View source for Breastfeeding

{{short description|Feeding of babies or young children with milk from a woman's breast}}
{{redirect|Suckling|other uses|Suckling (disambiguation)}}
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{{Use dmy dates|date=March 2022}}
{{Use American English|date=September 2017}}
[[File:Breastfeeding infant.jpg|250px|thumb|upright=0.75|A baby being breastfed]]
[[File:En.Wikipedia-VideoWiki-Breastfeeding.webm|250px|thumb|thumbtime=2:03|upright=0.75|Video summary of article with [[Wikipedia:VideoWiki/Breastfeeding|script]]]]

'''Breastfeeding''', also known as '''nursing''', is the process where [[breast milk]] is fed to a child.<ref name="NIH20132">{{cite web|date=19 December 2013|title=Breastfeeding and Breast Milk: Condition Information | work = National Institute of Child Health and Human Development | publisher = National Institutes of Health (NIH), U.S. Department of Health and Human Services |url=https://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/Pages/default.aspx|url-status =dead |archive-url= https://web.archive.org/web/20150727155223/http://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/Pages/default.aspx|archive-date=27 July 2015|access-date=27 July 2015}}</ref><ref>{{cite book |last1=Pinto |first1=Tiago Miguel |last2=Costa |first2=Raquel |title=Encyclopedia of Sexual Psychology and Behavior |date=2023 |publisher=[[Springer, Cham]] |isbn=978-3-031-08956-5 |pages=1–3 |chapter-url=https://link.springer.com/referenceworkentry/10.1007/978-3-031-08956-5_369-1 |language=en |chapter=Infancy: Breastfeeding |doi=10.1007/978-3-031-08956-5_369-1}}</ref> Infants may suck the milk directly from the breast, or milk may be extracted with a [[Breast pump|pump]] and then fed to the infant. The [[World Health Organization]] (WHO) recommend that breastfeeding begin within the first hour of a baby's birth and continue as the baby wants.<ref name="WHO2014">{{cite web|date=February 2014|title=Infant and young child feeding Fact sheet N°342|url=https://www.who.int/mediacentre/factsheets/fs342/en/|url-status=live|archive-url=https://web.archive.org/web/20150208145357/http://www.who.int/mediacentre/factsheets/fs342/en/|archive-date=8 February 2015|access-date=8 February 2015|publisher=WHO}}</ref> Health organizations, including the WHO, recommend breastfeeding exclusively for six months.<ref name="WHO20142">{{cite web|date=9 June 2021|title=Infant and young child feeding Fact sheet N°342|url=https://www.who.int/mediacentre/factsheets/fs342/en/|url-status=live|archive-url=https://web.archive.org/web/20150208145357/http://www.who.int/mediacentre/factsheets/fs342/en/|archive-date=8 February 2015|access-date=8 February 2015|publisher=World Health Organization (WHO)}}</ref><ref name="Johnston_2012">{{cite journal|vauthors=Johnston M, Landers S, Noble L, Szucs K, Viehmann L|date=March 2012|title=Breastfeeding and the use of human milk|journal=Pediatrics|volume=129|issue=3|pages=e827–e841|doi=10.1542/peds.2011-3552|pmid=22371471|s2cid=5791615 |collaboration=Section on Breastfeeding|doi-access=free}}</ref><ref name="Kramer_2012">{{cite journal | vauthors = Kramer MS, Kakuma R | title = Optimal duration of exclusive breastfeeding | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | issue = 8 | pages = CD003517 | date = August 2012 | pmid = 22895934 | pmc = 7154583 | doi = 10.1002/14651858.CD003517.pub2 }}</ref> This means that no other foods or drinks, other than [[vitamin D]], are typically given.<ref>{{Cite web | url=https://www.who.int/westernpacific/health-topics/breastfeeding | title=Breastfeeding }}</ref> The WHO recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond.<ref name="WHO20142" /><ref name="Johnston_2012" /> Between 2015 and 2020, only 44% of infants were exclusively breastfed in the first six months of life.<ref name="WHO20142" />  <!-- Benefits for the baby -->

Breastfeeding has a number of benefits to both mother and baby that [[infant formula]] lacks.<ref name="Johnston_2012" /><ref name="IP20092">{{cite journal | vauthors = Ip S, Chung M, Raman G, Trikalinos TA, Lau J | title = A summary of the Agency for Healthcare Research and Quality's evidence report on breastfeeding in developed countries | journal = Breastfeeding Medicine | volume = 4 | issue = Suppl 1 | pages = S17–S30 | date = October 2009 | pmid = 19827919 | doi = 10.1089/bfm.2009.0050 }}</ref> Increased breastfeeding to near-universal levels in low and medium income countries could prevent approximately 820,000 deaths of children under the age of five annually.<ref name="Victora_2016">{{cite journal | vauthors = Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC | title = Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect | journal = Lancet | volume = 387 | issue = 10017 | pages = 475–490 | date = January 2016 | pmid = 26869575 | doi = 10.1016/s0140-6736(15)01024-7 | hdl = 10072/413175 | s2cid = 24126039 | hdl-access = free }}</ref> Breastfeeding decreases the risk of [[respiratory tract infection]]s, [[Otitis media|ear infections]], [[Sudden infant death syndrome| sudden infant death syndrome (SIDS)]], and [[diarrhea]] for the baby, both in [[Developing country|developing]] and [[Developed country|developed countries]].<ref name="WHO20142" /><ref name="Johnston_2012" /><ref name="Eglash_2020">{{cite book| title=The Little Green Book of Breastfeeding Management for Physicians & Other Healthcare Providers| vauthors= Eglash A, Leeper K| publisher=The Institute for the Advancement of Breastfeeding and Lactation Education| year=2020|isbn=978-0-9987789-0-7|edition=7|location=Madison, WI}}</ref>{{rp|13}} Other benefits have been proposed to include lower risks of [[asthma]], [[food allergies]], and [[diabetes]].<ref name="Johnston_2012" /><ref name="Victora_2016" /> Breastfeeding may also improve [[cognitive development]] and decrease the risk of [[obesity]] in adulthood.<ref name="WHO20142" /><ref>{{cite book |title = Breastfeeding: A Guide for the Medical Profession |publisher = Elsevier Health Sciences |date = 1 January 2011 |isbn = 978-1-4377-0788-5 | vauthors = Lawrence RA, Lawrence RM |pages = 227–228 }}</ref><!-- Benefits to the mother -->

Benefits for the mother include less [[Bleeding|blood loss]] following [[Childbirth|delivery]], better contraction of the uterus, and a decreased risk of [[postpartum depression]].<ref name="Johnston_2012" /> Breastfeeding delays the return of [[menstruation]], and in very specific circumstances, [[fertility]], a phenomenon known as [[lactational amenorrhea]].<ref name="Johnston_2012" /><ref name="Eglash_2020" />{{rp|83}} Long-term benefits for the mother include decreased risk of [[breast cancer]], [[cardiovascular disease]], [[diabetes]], [[metabolic syndrome]], and [[rheumatoid arthritis]].<ref name="Johnston_2012" /><ref name="Victora_2016" /><ref name="Eglash_2020" />{{rp|13}}  Breastfeeding is less expensive than [[infant formula]],<ref name="APP_19972">{{cite journal |vauthors= |date=December 1997 |title=Breastfeeding and the use of human milk. American Academy of Pediatrics. Work Group on Breastfeeding |url=http://pediatrics.aappublications.org/content/100/6/1035.full.pdf+html |url-status=live |journal=Pediatrics |volume=100 |issue=6 |pages=1035–1039 |doi=10.1542/peds.100.6.1035 |pmid=9411381 |s2cid=81585356 |archive-url=https://web.archive.org/web/20121023001839/http://pediatrics.aappublications.org/content/100/6/1035.full.pdf+html |archive-date=23 October 2012 |doi-access=free }}</ref><ref>{{cite web |date=14 April 2014 |title=What are the benefits of breastfeeding? |url=https://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/Pages/benefits.aspx |url-status=live |archive-url=https://web.archive.org/web/20150810214206/https://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/Pages/benefits.aspx |archive-date=10 August 2015 |access-date=27 July 2015 }}</ref> but its impact on mothers' ability to earn an income is not usually factored into calculations comparing the two feeding methods.<ref>{{cite news | vauthors = Momigliano A  |date=21 May 2019 |title=Breast-feeding isn't free. This is how much it really costs. |newspaper=[[Washington Post]] |url=https://www.washingtonpost.com/lifestyle/2019/05/28/breast-feeding-isnt-free-this-is-how-much-it-really-costs/ |access-date=11 March 2021}}</ref> It is also common for women to experience generally manageable symptoms such as; vaginal dryness, [[De Quervain syndrome]], cramping, [[mastitis]], moderate to severe nipple pain and a general lack of bodily autonomy. These symptoms generally peak at the start of breastfeeding but disappear or become considerately more manageable after the first few weeks.

Feedings may last as long as 30–60 minutes each as milk supply develops and the infant learns the Suck-Swallow-Breathe pattern.<ref name="Eglash_2020" />{{rp|50–51}}  However, as milk supply increases and the infant becomes more efficient at feeding, the duration of feeds may shorten.<ref name="Eglash_2020" />{{rp|50–51}} Older children may feed less often.<ref>{{cite web|date=19 December 2013|title=What is weaning and how do I do it?|url=https://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/Pages/weaning.aspx|url-status=live|archive-url=https://web.archive.org/web/20150708102841/https://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/Pages/weaning.aspx|archive-date=8 July 2015|access-date=27 July 2015}}</ref> When direct breastfeeding is not possible, expressing or pumping to empty the breasts can help mothers avoid [[plugged milk duct]]s and [[Mastitis|breast infection]], maintain their milk supply, resolve [[Breast engorgement|engorgement]], and provide milk to be fed to their infant at a later time.<ref name="NIH20132" /><ref>{{cite journal| vauthors=Amir LH| date=June 2014|title=ABM clinical protocol #4: Mastitis, revised March 2014|journal=Breastfeeding Medicine| volume=9|issue=5|pages=239–243|doi=10.1089/bfm.2014.9984|pmc=4048576|pmid=24911394}}</ref><ref name="Berens_2016">{{cite journal| vauthors=Berens P, Brodribb W|date=May 2016|title=ABM Clinical Protocol #20: Engorgement, Revised 2016|journal=Breastfeeding Medicine|volume=11|issue=4|pages=159–163|doi=10.1089/bfm.2016.29008.pjb|pmc=4860650|pmid=27070206}}</ref><ref name="Eglash_2020" />{{rp|55, 63–67}} Medical conditions that do not allow breastfeeding are rare.<ref name="Johnston_2012" /> Mothers who take certain [[recreational drugs]] should not breastfeed, however, most medications are compatible with breastfeeding.<ref name="Eglash_2020" />{{rp|17}} Current evidence indicates that it is unlikely that [[COVID-19]] can be transmitted through breast milk.<ref name="auto">{{cite web|title=Agencies encourage women to continue to breastfeed during the COVID-19 pandemic|url=https://www.who.int/news/item/27-05-2020-countries-failing-to-stop-harmful-marketing-of-breast-milk-substitutes-warn-who-and-unicef|access-date=8 March 2021|website=World Health Organization}}</ref> 
Smoking tobacco and consuming limited amounts of alcohol or coffee are not reasons to avoid breastfeeding.<ref>{{cite web|date=21 December 2017|title=Breastfeeding and alcohol|url=http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-alcohol.aspx#close|url-status=live|archive-url=https://web.archive.org/web/20160801110239/http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-alcohol.aspx#close|archive-date=1 August 2016|website=NHS Choices|publisher=NHS}}</ref><ref>{{cite web|date=26 March 2018|title=Breastfeeding and diet|url=http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-diet.aspx|url-status=live|archive-url=https://web.archive.org/web/20160807233307/http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-diet.aspx|archive-date=7 August 2016|website=NHS Choices|publisher=NHS}}</ref><ref>{{cite web|date=21 March 2018|title=Tobacco Use &#124; Breastfeeding &#124; CDC|url=https://www.cdc.gov/breastfeeding/disease/tobacco.htm|url-status=live|archive-url=https://web.archive.org/web/20160809151407/http://www.cdc.gov/breastfeeding/disease/tobacco.htm|archive-date=9 August 2016|access-date=4 August 2016|website=www.cdc.gov}}</ref>

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== Breastfeeding physiology ==
[[File:Breast-Diagram.gif|thumb|right|When the baby suckles their mother's breast, a hormone called [[oxytocin]] compels the milk to flow from the [[mammary alveolus|alveoli]] (lobules), through the ducts (milk canals), into the sacs (milk pools) behind the [[areola]], and then into the baby's mouth.]]
[[File:Histology of lactating breast, annotated.png|thumb|Normal histology of the breast during lactation.]]
{{Main|Lactation|Maternal physiological changes in pregnancy}}

Breast development starts in puberty with the growth of ducts, [[Adipose tissue|fat cells]], and connective tissue.<ref name="Eglash_2020" />{{rp|18–21}} The ultimate size of the breasts is determined by the number of fat cells. The size of the breast is not related to a mother's breastfeeding capability or the volume of milk she can produce.<ref name="Eglash_2020" />{{rp|18–21}} The process of milk production, termed '''lactogenesis''', occurs in 3 stages. The first stage takes place during pregnancy, allowing for the development of the breast and production of colostrum, the thick, early form of milk that is low in volume, but rich in nutrition.<ref name="Eglash_2020" />{{rp|18–21}}  The birth of the baby and the placenta triggers the onset of the second stage of milk production, triggering the milk to come in over the next several days. The third stage of milk production occurs gradually over several weeks, and is characterized by a full milk supply that is regulated locally (at the breast), predominately by the infant's demand for food. This differs from the second stage of lactogenesis, which is regulated centrally (in the brain) by hormone feedback loops that naturally occur after the placenta is delivered.<ref name="Eglash_2020" />{{rp|18–21}}<ref name="Brodribb_2018" />

Although traditionally, lactation occurs following pregnancy, lactation may also be [[#Re-lactation and induced lactation|induced]] with hormone therapy and nipple stimulation in the absence of pregnancy.

