Breastfeeding: Healthy Mothers 
and Healthy Babies 
 

Breastfeeding is well-recognised and as a means to protect, promote and support the health of infants and young children.  Mother's milk fosters optimal growth and development of a baby's brain, immune system, and general physiology and is a vital factor in preventing common illnesses, especially diarrhoea and infections of the respiratory tract (including pneumonia), ear, and urinary tract.  The act of breastfeeding releases growth hormones, promotes healthy oral development, and establishes a trusting relationship between baby and mother.  Exclusive breastfeeding for the first six months reduces the risk of environment-borne illnesses, malnutrition, food sensitisation and allergy.

Breastfeeding also has definite benefits for mothers.  It is a fundamental, physiologic continuation of pregnancy and childbirth.  Thus, beginning exclusive breastfeeding shortly after birth lowers the mother's risk for excess post-partum bleeding and anaemia. Once mother and baby have learned to do it easily, breastfeeding can reduce a mother's stress by keeping her infants or young children healthy and well nourished.  Exclusive breastfeeding for the first six months saves the mother money, energy, and time: nothing to buy, prepare, or clean up. Exclusive breastfeeding* can also boost a mother's own immune system, help delay a new pregnancy, and reduce the insulin needs of diabetic mothers.  In the long term, breastfeeding can help protect a mother from breast and ovarian cancers and brittle bones.  

Too often, a mother's needs and wants go unrecognised or unsupported.  Her physical and emotional health, her level of education, the help she receives from others, and her household economics influence her breastfeeding practices and other aspects of caring for her children. In particular, a woman's pregnancy and childbirth experience can greatly impact the way breastfeeding begins and continues.

This year, World Breastfeeding Week seeks to underscore the urgent need to protect, promote, and support the health and well-being of mothers as well as to protect, promote, and support the health and well-being of babies, through breastfeeding.  The Goals for WBW 2002 are:

• To reinstate breastfeeding as an integral part of women's reproductive cycle and health
• To create awareness of women's right to humane and non-invasive birthing practices
• To promote the Global Initiative for Mother Support (GIMS) for Breastfeeding as one way to strengthen the support for mothers. 

Health is internationally accepted as a fundamental human right.  Women and girls' right to health of the highest attainable standard includes the right to full and reliable medical information; to informed consent, choice and decision-making in health care, reproduction and infant feeding; to privacy and confidentiality; and to safe conditions of work and environment.  These rights are reiterated in numerous national and international documents, beginning with the Universal Declaration of Human Rights and the International Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW).

Women in good health have the best chance to have healthy babies.  Nevertheless, women who are not in optimal health still become pregnant, have healthy babies, and breastfeed successfully.  This is a testament to the marvellous capacity and resilience of the female body!  While all mothers need support in caring for themselves and their families, breastfeeding mothers should have extra support to maintain and promote their own health as well as to give the gift of life and breastmilk to their babies.

Essential Components for Healthy Mothers:

• A diet with appropriate protein, calories, vitamins and minerals to support the mother's overall health, decreases the risk of having a sick, premature or low-birthweight baby, and assure continued health in recovery and during breastfeeding
• Access to health care services for general wellness, pregnancy care, timely treatment of illness, and in medical emergencies
• Working and living conditions that are safe and healthy
• Limited use of alcohol, tobacco/cigarettes, and other addictive drugs
• Pregnancy, childbirth, and new-mother care that is evidence-based, clean, respectful, culturally appropriate and family-centred
• Accurate information and support for exclusive breastfeeding for the first six months of life and the appropriate use of complementary foods, preferably home-made, along with breastfeeding until age two years and beyond
• The ability to space pregnancies, in the first six months possibly through breastfeeding (lactational amenorrhea method), fertility awareness, and other family planning methods
• A network of friends and family for support and information
• Awareness of the commercial and economic influences on pregnancy, childbirth, and breastfeeding.

