Feeding Infants at TEOTWAWKI: The Critical Advantages of Breastfeeding, by Dr. Goscienski, M.D. – Part I

Milk is the primary source of nourishment and hydration for infants during the first two years of life. We have become so accustomed to the ready availability of cow’s milk, or sometimes other sources, such as goat or soy, that we have neglected the best source– the human breast. What is not often appreciated is that human milk, according to one expert on the subject, “exerts effects far beyond its nutritional value.” The full impact of that concept in a TEOTWAWKI (The End of the World as We Know It) situation is the subject of this article.

An adult can survive for weeks without food and days without water, but infants in the first few weeks of life will succumb quickly when either breastmilk or formula is not available for even a short time. Substitutes that might be available during a disaster will not be adequate.

In a regional disaster, such as a moderate earthquake, it might be possible to obtain supplies within hours or days from unaffected neighbors. In a massive collapse, such as an EMP (ElectroMagnetic Pulse), a nationwide cyber attack, or a severe earthquake that involves a wide area, the lack of food and safe water, communications, and transportation will affect our youngest children soonest, unless we preserve the single best infant survival resource– breastmilk.

Most American infants below the age of six months are not receiving breastmilk. Although nearly 75 percent of newborn babies are exclusively breastfed at the time of hospital discharge, that number falls to about 33 percent at 3 months and less than 12 percent when the child is 6 months old. Those figures are far from the goals of the American Academy of Pediatrics and the Healthy People 2010 initiative of the U.S. Department of Health and Human Services. What is far more important than the HHS goals is that at TEOTWAWKI, the vast majority of mothers will have no way to prevent their babies from becoming dehydrated in the short term and starving in the long term.

That is not the whole story. In a societal collapse infectious diseases will take the lives of millions of persons. The first to be affected will be the very young, whose immune systems have not matured. Infants who are not breastfed will be most at risk. In order to understand why breastfeeding will be so important at TEOTWAWKI, it’s necessary to describe some basic principles concerning this ancient practice. To be sure, the vast majority of persons have no knowledge of breastfeeding and neither do most healthcare professionals. This is partly explained by the complacent acceptance of artificial (cow’s milk formula) feeding among parents but also because the topic is barely discussed either in medical schools or in the postgraduate training of physicians. In addition, much has been discovered in the past few years on the nature of breastmilk. The goals of this essay are to educate the readers of Survivalblog and to prepare women of childbearing age with the information, the attitude, and the nutritional knowledge that will enable their children to survive. Stored food, water, and MREs won’t accomplish that.

The basics of breastfeeding

Human breastmilk has several characteristics that are simply impossible to duplicate with the milk of any other animal, modified or not. The mother and infant comprise a dyad, a unique pairing consisting of genetic and environmental elements that, like fingerprints, have no exact matches in life. If a mother delivers a male child one year and a female child the next, the breastmilk that she produces for each will not be the same. Simply put, milk for boys is different from milk for girls. Imagine then, how different must be the milk of every mother from every other mother/infant dyad.

Beginning with the first contractions of the uterus in labor, the infant is subject to stress. After a few hours of being squeezed and then being forced through a tight passageway, feeling the temperature drop when the trip is complete, and then expanding his/her lungs for the very first time, the term stress must seem inadequate for this new little human. Yet nature has prepared for this, provided that the infant is allowed access to its mother’s breast immediately. The first few drops of milk, and the several ounces that follow in the next couple of days contain endorphins (endogenous morphine), chemicals that relax the infant and alleviate the stress that he/she has undergone. Endorphins also appear to increase the bonding that occurs within the mother/infant dyad. Formula-fed infants are not so fortunate.

With occasional, and sometimes serious, exceptions, the infant in the womb is protected from infectious agents. That changes within moments of entering a microbe-filled world. Fortunately, the baby has received some protective antibodies against those germs to which the mother has been exposed, either through natural infection or from vaccination. For the rest, nature has provided some temporary but critical protections in breastmilk.

Lysozyme is found in tears, breastmilk, and other secretions, and it literally dissolves bacteria. Oligosaccharides are sugar-like molecules that block bacteria from attaching themselves to the lining of the throat and the intestine. Secretory IgA is a type of antibody formed within the mother’s breast that also protects the infant from infectious agents. Substances in breastmilk induce the infant’s cells to produce interferon– a class of chemicals that inhibit viruses. As an example, when a mother develops influenza, her breastfed infant will respond by producing larger amounts of interferon, a phenomenon that is being studied with great interest.

Of all the ways in which breastmilk protects the infant, the presence of live cells may be the most important. More than 160 years ago live cells were discovered in normal breastmilk. Over the next century these cells were observed to kill bacteria and fungi. They include neutrophils– cells that form the bulk of pus observed in a wound, for example. It has taken decades to unravel the significance of macrophages and lymphocytes, whose role in the immune process is still not fully known but that are important in the fight against all types of microorganisms. Still more intriguing are stem cells, whose function in breastmilk is not yet well understood but that undoubtedly play a role in survival.