=== Lactogenesis I and other changes in pregnancy ===
[[File:Areolar enlargement - cropped.png|thumb|Areolar enlargement in early pregnancy]]
Changes in [[pregnancy]], starting around 16 weeks [[Gestational age (obstetrics)|gestational age]], prepare the breast for lactation. These changes, collectively known as '''Lactogenesis I''', are directed by hormones produced by the placenta and the brain, namely [[estrogen]], [[progesterone]], [[prolactin]], which gradually increase throughout the pregnancy, and result in the structural development of the alveolar (milk-producing) tissue and the production of [[colostrum]].<ref name="Eglash_2020" />{{rp|18–21}}<ref>{{cite journal | vauthors = Napso T, Yong HE, Lopez-Tello J, Sferruzzi-Perri AN | title = The Role of Placental Hormones in Mediating Maternal Adaptations to Support Pregnancy and Lactation | journal = Frontiers in Physiology | volume = 9 | pages = 1091 | date = 2018 | pmid = 30174608 | pmc = 6108594 | doi = 10.3389/fphys.2018.01091 | doi-access = free }}</ref><ref>{{cite book|url=https://www.worldcat.org/oclc/233970853|title=Hale & Hartmann's textbook of human lactation|vauthors=Hale TW, Hartmann PE, Czank C, Henderson J, Kent JC, Lai CT|date=2007|publisher=Hale Pub|isbn=978-0-9772268-9-4|edition=1|location=Amarillo, TX|pages=89–111|oclc=233970853}}</ref> While prolactin is the predominant hormone in milk ''production,'' [[progesterone]], which is at high levels during pregnancy, blocks the prolactin receptors in the breast, thus inhibiting milk from "coming in" during pregnancy.<ref name="Eglash_2020" />{{rp|18–21}}<ref name="Brodribb_2018">{{cite journal | vauthors = Brodribb W | title = ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production, Second Revision 2018 | journal = Breastfeeding Medicine | volume = 13 | issue = 5 | pages = 307–314 | date = June 2018 | pmid = 29902083 | doi = 10.1089/bfm.2018.29092.wjb | s2cid = 49211760 }}</ref><ref name="Lawrence-2016" />

Many other physiologic changes occur under the control of progesterone and estrogen. These changes include, but are not limited to, dilation of blood vessels, increased blood flow to the uterus, increased availability of glucose (which subsequently is passed through the [[placenta]] to the fetus), and increased skin pigmentation, which results in darkening of the [[nipple]]s and [[areola]], formation of the [[linea nigra]], and onset of [[Melasma|melasma of pregnancy]].<ref name="Eglash_2020" />{{rp|18–21}}<ref name="Elling_1997">{{cite journal | vauthors = Elling SV, Powell FC | title = Physiological changes in the skin during pregnancy | journal = Clinics in Dermatology | volume = 15 | issue = 1 | pages = 35–43 | date = January 1997 | pmid = 9034654 | doi = 10.1016/S0738-081X(96)00108-3 | series = Dermatologic Diseases and Problems of Women Throughout the Life Cycle }}</ref><ref name="Simpson-2014" />

From about the 16th week of pregnancy the breasts are able to begin to produce milk. It’s not unusual for small amounts of straw-coloured fluid called [[colostrum]] to leak from the nipples during this relatively early stage.<ref>{{Cite web |date=2020-12-08 |title=Leaking from your nipples |url=https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/leaking-nipples/ |access-date=2024-12-27 |website=nhs.uk |language=en}}</ref><ref>{{cite web |date=23 June 2017 |title=Breast changes during and after pregnancy |url=https://breastcancernow.org/information-support/have-i-got-breast-cancer/breast-changes-during-after-pregnancy |publisher=Breast Cancer Now}}</ref><ref>{{Cite web |title=Colostrum: When you start producing milk, and why your breasts are leaking |url=https://www.babycenter.com/pregnancy/your-body/leaking-colostrum_40007942 |archive-url=https://web.archive.org/web/20210222163038/https://www.babycenter.com/pregnancy/your-body/leaking-colostrum_40007942 |url-status=usurped |archive-date=22 February 2021 |access-date=2024-12-27 |website=BabyCenter |language=en}}</ref>

Breast development throughout pregnancy may result in significant [[Areola]] and [[Areolar gland]] enlargement, erectile nipples or nipple sensitivity.<ref>{{Cite journal |title=Physiologic changes of pregnancy: A review of the literature |date=2017 |pmc=5715231 |journal=International Journal of Women's Dermatology |volume=3 |issue=4 |pages=219–224 |doi=10.1016/j.ijwd.2017.09.003 |pmid=29234716 | vauthors = Motosko CC, Bieber AK, Pomeranz MK, Stein JA, Martires KJ }}</ref><ref>{{Cite book |last1=Alex |first1=Ashley |last2=Bhandary |first2=Eva |last3=McGuire |first3=Kandace P. |title=Diseases of the Breast during Pregnancy and Lactation |date=2020 |chapter=Anatomy and Physiology of the Breast during Pregnancy and Lactation |chapter-url=https://pubmed.ncbi.nlm.nih.gov/32816256/ |series=Advances in Experimental Medicine and Biology |volume=1252 |pages=3–7 |doi=10.1007/978-3-030-41596-9_1 |issn=0065-2598 |pmid=32816256|isbn=978-3-030-41595-2 }}</ref>

=== Lactogenesis II ===
[[File:Hormone Levels in Pregnancy and Postpartum Period.jpg|thumb|Maternal hormone levels during pregnancy and after delivery of the placenta. Estradiol, estriol, progesterone, testosterone, and sex hormone binding globulin (SHBG) all increase throughout the pregnancy, and experience an abrupt drop-off after delivery of the placenta.<ref name="Lawrence-2016">{{cite book| vauthors = Lawrence RA, Lawrence RM | title=Breastfeeding : a guide for the medical profession|date=2016 |isbn=978-0-323-39420-8|edition=8|location=Philadelphia, PA|oclc=921886130}}</ref><ref name="Elling_1997" />]]
The [[third stage of labor]] describes the period between the birth of the baby and the delivery of the placenta, which normally lasts less than 30 minutes.<ref name="Zheng_2020">{{cite book|title=Comprehensive Handbook: Obstetrics & Gynecology|vauthors=Zheng T|date=2020|publisher=Phoenix Medical Press|location=Paradise Valley, AZ|oclc=1249555693}}</ref> The delivery of the placenta causes an abrupt drop off of placental hormones.<ref name="Zheng_2020" /><ref name="Eglash_2020" />{{rp|18–21}}<ref name="Lawrence-2016" /> This drop, specifically in progesterone, allows prolactin to work effectively at its receptors in the breast, leading to an array of changes over the next several days that allow the milk to "come in"; these changes are known collectively as Lactogenesis II.<ref name="Eglash_2020" />{{rp|18–21}}<ref name="Lawrence-2016" /><ref>{{cite journal | vauthors = Hurst NM | title = Recognizing and treating delayed or failed lactogenesis II | journal = Journal of Midwifery & Women's Health | volume = 52 | issue = 6 | pages = 588–594 | date = 2007 | pmid = 17983996 | doi = 10.1016/j.jmwh.2007.05.005 }}</ref> [[Colostrum]] continues to be produced for these next few days, as Lactogenesis II occurs.<ref name="Eglash_2020" />{{rp|18–21}} Milk may "come in" as late as five days after delivery; however, this process may be delayed due to a number of factors as described in  the [[#Process|Process]] "Delay in milk 'coming in'" subsection  below.<ref name="Eglash_2020" />{{rp|18–21}}<ref name="Lawrence-2016" /> [[Oxytocin]], which signals the [[smooth muscle]] of the [[uterus]] to contract during pregnancy, labor, birth and following delivery, is also involved in the process of breastfeeding.<ref name="Zheng_2020" /><ref name="Lawrence-2016" /> Oxytocin also contracts the smooth muscle layer of band-like cells surrounding the milk ducts and alveoli to s the newly produced milk through the duct system and out through the nipple.<ref name="Eglash_2020" />{{rp|18–21}}<ref name="Lawrence-2016" /> This process is known as the ''milk ejection reflex'', or ''let-down.''<ref name="Eglash_2020" />{{rp|18–21}} Because of oxytocin's dual activity at the breast and the uterus, breastfeeding mothers may also experience uterine cramping at the time of breastfeeding, for the first several days to weeks.<ref name="Lawrence-2016" />

=== Lactogenesis III ===
[[Prolactin]] and [[oxytocin]] are vital for establishing milk supply initially, however, once the milk supply is well established, the volume and content of the milk produced is controlled locally.<ref name="Eglash_2020" />{{rp|18–21}}<ref name="Brodribb_2018" /> Although prolactin levels are higher on average among breastfeeding mothers, prolactin levels themselves do not correlate to milk volume.<ref name="Eglash_2020" />{{rp|18–21}} At this stage, production of milk is triggered by milk drainage from the breasts. The only way to maintain milk supply is to drain the breasts frequently. Infrequent or incomplete drainage of the breasts, decreases blood flow to the alveoli and signals the milk-producing cells to produce less milk.<ref name="Eglash_2020" />{{rp|18–21}}<ref name="Brodribb_2018" /><ref name="Lawrence-2016" /><ref name="Eglash_2020" />{{rp|72–80}} [[Breast pump|Breast pumps]] are often used to drain the breasts when the infant is not feeding.<ref>{{Cite journal |title=Breast Pumps and Mastitis in Breastfeeding Women: Clarifying the Relationship |date=2022 |pmc=9226559 |journal=Frontiers in Pediatrics |volume=10 |doi=10.3389/fped.2022.856353 |doi-access=free |pmid=35757121 | vauthors = Mitoulas LR, Davanzo R }}</ref> 

A condition called [[Mastitis]] sometimes occurs in this stage, resulting from incomplete milk drainage. The [[Academy of Breastfeeding Medicine]] recommends against trying to "empty" the breasts, whether through pushing the baby to feed more or through over use of a breast pump, to prevent causing [[Hyperlactation syndrome|milk oversupply]].<ref name=":1">{{cite journal |display-authors=6 |vauthors=Mitchell KB, Johnson HM, Rodríguez JM, Eglash A, Scherzinger C, Zakarija-Grkovic I, Cash KW, Berens P, Miller B |date=May 2022 |title=Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022 |journal=Breastfeeding Medicine |volume=17 |issue=5 |pages=360–376 |doi=10.1089/bfm.2022.29207.kbm |pmid=35576513 |s2cid=248832395}}</ref>

== Breast milk ==
{{Main|Breast milk}}

[[File:Human Breastmilk - Foremilk and Hindmilk.png|thumb|upright=0.75|Two 25&nbsp;ml samples of human breast milk. The sample on the left is ''foremilk'', the watery milk coming from a full breast. To the right is ''hindmilk'', the creamy milk coming from a nearly empty breast.<ref>{{cite web |url = http://www.drpaul.com/breastfeeding/colostrum.php |title = Colostrum, Foremilk and Hindmilk | vauthors = Dobransky P |author-link = Dobransky |publisher = www.drpaul.com |url-status = dead |archive-url = https://web.archive.org/web/20170703211227/http://drpaul.com/breastfeeding/colostrum.php |archive-date = 3 July 2017 |access-date = 24 July 2017 }}</ref>]]

The content of [[breast milk]] should be discussed in two separate categories – the nutritional content and the bioactive content, that is the [[enzyme]]s, [[protein]]s, [[Antibody|antibodies]], and [[Transcription factor|signaling molecules]] that assist the infant in ways outside of nutrition.<ref name="Eglash_2020" />{{rp|10–14}}

