Human milk is ideal food for newborns in that it provides agespeciic nutrients, immunological factors, and antibacterial substances. Milk also contains factors that act as biological signals for promoting cellular growth and diferentiation. A list of the advantages of breastfeeding is shown in Table 36-3. For both mother and infant, the beneits of breastfeeding are long-term. For example, women who breastfeed have a lower risk of breast and reproductive cancer, and their children have increased adult intelligence independent of a wide range of possible confounding factors (J ong, 2012; Kramer, 2008). Breastfeeding is associated with decreased postpartum weight retention (Baker, 2008). In addition, rates of sudden-infant-death syndrome are signiicantly lower among breastfed infants. Bartek and colleagues (2013) estimate that a 90-percent breastfeeding rate for 12 months would save more than $3 billion annually in excess infant and maternal morbidity costs. For all these reasons, the
TABLE 36-3. Advantages of Breastfeeding
Data from American Academy of Pediatrics and the American College of Obstetricians and Gynecologists:
Guidelines for Perinatal Care, 8th ed, Elk Grove Village, AAP, 2017.
TABLE 36-4. Ten Steps to Successful Breastfeeding 1n. Have a written breastfeeding policy that is regularly communicated to all health-care staff 2.
Train all staf in skills necessary to implement this policy 3.
Inform all pregnant about the beneits and management of breastfeeding 4.
Help mothers initiate breastfTeding within an hour of birth 5.
Show mothers how to breastfeed and how to sustain lactation, even if they should be separated from their infants 6.
Feed newborns nothing but breast milk, unless medi cally indicated, and under no circumstances provide breast milk substitutes, feeding bottles, or paCiiers free of charge or at low cost 7.
Practice rooming-in, which allows mothers and newborns to remain together 24 hours a day 8.
9.
Give no artiicial paCiiers to breastfeeding newborns 10.
Help start breastfeeding support groups and refer mothers to them
Adapted with permission from World Health Organization:
Protecting, promoting and supporting breast-feeding: the special role of maternity services. Geneva, World Health Organization, 1989.
American Academy of Pediatrics (2017) and American College of Obstetricians and Gynecologists (2016a, 20 17b) supports the World Health Organization (201r1) recommendations of exclusive breastfeeding for up to 6 months.
The Surgeon General of the u.S. Department of Health and Human Services (2011) lists some barriers to breastfeeding and suggests practical means of overcoming them. Educational initiatives that include father and peer counseling may improve these rates (Pisacane, 2005; Wolfberg, 2004). The Baby Friendy Hospital Initiative is an international program to increase rates of exclusive breastfeeding and to extend its duration. It is based on the World Health Organization (1989) Ten Steps to Successul Breaseeding (Table 36-4). Worldwide, almost 20,000 hospitals are designated as "baby-friendly," however, only 10 to 15 percent of hospitals in the United States are so designated (Centers for Disease Control and Prevention, 2014; Perrine, 2015). Forrester-Knauss and coworkers (2013) described successul trends toward exclusive breastfeeding in Switzerland during 9 years in which a Baby-Friendly Hospital Initiative was implemented. In a large population-based study done in the United States, fewer than two thirds of term neonates were exclusively breastfed at the time of discharge (McDonald, 2012).