mom alert and yet also relaxed - an equalibrium which improves her overall comprehension skills.

Enhanced Efficiency

Does breastfeeding make a woman a more efficient mother? Formula apologetics would unsurprisingly argue – no. However suppose we did an experiment. Perhaps this experiment could involve depriving families of food and then watching to see which mothers were most efficient at obtaining it. Who would come up trumps, breastfeeders or formula feeders? This would, of course, be highly unethical, and so the hypothesis can never be tested on humans, but other mammals – bring it on. And that’s exactly what psychologist Dr Craig Kinsley did with our friends, the rats. He looked at the behaviour of age-matched rat moms, comparing those who were lactating and those who were not.  The rats were temporarily deprived of food and then given crickets. In order to feed, the rats had to capture and kill the crickets whilst Kinsley’s team observed.

In the animal world, a heightened ability to capture prey means a decreased amount of time the mother spends away from vulnerable offspring and this decreased window of vulnerability means a lower infant mortality rate. The results of Kinsley’s study showed that lactation gives mothers the edge, with the non-lactating rats taking around 290 seconds to catch the crickets, whilst the lactating group only took about 70 seconds. Speaking of his findings, Kinsley commented: “The lactating brain expresses a great deal of plasticity and creativity in service to, and in support of, reproduction. In other words, mothers are not born, they are made through breastfeeding” (Kinsley and Lambert 2006). And what’s more, the breastfeeding rats’ gains in learning and memory were lasting up to twenty-four months, a full eighteen months past their last litter, and the equivalent of about 80 years of age for a human! 80 years, people!

Another research team, this time from Okayama University in Japan, found more evidence to support the existence of permanent change. They discovered something called ‘long-lasting, long-term potentiation’, known as L-LTP, in the hippocampi part of the brain of lactating mammals. L-LTP is a psychological marker of long-term memory foundation, involving an actual increase in the efficiency of synapses – i.e. the structure that permits a neuron to pass a signal to another cell (Tomizawa et al 2003). Essentially: the changes to a mother’s brain do not subside once mom stops breastfeeding. Scientists have good evidence to believe that permanent changes occur. They base this partly on research showing that humans and other mammals respond more readily, and emotionally, to their second baby than to their first. This is much more than a matter of knowing what to expect: the differences appear to become hard-wired, even influencing mothers’ milk flow, which is generally freer second time around (Ellison 2006).

In short, breastfeeding mothers are more present, focused, and organized – changes which last for the entirety of a woman’s mothering AND grandmothering journey. Just as nursing rat mothers build a nest, protect their young from danger, and keep them clean, so nursing human mothers perform in comparable ways - and keep on performing. 

Adoptive mothers and formulas feeders can also lap up these benefits. How? Well, it's not easy. When virgin rats are injected with breastfeeding hormones (doing this to humans would be deemed 'unethical' so here we have the rats again), they go from their usual behaviour of rejecting rat pups, to nurturing them (Moberg 2011). Adoptive human mothers can induce lactation to produce the same effect. Formula feeders can relactate.

Wow. You've just sat through a neuroscience lecture. That's a lot of learning, and being a badass breastfeeder, you probably soaked it all up. Let's sum up this post: Breastfeeding is so much more than nutrition – it changes the architecture of the brain. The way neurons in a woman’s brain are restructured in response to lactation enables her to respond to her baby with a richer and more enhanced behavioural repertoire. In the blood, lactation hormones govern milk ejection, while in the brain they affect behaviour. And these changes are the most profound and permanent of a woman's life. Mother Nature knows her stuff.

Now, of course, since breastfeeding is the biological norm for humans, an accurate conclusion from the science is not "Breastfeeding makes mothers more empathic, more intelligent and more efficient" but rather: "Formula feeding makes mothers less empathic, less intelligent, and less efficient". Oh dear, sirens are going off at Formula Feeder HQ...

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Monday, June 9, 2014

All Breasts Can Breastfeed

Stories of breastfeeding failure are demoralizing on a viral scale. One of the most common excuses mothers give for quitting breastfeeding is the assertion that their breasts malfunctioned. This gives other women a shaky perception of what their bodies are actually capable of. In this post I explain how and why the myth of widespread malfunctioning mammaries is utter tosh.

Pierced nipples: 

These chicks don’t usually cause a problem with breastfeeding. Occasionally, nipple piercings cause some of the milk ducts to seal over, so milk can’t get out from those sections of the breast. If this happens, milk production will stop in those areas and the rest of the breast will produce more (La Leche League 1999). You should remove any rings or bars before you feed, though, so they don’t hurt your baby’s mouth, or you may prefer to let the holes close and have your nipples re-pierced later.


Implants are inserted behind the milk-making tissue, so they don’t interfere with milk production or with the baby getting milk out (La Leche League 2013). Some women who have had implants find that their breasts are a bit tight, making them uncomfortable very quickly if feeding is delayed. You can prevent this by encouraging your baby to feed frequently and by hand-expressing your milk whenever he has a longer gap.

Breast Surgery: 

Whether breast surgery may affect breastfeeding depends on the reason for the operation and the way it was carried out. Surgery to remove a breast lump usually causes damage to the ducts, but only in one area of the breast. The rest of the breast (and the other breast, of course) will work normally. After a mastectomy it’s usually possible to fully breastfeed from the remaining breast (Rapley and Murkett 2012). I know personally of a mother who successfully breastfed after surgery to remove a breast tumour. Click here to read her story.

Breast Reduction: 

Breast reduction usually relies on removal of fat tissue (rather than milk-making tissue) but sometimes it involves cutting the milk ducts and the nerves that supply the nipple. If your nipples have been re-sited – and especially if they are no longer sensitive – breastfeeding may be difficult. Surgery to alter the shape of the nipples can have the same effect. However, breastfeeding can work after surgery and even if you can’t breastfeed your baby fully, he may be able to have some of your milk (Witte et al 2004La Leche League 2002).

