As stated earlier, in Part I of this article, 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.
There are some circumstances in which breastfeeding should be avoided. HIV-positive mothers should not breastfeed, nor should women with active tuberculosis or those with herpes infections of the breast. Those with a history of genital herpes, however, may breastfeed without risk. If a woman enters labor with active genital herpes, it is an indication for C-section, an option that unfortunately may not be available in TEOTWAWKI.
Breast augmentation using silicone or saline implants is one of the most common surgical procedures of modern times. Neither kind of implant poses a risk to the infant. In fact, silicone levels in grocery store milk are approximately 13 times as great as those in breastmilk. Commercial infant formula contains 80 times as much silicone as breastmilk!
Breastfeeding women often develop mastitis– a painful inflammation of one or both breasts. Although it probably affected women back in the Stone Age, there is a remarkable lack of unanimity even in the definition of the condition. Fortunately, even in the minority of cases in which infection, not just obstruction, is the cause, it is not a reason for discontinuing breastfeeding. With the proper foreknowledge of breastfeeding techniques, mothers can usually avoid mastitis. This is exceedingly important in TEOTWAWKI, when finding a safe and nutritious substitute for breastmilk will be a serious problem.
An unusual finding among women who have suffered from mastitis is the heartening news that they have a lower risk of developing ovarian cancer. The benefit actually increases with increasing numbers of children and episodes of mastitis. The protective effect in women who have experienced mastitis has opened the door to new investigations and even to the possibility that there will someday be a vaccine that will prevent ovarian cancer. The survival rate of ovarian cancer today is one of the lowest among all types of cancer, largely because it remains silent, with no symptoms, until it has spread throughout the abdominal cavity. Breastfeeding women who survive TEOTWAWKI can find some solace in the knowledge that their risk of this terrible disease is about 30 percent lower, if they have experienced the temporary discomfort of mastitis.
Nursing is instinctive for the infant but not for the mother. Babies practice in the womb. Ultrasound images of fetuses sucking their thumbs are considered cute, but they overlook an evolutionary reality. Prenatal thumbsucking prepares the infant for the hard work of nursing by reinforcing neural circuits and by developing the facial and tongue muscles that are necessary for feeding. Mothers don’t have the equivalent of nursing practice, so for millennia they have relied on generational experience to become effective providers. Human mothers aren’t alone; primate moms need help too.
Zookeepers and primate researchers are aware that a first-time primate female, that has been raised apart from other females, has difficulty in bonding with her infant and nursing it. Without intervention by its keepers the chimpfant may not survive. In the wild, young females observe feeding and infant care. It has been like that for Homo sapiens as well. Perhaps the main cause of breastfeeding failure is the lack of role models and subsequently the inadequate knowledge of how to nurse a child. Without both instruction and encouragement, or at least providing examples that the eventual mother can observe on a daily basis, she simply doesn’t know what comes next after the infant leaves the womb.
Obesity affects about one-third of adults and nearly as many women of childbearing age. Large breasts make it more difficult for a child to latch on to the nipple and that sometimes results in cracked nipples. The pain and discomfort are discouraging and make quitting easier. When poor nursing technique causes breast engorgement and/or mastitis, it’s easy to see why the rate of breastfeeding drops off dramatically in the first month after delivery. Obesity also causes a delay in the onset of milk production, so that mothers fear that their supply will not be adequate.
In explaining why they stopped breastfeeding some mothers say “My husband didn’t want me to.” Society’s breast fixation might be a partial explanation, and some mothers frankly admit that nursing a baby interferes with sexual pleasure. However, fathers can be educated about the value of breastfeeding. In a study in which the male partner was educated about the value of nursing, breastfeeding rates went up from 41 percent to 74 percent.
Occasional reports of drugs and toxins in breastmilk have fueled fear among some women, who thus favor bottle feeding. In spite of the presence of dioxins, phthalates, and other chemicals, the advantages of breastfeeding far outweigh the risks of other sources of nourishment.
The single most important factor in making breastfeeding as universal as possible is society’s mindset. It begins with educating young and old in the unique, irreplaceable benefits of breastmilk. From elementary school to medical school, curricula must foster knowledge and acceptance of this very natural practice. Until the educational system reflects such changes, it’s important for healthcare providers to learn these concepts and to promulgate them among their patients. No woman should leave an obstetrician’s or midwife’s office without lactation advice at her first visit. Pediatricians must support new mothers, keep them from becoming discouraged if their milk supply seems to be lagging, recognize that breastfed infants gain weight less rapidly than their bottle-fed counterparts, and preemptively recommend a lactation counselor at the first hint of a problem.
In the delivery room, immediate skin-to-skin contact and putting the child to the breast immediately take priority over cleanup, eye drops, and the all-important injection of vitamin K. A few minutes’ delay for these latter steps is of absolutely no consequence.
Rooming-in is now standard in almost all hospitals that provide obstetric care, and hospital workers should point out that it makes sense at home, too. One reason for breastfeeding failure is the unhistoric separation of mother and child in their own rooms. Not only is that a recent phenomenon, studies show that both mothers and babies get more sleep when they share the same room.
Does breastfeeding prevent conception? The answer is “yes” but not American-style breastfeeding. It’s an unusual mother who isn’t wont to brag that her 3-month old already sleeps through the night, whether breast- or bottle-fed. If she has not yet resumed a birth-control method, relying on breastfeeding to spare her that inconvenience, she will probably learn that she became pregnant that month as well. In order for breastfeeding to prevent conception, it must be frequent, that is, at intervals no greater than every two hours. That’s not very convenient for a modern housewife, but it is no problem for today’s hunter-gatherer women who carry the baby in a sling all day and sleep with him/her at night. Under those conditions it’s typical for an infant to be at the breast every 15 minutes, day and night. The result is that one pregnancy does not follow another until weaning occurs. In hunter-gatherer societies the interval between babies is 3 to 4 years. That might be a significant advantage in TEOTWAWKI when resources, including the pill, are not available.
Successful breastfeeding requires using no pacifiers and giving no other fluids, even water, and no occasional formula “just in case she’s not getting enough.” For the times when the mother is not available because of illness, a challenging work schedule, or some unforeseen emergency, having a few bottles of expressed breastmilk in the freezer is good insurance. Freezing and even refrigeration kill the maternal cells in breastmilk, but that occasional loss is of no consequence.
In a TEOTWAWKI world, breastfeeding will not be an option. It will be the cornerstone of survival for the most vulnerable among us.
Philip J. Goscienski, M.D. is a retired pediatric infectious diseases specialist and the author of Health Secrets of the Stone Age, Better Life Publishers, 2005. He has archived more than 450 of his weekly newspaper columns at The Stone Age Doc.