During her pregnancy, a woman's body both grows a baby and prepares to nourish it.  Mammary glands multiply, extra fat is stored, vitamin and mineral metabolism is enhanced, and the hormones for lactation are present.  By the 16th week of pregnancy, colostrum is produced and the breasts are ready to make milk.

All pregnant women have a right to basic health care in order to promote healthy personal care and nutrition as well as to monitor for complications in mother and baby.   Such care should include objective and factual information on:

• The physical and emotional aspects of normal childbirth and breastfeeding
• Drug-free methods for managing problems in pregnancy and the work of labour and birthing
• Recognising and responding to unexpected complications
• The importance of colostrum and early breastfeeding
• The innate abilities of the infant at birth
• Techniques for effective breastfeeding and overcoming difficulties.

A woman in labour, regardless of birth setting, should have:

• Access to care that is sensitive and responsive to the specific beliefs, values, and customs of the mother's culture, ethnicity and religion
• Access to birth companions of her choice who provide emotional and physical support throughout labour and delivery
• Freedom to walk, move about, and assume the positions of her choice during labour and birth (unless restriction is specifically required to correct a complication).  The use of the lithotomy position (flat on back with legs elevated) is discouraged
• Care that minimises routine practices and procedures that are not supported by scientific evidence (e.g., withholding nourishment; early rupture of membranes, Ivs (intravenous drip); routine electronic foetal monitoring; enemas; shaving)
• Care by staff who minimise invasive procedures, such as rupture of membranes or episiotomy
• Care by staff trained in non-drug methods of pain relief and who do not promote the use of analgesic or anaesthetic drugs unless required by a medical condition.

• Supportive policies that encourage mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions 
• Clearly defined policies and procedures for: collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary; linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support 
• Policy on mother-baby friendly services (as outlined above) and staff who are trained to understand that the health and well-being of the mother, her foetus, her newborn, and the successful initiation of breastfeeding, are all part of a continuum of care. 

Childbirth

Labour and birth are defining moments in a woman's life in every culture.  Months of planning and dreaming finally move into reality.   When a woman can labour and deliver in a safe, supportive, and respectful environment with minimal interference, she and her baby have the opportunity to be alert, interactive, and ready to breastfeed.

Normal pregnancy, labour, birth, and breastfeeding are interdependent experiences.  Evidence-based practices can keep birth normal and empower women to make decisions about the care she and her baby receive.  Refer to the box at on page 2 for an example of best practices for normal childbirth. 

Unfortunately, this fundamental ability of women to give birth to their babies is often poorly supported or even undermined. Many women lack factual information and skilled and assertive support for childbirth and early breastfeeding.  They may not be encouraged to participate in decisions about their own care.  In fact, they may be encouraged to passively accept practices that are 'routine' rather than evidence-based.  
 
Furthermore, there is an increasing gap worldwide in the care of the birthing mother.  On one hand, many women in resource-poor areas may give birth in unclean conditions without a skilled birth attendant.  In such instances, breastfeeding shortly after birth can be vital to reducing post-partum bleeding and maintaining the baby's body temperature, but may be constrained or delayed by giving teas or other fluids or withholding colostrum.  

On the other hand, women in resource-rich areas may be inundated with medical technology and specialised health care that promote the use of unnecessary and excessive birth interventions in normal, healthy births.  A 1997 Technical Paper by the World Health Organization (WHO), Care in Normal Birth, provides an evidence-based review of various practices and procedures in childbirth. Its recommendations for practices to be promoted, eliminated, and used more appropriately generally reiterate those listed in the box on page 2 Best Practices for Normal Childbirth.  

Despite these recommendations, many harmful, ineffective, and inappropriately applied practices persist.  In some settings they are being aggressively marketed to women and health care providers as being 'convenient' and 'pain-free' without providing clear information on their impact on childbirth, babies and breastfeeding.  In particular, narcotic and anesthetic drugs given to mothers for labour pain relief can actually lengthen labour and increase the risk for other invasive and expensive procedures.  These drugs also reach the foetus and can affect the newborn's ability to breathe, suck, swallow, and thus breastfeed effectively.