=== Nutritional content ===
The pattern of intended [[nutrient]] content in breast milk is relatively consistent. Breastmilk is made from nutrients in the mother's [[bloodstream]] and bodily stores. It has an optimal balance of fat, sugar, water, and [[protein]] that is needed for a baby's age appropriate growth and development.<ref name="Eglash_2020" />{{rp|10–14}}<ref name="HHS">{{cite web|date=27 February 2009|title=Mothers and Children Benefit from Breastfeeding|url=http://www.4woman.gov/breastfeeding/index.cfm?page=227|url-status=dead|archive-url=https://web.archive.org/web/20090316071541/http://www.4woman.gov/breastfeeding/index.cfm?page=227|archive-date=16 March 2009|publisher=Womenshealth.gov}}</ref> That being said, a variety of factors can influence the nutritional makeup of breastmilk, including gestational age, age of infant, maternal age, maternal smoking, and nutritional needs of the infant.<ref name="Eglash_2020" />{{rp|10–14}}<ref name="Hendrickson2012">{{cite journal|vauthors=Hendrickson RG, McKeown NJ|date=January 2012|title=Is maternal opioid use hazardous to breast-fed infants?|journal=Clinical Toxicology|volume=50|issue=1|pages=1–14|doi=10.3109/15563650.2011.635147|pmid=22148986|s2cid=207673799}}</ref>

The first type of milk produced is called ''[[colostrum]]''. The volume of colostrum produced during each feeding is appropriate for the size of the newborn stomach and is sufficient, calorically, for feeding a newborn during the first few days of life.<ref name="Eglash_2020" />{{rp|27–34}}<ref name="Flaherman_2017">{{cite journal | vauthors = Flaherman VJ, Maisels MJ | title = ABM Clinical Protocol #22: Guidelines for Management of Jaundice in the Breastfeeding Infant 35 Weeks or More of Gestation-Revised 2017 | journal = Breastfeeding Medicine | volume = 12 | issue = 5 | pages = 250–257 | date = June 2017 | pmid = 29624434 | doi = 10.1089/bfm.2017.29042.vjf | publisher = Academy of Breastfeeding Medicine }}</ref> Produced during pregnancy and the first days after childbirth, colostrum is rich in protein and Vitamins A, B12 and K, which supports infants' growth, brain development, vision, immune systems, red blood cells, and clotting cascade.<ref>{{cite web|title=WHO {{!}} Vitamin A supplementation in neonates|url=http://www.who.int/elena/titles/vitamina_neonatal/en/|archive-url=https://web.archive.org/web/20140331090800/http://www.who.int/elena/titles/vitamina_neonatal/en/|url-status=dead|archive-date=31 March 2014|access-date=10 November 2021|website=WHO}}</ref><ref name="de Vries-2018">{{cite journal | vauthors = Y de Vries J, Pundir S, Mckenzie E, Keijer J, Kussmann M | title = Maternal Circulating Vitamin Status and Colostrum Vitamin Composition in Healthy Lactating Women-A Systematic Approach | journal = Nutrients | volume = 10 | issue = 6 | pages = E687 | date = May 2018 | pmid = 29843443 | pmc = 6024806 | doi = 10.3390/nu10060687 | doi-access = free }}</ref><ref>{{cite web|last=CDC|date=26 August 2021|title=Do infants get enough B12 from breast milk?|url=https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/diet-and-micronutrients/vitamin-b12.html|access-date=10 November 2021|website=Centers for Disease Control and Prevention|language=en-us}}</ref><ref>{{cite web|last=CDC|date=19 December 2019|title=FAQs About Vitamin K Deficiency Bleeding {{!}} CDC|url=https://www.cdc.gov/ncbddd/vitamink/faqs.html|access-date=10 November 2021|website=Centers for Disease Control and Prevention|language=en-us}}</ref> The breast milk also has long-chain [[polyunsaturated fatty acids]] which help with normal [[retina]]l and [[neural]] development.<ref name="Colen_2014">{{cite journal | vauthors = Colen CG, Ramey DM | title = Is breast truly best? Estimating the effects of breastfeeding on long-term child health and wellbeing in the United States using sibling comparisons | journal = Social Science & Medicine | volume = 109 | pages = 55–65 | date = May 2014 | pmid = 24698713 | pmc = 4077166 | doi = 10.1016/j.socscimed.2014.01.027 }}</ref>
The caloric content of colostrum is about 54 Calories/100mL.<ref>{{cite journal | vauthors = Gidrewicz DA, Fenton TR | title = A systematic review and meta-analysis of the nutrient content of preterm and term breast milk | journal = BMC Pediatrics | volume = 14 | issue = 1 | pages = 216 | date = August 2014 | pmid = 25174435 | pmc = 4236651 | doi = 10.1186/1471-2431-14-216 | doi-access = free }}</ref> The second type of milk is transitional milk, which is produced during the transition from colostrum to mature breast milk. As the breast milk matures over the course to several weeks, the protein content of the milk decreases on average.<ref name="Eglash_2020" />{{rp|10–14}} The caloric content of breastmilk is reflective of the caloric requirements of the infant, increasing steadily after 12 months.<ref name="Eglash_2020" />{{rp|10–14}} The caloric content of breastmilk in the first 12 months of breastfeeding is approximated to be 58-72 Calories/100mL. Comparatively, the caloric content after 48 months is approximately 83-129 Calories/100mL.<ref name="Eglash_2020" />{{rp|10–14}}

When a mother has her full milk supply and is feeding her infant, the first milk to be expressed is called the foremilk. Foremilk is typically thinner and less rich in calories. The hindmilk that follows is rich in calories and fat.<ref name = "Lawrence_2021">{{cite book| vauthors = Lawrence RA, Lawrence RM, Noble L, Rosen-Carole C, Stuebe AM |title=Breastfeeding: a guide for the medical profession |date=2021 |isbn=978-0-323-68014-1 |edition=9th |location=Philadelphia, PA  |oclc=1256449680}}</ref>{{rp|239}}

If the mother is not deficient in vitamins, breast milk normally supplies the baby's needs, with the exception of Vitamin D.  The [[Centers for Disease Control and Prevention|CDC]], [[National Health Service]] (UK), [[Canadian Paediatric Society]], the [[American Academy of Pediatrics]], and the [[American Academy of Family Physicians]] all agree that breast milk alone does not provide infants with an adequate amount of Vitamin D, thus they advise parents to supplement their infants with 400 [[International unit|IU]] Vitamin D daily.<ref name="AA Peds-2021">{{cite web |title=Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents |url=https://www.naspghan.org/files/documents/pdfs/training/curriculum-resources/nutrition/sentinel-articles/Wagner_Prevention_of_rickets_and_vitamin_D_deficiency.pdf |website=American Academy of Pediatrics |access-date=17 May 2021}}</ref><ref name="Casey-2010">{{cite journal | vauthors = Casey CF, Slawson DC, Neal LR | title = Vitamin D supplementation in infants, children, and adolescents | journal = American Family Physician | volume = 81 | issue = 6 | pages = 745–748 | date = March 2010 | pmid = 20229973 | url = https://www.aafp.org/afp/2010/0315/p745.html }}</ref><ref name="CDC-2021c">{{cite web|last=CDC|date=2 July 2021|title=Vitamin D is needed to support healthy bone development.|url=https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/diet-and-micronutrients/vitamin-d.html|access-date=10 November 2021|website=Centers for Disease Control and Prevention|language=en-us}}</ref><ref name="CDC 20092">{{cite web|date=20 October 2009|title=Vitamin D Supplementation – Breastfeeding|url=https://www.cdc.gov/breastfeeding/recommendations/vitamin_d.htm|access-date=15 January 2018|website=CDC}}</ref><ref name="Canadian Paediatric Society2">{{cite web|author=Canadian Paediatric Society|title=Vitamin D|url=https://www.caringforkids.cps.ca/handouts/vitamin_d|access-date=15 January 2018|website=Caring for Kids}}</ref><ref name="NHS Choices Home Page2">{{cite web|date=21 December 2017|title=Vitamins for children - NHS.UK|url=https://www.nhs.uk/conditions/pregnancy-and-baby/vitamins-for-children/|access-date=15 January 2018|website=NHS Choices Home Page}}</ref> Providing this quantity of Vitamin D to breastfeeding infants has been shown to reduce rates of Vitamin D insufficiency (defined as 25-OH vitamin D < 50 nmol/L). However, there was insufficient evidence in the most recent [[Cochrane (organisation)|Cochrane Review]], to determine if this quantity reduced rates of Vitamin D deficiency (defined as 25-OH vitamin D < 30 nmol/L) or [[rickets]].<ref>{{cite journal | vauthors = Tan ML, Abrams SA, Osborn DA | title = Vitamin D supplementation for term breastfed infants to prevent vitamin D deficiency and improve bone health | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 12 | pages = CD013046 | date = December 2020 | pmid = 33305822 | doi = 10.1002/14651858.CD013046.pub2 | pmc = 8812278 | s2cid = 228101037 }}</ref> Term infants typically do not need iron supplementation. Delaying clamping of the cord at birth for at least one minute improves the infants' iron status for the first year.<ref name="Eglash_2020" />{{rp|50–51}}<ref name="CDC-2021b">{{cite web|last=CDC|date=2 September 2021|title=Do infants get enough iron from breast milk?|url=https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/diet-and-micronutrients/iron.html|access-date=10 November 2021|website=Centers for Disease Control and Prevention|language=en-us}}</ref> When complementary (solid) foods are introduced at about 6 months of age, parents should make sure to choose iron-rich foods to help maintain their children's iron stores.<ref name="Eglash_2020" />{{rp|50–51}}<ref name="CDC-2021b" />

=== Bioactive content ===
In addition to the nutritional benefits of breastmilk, breast milk also provides enzymes, antibodies, and other substances that support the infant's growth and development.<ref name="Eglash_2020" />{{rp|10–14}} The bioactive makeup of breastmilk also changes based on the needs of the infant; for example, when an infant is recovering from an [[Upper respiratory tract infection|upper respiratory infection]], local signaling allows for increased passage of immune cells and proteins to aid the infant's immune system.<ref name="Eglash_2020" />{{rp|10–14}}<ref>{{cite journal | vauthors = Riskin A, Almog M, Peri R, Halasz K, Srugo I, Kessel A | title = Changes in immunomodulatory constituents of human milk in response to active infection in the nursing infant | journal = Pediatric Research | volume = 71 | issue = 2 | pages = 220–225 | date = February 2012 | pmid = 22258136 | doi = 10.1038/pr.2011.34 | s2cid = 2358000 | doi-access = free }}</ref>

Produced during pregnancy and the first days after childbirth, [[colostrum]] is easy to digest and has laxative properties that help the infant to pass early stools.<ref name="Eglash_2020" />{{rp|27–34}}<ref name="de Vries-2018" /> This aids in the excretion of excess [[bilirubin]], which helps to prevent [[jaundice]].<ref name="Eglash_2020" />{{rp|34–47}} Colostrum also helps to seal the infants [[gastrointestinal tract]] from foreign substances and germs, which may sensitize the baby to foods that the mother has eaten and decrease the risk of [[Diarrhea|diarrheal illness]].<ref name="Eglash_2020" />{{rp|10–14}}<ref name="Lawrence-2016" /> Although the baby has received some antibodies ([[Immunoglobulin G|IgG]]) through the placenta, colostrum contains a substance which is new to the newborn, secretory [[immunoglobulin A]] (IgA).  IgA works to attack germs in the [[mucous membrane]]s of the throat, lungs, and intestines, which are most likely to come under attack from germs.<ref name="Eglash_2020" />{{rp|10–14}}<ref name="Lawrence-2016" /><ref name="La Leche League">{{cite web|title=What is colostrum? How does it benefit my baby?|url=http://www.lalecheleague.org/faq/colostrum.html|url-status=dead|archive-url=https://web.archive.org/web/20151127154000/http://www.lalecheleague.org/faq/colostrum.html|archive-date=27 November 2015|access-date=28 November 2015|publisher=La Leche League}}</ref> Additionally, colostrum and mature breast milk contain many [[antioxidant]] and [[anti-inflammatory]] [[enzyme]]s and [[protein]]s that decrease the risk of gastrointestinal allergies to food, [[Allergic rhinitis|respiratory allergies]] to air particles like pollen, and other [[Atopy|atopic diseases]], such as [[asthma]] and [[Atopic dermatitis|eczema]].<ref name="Eglash_2020" />{{rp|10–14}}<ref name="Lawrence-2016" />

== Process ==

=== Commencement ===
[[File:Geburt 01.jpg|thumb|Newborn rests as a [[caregiver]] checks its breath sounds with a [[stethoscope]]]]

