Breast milk :

The most precious gift from mother to newborn

By Wasundara Rathnaweera

Breast milk is the ever known best and perfect food for the newborn infants up to six months from birth. It contains all the essential nutrients for the baby's growth and other immune factors which are necessary for the good health of the baby. More importantly, mother's milk can protect infants from diarrhoea and acute respiratory infections; which are known to be two leading causes of infant death. Virtually all mothers who attempt to breast feed their babies can successfully initiate the process with accurate knowledge and sufficient family and social support; whereas the failure is caused mainly due to psycho-social or improper breast feeding management factors, rather than the inadequate maternal nutrition.

Lactation - Natural phenomenon to nourish infant

Lactation is a cyclic process which begins at the conception and comes about with the involvement of several hormones. This natural scenario is pivotal in providing nutrition to the new born and young infants. Fully functional and well developed mammary glands are mandatory in successful lactation. At the stage of puberty, extensive growth of the breasts is occurred as the early preparation for lactation, and the hormonal changes befall during pregnancy induce the mammary development. As soon as the placenta is delivered after the child birth, milk production is initiated with the action of prolactin hormone and milk ejection is impelled by oxytocin hormone. Actually, milk ejection occurs in response to a neuro-hormonal mechanism where the nipple stimulation (by means of sucking) by the infant results in the secretion of oxytocin by the posterior pituitary gland and thereby prompts the milk ejection. Regardless of the size of breast, all the mothers who are willing to breast feed their babies can produce adequate amount of milk for the infants.

First milk - very important

The first milk coming out from the mother's breasts is known as "Colostrum" or "Golden Milk". It is a sticky, yellowish liquid, which is secreted for the first three to five days after the delivery. Colostrum is rich in anti-infective agents, namely Immunoglobulin A (IgA) and lactoferrin, that protects the infants from the infections. Also this liquid contains a higher amount of vitamin A and sodium, compared to mature milk. This vitamin A is vital in proper functioning of the infant's eyes, skin and immune system. However the fat and lactose content of the colostrum is lower than that of mature milk, which offers the most pertinent and healthy composition for the correct functioning of their immature digestive system and kidneys, while providing the optimum nutrition to the infant. It is recommended to start breast feeding within the first hour after the child

birth in order to give this precious source to the newborn. The importance of colostrum is that it is not only there to provide nutrients, but also to immunize the babies.

What is Exclusive Breastfeeding?

Exclusive breastfeeding is giving the infants only breast milk, with the exception of drops or syrups consisting of vitamins, mineral supplements or drugs and not even giving them water. World Health Organization (WHO) recommends exclusive breastfeeding up to six months of age of the baby. According to the Sri Lanka Demographic and Health Survey (SLDHS) of 2007, the rate of exclusive breastfeeding among infants aged 0-5 months in Sri Lanka was greater than 75 percent, which is the highest reported rate for the South Asian region and is far beyond even the ten-year target for some countries of the region.

Composition of breast milk

The composition of breast milk is not uniform. Basically it varies with the stage of lactation. Also some individual characteristics of the mothers such as parity, age and other maternal characteristics affect the breast milk composition. There are major four phases of lactation which differ the composition and volume of milk produced. For the first 3 to 5 days after the delivery, 'Colostrum' is secreted. The amount of colostrum secreted varies with the time. At the first day, about 40 milliliters is secreted

and when it comes to the third day, the volume is around 200 millilitres. After the colostrum, until the end of the second week, 'Transitional milk' is secreted. The volume of transitional milk is higher than that of colostrum and the amount of fat and lactose is also higher in this milk. After the second week, during the full lactation, 'Mature milk' is secreted with a high concentration of lactose, fat, calcium and some vitamins like vitamin B1, vitamin B2 and vitamin C to meet the increasing demand by the

infant. At the end of the lactation 'Involutional milk' is secreted which is low in its lactose content.

Breast milk contains almost all the nutrients and enough water needed for the newborn for the first six months of the life. However, it is a poor source of iron. But the baby has some stores of iron from the birth and these stores can compensate the iron requirement of the baby.

Lactose; which is used for energy production is the predominant carbohydrate in human milk and mature milk contains about 7grams of lactose per 100 millilitres of breast milk. Breast milk holds several important fatty acids including the two essential fatty acids; linoleic and linoleic acid. Also it contains comparatively high proportions of arachidonic acid and docosahexaenoic acid (DHA) which are some important constituents of brain and neural tissue and are needed for mental and visual development in early life. There are two types of proteins in breast milk, namely, casein and whey proteins; present in the ratio of about 40:60.Many of the proteins present in the milk have multiple potential functions. For instance, lactoferrin transports and promotes the absorption of iron, act against a range of micro-organisms (bacteria) and also acts as a nutritional protein.

