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The importance of breastfeeding

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Matt Smith:

Welcome to the La Trobe University podcast. I will be your host Matt Smith, and I’m here with Dr. Lisa Amir. She is a Senior Research Fellow at the Mother and Child Health Research centre of La Trobe University. Thank you for joining me, Lisa.

Lisa Amir:

Thank you.

Matt Smith:

I want to talk to you about the research that you’re doing, but I also want to talk to you about the wider subject of breastfeeding, which is something that you’ve had a lot to do with in the past. What do you think about breastfeeding as opposed to giving formula? It’s generally preferable to breastfeed an infant rather than use formula. But, why is that?

Lisa Amir:

There are a number of reasons why we think breastfeeding is important for both the mother and the baby. We know that as humans we are mammals and the mammals produce specialized milk for their young. Some people don’t realize the infant formula is basically just cow’s milk that has had various nutrients and vitamins added to it.

So, what we’re doing if we’re offering formula is using the milk of another species. And if you think about other mammals for example, the new baby elephant at the zoo, according to the reports, the baby is drinking 14 litres of mother milk a day. And we wouldn’t think about giving elephant milk to one of our children.

So, we need to think twice about formula because it’s actually really basically cow’s milk or sometimes, even soy milk which is just made from soy beans. Firstly, there’s a nutritional aspect of it that human milk has the right sort of proteins and sugars and so on that human’s need.

And as well as nutritional aspects, human milk has actually living cells in it, so that the baby gets even white blood cells from the mother. Some people refer to breast milk as white blood and in some cultures, there’s a kinship that develops by being breastfed by another woman.

And then people are often familiar with the idea of antibodies being in the breast milk that the baby receives immunity from the mother. So that the thing about this is that the mother is exposed to microorganisms in her environment and she’ll develop antibodies to those and pass them on to her baby.

So that the specific for her baby that the organisms of that baby is exposed to that will receive significant levels of antibodies from the mother, even in very small amounts of breast milk. Some people don’t realize the value of small amounts of breast milk actually have higher concentrations of antibodies in them.

So it’s not that, you know one or two feeds a day is worthless. In fact, they might be getting as many antibodies as someone who’s being breastfed more frequently. So you can see these nutritional aspects and the immune aspects. And then there’s also the nurturing aspects you could call, yes. So that the baby gets skin-to-skin contact with the mother in the early hours after the birth, the skin-to-skin contact actually helps to regulate the baby’s temperature. So, if babies are kept close to the mother, they don’t become cold or hypothermic that they might be if separated from the mother. And it’s a way of helping the mother bond with the baby, and the baby bond with the mother.

Matt Smith:

A recent survey that’s being reported around in newspapers around the world at the moment, and announced amongst other things that generation Y, however you classify that, is embarrassed to breastfeed from 18 to 29 year olds in public. They’re embarrassed to breastfeed in public and that 75% are unlikely to breastfeed their children exclusively until six months, which is the method that is recommended by the World Health Organization. Is this a worrying figure? What do you think of this study?

Lisa Amir:

I haven’t actually seen the study itself, but we are aware of women saying that they’re uncomfortable about breastfeeding in public. And it’s something that we've been saying, this is the message we need to get across to the community that it’s not against the law and in fact the baby has the right to breastfeed wherever they need to.

They need to know that it is OK to breastfeed and we need community education programs so that other people in the community feel more comfortable about mothers breastfeeding. And we’re not quite sure why people are getting more embarrassed about it when we see young woman wearing skimpy clothes.

So, it must be something to do with the sexualization of the breast that these young woman are happy to go out in the street in skimpy outfits, but they feel too self conscious to feed the baby or they’re not sure about people's reactions. So it is concerning and the recommendation as we said to exclusively breastfeed for six months.

Some women will need to go back to work so, we need to explain to women that there are ways of expressing their milk if they do need to leave the baby or going out in public with their baby, they don’t need to stay at home for six months. But probably also, a lot of women don’t know the recommendation to exclusively breastfeed.

Matt Smith:

What’s more the reality for women who are about to become mothers? Are they more likely to breastfeed than to feed with formula?

Lisa Amir:

Yes, that’s right. So, in pregnancy women usually receive information about infant feeding and hospitals highly promote breastfeeding. So, we find generally being 80 and 90% of women initiate breastfeeding in hospital.

