Ethologists

1
Ethologists Earth MothersResearch
Controversy on Extended Breastfeeding

• Kathleen Kendall-Tackett, Ph.D.
• Family Research Laboratory
• University of New Hampshire

2
Breastfeeding in Worldwide Perspective
(Dettwyler, 1995)

• Breastfeeding is biological and heavily
  culturalized, modified by a wide variety of
  beliefs about
• infant health and nutrition
• nature of human infancy
• proper relationship between mother and child
• personal autonomy and independence

3
Era of Science as Savior

• Elimination of old wives tales
• Male experts and authorities
• High-tech better than low-tech
• Approaches developed to improve on nature
• Elimination of useless organs
• Locating active ingredient in plant-based
  treatments
• Formula to replace breastmilk

4
Scientific Health

• The effect on womens health
• medicalization of childbirth
• episiotomy and forceps
• length of labor restricted
• outlaw midwifery
• outlaw or discredit herbal medicine and other
  approaches

5
Scientific Parenting Style

• Scheduled and timed feedings
• Breastfeeding short-term, if at all
• Emphasis on early independence
• Sleeping separate from parents
• Reliance on experts for advice
• Dominant American style

6
Scientific Parenting and Breastfeeding

• Scientific approach was a disaster for
  breastfeeding
• Failure of basic breastfeeding management
• Spaced and timed feedings
• Early supplementation
• Early introduction of bottle
• Practitioners often unable to solve simple
  problems
• Lack of early follow-up
• Led to insufficient milk supply

7
Attachment Theory (Ainsworth Bowlby, 1991)

• Attachment between parent and child is promoted
  by proximity and maternal/caregiver
  responsiveness.
• Based on evolutionary theory, genetically based
  behaviors to promote proximity include crying,
  sucking, smiling, clinging and following.
  Separation activates these behaviors.

8
Intuitive (Attachment) Style

• Breastfeeding on demand
• Extended breastfeeding
• Meeting dependency needs
• Co-sleeping
• Baby wearing, close proximity
• Mother as expert. Wisdom passed mother to mother.
  

9

• Male physicians, who have no idea what
  motherhood is like, have cowed women for decades
  into doing unnatural and destructive things.
• Robert Wright (1997)

10
World Health Organization (1990)

• WHO Recommended breastfeeding for up to two
  years and beyond for infants worldwide.

11
American Academy of Pediatrics (1997)

• AAP recent statement in support of breastfeeding
  recommended breastfeeding for the first year and
  as long thereafter as is mutually desired.
• Sugarman Kendall-Tackett (1995)

12
American Association for the Advancement of
Science (1992)

• Is attachment parenting adaptive for humans?
• increased infant survival
• decreased infant illness and morbidity
• improved maternal health
• the natural or dominant style

13
Hypothesis 1

• Attachment parenting decreases infant mortality.
• Historical review
• Premature babies
• SIDS

14
Historical Review(Stuart-MacAdam, 1995)

• 99.9 of our existence on earth, all human babies
  were breastfed (either by mother or wet-nurse).
• No safe alternative.
• Still true in many countries today.

15
Historical Review

• Dublin Foundling Hospital (1775-1779). 10,272
  babies admitted, 45 survived. Mortality rate of
  99.6.
• 15th century, no breastfeeding in Germany,
  Bohemia, Austrian Tirol, Finland, Iceland or
  Russia. 50 infant mortality rate.

16
Historical Review

• Woodbury (1925) study in 8 American cities
  (N22,422). Mortality rates for bottle-fed
  babies
• 3 times higher, first month
• 4 times higher, second month
• 6 times higher, third month
• 5 times higher, fourth to seventh month

17
Still true today

• World Health Organization estimates that 1
  million babies per year die as a result of not
  breastfeeding.

18
Conditions that Influence the Safety of Bottle
Feeding (Palmer, 1988)

• Access to Safe Water
• An Uncontaminated Environment
• Fuel to Boil Water and Refrigerate
• Money to Purchase Formula
• Literacy to Understand Preparation Instructions
• Access to Medical Care

19
Premature Babies in Columbia

• Death rate for premature babies in Columbia 70
• Many babies abandoned.
• No incubators. Hospital temps around 50 degrees.

20
Kangaroo Care

• Developed by neonatologists Edgar Rey Hector
  Martinez in Bogota, Columbia
• Babies worn by mothers and fathers.