Therefore, breast milk can be identified as a bunch of nutritional constituents and bioactive components including antimicrobial factors, anti-inflammatory substances, hormones, growth modulators and digestive enzymes.

Why not formula milk or other animal milks?

Cow's milk protein and soy protein are the main protein sources of most infant formula milks. Since cow's milk is casein dominant (Whey: casein ratio is typically 20:80), its protein composition is entirely different from that of human milk. Curds produced by casein are difficult to digest by the immature digestive system of the newborn. Even though the formulas are made similar to the human milk's whey: casein ratio, there are differences in the function and make-up of the whey and casein in human milk and formula milk. For instance cow milk proteins do not contain lactoferrin, immunoglobulin, or digestive enzymes.

Breast milk offers the perfect combination of nutrients and other non-nutritional factors essential for the growth and development of the baby.

The growth factors, anti-infective factors such as lctoferrin, immunoglobulin cannot be present in formula milk, as they can only be present in a live fluid like breast milk. Even when the babies are born prematurely, the milk secreted from the mother's breasts is different in its composition and formulated to meet the needs of the premature infant.

Benefits of breast feeding Breastfed babies tend to have fewer incidences of infections, respiratory illness, allergies, diarrhea, and vomiting, due to its healthy constituents. Breast feeding also reduces the risk of meningitis, chronic intestinal disease, urinary tract infections, Sudden Infant Death Syndrome (SIDS), leukemia and other childhood cancers. Furthermore, juvenile

diabetes and Crohn's disease are less common among breastfed babies. Breast milk is constantly changing in its composition with the exact combination of sugars, protein, fats, vitamins, minerals, and other non-nutritional components needed for the infant at various stages of the growth with changing nutritional needs. There are some evidence to prove that breastfed babies have fewer learning disabilities and behavior problems, compared to the babies who are not breastfed.

Not only the child, but also the mother gets several plus points because of breast feeding. Breast feeding helps to contract mother's uterus after the delivery and reduces the postpartum bleeding. Also it supports to bring the uterus to the pre-pregnancy state more quickly. Mothers who do breastfeeding their infants can burn calories easily and lose extra weight that is gained during pregnancy. Apart from these, breastfeeding helps to reduces several health risks in late life of the mother. It reduces the risk of ovarian, breast and other reproductive cancers in their future life. Several studies have found a strong inverse association between the duration of breastfeeding and incidence of breast cancer. Keeping birth-spacing is an additional advantage of breast feeding. Prolactin secreted during lactation acts as a natural contraceptive and helps to have longer birth-intervals which benefit the health of both mothers and their children.

Breast feeding is the most economical way of infant feeding, and it is always available with the correct composition and temperature. Breast milk is clean; has less chance of contamination and it is easy to feed. More importantly, the bond between the mother and the child is enhanced with breast feeding.

Be careful

Though breast milk is safe to feed your baby, it has also been shown an excretory route for a range of substances that can be harmful to the infant. Viruses such as Human Immunodeficiency Virus (HIV), components of mother's diet that can cause allergies to the infant (aflatoxins, trans fatty acids), common stimulants such as nicotine, caffeine and some environmental and occupational pollutants like DDT and dioxins can be passed from mother to the infant via breast milk. Therefore, mothers should carefully select their diet and have proper behavioural patterns to minimise the harmful substances passed with breast milk to their babies.

As breast milk plays such a vital role, it will not be an exaggeration if it is termed as 'where the life begins'. If you are a mother, you are blessed with the most precious wealth of the world; children. They are the future of this world, and we all have a great responsibility to protect them.

'Mother' is the key person in the mission of liberating healthy future generation to the society and breastfeeding is a crucial step of it. Since breastfeeding is so important, the World Breastfeeding Week is announced on the first week of August every year. This year, it comes with the theme of "Breastfeeding; A Winning Goal - For Life", asserting the importance of increasing and sustaining the protection, promotion and support of breastfeeding, as it is a vital, life-saving goal. So, do not hesitate to give this precious gift to your baby, as it is not just milk; it is the drop of life.

(The writer is a final year undergraduate at the Department of Applied Nutrition, Faculty of livestock, Fisheries & Nutrition, Wayamba University of Sri Lanka)