Inverted Nipples: 

There are different degrees of nipple inversion. Some nipples are only slightly inverted, and a baby with a normal suck will bring out the nipple with no difficulty. Other nipples are moderately or severely inverted, which means that when compressed they retract deeply, to a level even with or behind the surrounding areola. But here’s an interesting and comforting fact: most nipples that are inverted in pregnancy will correct themselves by the time of delivery (See: ‘Timeline of Breast Changes in Pregnancy’). For those that don’t, good positioning and latch are normally sufficient to enable successful milk withdrawl. Remember, babies don't nipple-feed, they breastfeed. If baby is able to get a decent mouthful of breast, most types of inverted nipple will not cause a problem. A good latch means that baby’s mouth and gums will pypass the nipple entirely and latch on to the areola for effective breastfeeding. Other techniques, such as using breast shells and nipple shields, have not been proven in controlled studies to be effective (La Leche League 2003). If you do decide to use a nipple shield, try to remove it within the first few minutes of the feeding. Click here  to read an inverted nipples success story.

Flat Nipples: 

Like inverted nipples, a true flat nipple is one that cannot be compressed outward when stimulated or compressed. Also like inverted nipples, correct positioning will normally facilitate breastfeeding. Use of a breast pump or other suction device may help some women draw out flat or inverted nipples so that baby can latch onto the breast more easily (Click here to read about one mom’s success with flat nipples).

Large Breasts: 

Some large-breasted women have difficulty putting their babies to the breast because when they are sitting their breasts almost engulf their lap. If this is you, try rolling up a diaper or baby blanket and put it under their breast for support, to lift it high enough so that baby can latch on more easily. This will also enable you to get a good view of the latching action. Additionally, you may find the football hold more versatile than other positions as it gives you more control over your baby’s head and other movements, as well as giving you a stellar view. Lying down is another good position as your breast may rest on the mattress making it easier and more comfortable for both baby and you.

Small Breasts: 

Even if a woman is flat as a pancake her breasts will be able to do the job they were intended for. It is a myth that women with big breasts will be ‘better’ at breastfeeding. They may have more fatty tissue inside their breasts, but fat does not have a function as far as breastfeeding is concerned. Anatomically speaking, all lactating breasts perform in the same way. In no way does outward appearance affect the production of milk or a mother’s ability to dispense it.

Breast Trauma: 

Breast injury resulting from a fall or from being struck may result in nerve damage or damaged milk ducts. If the nipples and areolas have been injured, the ability to breastfeed depends on how well milk can flow through them. If only one breast is affected, mom should be able to feed exclusively using the unaffected breast. She will still make plenty of milk. Click here to read one mom’s success story of breastfeeding after breast trauma.

Raynaud’s of the nipple: 

This condition occurs when a spasm of blood vessels prevents blood from getting to the nipple (see illustration), this is usually felt as a burning sensation. Also referred to as a vasospasm, the condition is often worsens in response to a drop in temperature. There is no reason why a mother with Raynaud’s cannot breastfeed. Keeping the breast warm and covering straight after feeds are useful strategies. If pain is still an issue, Dr Jack Newman recommends a two week course of Nifedipine, a safe drug used for hypertension.

Nipple eczema: 

There is no reason why a mother with nipple eczema cannot breastfeed. In fact, freshly expressed breastmilk applied to the area can help to moisturize your skin and promote healing.

Large Nipples: 

Long or very wide nipples can occasionally make latching difficult because they trick the baby into starting to suck before he’s scooped up enough of the breast. Click here to read one mother’s triumph with large nipples. If your baby is having a hard time trying to get a big enough mouthful because you have large nipples, you may be able to help him by gently pressing your thumb into your breast just above your baby’s nose to tilt the nipple up slightly as you offer it to him, then let it unfold in his mouth, helping him to draw it in deeply before he starts sucking. 


Hypoplasia is underdevelopment or incomplete development of breast tissue (famously known as ‘insufficient glandular tissue’). When it comes to breastfeeding scaremongering, hypoplasia reigns supreme - an apparent 'Get Out of Jail Free' card. However La Leche League 2009 maintain: "With medical and emotional support and accurate information, mothers with hypoplasia can breastfeed their babies". Notice the use of the word 'can', not 'maybe'. Interesting. So, what's going on here? Well, some studies have asserted that the proportion of glandular tissue and the number and size of ducts are not even related to milk production (Ramsey et al 2005). And indeed, not all women with hypoplasia have milk supply difficulties, some exclusively breastfeed without any supplementation at all (Bodley and Powers 1999). In other cases, milk supply may be ‘compromised’. I say ‘compromised’ in inverted commas because all it not lost. In unilateral hypoplasia, for instance, blood flow velocities of the Internal Mammary Artery and the Lateral Thoracic Artery have been shown to be reduced by half to two-thirds compared to the breast producing copious amounts of milk (Geddes et al 2012). This, of course, means that at least a third of the woman’s milk supply will be a-okay. When hypoplasia reduces some of a mother's supply, there are numerous medications and herbs that have proven efficacy in increasing breast milk production (Arbour and Kessler 2013Duran and Spatz 2011). And some breast milk is always better than no breast milk. Always. Whether or not a mother continues to breastfeed with the milk she does have is telling of her true intentions. Many women with genuine hypoplasia go on to successfully breastfeed their babies with supplementation, despite having a seemingly perfect excuse to quit altogether (Thorley 2005). Funny that.

So there you have it. The reality is that the size, shape and features of your breasts are not reasons to hit the quit button.

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