Immediate Breastfeeding after Birth

Babies are born with the innate ability to find the breast, self-attach, and feed. Babies left in skin-to-skin contact with the mother remain warm and can more easily regulate breathing and heart rate. Breastfeeding in the minutes following birth can help to expel the placenta, reduce bleeding and reinforce emotional attachment of the mother to the baby.  If left undisturbed, babies may remain in an active, alert state from 40 minutes up to two hours after birth, after which they drop into deep sleep.

Just as with childbirth, many procedures in the early post-partum interfere with establishing early breastfeeding. Procedures that invade the infant's nose, mouth, and throat may damage delicate membranes, disrupt early sucking reflexes, or create aversion to oral stimuli. Removing the baby from the mother for measurements, inoculations, or bathing can disrupt the newborn's alert state. Eye drops given before the first mother-baby eye contact and breastfeed disrupt the visual contact vital for mutual attachment.

Best practices in the newborn period are the Ten Steps for Successful Breastfeeding, which form the core of the Baby-Friendly Hospital Initiative (BFHI).  By keeping mother and baby together in a supportive environment with minimal interference, exclusive breastfeeding is protected and encouraged.  If the birth experience was not ideal, the Ten Steps can promote mother-baby attachment and empathetic breastfeeding assistance from trained birth attendants, lactation consultants, nursing and medical staff, and breastfeeding counsellors.  This support can reinforce a mother's own determination and motivation to breastfeed.  For more information on BFHI, visit the UNICEF website at http://www.unicef.org/bfhi.

Support for the Mother's Health

Once breastfeeding has been established, mothers continue to need support to maintain their physical and emotional health.  Frequent home visits by a health worker or trained volunteer in the early weeks can check on the health of mother and baby and the progress of breastfeeding, and provide access to a supportive and informative friend.  Participation in mothers groups can provide social activity and support as well as role-models for mothering and breastfeeding. Extra care and assistance from the family helps the new mother gradually adjust to her new responsibilities.   

Mothers also need:

• Health care services for themselves and their children  
• Continued reassurance and support to maintain exclusive breastfeeding for the first 6 months and subsequent breastfeeding with appropriate complementary food thereafter 
• Worksite policies that facilitate breastfeeding, at a minimum following the provisions in the ILO Convention 183 on Maternity Protection 
• Information on and assistance in family planning that is compatible with breastfeeding, such as the lactational amenorrhea method (LAM), as well as access to other methods of child spacing once fertility has returned 
• Household foods with appropriate protein, calories, vitamins and minerals for themselves and as complementary foods for their children after six months. 

The Global Initiative for Mother Support (GIMS) for Breastfeeding

GIMS for Breastfeeding is a new global initiative coordinated by WABA's Mother Support Task Force.  It aims to improve the environment of support for a mother to initiate and sustain breastfeeding.  Such support generally includes encouragement, accurate and timely information, humane care during childbirth, advice, reassurance, affirmation, hands-on assistance, and practical tips. 

Women need the support of professional health providers, employers, friends, family and the community. Conditions need to be created during pregnancy, birth and lactation so that women can safely carry healthy babies to term and give birth in the company of those they select to share this experience. Employed women should receive support for practising exclusive breastfeeding for the first six months and continued breastfeeding after the introduction of complementary foods.

For more information on GIMS, contact the WABA Secretariat.

Breastfeeding  for Baby's Health!

• Exclusive breastfeeding meets all the nutritional needs of a baby for the first six months. Breastfeeding continues to make a significant contribution to the baby's nutritional and emotional health into the second year and beyond 
• Breastfeed babies have stronger immune systems and are healthier than bottle fed babies 
• Special fatty acids in breastmilk lead to increased intelligence quotients (IQs) and better visual acuity 
• Research shows that breastfeeding can save the lives of over 1.5 million babies who die every year from diseases such as diarrhoea and pneumonia. 