It is recommended for mothers to initiate breastfeeding within the first hour after birth.<ref name="Zheng_2020" /><ref name="Eglash_2020" />{{rp|27–34}}<ref name="who.int" /><ref>{{cite book |title=Protecting, promoting and supporting Breastfeeding in facilities providing maternity and newborn services |date=2018 |url=https://www.who.int/nutrition/publications/infantfeeding/bfhi-implementation-2018.pdf |archive-url=https://web.archive.org/web/20180417175211/http://www.who.int/nutrition/publications/infantfeeding/bfhi-implementation-2018.pdf |url-status=dead |archive-date=17 April 2018 |access-date=16 September 2019}}</ref><ref name="Holmes_2013">{{cite journal | vauthors = Holmes AV, McLeod AY, Bunik M | title = ABM Clinical Protocol #5: Peripartum breastfeeding management for the healthy mother and infant at term, revision 2013 | journal = Breastfeeding Medicine | volume = 8 | issue = 6 | pages = 469–473 | date = December 2013 | pmid = 24320091 | pmc = 3868283 | doi = 10.1089/bfm.2013.9979 }}</ref> Uninterrupted skin-to-skin contact and breastfeeding can begin immediately after birth, and should continue for at least one hour after birth.<ref name="Eglash_2020" />{{rp|27–34}}<ref name="Holmes_2013" /> This period of infant-mother interaction, known generally as [[kangaroo care]], or the "golden hour" during the immediate postpartum period, assists in the mother–child bonding for both mother and baby, and is thought to encourage instinctual breastfeeding behavior in the infant.<ref name="Eglash_2020" />{{rp|27–34}}<ref name="Breast Crawl">{{cite web|title=Breast Crawl|url=http://breastcrawl.org/science.shtml|website=The Mother and Child Health and Education Trust|access-date=22 March 2018|archive-date=23 March 2018|archive-url=https://web.archive.org/web/20180323031339/http://breastcrawl.org/science.shtml|url-status=dead}}</ref> Newborns who are immediately placed on their mother's skin have a natural instinct to latch on to the breast and start nursing, typically within one hour of birth. Success with breastfeeding in this "golden hour" increases the likelihood of successful breastfeeding at discharge.<ref name="Eglash_2020" />{{rp|27–34}}

Skin-to-skin mother-baby contact should still occur, even if the baby is born by [[Cesarean]] surgery.<ref name="Eglash_2020" />{{rp|27–34}}<ref>{{cite journal | vauthors = Moore ER, Bergman N, Anderson GC, Medley N | title = Early skin-to-skin contact for mothers and their healthy newborn infants | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD003519 | date = November 2016 | issue = 11 | pmid = 27885658 | pmc = 6464366 | doi = 10.1002/14651858.CD003519.pub4 }}</ref>  The baby is placed on the mother in the operating room or the recovery area.  If the mother is unable to immediately hold the baby a family member can provide skin-to-skin care until the mother is able.

==== Breast crawl ====
According to studies cited by [[UNICEF]], babies naturally follow a process which leads to a first breastfeed. Shortly after birth, the infant relaxes and makes small movements of the arms, shoulders and head. If placed on the mother's abdomen the baby gradually inches towards the breast, called the [[breast crawl]]<ref name="Breast Crawl" /> and begins to feed. After feeding, it is normal for a baby to remain latched to the breast while resting. This is sometimes mistaken for lack of appetite. Absent interruptions, all babies follow this process. Rushing, by picking up and moving the infant to the breast, or interrupting the process, such as removing the baby to be weighed, may complicate subsequent feeding.<ref name="autogenerated1">{{cite web | url = http://www.unicef.org.uk/BabyFriendly/Resources/Guidance-for-Health-Professionals/Learning-about-breastfeeding/Skin-to-skin-contact/ | title = The Baby Friendly Initiative | archive-url = https://web.archive.org/web/20130506073942/http://www.unicef.org.uk/BabyFriendly/Resources/Guidance-for-Health-Professionals/Learning-about-breastfeeding/Skin-to-skin-contact/ | archive-date = 6 May 2013 | url-status = dead }}</ref> Activities such as weighing, measuring, bathing, needle-sticks, and eye prophylaxis wait until after the first feeding.<ref name="Gartner_2005">{{cite journal|vauthors=Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, Eidelman AI|date=February 2005|title=Breastfeeding and the use of human milk|journal=Pediatrics|volume=115|issue=2|pages=496–506|doi=10.1542/peds.2004-2491|pmid=15687461|s2cid=5791615}}</ref>

==== Preterm or low-tone infants ====
Children who are born [[Preterm birth|preterm]] (before 37 weeks), children born in the early term period (37 weeks–38 weeks and 6 days), and children born with low muscular tone, such as those with [[Chromosome abnormality|chromosomal abnormalities]] like [[Down syndrome]] or neurological conditions like [[Cerebral palsy]], may have difficulty in initiating breast feeds immediately after birth.<ref name="Eglash_2020"/>{{rp|34–47}}<ref>{{cite journal | vauthors = Thomas J, Marinelli KA | title = ABM Clinical Protocol #16: Breastfeeding the Hypotonic Infant, Revision 2016 | journal = Breastfeeding Medicine | volume = 11 | issue = 6 | pages = 271–276 | date = August 2016 | pmid = 27314160 | doi = 10.1089/bfm.2016.29014.jat }}</ref><ref>{{cite journal | vauthors = Boies EG, Vaucher YE | title = ABM Clinical Protocol #10: Breastfeeding the Late Preterm (34–36 6/7 Weeks of Gestation) and Early Term Infants (37–38 6/7 Weeks of Gestation), Second Revision 2016 | journal = Breastfeeding Medicine | volume = 11 | issue = 10 | pages = 494–500 | date = December 2016 | pmid = 27830934 | doi = 10.1089/bfm.2016.29031.egb }}</ref> These [[Late preterm infant|late preterm]] (34 weeks –36 weeks and 6 days) and early term (37 weeks–38 weeks and 6 days) infants are at increased risk for both breastfeeding cessation and complications of insufficient milk intake (e.g., dehydration, hypoglycemia, jaundice, and excessive weight loss).<ref name="Boies-2016">{{cite journal |vauthors=Boies EG, Vaucher YE |date=December 2016 |title=ABM Clinical Protocol #10: Breastfeeding the Late Preterm (34–36 6/7 Weeks of Gestation) and Early Term Infants (37–38 6/7 Weeks of Gestation), Second Revision 2016 |journal=Breastfeeding Medicine |volume=11 |issue=10 |pages=494–500 |doi=10.1089/bfm.2016.29031.egb |pmid=27830934}}</ref> They are often expected to feed like term babies, but they have less strength and stamina to feed adequately.<ref name="Boies-2016" />

By convention, such children are often fed on [[expressed breast milk]] or other supplementary feeds through tubes, [[supplemental nursing systems]], bottles, spoons or cups until they develop satisfactory ability to suck and swallow breast milk. Regardless of feeding method chosen, human milk feedings, whether from the mother or a donor, are important in the brain development of premature infants, and the NICU having a standardized protocol for feeding is protective against dangerous gastrointestinal infections ([[necrotizing enterocolitis]]) in these infants.<ref name="Lawrence_2021" />{{rp|502–545}} Frequent breastfeeding or small amounts of supplementation may be needed for successful outcomes; breast pumping or [[Hand expression of breast milk|hand expression]] is often helpful in providing adequate stimulation to the mother's breasts.<ref name="Boies-2016" />

Starting to breastfeed may be challenging for mothers of preterm infants, especially those born before 34 weeks, because their breasts may still be developing (in Lactogenesis I, see Breastfeeding Physiology). Additionally, mother–infant separation and the stressful environment of the NICU are also barriers to breastfeeding. Availability of a lactation specialist in the NICU can be helpful for mothers trying to establish their milk supply.<ref name="Lawrence_2021" />{{rp|502–545}} Additionally, skin-to-skin [[Kangaroo care|(Kangaroo Care)]] has been shown to be safe and beneficial to both mother and baby.<ref name="Lawrence_2021" />{{rp|502–545}} Kangaroo Care stabilizes newborn premature infants' vital signs, such as their heart rate, providing a naturally warm environment that helps them regulate their temperature.<ref name="Lawrence_2021" />{{rp|502–545}} It is also beneficial to the mother, as it may improve the development of milk supply and be beneficial for mental health.<ref name="Eglash_2020" />{{rp|34–47}}

=== Timing ===

Newborn babies usually breastfeed 8 to 12 times every 24 hours, and they typically express hunger cues every one to three hours for the first two to four weeks of their lives.<ref name="Zheng_2020" /><ref name="Eglash_2020" />{{rp|27–34}}<ref name="Eglash_2020" />{{rp|50–51}}<ref name="cpmc">{{cite web | url = http://www.cpmc.org/services/pregnancy/information/breastfeeding-frequency.html | title = Breastfeeding Frequency | archive-url = https://web.archive.org/web/20120628053233/http://www.cpmc.org/services/pregnancy/information/breastfeeding-frequency.html | archive-date = 28 June 2012 | publisher = California Pacific Medical Center | url-status = dead }}</ref>
A [[Infant|newborn]] has a small stomach capacity, approximately 20 ml.<ref>{{cite journal | vauthors = Bergman NJ | title = Neonatal stomach volume and physiology suggest feeding at 1-h intervals | journal = Acta Paediatrica | volume = 102 | issue = 8 | pages = 773–777 | date = August 2013 | pmid = 23662739 | doi = 10.1111/apa.12291 | s2cid = 8354240 }}</ref>  The amount of breast milk that is produced is timed to meet the infant's needs in that the first milk, colostrum, is concentrated but produced in only very small amounts, gradually increasing in volume to meet the expanding size of the infant's stomach capacity.<ref name="Eglash_2020" />{{rp|27–34}}<ref name="La Leche League"/> [[Cluster feeding]] may occur for several months, whereby infants will feed very frequently (every 30 minutes to 1 hour), usually associated with [[Child development stages|developmental milestones]].<ref>{{Cite web |title=What Is Cluster Feeding? |url=https://my.clevelandclinic.org/health/articles/cluster-feeding |archive-url=http://web.archive.org/web/20250213073339/https://my.clevelandclinic.org/health/articles/cluster-feeding |archive-date=2025-02-13 |access-date=2025-02-16 |website=Cleveland Clinic |language=en}}</ref><ref>{{Cite web |title=Cluster Feeding and Growth Spurts {{!}} WIC Breastfeeding Support |url=https://wicbreastfeeding.fns.usda.gov/cluster-feeding-and-growth-spurts |url-status=live |archive-url=https://web.archive.org/web/20250212052550/https://wicbreastfeeding.fns.usda.gov/cluster-feeding-and-growth-spurts |archive-date=February 12, 2025 |access-date=2025-02-16 |website=wicbreastfeeding.fns.usda.gov |language=en}}</ref>

Many newborns will typically feed for 10 to 15 minutes on each breast, however feeds may last up to 45 minutes depending on infant wakefulness and efficiency.<ref name="Eglash_2020" />{{rp|50–51}}<ref name="NIH2014How">{{cite web|date=14 April 2014|title=How do I breastfeed? Skip sharing on social media links|url=https://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/Pages/how-is-it-done.aspx|url-status=live|archive-url=https://web.archive.org/web/20150727155211/http://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/Pages/how-is-it-done.aspx|archive-date=27 July 2015|access-date=27 July 2015}}</ref>

It is important for parents to recognize the difference between Nutritive and Non-Nutritive Sucking. Nutritive Sucking follows a slow, rhythmic pattern, with one to two sucks per swallow. Non-nutritive sucking is a faster-paced sucking pattern with few swallows. This swallow pattern is often observed at the beginning or the end of a feed. At the beginning of the feed, this pattern triggers milk letdown, while at the end of the feed, this may be a signal of the infant tired or becoming relaxed with a slower milk velocity.<ref name="Eglash_2020" />{{rp|27–34}}