These cells have some important characteristics. They originate in the immune tissues of the mother and arrive in the immune tissues of the infant. Clearly, they do not appear in breastmilk by accident; they have a defined purpose. Unlike most elements of breastmilk, these cells escape digestion by the infant. Somehow they are not processed as food, as would be cells from any other source. Most remarkably, they remain in the child’s body for years and influence the function of the recipient’s immune system for nearly a decade, perhaps longer. There are no live cells in commercial infant formula.

There are other live cells in breastmilk: bacteria. These are not the dangerous kind but represent normal flora, also known as probiotics, without which we could not survive. Animals that are raised in a totally germ-free environment do not live long. These beneficial bacteria aid in the development of the immune system, they lower cholesterol, increase the caloric value of foods, and very importantly, they inhibit the growth of harmful bacteria that we encounter frequently.

New techniques in microbiology have revolutionized the study of the bacteria that live in and on us. Once thought to be few in number and only moderately diverse, genetic methods have revealed that the bacterial cells that we carry outnumber our own body cells (somatic cells) by a factor of ten to one. The number of different species of these beneficial bacteria is hard to grasp; nearly 1,000 separate species have been identified so far.

Until a few years ago infants were thought to acquire their allotted share of good bacteria in the first few hours after birth. Having a baby, after all, is a rather messy process. The vagina contains a myriad of bacteria, viruses, and other microorganisms, and only C-section babies avoid them (perhaps to their detriment). The close proximity of the birth canal to the alimentary canal inevitably leads to contamination with fecal material, where most good bacteria reside. Finally, the skin that covers the breast harbors many strains of bacteria so that the nursing infant partakes of them as well.

Recent studies have shown that breastmilk is not sterile. It contains beneficial bacteria that actually arrive there before labor begins. Obviously, nature intended that we should receive these helpful germs at the earliest possible moment.

How much does this matter in a TEOTWAWKI situation? When public sanitation facilities fail, when water supplies become contaminated, and when the lack of medical systems leads to rampant infection, every immunological element takes on great importance. We see this on a huge scale in developing countries where infant formula companies have successfully marketed their product but where the water that is used to reconstitute powdered or concentrated formula is often contaminated. In those countries diarrhea is the single leading cause of death in early childhood. Breastfed babies have less gastrointestinal disease, fewer respiratory infections, and lower rates of ear infections than their bottle-fed counterparts, even in the most modern societies.

A full-term pregnancy lasts about 40 weeks, but some babies don’t remain in the womb that long. The lower the birth weight, the greater the risk of breathing problems, infection, brain damage, and other difficulties. One of the most serious complications of prematurity is necrotizing enterocolitis (NEC), in which portions of the intestine are damaged and die. The mortality rate may be as high as 50 percent. Premature infants that receive their own mother’s breastmilk via a feeding tube have a significantly greater chance of avoiding NEC.

Omega-3 fats are important constituents of the brain and eyes, and the growing fetus receives these through the placenta. Most of the transfer of these nutrients occurs during the last eight weeks of pregnancy. What happens to the infant that is unfortunate enough to arrive two months early? As if to compensate for this lack of critical nutrients, the breast of the mother whose infant arrives early manufactures a greater amount of these fatty acids than the mother whose baby remains in the womb for a full 40 weeks. It is only recently that infant formula has been supplemented with omega-3 fats. That might not solve the problem. Fats can become rancid on storage in a can or a bottle, but they are always fresh in the mother’s breast.

A truly remarkable element in the mother/infant dyad is synchronicity, producing the right nutrients at the right time. In the first few days after delivery breastmilk is known as colostrum. It is rather scanty, but it contains a large amount of protein with lots of protective antibodies. From about the second week to three months the mother produces transitional milk. This is the period of the most rapid growth of a child’s life; his/her weight doubles in three months from an average birth weight of 7 pounds to about 14 pounds. The next 7 pounds will require another 9 months. It’s no wonder that transitional milk is very high in calories compared to every other stage of the nursing period. Mature milk is formed after the third month or so, and breastmilk changes every day because the baby does.

Contrast that with commercial formula. When Mom sends Dad to the store for formula on the day they arrive home with the new baby, he brings back several days’ supply. Next month or six months later the same brand contains exactly the same ingredients. It never changes.

How will we feed babies in TEOTWAWKI?

Alternatives for mother’s milk were not unknown in ancient times. There is archeological evidence from more than 2,000 years ago that infants received animal milks in specially designed feeding devices. The usual alternative, however, was a wet nurse. If a woman died at childbirth in Roman times, for example, the father could employ the services of a woman, usually a slave, who was still lactating to provide for her own child. Because a wet nurse may have been lactating for months or years, she supplies her new infant client with mature milk. The baby has therefore not only missed the initial feedings of colostrum, but also the high-calorie transitional milk.

In TEOTWAWKI there will be few, if any, wet nurses to fill in for the mother who cannot breastfeed or who has chosen not to and whose breasts are now dry.

The early history of substitute milks is dismal, and history may repeat itself in TEOTWAWKI. The lack of proper facilities and the paucity of expert knowledge of formula preparation could result in the dire effects of the late 19th century, when infant death rates among formula-fed infants were double those of breastfed babies during the first year. The tragedies that we still see in developing countries give us a clue of what to expect at TEOTWAWKI. Lack of pasteurization, contaminated water, and errors in recipe preparation lead to many deaths.