21
Effects of Kangaroo Care (Ludington-Hoe, 1993)

• Heart rate stabilizes
• Respiratory rate better. Fewer episodes of apnea.
• Oxygen saturation at normal levels
• Skin color better (more pink)
• Body temperature stabilizes
• Babies more alert, less crying
• Breastfeeding more likely. Moms produce more
  milk.
• Earlier hospital discharge
• Mothers and fathers feel more confident

22
Sleep and Arousal Deficiency (McKenna Bernshaw,
1995)

• Humans evolved under conditions of high degree of
  dependence on caregiver.
• low levels of fat and protein in human breast
  milk
• infantile neurological immaturity at birth
• slow postnatal growth

23
SIDS and Arousal Deficiency

• McKenna Mesko (1993)
• Mother/baby sleep/arousal cycles are synchronized
• Babies spend less time in deep stages of sleep,
  the most difficult to arouse from
• Co-sleeping creates more variable physiological
  experiences for infant
• Increased variation may lead to greater
  maturational synchrony among infants sub-systems

24
Co-sleeping and SIDS

• Co-sleeping is an evolutionary ancient
  arrangement, one humans adapted under.
• In countries where co-sleeping occurs as a
  favored and elected childcare pattern, rates of
  SIDS are the lowest in the world. For example,
  Japan .15/1000

25
Hypothesis 2

• Attachment parenting leads to a decrease in
  infant illness and morbidity.

26
Benefits to Babies

• Human milk uniquely suited for human infants
• Easy to digest and contains all nutrients that
  babies need
• Protects against a wide variety of illnesses for
  as long as they breastfeed
• Fatty acids, unique to human milk, may play a
  role in infant brain and visual development

27
bLower Risk of Infection (American Academy of
Pediatrics, 1997)

• Diarrhea
• Otitis Media
• Bacteremia
• Bacterial Meningitis
• Botulism
• Urinary Tract Infection
• Necrotizing enterocolitis

28
Fewer Respiratory Problems (AAP, 1997)

• Less respiratory illness including bronchitis and
  pneumonia.
• Lower risk of childhood asthma
• Fewer allergies, including fatal shock

29
Fewer Digestive Diseases (AAP, 1997)

• Insulin-dependent Diabetes Mellitus
• Crohns disease
• Ulcerative colitis
• GI allergies (celiac disease, allergic colitis)

30
Lower Lifetime Cardiovascular Risk

• Breastmilk has a beneficial effect on serum Lp(a)
  concentration in infants. Earliest precursors of
  arteriosclerosis (Routi, 1995)
• In healthy adolescents, those with short duration
  of breastfeeding (lt6 months) or early
  introduction of formula, had higher mean values
  of total serum cholesterol than those breastfed
  longer than 6 months (Bergstrom, 1995)

31
Other Long-term Effects

• Breastfeeding decreases later risk of breast
  cancer for breastfed children (Freudenheim et
  al., 1994)
• Lower cancer risk for offspring when mothers
  consume soy products. These protective factors
  are more bio-available through human milk (Davis,
  Savitz Graubard, 1988)
• Lower risk for lymphomas, especially Hodgkins
  lymphoma (Shu et al., 1995)

32
Emotional Benefits (Anisfeld et al., 1990)

• A study of the effect of baby-wearing on
  attachment in low-SES inner-city mothers
• At 3 months, the mothers were more contingently
  responsive
• At 13 months, the infants were more likely to be
  securely attached
• Maternal responsivity in the early months led to
  less crying and more secure attachments
  (Ainsworth Bowlby, 1991)

33
Hypothesis 3

• Mothers experience health benefits from extended
  breastfeeding and attachment parenting.

34
Benefits to Mothers

• Breastfeeding helps mothers recover from
  childbirth
• Shrinks uterus to pre-pregnancy state and reduces
  amount of blood lost
• Mothers lose more weight the first 3 to 6 months.
  Postpartum obesity is less common
• Menstrual cycles resume 20 to 30 weeks later
• Mothers with gestational diabetes who lactate
  decrease their risk of later Type II diabetes

35
Benefits to Mothers (AAP, 1997)

• Breastfeeding keeps women healthier throughout
  their lives.
• Is important in child spacing
• Reduces risks of breast, endometrial, and ovarian
  cancers
• May reduce risk of osteoporosis
• Reduces mothers total cholesterol, LDL, and
  triglycerides, while HDL remains high