===Duration and exclusivity===
Numerous health organizations, including, but not limited to, the CDC, WHO, National Health Service, Canadian Pediatric Society, American Academy of Pediatrics, and American Academy of Family Physicians, recommend breastfeeding exclusively for six months following birth, unless medically contraindicated.<ref name="WHO20142" /><ref name="Eglash_2020" />{{rp|15–17}}<ref name="USCDC">{{cite web |url = https://www.cdc.gov/breastfeeding/data/reportcard2.htm |title = Breastfeeding: Data: Report Card 2012: Outcome Indicators – DNPAO – CDC |url-status = live |archive-url = https://web.archive.org/web/20170707195729/https://www.cdc.gov/breastfeeding/data/reportcard2.htm |archive-date = 7 July 2017 |date = 20 August 2018 }}</ref><ref name="Health Canada2">{{cite web |url = http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/index-eng.php |title = Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months |date = 18 August 2015 |publisher = Health Canada |website = A joint statement of Health Canada, Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada |access-date = 31 January 2017 |url-status = live |archive-url = https://web.archive.org/web/20161223134637/http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/index-eng.php |archive-date = 23 December 2016 }}</ref><ref name="Australian Government Department of Health">{{cite web |url = http://www.health.gov.au/breastfeeding |title = Breastfeeding |publisher = Australian Government |date = 27 May 2014 |access-date = 8 February 2015 |url-status = live |archive-url = https://web.archive.org/web/20150208183502/http://www.health.gov.au/breastfeeding |archive-date = 8 February 2015 }}</ref><ref name="UKNHS">{{cite web |url = http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/why-breastfeed.aspx#close |title = Why breastfeed? &#124; National Health Service |url-status = live |archive-url = https://web.archive.org/web/20130801095046/http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/why-breastfeed.aspx#close |archive-date = 1 August 2013 |date = 21 December 2017 }}</ref><ref name="Johnston_2012" /><ref name="CDC2011">{{cite web |url = https://www.cdc.gov/breastfeeding/promotion/index.htm |title = Breastfeeding: Promotion & Support |publisher = CDC |date = 2 August 2011 |url-status = live |archive-url = https://web.archive.org/web/20170729091438/https://www.cdc.gov/breastfeeding/promotion/index.htm |archive-date = 29 July 2017 }}</ref><ref name="Promotion of Breastfeeding in Europe">{{cite web |url = http://www.aeped.es/sites/default/files/6-newblueprintprinter.pdf |title = Protection, promotion and support of breastfeeding in Europe: a blueprint for action |publisher = Unit for Health Services Research and International Health |date = 2008 |access-date = 15 February 2015 |url-status = live |archive-url = https://web.archive.org/web/20140611213531/http://www.aeped.es/sites/default/files/6-newblueprintprinter.pdf |archive-date = 11 June 2014 }}</ref><ref>{{cite journal | vauthors = Cattaneo A, Burmaz T, Arendt M, Nilsson I, Mikiel-Kostyra K, Kondrate I, Communal MJ, Massart C, Chapin E, Fallon M | title = Protection, promotion and support of breast-feeding in Europe: progress from 2002 to 2007 | journal = Public Health Nutrition | volume = 13 | issue = 6 | pages = 751–759 | date = June 2010 | pmid = 19860992 | doi = 10.1017/S1368980009991844 | doi-broken-date = 1 November 2024 | s2cid = 41294219 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Smith HA, Becker GE | title = Early additional food and fluids for healthy breastfed full-term infants | journal = The Cochrane Database of Systematic Reviews | issue = 8 | pages = CD006462 | date = August 2016 | volume = 2016 | pmid = 27574798 | doi = 10.1002/14651858.CD006462.pub4 | pmc = 8588276 }}</ref><ref name="AAFP_position_paper">{{cite web|title=Breastfeeding, Family Physicians Supporting (Position Paper)|url=https://www.aafp.org/about/policies/all/breastfeeding-position-paper.html|access-date=1 November 2021|work=American Academy of Family Physicians (AAFP)|language=en-US}}</ref><ref name="ACOG_756">{{cite journal|vauthors=|date=October 2018|title=ACOG Committee Opinion No. 756: Optimizing Support for Breastfeeding as Part of Obstetric Practice|journal=Obstetrics and Gynecology|volume=132|issue=4|pages=e187–e196|doi=10.1097/AOG.0000000000002890|pmid=30247365|s2cid=52346183}}</ref> Exclusive breastfeeding is defined as "an infant's consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk and no foods) except for vitamins, minerals and medications."<ref name="Eglash_2020" />{{rp|15–17}}<ref name="Gartner_2005"/> Supplementation with human donor breastmilk may be indicated in some specific cases, as discussed below.<ref name="Abrams_2017">{{cite journal | vauthors =  Abrams SA, Landers S, Noble LM, Poindexter BB, Daniels S, Corkins M, etal | collaboration = Committee on Nutrition; Section on Breastfeeding; Committee on Fetus and Newborn | title = Donor Human Milk for the High-Risk Infant: Preparation, Safety, and Usage Options in the United States | journal = Pediatrics | volume = 139 | issue = 1 | pages = e20163440 | date = January 2017 | pmid = 27994111 | doi = 10.1542/peds.2016-3440 | s2cid = 21152598 | doi-access = free }}</ref>
After solids are introduced at around six months of age, continued breastfeeding is recommended. The American Academy of Pediatrics recommends that babies be breastfed at least until 12 months, or longer if both the mother and child wish.<ref name="Eglash_2020" />{{rp|15–17}}<ref name="Johnston_2012" /> The World Health Organization's guidelines recommend "continue[d] frequent, on-demand breastfeeding until two years of age or beyond.<ref name="who.int">{{cite web |url =https://www.who.int/topics/breastfeeding/en/ |title = Breastfeeding |url-status = live |archive-url = https://web.archive.org/web/20160220010829/http://www.who.int/topics/breastfeeding/en/ |archive-date = 20 February 2016 }}</ref><ref name="WHO2003">{{cite book |title = Global strategy for infant and young child feeding |location = Geneva, Switzerland |url = http://whqlibdoc.who.int/publications/2003/9241562218.pdf |publisher = [[World Health Organization]] and [[UNICEF]] |year = 2003 |isbn = 978-92-4-156221-8 |access-date = 20 September 2009 |author = World Health Organization. |url-status = live |archive-url = https://web.archive.org/web/20090924172259/http://whqlibdoc.who.int/publications/2003/9241562218.pdf |archive-date = 24 September 2009 }}</ref>

[[Extended breastfeeding]] means breastfeeding after the age of 12 or 24 months, depending on the source. In Western countries such as the [[United States]], [[Canada]], and [[Great Britain]], extended breastfeeding is relatively uncommon and can provoke criticism.<ref>{{cite web|title=Breastfeeding: Data: Report Card|url=https://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf|url-status=live|archive-url=https://web.archive.org/web/20160104135129/http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf|archive-date=4 January 2016|access-date=5 November 2015|publisher=Center for Disease Control and Prevention}}</ref><ref name="Mayo Clinic">{{cite web|title=Infant and toddler health|url=http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/extended-breastfeeding/art-20046962?pg=2|url-status=live|archive-url=https://web.archive.org/web/20160502045713/http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/extended-breastfeeding/art-20046962?pg=2|archive-date=2 May 2016|access-date=12 May 2016|publisher=Mayo Clinic}}</ref>

In the United States, 22.4% of babies are breastfed for 12 months, the minimum amount of time advised by the [[American Academy of Pediatrics]]. In [[India]], mothers commonly breastfeed for 2 to 3 years.<ref name="Stein_2004">{{cite journal|vauthors=Stein MT, Boies EG, Snyder D|date=October 2004|title=Parental concerns about extended breastfeeding in a toddler|journal=Journal of Developmental and Behavioral Pediatrics|volume=25|issue=5 Suppl|pages=S107–S111|doi=10.1097/00004703-200410001-00022|pmid=15502526}}</ref>

==== Supplementation ====
Supplementation is defined as the use of additional milk or fluid products to feed an infant, in addition to breastmilk, during the first 6 months of life.<ref name="Eglash_2020"/>{{rp|34–47}}<ref name="Kellams_2017">{{cite journal | vauthors = Kellams A, Harrel C, Omage S, Gregory C, Rosen-Carole C | title = ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017 | journal = Breastfeeding Medicine | volume = 12 | issue = 4 | pages = 188–198 | date = May 2017 | pmid = 28294631 | doi = 10.1089/bfm.2017.29038.ajk | hdl = 10150/626017 | hdl-access = free }}</ref> The Academy of Breastfeeding Medicine recommends only supplementing when medically indicated, as opposed to mixing use of formula and breastmilk for reasons that are not necessarily medical indications.<ref name="Kellams_2017" /> Some medical indications for supplementation include low blood sugar, dehydration, excessive weight loss or poor gain, and jaundice in the infant; true low milk supply; severe nipple pain unrelieved by interventions; and medical contraindications to breastfeeding, as described below.<ref name="Eglash_2020" />{{rp|34–47}}<ref name="Kellams_2017" /> Supplements can be delivered at the breast through a [[supplemental nursing system]] in order to stimulate the production of the mother's own milk and to preserve the breastfeeding relationship.<ref>{{cite journal | vauthors = Penny F, Judge M, Brownell E, McGrath JM | title = What Is the Evidence for Use of a Supplemental Feeding Tube Device as an Alternative Supplemental Feeding Method for Breastfed Infants? | journal = Advances in Neonatal Care | volume = 18 | issue = 1 | pages = 31–37 | date = February 2018 | pmid = 29373347 | doi = 10.1097/ANC.0000000000000446 | s2cid = 42316139 }}</ref> Some parents may desire to supplement proactively if early signs of insufficient intake, such as decreased urination, dry mucous membranes, or persistent signs of hunger, are noticed. If these signs are noticed, it is important to have the mother-infant dyad evaluated by a breastfeeding specialist or pediatrician to determine the true cause of the symptoms and determine the need for supplementation.<ref name="Kellams_2017" /> Often, these symptoms are caused by poor milk transfer at the breast, and can be solved with adjustments to the latch, but occasionally they may be caused by other processes, unrelated to breastfeeding, so evaluation is necessary.<ref name="Eglash_2020" />{{Rp|pages=72–73}} Supplementation with formula is associated with decreased rates of exclusive breastfeeding at 6 months, and overall decreased length of breastfeeding.<ref name="Kellams_2017" />

In terms of ''what'' to supplement with, the first choice is always the mother's own breastmilk, save any medical contraindications to its use.<ref name="Eglash_2020" />{{rp|34–47}}<ref name="Kellams_2017" /> The second best option for supplementation is [[Pasteurization|pasteurized]] human [[Human milk bank|donor milk]].<ref name="Eglash_2020" />{{rp|34–47}}<ref name="Kellams_2017" /> Finally, specific formulas may be used for supplementation if maternal or donor breastmilk are not options.<ref name="Eglash_2020" />{{rp|34–47}}<ref name="Kellams_2017" /> One situation where this may be the case is in cases of infant metabolic diseases, such as [[galactosemia]].<ref name="Eglash_2020" />{{rp|15–17}}<ref name="Kellams_2017" /> The Academy of Breastfeeding Medicine recommends that supplementation only be used when medically indicated and when overseen by a medical professional, such as a pediatrician or family physician, and after consultation with an IBCLC.<ref name="Eglash_2020" />{{rp|34–47}} Without sufficient breast stimulation, supplementation can reduce the mother's milk production, so pumping would be indicated in these cases if continued breastfeeding is desired.

Indications for use of [[Human milk bank|donor breastmilk]] are very closely outlined by the [[American Academy of Pediatrics]] (AAP). Due to low availability and high cost of donor breastmilk, the AAP recommends prioritizing the use of the milk for infants born with a weight of less than 1500g (approximately 3lb 5oz), as it is helpful in decreasing rates of the severe intestinal infection, [[necrotizing enterocolitis]], in this population.<ref name="Abrams_2017" />

=== Position ===
[[File:Woman breastfeeding an infant.jpg|thumb|A mother cradling an infant while breastfeeding]]
Effective positioning and technique for latching on are necessary to prevent nipple soreness and allow the baby to obtain enough milk.<ref name="Eglash_2020" />{{rp|27–34}}<ref name="Eglash_2020" />{{rp|50–51}}<ref>{{cite web | author = Healthwise Staff | title = Breast-feeding: Learning how to nurse |url = http://healthlinksbc.org/kb/content/actionset/ue5284.html |access-date = 17 June 2009 |url-status = live |archive-url = https://web.archive.org/web/20120321005052/http://healthlinksbc.org/kb/content/actionset/ue5284.html |archive-date = 21 March 2012 }}</ref>

Babies can successfully latch on to the breast from multiple positions. Each baby may prefer a particular position. The "football" hold places the baby's legs next to the mother's side with the baby facing the mother. Using the "cradle" or "cross-body" hold, the mother supports the baby's head in the crook of her arm. The "cross-over" hold is similar to the cradle hold, except that the mother supports the baby's head with the opposite hand. The mother may choose a reclining position on her back or side with the baby lying next to her.<ref>{{cite web |title = Positions and Tips for Making Breastfeeding Work |url = http://www.babycenter.com/0_positions-and-tips-for-making-breastfeeding-work_8784.bc |website = BabyCenter.com |access-date = 27 October 2014 |url-status = usurped |archive-url = https://web.archive.org/web/20141027022837/http://www.babycenter.com/0_positions-and-tips-for-making-breastfeeding-work_8784.bc |archive-date = 27 October 2014 }}</ref>

No matter the position the parent-infant dyad finds most comfortable, there are a few components of every position which will help facilitate a successful [[Latch (breastfeeding)|latch]]. One key component is maternal comfort. The mother should be comfortable while breastfeeding, and should have her back, feet, and arms supported with pillows as necessary. Additionally, when starting the latch process, the infant should be aligned with their abdomen facing their mother, which can be remembered as "tummy-to-mummy," and with their hips, shoulders and head aligned. This alignment helps to facilitate proper, efficient swallowing mechanics.<ref name="Eglash_2020" />{{rp|27–34}}

<gallery>
File:ASC Leiden - Coutinho Collection - 1 12 - Life in Canjambari, Guinea-Bissau - Guinean mother breastfeeding her baby - 1973 (cropped).tiff|Standing mother breastfeeding her baby, Canjambari, [[Guinea-Bissau]], 1973
File:Breastfeeding - Cradle Hold.png|Breastfeeding – Cradle hold.
File:Breastfeeding - Cross Cradle Position.png|Breastfeeding – Cross cradle position.
File:Breastfeeding - Football Hold.png|Breastfeeding – Football hold.
File:Breastfeeding - Semi-Reclining Position.png|Breastfeeding – Semi-reclining position.
File:Breastfeeding - Side-Lying Position.png|Breastfeeding – Side-lying position.
File:Breastfeeding - Supine Position.png|Breastfeeding – Supine position.
File:Breastfeeding - Twins, Cross Cradle Position I.png|Breastfeeding – Twins, cross cradle position I.
File:Blausen 0134 Breastfeeding Twins FootballorClutchHold 02.png|Breastfeeding – Twins, football or clutch hold.
File:Breastfeeding - Twins, Parallel Position II.png|Breastfeeding – Twins, parallel position II.
</gallery>

=== Latching ===
{{Main|Latch (breastfeeding)}}
Latching refers to how the baby uses their lips, cheek, and tongue to attach to the nipple and breast.