To promote women's health:

• Establish and/or promote programmes to improve the physical and emotional health of girls and women, including quality nutrition, smoking prevention and cessation, physical activity, formal schooling, and family planning. 
• Help women with acute or chronic health conditions, such as tuberculosis, hepatitis C, HIV/AIDS, and drug addictions, receive humane health care. 
• Organise a 'best practices' seminar on pregnancy, childbirth, breastfeeding, and women's health for families, health care providers, health care payors (insurance and government), law-makers and government officials. 
• Collect information on deficiencies, adequacies, and superiorities in breastfeeding and women's health protection, promotion and support in your community.  This could include health clinics, worksites, hospitals, and community groups.  Award those with best practices. 

• Collect information at the local, regional or national level on women's perinatal health: 
• o greatest barriers to a healthy pregnancy  
• o important issues for a safe and informed birth experience 
• Organise families in your community to ask for improvements in maternity care: 
• access to health care and social services 
• childbirth education classes based on factual information that teach how to manage the work of labour 
• new parent classes on baby care and breastfeeding 
• healthy lifestyles for the family 
• acceptible and effective birth-spacing methods.
• Ask local hospitals and health providers about their antenatal, childbirth, and post-partum services. Suggest changes (refer to Care in Normal Birth and Evidence-Based Guidelines for Breastfeeding Management During the First Fourteen Days) that can humanise mother-baby care, improve patient satisfaction, and save money and resources. 
• Encourage training programmes for birth attendants, doulas, and other childbirth supporters. 
• Review health standards, policies, and laws pertaining to birth and newborn care; collaborate with physicians, lawmakers, and officials to change those that mandate procedures in birth and the early post-partum that can interfere with mother-infant attachment and breastfeeding. 

• Add breastfeeding as greater component in local, regional, and national "Safe Motherhood" Initiatives and other maternity or baby health programmes. 
• Establish or promote breastfeeding information and support classes and outreach programmes within your community.  
• Create breastfeeding committees or coordinating groups at local, regional, and national levels. 
• Strengthen the Baby Friendly Hospital Initiative: 
• o encourage local hospitals to become Baby-Friendly 
• o help those hospitals which are already Baby-Friendly to maintain their quality, evidence-based practices 
• o broaden BFHI criteria to include birthing care and care in HIV prevalent settings. 
• Support the International Code of Marketing of Breast-milk Substitutes and subsequent WHA resolutions on infant feeding: 
• urge government leaders and hospital administrators to use the Code in the development of laws, regulations and contractual agreements 
• educate colleagues and community members on the Code, how it is violated, and how this impacts families in your community.  Encourage them to follow the Code. 

• Discover local resources and services for postnatal medical and social care, such as home visitors, food programmes, family planning and mother-to-mother support.  Tell colleagues and mothers about these resources. 
• Support the development or maintenance of mother-to-mother support groups in local communities. 
• Work to implement the new International Labour Organization Maternity Protection Convention (183) and Recommendation (95) in your country, and its provisions voluntarily in local worksites.  For specific action ideas, visit the WABA webpage on the ILO Campaign:  http://www.waba.org.my/actilo.htm 
• understand laws and policies on maternity leave and mother's working conditions in formal and informal sites 
• identify resources and services for crèche facilities in the work place. 
• Join and endorse the GIMS and act locally. 