36
Benefits to Mothers

• Lactating mothers have better responses to stress
• Breastfeeding women produce lower levels of
  stress hormones than do women who bottle feed
• Inverse relationship between oxytocin and levels
  of anxiety and depression (Altemus et al., 1995)

37
Suppression of Fertility (Ellison, 1995)

• In study of !Kung, frequency of nipple
  stimulation is crucial. Prolactin levels
  chronically high, keeping estradiol and
  progesterone suppressed
• When nursing intervals are widely spaced,
  prolactin levels are transient and separated by
  long periods of circulating hormones. Not
  significantly different from non-lactating women

38
Breastfeeding and Population

• Breastfeeding helps reduce world overpopulation
• Breastfeeding highly effective means of
  contraception, especially in third world
• Limits fertility, creating greater birth spacing
• Breastfeeding credited with preventing an average
  of 4 births/woman in Africa and 6.5 births/woman
  in Bangladesh

39
Environmental Waste

• For every 3 million bottle-fed babies..
• 450,000 million tins of formula are used
• 70,000 tons of metal are discarded
• These metals are not recycled in developing
  countries

40
Hypothesis 4

• Attachment parenting is the dominant pattern
• in history
• in other cultures

41
Weaning in History (Stuart-MacAdam, 1995)

• Babylon (3000 BC) specified nursing for 2 to 3
  years
• Hebrews (Torah) Weaning at 3 years
• Egyptian papyrus, weaning at 3 years
• India. Medical texts in Ayurvedic period (1500 to
  800 BC) recommend only breast milk for first
  year, breast milk and solids for second year,
  gradual weaning after that.

42
Weaning in History

• Byzantium (400 to 700 BC), weaning 20 months to 2
  years
• Quran Islamic children should be breastfed at
  least 2 years
• Talmud (536 BC), babies are to be put to breast
  immediately and suckled 18 months to 2 years

43
Weaning Ages in Modern Preindustrial or Rural
Communities (Wickes, 1953)

• Samoans, 1 yr
• Australian aborigines, 2-3 yrs
• Greenlanders, 3-4 yrs
• Hawaiians, 5 yrs
• Inuit, 7 yrs

44
Modern Rural African Communities (Fildes, 1986)

• Gambia, 21 months
• Ivory Coast, 42 months
• Northern Sudan, 2 to 3 years
• Morocco Algeria, at least 2 years
• Pakistan, 92 still breastfeeding at 2 years

45
Hominid Blueprint for the Natural Age of
Weaning (Dettwyler, 1995)

• What life-history variables are associated with
  weaning in non-human primates?
• Weaning according to tripling or quadrupling of
  birth weight
• Quadruple weight better estimate for large-bodied
  mammals. 27 mos for males, 30 mos for females

46
Hominid Blueprint (2)

• Weaning according to attainment of one-third of
  adult weight
• 4 to 7 years for humans, with boys nursed longer
  than girls
• Weaning according to adult body size
• 2.8 to 3.7 years, depending on average adult
  female body weight

47
Hominid Blueprint (3)

• Weaning according to gestation length
• Affected by adult size
• A minimum of six times gestational age
• 4.5 years
• Weaning according to dental eruption
• Weaning at eruption of first permanent molars.
  5.5 to 6.5 years in modern humans

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• The nursing patterns adopted in modern Western
  settings are, in fact, largely a cultural
  aberration. By imposing them, we are simply
  testing the infants ability to adapt his or her
  pattern of feeding to the extremes that the
  culture has sought to impose. The message should
  therefore be--Stop doing it!
• Michael Woolridge

49
Extended Breastfeeding in the US(Sugarman
Kendall-Tackett, 1995)
50
Extended Breastfeeding in the US

• American women are practicing extended
  breastfeeding and attachment parenting.
• Secret or closet nursing. Strangers were
  category most negative toward long-term
  breastfeeding (Kendall-Tackett Sugarman, 1995)
• Most women never tell their doctors.
• An issue in custody disputes. Failure to wean
  in a timely manner seen as cause for removal.

51
What We Can Learn from Earth Mothers.

• We can learn the full range of nursing behavior
  and weaning ages in our culture.
• We can learn about behaviors that build and
  sustain an adequate milk supply (or which
  behaviors may lead to premature weaning).

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What We Can Learn, contd

• We can broaden our perspective past our own
  experience and view breastfeeding in a global
  context.
• We can understand the importance of support from
  other women and partners in sustaining a socially
  stigmatized behavior.