==== Making use of anatomy and reflexes ====
[[File:Good breastfeeding latch and breast compression.ogv|thumb|upright=0.75|The process of latching a newborn onto the breast<ref name="Newman">{{cite web | vauthors = Newman J | title = International Breastfeeding Centre| quote = A mother and her 28-hour-old infant breastfeeding, with the help of an International Board-Certified Lactation Consultant. This video illustrates how to latch a baby onto the breast, what a good latch looks like, and the movements that are associated with swallowing milk. The mother uses a breast compression technique to help move milk into the baby's mouth. |date=1 January 2016 |url= https://commons.wikimedia.org/wiki/File:Good_breastfeeding_latch_and_breast_compression.ogv |access-date=12 November 2021}}</ref>]] Sebaceous glands called [[Glands of Montgomery]] located in the areola secrete an oily fluid that lubricate and protect the nipple during latching. The visible portions of the glands can be seen on the skin's surface as small round bumps.<ref name="Eglash_2020" />{{rp|18–21}}

The [[rooting reflex]] is the baby's natural tendency to turn towards the breast with the mouth open wide.<ref>{{cite web|title=default – Stanford Children's Health|url=https://www.stanfordchildrens.org/en/topic/default?id=newborn-reflexes-90-P02630|access-date=12 November 2021|website=www.stanfordchildrens.org}}</ref> When preparing to latch, mothers should make use of this reflex by gently stroking the baby's [[philtrum]], the area between the upper lip and the nose, with their nipple to induce the baby to open their mouth with a wide gape.<ref name="Newman" /> One way to help the infant achieve a deep latch is to compress the breast tissue into a "U" or "hamburger shape," so that the infant can fit the breast tissue into their mouth. This is done by the mother placing her thumb and fingers in line with the infant's nose and mouth respectively and using this grip to compress the breast tissue.<ref name="Newman" />
==== Bringing the infant in to latch ====
[[File:Breastfeeding - Incorrect vs Correct Latch-On.png|left|thumb|Illustration noting the lower lip of the infant during latching]]
If the newborn seems to need help in latching on, the mother should focus on helping the infant by bringing their chin to the breast first. This facilitates a deep, asymmetric latch, and also helps the infant [[Anatomical terms of motion|extend their neck]] and tilt their forehead back to maintain this deep latch and ease the swallowing process.<ref>{{cite book| vauthors = Walker M |url= https://www.worldcat.org/oclc/833313234 |title=Breastfeeding management for the clinician: using the evidence|date=2014|publisher=Jones & Bartlett Learning|isbn=978-1-4496-9465-4|edition=3|location=Burlington, MA|oclc=833313234}}</ref>

==== Signs of a good, deep latch ====
[[File:Good Latch.jpg|thumb|Example and indicators of a good latch<ref name="ibconline.ca">{{cite web|title=International BreastFeeding Centre {{!}} What's missing in helping mothers with breastfeeding?|url=https://ibconline.ca/the-asymmetric-latch/|access-date=5 November 2021|language=en-CA}}</ref><ref name="Simpson-2014">{{cite book|url=https://www.worldcat.org/oclc/864058193|title=Perinatal nursing|date=2014| vauthors = Simpson KR, Creehan PS | publisher = Obstetric, and Neonatal Nurses Association of Women's Health|isbn=978-1-4698-8109-6|edition=4|location=Philadelphia|oclc=864058193}}</ref>]]In a good latch, a large amount of the areola, in addition to the nipple, is in the baby's mouth. The amount of areola visible on either side of the infant's mouth should be '''asymmetric''', meaning most of the "bottom" of the areola should be in the infants mouth and much more of the "top" of the areola should be visible. This position is helpful in pointing the nipple toward the roof of the infant's mouth, helping the infant recruit more milk.<ref name="ibconline.ca" />  The baby's lips should be flanged out.<ref name="NHS 2016">{{cite web | title=Breastfeeding: positioning and attachment – NHS.UK | website=NHS Choices Home Page | date=28 October 2016 | url=https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-positioning-attachment/ | access-date=7 April 2018}}</ref>{{sfn|Lawrence|Lawrence|2015|p=249}} The neck should be [[Anatomical terms of motion|extended]] to facilitate swallowing, and as such, the chin will be close to the breast, and the forehead and nose should be far from the breast.<ref name="ibconline.ca" /> Another sign of a good latch is the contour of the infant's cheeks; the cheeks should be rounded all the way to the edge of the mouth, rather than dimpled or creased at the edge of the mouth.<ref>{{cite web|date=7 December 2020|title=Breastfeeding: positioning and attachment|url=https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/positioning-and-attachment/|access-date=12 November 2021|website=nhs.uk|language=en}}</ref> This is a good indicator of effective suck mechanics. Additionally, in order to achieve a deep latch, the infant's mouth must be open wide, preferably wider than 140 degrees.<ref name="Simpson-2014" />

==== Signs of a poor, shallow latch ====
[[File:Shallow Latch.jpg|thumb|Example and indicators of a poor, shallow latch<ref name="ibconline.ca"/>]]
In a poor, shallow latch, the infant may latch close to, or at, the nipple, which can cause the mother pain.<ref name="LLL GB-2016">{{cite web|date=30 January 2016|title=Nipple Pain|url=https://www.laleche.org.uk/nipple-pain/|access-date=12 November 2021|website=La Leche League GB|language=en-GB}}</ref> While the infant is at the breast, the first indicators of a shallow latch are having the [[areola]] be largely visible outside the infant's mouth and a narrow infant mouth angle.<ref name="ibconline.ca"/> Additional signs result from poor positioning when the infant comes toward the breast to latch. If the infant leads with their brow or forehead, they are likely to flex their neck; this mechanism of latching causes the nipple to point down and then hit the hard palate during sucking.<ref name="LLL GB-2016" /> From an external view, this manifests as the nose and forehead being close to the breast and the chin far from the breast.<ref name="ibconline.ca"/> This neck flexion also obstructs the normal swallowing mechanism, preventing the infant from drinking efficiently.<ref name="ibconline.ca"/> In addition to not being able to swallow properly, this shallow latch prevents the infant from adequately compressing the glandular tissue behind the nipple and stimulating milk flow; thus, they may begin to apply more suction, which manifests externally as cheek dimpling, or sucking their cheeks in.<ref name="Eglash_2020" />{{rp|27–34}}<ref name="ibconline.ca"/>

=== Let-down reflex ===

{{see also|Lactation#Milk ejection reflex}}

When  the baby suckles muscles in the breast squeeze milk towards the nipples.  This is called the let-down reflex.  Some women report that they do not experience anything while others report a tingling feeling which is sometimes described as quite strong.
The baby may be seen to respond to the beginning of the flow of milk by changing from quick sucks to deep rhythmic swallows.  Sometimes the let-down is so strong that the baby splutters and coughs and the mother may need to remove the baby from her breast for a short time until the flow becomes less forceful.  Milk may also let-down unexpectedly when a mother hears her baby cry or even only thinks about the baby. Nursing pads may be made or purchased to absorb unexpected  milk flows.<ref>{{cite web |title=Pain: General |url=https://www.llli.org/breastfeeding-info/pain-general/ |website=Le Leche League International |access-date=12 January 2022}}</ref><ref>{{cite web |title=Breastfeeding: the first few days |url=https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/the-first-few-days/ |website=NHS |date=7 December 2020 |access-date=12 January 2022}}</ref>

=== Problems with breastfeeding ===
{{main|Breastfeeding difficulties}}

==== Inverted nipples ====
{{main|Inverted nipple}}
Infants of mothers with inverted nipples can still achieve a good latch with perhaps a little extra effort.  For some women, the nipple may easily become erect when stimulated. Other women may require modified breastfeeding techniques, and some may need extra devices, such as nipple shells, modified syringes, or breast pumps to expose the nipple.<ref name="LLLI-2021b">{{cite web|title=Inverted and Flat Nipples|url=https://www.llli.org/breastfeeding-info/inverted-flat-nipples/|access-date=12 November 2021|website=La Leche League International|language=en-US}}</ref><ref name="Cheung_2017">{{cite web| vauthors = Cheung W |title=Acrobat Accessibility Report|url=https://www.toronto.ca/wp-content/uploads/2017/11/8ee4-tph-breastfeeding-protocol-8-flat-inverted-nipples-2013.pdf|access-date=12 November 2021|website=www.toronto.ca|language=en-us}}</ref>  La Leche League and Toronto Public Health offer several techniques to use during pregnancy or even in the early days following birth that may help to bring a flat or inverted nipple out.<ref name="LLLI-2021b" /><ref name="Cheung_2017" />

==== Use of pacifiers ====
The World Health Organization's Ten Steps to Successful Breastfeeding recommends total avoidance of  pacifiers for breastfeeding infants. In 2016 a large review of studies  reported that the use of a pacifier beginning at birth or after lactation was established did not significantly affect the duration of exclusive and partial breastfeeding up to four months of age.  The CDC, however, currently (2022) reports that early use of pacifiers can have a negative outcome on the success of breastfeeding and they suggest that it should be delayed until breastfeeding is firmly established.<ref>{{cite web |title=Infant Safety in Maternity Care Practices that Support Breastfeeding in US Birth Facilities |url=https://www.cdc.gov/breastfeeding/recommendations/safety-in-maternity-care.html |website=CDC |date=28 January 2021 |access-date=14 January 2022}}</ref><ref name="Marmet_2000">{{cite journal | vauthors = Marmet C, Shell E, Aldana S | title = Assessing infant suck dysfunction: case management | journal = Journal of Human Lactation | volume = 16 | issue = 4 | pages = 332–336 | date = November 2000 | pmid = 11188682 | doi = 10.1177/089033440001600409 | s2cid = 208505043 }}</ref><ref name="JaafarHo2016">{{cite journal | vauthors = Jaafar SH, Ho JJ, Jahanfar S, Angolkar M | title = Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 8 | pages = CD007202 | date = August 2016 | pmid = 27572944 | pmc = 8520760 | doi = 10.1002/14651858.CD007202.pub4 }}</ref>
[[File:Ankyloglossia 1.jpg|thumb|Anterior tongue-tie<ref>{{cite web | author = Gzzz|title=Français: Ankyloglossie (frein lingual court) chez un enfant de 4 ans.|date=12 June 2018|url=https://commons.wikimedia.org/wiki/File:Ankyloglossia_1.jpg|access-date=12 November 2021}}</ref>]]