There is a misguided impression that “natural” vegetable milks are satisfactory substitutes for standard infant formula. Soy, almond, rice, and sweet chestnut milks, designed for adult consumption, are almost always deficient in calories, protein, vitamins, and minerals relative to an infant’s needs. These have resulted in growth failure, seizures, iron deficiency anemia, rickets, pneumonia, coma, and death.

As more families relocate to rural areas there is an increasing likelihood that they will depend on private wells for their water supply. This adds one more reason for mothers to breastfeed and not to rely on home-prepared infant formula: nitrate contamination. Over the decades there has been increased use of nitrogen-containing fertilizers and those have seeped into water tables. In the mid-1990s the Centers for Disease Control and Prevention reported that 13 percent of wells in Midwestern states had elevated levels of nitrates. If nitrate-contaminated water is used to make infant formula, there is a risk of methemoglobinemia– a reduced ability of blood to carry oxygen. Affected infants turn blue, become irritable or lethargic, may develop coma, and will die if untreated.

The breastmilk of mothers who consume nitrate-contaminated water will not harm the infant, because the substance does not pass into the milk. In addition, the good bacteria that breastfed infants acquire prevent the chemical conversion of any ingested nitrates to the toxic form. In case a mother needs to revert to cow’s milk formula prepared at home, every family that relies on well water should have it tested for nitrates before the need arises.

The breastfeeding mindset

Although we have made some progress in the past generation, we are not a breastfeeding society. Consider the regular but disheartening stories of mothers who have been excluded from shopping malls, city council meetings, airplanes, and other venues because they were doing what mothers have done for millennia– nourishing their infants. Despite the fact that they almost always have done this discreetly, showing less breast than many magazine covers at the local Barnes and Noble bookstore, they have been ridiculed, or worse. It’s time to change our culture and to do so before TEOTWAWKI. A society in which exposed but empty breasts are visible on prime-time TV and in PG-13 movies ought to be able to tolerate breastfeeding in public.

We must also prepare the pregnant. Surveys among medical students and healthcare workers reveal a dismal picture: physicians do not encourage breastfeeding. One reason, of course, is that it is never part of the medical school curriculum. They are therefore unaware of the shortcomings of commercial infant formulas and the clear superiority and the importance of breastmilk. Obstetricians are more interested in what happens until the umbilical cord is cut than what happens afterward. That should be the pediatrician’s turf, but pediatric residency training rarely includes discussions of breastfeeding. The lactating breast only receives attention when the mother complains of pain, engorgement, cracked nipples, or the frustrating concern that “I’m not producing enough milk.”

It is a rare mother that does not produce enough milk. On the contrary, mothers of twins can breastfeed both exclusively for a full six months, in accordance with the current guidelines of the American Academy of Pediatrics. One of the notable achievements of nature is that as the demand for milk goes up, so does production.

There is another person who requires education regarding the irreplaceable advantages of breastfeeding: the grandmother. The women who bore children a generation ago had very low rates of breastfeeding. I don’t mean to disparage those who belong to the Baby Boomer generation, but when they burned their bras they did so with the conviction that breasts were not for milking. That was largely because physicians accepted the pitches of infant formula manufacturers, whose products were said to be virtually identical to breastmilk. After all, the trade name Similac® clearly implied that it was “similar to lactation.”

The grandmother who never breastfed has little to offer her daughters on this subject. She likely still holds the opinion that there is little difference between breast and bottle. After all, aren’t she and her daughters still perfectly healthy? Grandma shouldn’t be ignored; she should be educated along with the rest of the population. Expect some resistance, mixed with not a little guilt when she learns that there is, indeed a difference between the breast and the bottle.

In regard to the presumption that she and her daughters are perfectly healthy, that is simply incorrect. There is a wealth of evidence that breastfeeding has a profound influence on the health of both the baby and the mother. Following are some examples, all of which are facts, not speculation.

Babies that are breastfed have a lower risk of:

  • SIDS (Sudden Infant Death Syndrome),
  • ear infections,
  • respiratory diseases,
  • diarrhea, and
  • pyloric stenosis (obstruction of the stomach outlet that usually requires surgery).

In later childhood they are less likely to have:

  • asthma,
  • eczema,
  • leukemia,
  • lymphoma, and
  • type 1 diabetes.

As adults they are at lower risk of:

  • type 2 diabetes and,
  • osteoporosis.

In prior generations adults were also less apt to become obese, but there are now so many overriding factors predisposing to obesity that this benefit has disappeared.

The uterus of the mother who suckles her infant immediately after delivery contracts more vigorously and so limits blood loss. She bonds more strongly with her infant and has less chance of developing postpartum depression.

The mother’s greatest health benefits will come much later (after breastfeeding is long over):

  • less likelihood of premenopausal breast cancer,
  • less likelihood of ovarian cancer,
  • a reduced risk of metabolic syndrome,
  • a reduced risk of heart disease, and
  • a reduced risk of type 2 diabetes.

All of the above are major causes of death and disability.