For the Love of Breastfeeding

As Nicky approaches 1 year old, I am bracing myself for the likelihood that I will receive more questions from strangers and loved ones as to how long I plan to continue breastfeeding him. My answer is simple - I don't know! I don't have any concrete plans or a set date in mind.

My initial goal after Nicky was born and our breastfeeding relationship was firmly established was to make it until he was at least one year old. One reason for this initial goal was that the American Academy of Pediatrics says that, "exclusive breastfeeding is advocated for approximately the first 6 months after birth and continuation of breastfeeding for at least 12 months and thereafter for as long as mutually desired." Notice the "and thereafter for as long as mutually desired" part. In addition, the World Health Organization says, "infants should be exclusively breastfed(1) for the first six months of life to achieve optimal growth, development and health (2). Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. Exclusive breastfeeding from birth is possible except for a few medical conditions, and unrestricted exclusive breastfeeding results in ample milk production." I had always hoped that I could make it past the one year mark, but it is good to set smaller mini goals that make up a bigger goal you have in mind. So, starting out, I knew that breastfeeding was a good thing for my baby for the first year especially, but I also realized how challenging it can be so I didn't want to get too far ahead of myself.

Now that Nicky is one month away from being a toddler, he is starting to eat more solid foods, but breast milk will still continue to serve a role in his nutrition, overall health, and his emotional development as well as our relationship. Unfortunately, I think that extended breastfeeding is something that many people in this country don't understand and hence, don't support. For example, the other day at the mall, the saleslady asked how long I was going to keep breastfeeding. Upon hearing my lack a definite date, she said, "Oh, you're not going to nurse him until he's 3 are you? I find that just vulgar!" She knew that people in other parts of the world nurse until their kids are older, in some places until the child is 7 years old, but that didn't change her opinion. She said, "but that's not what we do in the United States." She's right on that for the most part, and I ended the conversation by acknowledging that we each have a right to our own opinions. The conversation made me a little sad (although I held no hard feelings - I made a purchase from that saleslady) because I think it hinted at the main thing that I think interferes with breastfeeding attitudes in the U.S. and that is our sexualization of breasts. It is like we have forgotten that the primary purpose of breasts is to feed children. We have focused on breasts as sexual objects so much that it is okay for women to walk around with low-cut tops or tiny bikinis, but many people still look down on breastfeeding in public, even if it is done discretely. Seriously, except for the occasional glimpse of nipple if the baby pops off the breast unexpectedly, you are going to see more skin from one of those before mentioned low-cut tops then you are from a breastfeeding mother. The baby generally lies against the mother's abdomen and covers the bottom of the breast and most mothers pull their shirts up just over the nipple so the top of the breast is still covered. The only thing that is exposed is maybe part of the mom's side. Whoa, so risque!

Another reason I think extended breastfeeding is looked down upon in our country is because of our focus on independence. I have stated before that I think we push our kids to be independent many times before they are ready to do so, and I think it may backfire and actually lead to behavior and attachment problems in children as well as some emotional problems in adults. In essence, pushing children to be independent before they are ready to be can make them anxious and clingy and result in less mature independence, not more. And I have support: Dr. Waletzky, a female psychiatrist, commented in her article that, "ironically, early forced weaning may actually hinder emotional development and increase dependency needs." This opinion is not a new one (her article is from 1979) and it has been supported by other, more recent research.

Plus, there are benefits to breastfeeding past one year. This is from a La Leche League article:

Research shows that babies may benefit from nursing beyond one year. One benefit is nutrition. Research has shown that second-year milk is very similar to the first-year milk nutritionally (Victora, 1984). Even after two years or more it continues to be a valuable source of protein, fat, calcium, and vitamins (Jelliffe and Jelliffe, 1978).

A second benefit is immunity to disease. The immunities in breast milk have been shown to increase in concentration as the baby gets older and nurses less, so older babies still receive lots of immune factors (Goldman et al, 1983). A study from Bangladesh provides a dramatic demonstration of the effect these immunities can have. In this deprived environment, it was found that weaning children eighteen to thirty-six months old doubled their risk of death (Briend et al, 1988). This effect was attributed mostly to breast milk's immune factors, although nutrition was probably important as well. Of course in developed countries weaning is not a matter or life and death, but continued breastfeeding may mean fewer trips to the doctor's office.

A third health benefit is avoidance of allergies. It is well documented that the later that cow's milk and other common allergens are introduced into the diet of a baby, the less likelihood there is of allergic reactions (Savilahti, 1987).

It goes on to comment on psychological benefits:

Any mother who has nursed an older baby knows the tenderness and feelings of closeness generated by nursing a little one who is old enough to talk about it. We don't need medical journals to tell us it's rewarding for mother and baby. But has anything been documented and published on these benefits?

One paper written by a female psychiatrist (Waletzky, 1979) recommends natural weaning. She refers to early forced weanings as emotionally traumatic for the baby and states that most weaning recommendations given by pediatricians are "based on personal feelings and prejudices and not medical documentation." In her words: "Suddenly and prematurely taking from a baby the most emotionally satisfying experience he has ever known could . . . lead to significant immediate and long-term distress.... Such an approach considers breastfeeding only as a source of milk and fails to understand its significance as a means of comfort, pleasure, and communication for both mother and baby." Well said! Yet Waletzky's paper is based on her impressions from her psychiatric practice, not on research.

One study that dealt specifically with babies nursed longer than a year showed a significant link between the duration of nursing and mothers' and teachers' ratings of social adjustment in six- to eight-year-old children (Ferguson et al, 1987). In the words of the researchers, "There are statistically significant tendencies for conduct disorder scores to decline with increasing duration of breastfeeding." The authors were cautious in their interpretation of the results, saying that they did not control for differences in mother-child interaction between breastfeeders and bottle-feeders, which could account for the differences they saw in later social adjustment. But it makes no real difference whether the improvement in later child behavior is due to breastfeeding per se, or the maternal behaviors that are typical of women who are open to nursing their babies for a year or more. The outcome is what matters; the children who nursed the longest were perceived later to be those with the best social adjustment. The link between duration of breastfeeding and social adjustment was stronger and more consistent when the children's behavior was rated by mothers rather than by teachers (although for both rating groups the association was significant), suggesting that mothers who breastfeed for longer periods may tend to view their children in a more positive light than mothers who do not.

It was not surprising to ready positive extended breastfeeding information from La Leche League, but I was happily surprised to read the following on my weekly ivillage Pregnancy & Parenting email (a fairly mainstream website):

As she nears her first birthday, you may be thinking of weaning her from the breast. If you are both enjoying your nursing relationship, consider continuing for another few weeks or even months. The benefits of breastfeeding continue far past her first birthday. Actually, the worldwide average age of weaning is between three and four years of age. Not only will she continue to receive a very beneficial boost of infection-fighting antibodies each time she nurses, she’ll continue to enjoy a wonderfully nurturing time with Mom. The act of sucking will continue to be quite comforting for her. The show of comfort and support you exhibit each time you offer her your breast will encourage her to grow into a confident, self-respecting child. Enjoy this relationship as long as possible!

So, there you have it folks. My two cents on extended breastfeeding.