==== Ankyloglossia ====
{{main|Ankyloglossia}}
Ankyloglossia, also called "tongue-tie" may cause shallow latch, poor milk transfer, and other problems with breastfeeding.<ref name="Eglash_2020"/>{{rp|34–47}} There are two types of tongue-ties; an anterior tongue-tie occurs when a band of tissue, known as the [[Frenulum of tongue|frenulum]], attaches the tongue to the base of the mouth, restricting the tongue's vertical movement and preventing the infant from pressing the breast and nipple into the [[soft palate]].<ref name="Eglash_2020"/>{{rp|34–47}} A posterior tongue-tie is a band of tissue that can only be ''felt'' on exam, and tends to impact breastfeeding less severely than its anterior counterpart.<ref name="Eglash_2020"/>{{rp|34–47}} If it is determined that the inability to latch on properly is related to ankyloglossia, a simple surgical procedure to clip the frenulum can correct the condition.<ref name="Eglash_2020"/>{{rp|34–47}}<ref>{{cite web|title=Tongue-tie (ankyloglossia)|url=https://www.mayoclinic.org/diseases-conditions/tongue-tie/symptoms-causes/syc-20378452|access-date=21 March 2018|website=Mayo Clinic}}</ref><ref name="whgov">{{cite web|date=9 June 2017|title=Breastfeeding checklist: How to get a good latch|url=https://www.womenshealth.gov/itsonlynatural/overcoming-challenges/breastfeeding-checklist-how-to-get-good-latch.html|url-status=live|archive-url=https://web.archive.org/web/20170804173646/https://www.womenshealth.gov/itsonlynatural/overcoming-challenges/breastfeeding-checklist-how-to-get-good-latch.html|archive-date=4 August 2017|access-date=4 August 2017|publisher=WomensHealth.gov}}{{PD-notice}}</ref><ref name="whgov2">{{cite web|date=9 June 2017|title=Common questions about breastfeeding and pain|url=https://www.womenshealth.gov/itsonlynatural/overcoming-challenges/common-questions-about-breastfeeding-pain.html|url-status=live|archive-url=https://web.archive.org/web/20170804173525/https://www.womenshealth.gov/itsonlynatural/overcoming-challenges/common-questions-about-breastfeeding-pain.html|archive-date=4 August 2017|access-date=4 August 2017|publisher=womenshealth.gov}}{{PD-notice}}</ref><ref>{{cite journal | vauthors = Amir LH, James JP, Donath SM | title = Reliability of the hazelbaker assessment tool for lingual frenulum function | journal = International Breastfeeding Journal | volume = 1 | issue = 1 | pages = 3 | date = March 2006 | pmid = 16722609 | pmc = 1464379 | doi = 10.1186/1746-4358-1-3 | doi-access = free }}</ref>  The Academy of Breastfeeding Medicine and the Australian Dental Association have raised concern over the growing trend of oral tie surgeries, due to evidence for benefit being low-quality, inconsistent, or unsupported.<ref>{{cite journal | vauthors = LeFort Y, Evans A, Livingstone V, Douglas P, Dahlquist N, Donnelly B, Leeper K, Harley E, Lappin S | title = Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in Breastfeeding Dyads | journal = Breastfeeding Medicine | volume = 16 | issue = 4 | pages = 278–281 | date = April 2021 | pmid = 33852342 | doi = 10.1089/bfm.2021.29179.ylf | s2cid = 233242365 }}</ref><ref>{{cite journal | vauthors = O'Shea JE, Foster JP, O'Donnell CP, Breathnach D, Jacobs SE, Todd DA, Davis PG | title = Frenotomy for tongue-tie in newborn infants | journal = The Cochrane Database of Systematic Reviews | volume = 3 | issue = 6 | pages = CD011065 | date = March 2017 | pmid = 28284020 | pmc = 6464654 | doi = 10.1002/14651858.cd011065.pub2 }}</ref><ref>{{cite journal | vauthors = Visconti A, Hayes E, Ealy K, Scarborough DR | title = A systematic review: The effects of frenotomy on breastfeeding and speech in children with ankyloglossia | journal = International Journal of Speech-Language Pathology | volume = 23 | issue = 4 | pages = 349–358 | date = August 2021 | pmid = 33501864 | doi = 10.1080/17549507.2020.1849399 | s2cid = 231760695 }}</ref><ref>{{cite web |date=2020 |title=Ankyloglossia and Oral Frena Consensus Statement |url=https://ada.org.au/policy-statement-2-13-ankyloglossia-and-oral-frena |work=The Australian Dental Association}}</ref>

==== Engorgement ====
{{main|Breast engorgement}}
[[File:Montée lait avant.JPG|thumb|Pre-pregnant human breasts]]
[[File:Montée lait après.JPG|thumb|Lactating human breasts showing evidence of engorgement]]
Engorgement is the swelling and stretching of the breast tissue due to accumulation of fluid in the tissue surrounding and supporting the milk-producing cells and ducts.<ref name="Eglash_2020" />{{rp|55}}<ref name="Berens_2016" /> Engorgement most frequently occurs as milk "comes in" and during the [[weaning]] process.<ref name="Eglash_2020" />{{rp|55}}<ref>{{cite web|date=28 January 2016|title=Engorged Breasts – avoiding and treating|url=https://www.laleche.org.uk/engorged-breasts-avoiding-and-treating/|access-date=14 November 2021|website=La Leche League GB|language=en-GB}}</ref> As milk is coming in, several processes occur. At the end of pregnancy there is dilation of the blood vessels which supply the breast, allowing for leaking into the tissue or [[Interstitial fluid|interstitial space]].<ref name="Berens_2016" /> Additionally, the birth of an infant is followed by massive fluid shifts to both offload excess fluid, which had been used to supply oxygen and nutrients to the fetus through the placenta, which is no longer needed, and supply additional fluid to the breasts in order to start the process of making milk. These fluid shifts often result in some of this excess fluid leaking into the breast tissue.<ref name="Eglash_2020" />{{rp|55}} Finally, milk "coming in" can create an uncomfortably full feeling, which combined with the aforementioned fluid accumulation in the breast tissue, can cause severe pain.<ref name="Berens_2016" /><ref name="Eglash_2020" />{{rp|55}} If breastfeeding is suddenly stopped, the breasts are likely to become engorged. Pumping small amounts to relieve discomfort helps to gradually train the breasts to produce less milk. There is presently no safe medication to prevent engorgement, but cold compresses and [[ibuprofen]] may help to relieve pain and swelling. Pain should go away with emptying of the breasts. If symptoms continue and comfort measures are not helpful, it is possible a [[blocked milk duct]] or infection may be present and seek medical intervention.<ref name="WebMed, LLC">{{cite web|title=Stopping Breastfeeding Suddenly – Topic Overview|url=http://www.webmd.com/women/tc/stopping-breast-feeding-suddenly-topic-overview|url-status=live|archive-url=https://web.archive.org/web/20160504233022/http://www.webmd.com/women/tc/stopping-breast-feeding-suddenly-topic-overview|archive-date=4 May 2016|access-date=6 May 2016|publisher=WebMed, LLC}}</ref>

==== Nipple pain ====
{{main|Nipple pain in breastfeeding}}
Although very common, nipple pain and nipple trauma (cracking, open sores) should not be normalized, as these are often signs of a shallow latch or other underlying problem that can be evaluated and <u>fixed</u>.<ref name="Eglash_2020"/>{{rp|34–47}} In addition to shallow latch, other causes of nipple pain include, but are not limited to, skin infection or [[Dermatitis|inflammation]], [[Vasospasm|blood vessel spasm]] or the equivalent of [[Raynaud syndrome|Raynaud Syndrome]] in the breast, [[mastitis]], plugged ducts, and [[nipple bleb]]s.<ref name = "Lawrence_2021" />{{rp|572–593}}<ref name="Berens_2016b">{{cite journal | vauthors = Berens P, Eglash A, Malloy M, Steube AM | title = ABM Clinical Protocol #26: Persistent Pain with Breastfeeding | journal = Breastfeeding Medicine | volume = 11 | issue = 2 | pages = 46–53 | date = March 2016 | pmid = 26881962 | doi = 10.1089/bfm.2016.29002.pjb }}</ref> Pain caused by a problem deep in the breast may also present with nipple pain due to the paths of nerves in the breast.<ref name = "Lawrence_2021" />{{rp|572–593}} In addition to the serious nature of many of these causes, nipple pain is a common reason for a mother stopping breastfeeding, so it is important that mothers experiencing nipple pain be evaluated.<ref name = "Lawrence_2021" />{{rp|572–593}}<ref name="Berens_2016b" />

==== Delay in milk "coming in" ====
{{main|Delayed onset of lactation}}
While milk normally "comes in" by 3 days after birth, there are several reasons this may be delayed. Risk factors for this delay include [[Diabetes and pregnancy|maternal diabetes]], stressful delivery, [[retained placenta]], prolonged labor and birth by [[Caesarean section|C-section]].<ref name = "Lawrence_2021" />{{rp|84}}<ref name="Berens_2016" /><ref name="Eglash_2020"/>{{rp|34–47}} Mothers experiencing a delay in their milk coming in should consult with a lactation specialist and their pediatrician, as they may need to supplement with donor milk or formula to help the infant gain weight and pump to encourage milk to come in sooner and in greater volume.<ref name="Eglash_2020"/>{{rp|34–47}}

==== Low milk supply ====
{{main|Low milk supply}}
Breast milk supply augments in response to the baby's demand for milk, and decreases when milk is allowed to remain in the breasts.<ref name="Eglash_2020" />{{rp|18–21}}<ref name="Eglash_2020" />{{rp|27–34}}<ref name="Brodribb_2018" /><ref name="Eglash_2020" />{{rp|72–80}}{{sfn|Lawrence|Lawrence|2015|p=67}} When considering a possibly low milk supply, it is important to consider the difference between "perceived low milk supply" and "true low milk supply". Perceived low milk supply occurs when mothers, for a variety of reasons, believe that they are not making enough milk to feed their infant.<ref name="Eglash_2020" />{{rp|72–80}} These reasons may include fussiness, [[Baby colic|colic]], preference for the bottle as opposed to the breast, long nursing duration, decreased sensation of breast fulness, and even decreased frequency of infant stools.<ref name="Eglash_2020" />{{rp|72–80}} However, in these cases, it important to reassure the parent that infant weight gain is absolute proof of adequate milk intake.<ref name="Eglash_2020" />{{rp|49}} Thus, if the infant breastfeeding exclusively, and is gaining weight appropriately, then the parent can be reassured that they are producing enough milk.<ref name="Eglash_2020" />{{rp|49}}

True low milk supply can be either ''primary'' (caused by medical conditions or anatomical issues in the mother), ''secondary'' (caused by not thoroughly and regularly removing milk from the breasts) or both. Primary causes may manifest prior to or during pregnancy, during labor, and even after birth.<ref name="Eglash_2020" />{{Rp|pages=72–73}} Secondary causes are far more common than primary ones. One study found that 15% of healthy first-time mothers had low milk supply 2–3 weeks after birth, with secondary causes accounting for at least two-thirds of those cases.<ref name=neifert>{{cite journal | vauthors = Neifert MR | title = Prevention of breastfeeding tragedies | journal = Pediatr. Clin. North Am. | volume = 48 | issue = 2 | pages = 273–297 | date = April 2001 | pmid = 11339153 | doi = 10.1016/S0031-3955(08)70026-9 }}</ref>

Poor milk intake is signaled by poor infant weight gain, signs of dehydration, and hypoglycemia.<ref name="Eglash_2020" />{{rp|49}}<ref name="Eglash_2020"/>{{rp|34–47}} Poor milk intake can be caused by poor milk transfer by the infant or by true low milk supply by the mother.<ref name="Eglash_2020" />{{rp|52–54}}  When the milk "comes in" appropriately, but is followed by decreased [[Low milk supply|milk supply]], this is most often caused by allowing milk to remain in the breasts for long periods of time, or insufficiently draining the breasts during feeds.<ref name="Eglash_2020" />{{rp|72–80}} If the baby is [[latch (breastfeeding)|latching]] and swallowing well (signs of good milk transfer), but is not gaining weight as expected or is showing signs of dehydration, low milk supply in the mother can be suspected, and a lactation specialist should be consulted.<ref name="Eglash_2020" />{{rp|52–54}}<ref name="neifert" />

====Newborn jaundice====
{{main|Neonatal jaundice}}
More than 80% of newborns develop [[jaundice]] within several days of birth.<ref name="Flaherman_2017" /> [[Neonatal jaundice|Jaundice]], or yellowing of the skin and eyes, occurs when [[bilirubin]], a byproduct of the breakdown/recycling of red blood cells, builds up in the newborn's bloodstream faster than the liver can break it down and excrete it through the baby's urine and stool. By continuing to breastfeed frequently (start at 8-12 times per day), the infant's body can usually rid itself of the bilirubin excess by encouraging more urine and stool production.<ref name="Flaherman_2017" /> However, in some cases, the infant may need additional treatments, such as [[Light therapy|UV light therapy]] or additional feedings (see Supplementation) to keep the condition from progressing into more severe problems.<ref name="Flaherman_2017" /><ref name="cdc.gov">{{cite web|date=21 March 2018|title=Should a mother continue breastfeeding if her child has jaundice?|url=https://www.cdc.gov/breastfeeding/disease/jaundice.htm|access-date=22 March 2018|website=Centers for Disease Control and Prevention}}</ref>

There are two types of newborn jaundice related to breastfeeding.