Resources

Books/Monographs:

• Enkin, M., M.J.N.C. Keirse, M. Renfrew, and J. Neilson, A Guide to Effective Care in Pregnancy and Childbirth (second edition). New York: Oxford University Press, 1995. 
• IBFAN, Breaking the Rules, Stretching the Rules 2001: Evidence of Violations of the International Code of Marketing of Breast-milk Substitutes and Subsequent Resolutions (English and Spanish). IBFAN PDF version downloadable from www.ibfan.org/english/codewatch/btr01/main-en.htm 
• International Institute of Rural Reconstruction (IIRR), Indigenous Knowledge & Practices on Mother and Child Care: Experiencesfrom Southeast Asia and China. 2000 
• International Lactation Consultant Association (ILCA), Evidence-Based Guidelines for Breastfeeding Management During the First Fourteen Days.  1999.  Available from ILCA, www.ilca.org. Summary on-line at www.guideline.gov. 
• Maternity Centers Associations, Your Guide to Safe and Effective Care During Labor and Birth (2000 edition). Website: www.maternitywise.org, Tel (USA): +212-777-5000 ext. 5.   
• WHO, Care In Normal Birth. Print version ordered through WHO Geneva; PDF version downloadable from www.who.international/reproductive-health/publications/. 
• WHO, "Appropriate Technology for Birth (Fortaleza Recommendations)." Lancet Aug 24, 1985:436-437. 
• Williams CD, Baumslag N, Jelliffe DB, Mother and Child Health: Delivering the Services.  3rd edition, 1994. 

• Cochrane Collaboration Reviews Database www.cochrane.org. 
• Heinig MJ, Dewey KG, "Health effects of breastfeeding for mothers: a critical review."  Nutrition Research Reviews 1997; 10:35-56. 
• Kennell JH and Klaus MH, "Bonding: Recent Observations That Alter Perinatal Care" Pediatrics in Review 19(1) 4-12, 1998.  
• Walker M, "Do labor medications affect breastfeeding?"  J Hum Lact 13(2):131-137, 1997. 

• Gentle Birth Choices and Birth into Being. Available from www.waterbirth.org 
• Delivery Self-Attachment. Shows the difference at birth between babies born to mothers who did or did not use pain drugs in labor.  Available from Geddes Productions www.geddes.com or Health Education Associates, Tel: +508-888-8044 
• Birth in the Squatting Position.  Available through Academy Communications, Box 5224 Sherman Oaks, CA 91413 Tel (818) 788-6662  
• Giving Birth: Challenges and Choices by Suzanne Arms.  Available from www.BirthingtheFuture.com. 
• Tried and True.  An encyclopaedia of high touch, low-tech comfort techniques.  Available  from www.Injoyvideos.com 

• Alliance for the Transformation of the Lives of Children  www.ATLC.org  
• Doulas of North America, DONA <www.dona.org>  
• Save the Children Every Mother/Every Child Campaign <www.savethechildren.org> 

WBW Coordinating & Distributing Centres
 

Acknowledgements 

Written by Doraine Bailey, MA, with substantial technical assistance from Mary Kroeger, CNM MPH and Linda Smith, BSE, FAACE, IBCLC. Many thanks to the review panel: Helen Armstrong, Naomi Baumslag, Urban Jonsson, George Kent, Nikki Lee, Luann Martin, Pamela Morrison, Chris Mulford, Norjinah Moin, Jairo Osorno, Elaine Petitat-Côté, Gulnara Semenov, Virginia Thorley, Sarah Amin and Susan Siew. Illustrations: Jonah Salvosa. Production: Liew Mun Tip and C-Square Sdn. Bhd. This project is funded by the Dutch Ministry of Foreign Affairs (DGIS).

The World Alliance for Breastfeeding Action (WABA) is a global alliance of networks and organisations, such as IBFAN, LLLI and ILCA, and individuals, to protect, promote and support breastfeeding. WABA acts on the Innocenti Declaration and works in close liaison with United Nations Children's Fund (UNICEF).

Your local contact:

WABA does not accept sponsorship of any kind from companies producing breastmilk substitutes, related equipment and complementary foods. WABA encourages all participants of World Breastfeeding Week to respect and follow this ethical position.