They leave hospital breastfeeding at high rates, but it’s in the early weeks that the number of women breastfeeding drops off. So, they are getting the message to start breastfeeding, but often they’re not getting the support in the community possibly from their mothers who didn’t breastfeed in the 70s.

Or from their partners who feel uncomfortable about them breastfeeding or if they’re running into problems and not able to get the support immediately, so these are reasons why women do stop quickly, particularly if they don’t understand the importance.

Matt Smith:

What are some of the problems encountered with breastfeeding and why are women so unprepared?

Lisa Amir:

Well, we often find that in pregnancy, women can really focus only on the birth and they have trouble imagining what’s going to happen afterwards. Or, they often think that breastfeeding will just happen. In these days with much smaller families, new mothers often haven’t seen other women breastfeeding. Sometimes, new mothers haven’t even held a baby before so. So, they’re being expected in this period where they’ve just been through this major life changing event - having the baby, they have to learn how to hold the baby, how to attach the baby to the breast.

Sometimes, this means that they are into problems with nipple pain and damage. Other women find that they’re not confident that they’re producing enough milk because when the baby is being breastfed, obviously you can’t see what’s the baby is getting and people find it more reassuring sometimes to offer formula or sometimes to express milk, give the milk in the bottle.

Because they’re used to measuring things, that this is more reassuring. And we often think that women these days don’t have confidence in their body to produce milk. And if the baby is unsettled, often they quickly think they don’t have enough milk and often the family members suggesting that they top the baby up with formula and then quickly that becomes a self fulfilling prophecy and they’ll now stop feeding. So common problems that nipple and breasts pain, not enough milk…

Matt Smith:

And problem with women watching their diets so that the baby gets the right nutrition. Is that an aspect of things?

Lisa Amir:

I don’t think it’s really very often. Sometimes if people have an unsettled baby, then they’ll start restricting their diet. It’s more an issue sometimes if people need to take medication that they’re worried about the effect of that on the baby and often in fact they’re overconcerned.

Because with the breastfed baby, the baby is getting a much smaller amount of that medication than they would in pregnancy. And even some health professionals don’t differentiate between pregnancy and breastfeeding and will sometimes recommend that the mother stops breastfeeding unnecessarily because they’re concerned about the medication.

And because the drug companies don’t like to test drugs on women who are pregnant or breastfeeding, they’re often overly cautious. So if people have questions about medication, then they need often to contact an expert service like the pharmacy department at the maternity hospital where they can get this information. Because if the doctor or the patient looks up the patient information from the drug company, it can be misleading.

Matt Smith:

Can you tell me a bit about the research you are conducting into the condition known as breast thrush?

Lisa Amir:

That’s right. I’ve been a lactation consultant as well as a general practitioner for 20 years now and I continue to work in clinical practice seeing women with breastfeeding problems, in a private practice and also at the women’s hospital. One of the problems that I see commonly is women presenting with a condition called nipple or breast thrush where they have burning nipple pain, a radiating pain into the breast.

And we often think this is caused by a Candida infection so it’s like the vaginal thrush that women get or the thrush the babies get in the mouth. But it’s proven difficult to prove this and so it’s a contentious issue. My Masters research was looking at thrush on the breast and then I followed that by PhD looking at mastitis, which is a bacterial infection in the breasts.

And because when people do try to grow Candida from the nipple or the milk, often they are unsuccessful and they may grow or isolate the bacteria particularly the Staphylococcus aureus or the golden Staph. Some people believe that this radiating shooting pain in the breast is due to a Staph infection.

This is the basis of my CASTLE project, which is an NHMRC-funded project doing in collaboration with microbiologists at the Women’s Hospital. We’re recruiting currently women who are pregnant at the Women’s Hospital and Frances Perry House, which is a private hospital associated with the Women’s Hospital. And we’re following the women for eight weeks after the birth. So, we’re collecting samples from the mother’s nose and nipple and milk and the baby’s nose and mouth looking for both Candida and Staph before birth, after the birth and then each week at home for four weeks.

And then the study concludes with an interview on the telephone at eight weeks. So we’re collecting all the information about the symptoms that women have with nipple and breasts pain and any diagnosis of thrush or mastitis and treatment that they’re getting. And so we hope to be able to show with this, which organisms are involved in this condition known as breasts thrush.

Matt Smith:

Dr. Lisa Amir, thank you for your time today.

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