Breastfeeding jaundice is quite common and may occur in the first week of life in conjunction with ongoing weight loss.<ref name="Flaherman_2017" /> The cause is thought to be low caloric intake. Formula-fed infants tend to lose less weight after birth compared to breastfed infants, supporting the hypothesis that breastfeeding jaundice is related to caloric intake rather than volume intake.<ref name="Flaherman_2017" /> Individual risk factors, such as breastfeeding, are not ''predictive'' of developing severe jaundice: Breastfeeding is a risk factor for severely high levels of bilirubin, but the risk factor is very common, and the risk of severely high bilirubin remains small.<ref name="AA Peds-2004">{{cite journal | author = American Academy of Pediatrics Subcommittee on Hyperbilirubinemia | title = Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation | journal = Pediatrics | volume = 114 | issue = 1 | pages = 297–316 | date = July 2004 | pmid = 15231951 | doi = 10.1542/peds.114.1.297 | s2cid = 2216960 }}</ref>

Breast milk jaundice is jaundice that persists despite appropriate weight gain.<ref name="Flaherman_2017" /> This type of jaundice may start as breastfeeding jaundice and persist, or may not appear until after the baby has begun to gain weight, typically around 4–5 days old.<ref name="Eglash_2020"/>{{rp|34–47}}<ref name="Flaherman_2017" /> It often persists beyond the second and third weeks of life.<ref name="Flaherman_2017" /> There is no single cause of breast milk jaundice; rather, the causes are multifactorial and frequently debated in the literature.<ref name="Flaherman_2017" />  The causes of breast milk jaundice include variations in [[bilirubin metabolism]], [[genetic variation]]s, and variations in breastmilk, including the [[Human microbiome|harmless and helpful germs found naturally on the surface of the skin]] and in the breastmilk.<ref name="Flaherman_2017" /> Breast milk jaundice is usually not a reason to stop nursing.<ref name="cdc.gov"/> It is important to consult with a physician to determine when it may be necessary to test for other causes of jaundice that may require additional treatment, such as enzyme deficiencies or problems with the [[red blood cell]]s (i.e., [[Hereditary elliptocytosis|elliptocytosis]], [[Hereditary spherocytosis|spherocytosis]], [[hemolysis]], [[glucose-6-phosphate dehydrogenase deficiency]]).<ref name="Flaherman_2017" />

=== Weaning ===

Weaning is the process of replacing breast milk with other foods; the infant is fully weaned after the replacement is complete.<ref name="Eglash_2020" />{{rp|112–116}}<ref name="Eglash_2020" /> Psychological factors affect the weaning process for both mother and infant, as issues of closeness and separation are very prominent.<ref>{{cite journal | vauthors = Daws D |title = The perils of intimacy: Closeness and distance in feeding and weaning |journal = Journal of Child Psychotherapy |volume = 23 |issue = 2 |pages = 179–199 |date = August 1997 | doi = 10.1080/00754179708254541 }}</ref>  Unless a medical emergency necessitates abruptly stopping breastfeeding, it is best to gradually increase the period between feedings or eliminate feedings to allow the breasts to adjust to the decreased demands without becoming [[Breast engorgement|engorged]].<ref name="Eglash_2020" /> Studies show that a large number of women discontinue breastfeeding early due to lack of working place support for breastfeeding mothers.<ref name="today.com">{{cite web |title=Is it normal to breast-feed your toddler, and beyond? Science says... |url=https://www.today.com/parents/it-normal-breast-feed-your-toddler-beyond-science-says-t2521 |website=Today |date=12 February 2015 |access-date=March 26, 2023}}</ref>  La Leche League advises parents to shift their children's focus at bedtime away from breastfeeding, as it is often the most difficult feeding for them to let go.<ref name="La Leche League International">{{cite web |url = http://www.lalecheleague.org/faq/weanhowto.html |title = How Do I Wean My Baby? |publisher = La Leche League International |access-date = 6 May 2016 |url-status = dead |archive-url = https://web.archive.org/web/20160428113119/http://www.lalecheleague.org/faq/weanhowto.html |archive-date = 28 April 2016 }}</ref>

If  weaning is begun at 12 months or later it is not necessary to switch to infant formula or "toddler formula" as is sold commercially.  At 12 months it is recommended  that the baby be switched to whole cow's milk.  Reduced-fat or skim milk generally is not appropriate before age 2 because it does not have enough fat or calories to promote early brain development.<ref>{{cite web |title=Infant Formula: Your questions answered |url=https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/infant-formula/art-20045782 |website=Mayo Clinic |access-date=July 28, 2022}}</ref>

If the mother was experiencing [[lactational amenorrhea method|lactational amenorrhea]], periods will begin to return with weaning, along with restored fertility.<ref>{{cite web|title=Menstruation|url=https://www.llli.org/breastfeeding-info/menstruation/|access-date=15 November 2021|website=La Leche League International|language=en-US}}</ref>

===Extended breastfeeding===
{{Main|Extended breastfeeding}}
Extended breastfeeding usually means breastfeeding beyond the age of 12 to 24 months, depending on the culture. The American Academy of Family Physicians states that "health outcomes for mothers and babies are best when breastfeeding continues for at least two years.<ref>{{Cite web|title=Breastfeeding, Family Physicians Supporting (Position Paper)|url=https://www.aafp.org/about/policies/all/breastfeeding-position-paper.html|access-date=2021-03-18|website=www.aafp.org|language=en-US}}</ref> The American Academy of Pediatrics recommends that mothers nurse for the first 12 months and "thereafter for as long as mother and baby desire." The World Health Organization recommends breastfeeding up to age 2 "or beyond."<ref name="today.com"/>

Breast milk is known to contain [[lactoferrin]] (Lf), which protects the infant from infection caused by a wide range of [[pathogens]].  The amount of Lf in breast milk is lactation-stage related.  One study looked at Lf concentration in prolonged lactation from the first to the 48th month postpartum.  It was found to be at the highest level in colostrum, dropped to the lowest level during 1 – 12 months of lactation, and then increased significantly during the 13–24 months of lactation, close to the Lf concentration in colostrum.  At over 24 months the level dropped, though not significantly.<ref>{{cite journal |title=Lactoferrin in Human Milk of Prolonged Lactation |journal=Nutrients |year=2019 |pmid=31581741 |last1=Czosnykowska-Łukacka |first1=M. |last2=Orczyk-Pawiłowicz |first2=M. |last3=Broers |first3=B. |last4=Królak-Olejnik |first4=B. |volume=11 |issue=10 |page=2350 |doi=10.3390/nu11102350 |pmc=6835443 |doi-access=free }}</ref>

=== Professional breastfeeding support ===
[[Lactation consultants]] are trained to assist mothers in preventing and solving breastfeeding difficulties such as sore nipples and low milk supply. They commonly work in hospitals, physician or midwife practices, public health programs, and private practice. Lactation consultants earn their credential, International Board Certified Lactation Consultant (IBCLC), through the International Board of Lactation Consultant Examiners.<ref>{{cite web|title=IBLCE|url=https://iblce.org/|access-date=12 November 2021|website=IBLCE|language=en-US}}</ref><ref>{{cite web|title=ALPP – ALPP – The Academy of Lactation Policy and Practice|url=https://www.alpp.org/|access-date=12 November 2021|website=www.alpp.org|language=en}}</ref><ref name="ussg">{{cite web|title=US Surgeon General Breastfeeding Executive Summary|url=http://www.surgeongeneral.gov/library/calls/breastfeeding/executivesummary.pdf|url-status=live|archive-url=https://web.archive.org/web/20170513032923/https://www.surgeongeneral.gov/library/calls/breastfeeding/executivesummary.pdf|archive-date=13 May 2017|access-date=6 September 2017|website=surgeongeneral.gov}}</ref><ref>{{cite book|author1=Office of the Surgeon General (US)|url=https://www.ncbi.nlm.nih.gov/books/NBK52679/|title=Actions to Improve Breastfeeding (US)|author2=Centers for Disease Control and Prevention (US)|author3=Office on Women's Health (US)|chapter=Actions to Improve Breastfeeding |publisher=Office of the Surgeon General (US)|year=2011|language=en}}</ref>

Breastfeeding support from a lactation consultant is associated with higher rates of any breastfeeding at 6 months but not at 1 month or 3 months post pregnancy based on a meta-analysis of studies conducted in the US and Canada.<ref name=":0">Saldanha IJ, Adam GP, Kanaan G, Zahradnik ML, Steele DW, Danilack VA, Peahl AF, Chen KK, Stuebe AM, Balk EM. Postpartum Care up to 1 Year After Pregnancy: A Systematic Review and Meta-Analysis. Comparative Effectiveness Review No. 261. (Prepared by the Brown Evidence-based Practice Center under Contract No. 75Q80120D00001.) AHRQ Publication No. 23-EHC010. PCORI Publication No. 2023-SR-01. Rockville, MD: Agency for Healthcare Research and Quality; June 2023. DOI: https://doi.org/10.23970/AHRQEPCCER261.</ref> Peer support for breastfeeding has been found to be associated with higher rates of any breastfeeding at 1 month and 3 to 6 months and of exclusive breastfeeding at 1 month, but it is unrelated to breastfeeding outcomes past 6 months post pregnancy.<ref name=":0" />

== Contraindications to breastfeeding ==

=== Maternal contraindications ===
Medical conditions that do not allow breastfeeding are fairly rare.<ref name="Johnston_2012" /> Infants that are otherwise healthy uniformly benefit from breastfeeding,{{sfn|Lawrence|Lawrence|2015|loc=Chapter 7. Facilitating an Informed Decision About Breastfeeding pp. 215–232 }} however, extra precautions should be taken or breastfeeding  avoided in circumstances including certain infectious diseases and medical conditions.

====Maternal infections====
===== [[HIV]] =====
A breastfeeding child can become infected with HIV. Factors such as the mother's [[viral load]] complicate breastfeeding recommendations for HIV-positive mothers. The [[World Health Organization]] highlights the possibility of breastfeeding in mothers on [[HIV treatment|anti-viral therapy]] and with undetectable [[Viral load monitoring for HIV|viral loads]], especially in areas where access to clean water is poor and where death from infectious diseases is common, citing low transmission rates when the mother is on anti-viral therapy.<ref name="WHO20142" /><ref name="WHO-2014">{{cite web|title=WHO {{!}} Infant feeding for the prevention of mother-to-child transmission of HIV|url=http://www.who.int/elena/titles/hiv_infant_feeding/en/|archive-url=https://web.archive.org/web/20140331085523/http://www.who.int/elena/titles/hiv_infant_feeding/en/|url-status=dead|archive-date=31 March 2014|access-date=11 November 2021|website=WHO}}</ref><ref name="Aus DOH-2017">{{cite web|author=Australian Government Department of Health|title=Human Immunodeficiency virus (HIV)|url=http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-HIV.htm|access-date=16 December 2017|website=www.health.gov.au|language=en}}</ref> They also recommend that national authorities in each country decide which infant feeding practice should be promoted by their maternal and child health services to best avoid HIV transmission from mother to child.<ref name="Mead">{{cite journal|vauthors=Mead MN|date=October 2008|title=Contaminants in human milk: weighing the risks against the benefits of breastfeeding|url=http://www.ehponline.org/members/2008/116-10/focus.html|url-status=dead|journal=Environmental Health Perspectives|volume=116|issue=10|pages=A427–A434|doi=10.1289/ehp.116-a426|pmc=2569122|pmid=18941560|archive-url=https://web.archive.org/web/20081106182431/http://www.ehponline.org/members/2008/116-10/focus.html|archive-date=6 November 2008}}</ref>  However, the [[Centers for Disease Control and Prevention|CDC]] continues to recommend against HIV-positive mothers breastfeeding in the [[United States]].<ref name="Aus DOH-2017" /><ref>{{cite web|last=CDC|date=10 August 2021|title=Human immunodeficiency virus (HIV)|url=https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/hiv.html|access-date=11 November 2021|website=Centers for Disease Control and Prevention|language=en-us}}</ref>  Infant formula should only be given if this can be safely done.<ref name="WHO20142" />

===== [[Human T-lymphotropic virus]] (types I and II) =====
Human T-Lymphotrophic Virus (HTLV) is able to be passed through breastmilk from mother to child.<ref name="Eglash_2020" />{{rp|15–17}}<ref>{{cite journal|vauthors=Carneiro-Proietti AB, Amaranto-Damasio MS, Leal-Horiguchi CF, Bastos RH, Seabra-Freitas G, Borowiak DR, Ribeiro MA, Proietti FA, Ferreira AS, Martins ML|date=September 2014|title=Mother-to-Child Transmission of Human T-Cell Lymphotropic Viruses-1/2: What We Know, and What Are the Gaps in Understanding and Preventing This Route of Infection|journal=Journal of the Pediatric Infectious Diseases Society|volume=3 | issue = Suppl 1 |pages=S24–S29 |doi=10.1093/jpids/piu070 |pmc=4164183 |pmid=25232474}}</ref> The worldwide rate of transmission through breastmilk is estimated to be 3.9–27%, and this risk is increased by high maternal viral load and prolonged periods of breastfeeding.<ref name="auto2">{{cite web|title=Human T-lymphotropic virus type 1|url=https://www.who.int/news-room/fact-sheets/detail/human-t-lymphotropic-virus-type-1|access-date=11 November 2021|website=www.who.int|language=en}}</ref><ref>{{cite journal|vauthors=Paiva AM, Assone T, Haziot ME, Smid J, Fonseca LA, Luiz OD, de Oliveira AC, Casseb J|date=May 2018|title=Risk factors associated with HTLV-1 vertical transmission in Brazil: longer breastfeeding, higher maternal proviral load and previous HTLV-1-infected offspring|journal=Scientific Reports|volume=8|issue=1|pages=7742|doi=10.1038/s41598-018-25939-y|pmc=5958084|pmid=29773807|bibcode=2018NatSR...8.7742P}}</ref> Current data demonstrates that while breastfeeding for less than six months does not, independently, increase risk of HTLV-1 transmission, not breastfeeding during that time ''does'' decrease risk of transmission.<ref>{{cite journal|vauthors=Boostani R, Sadeghi R, Sabouri A, Ghabeli-Juibary A|date=October 2018|title=Human T-lymphotropic virus type I and breastfeeding; systematic review and meta-analysis of the literature|journal=Iranian Journal of Neurology|volume=17|issue=4|pages=174–179|pmc=6555888|pmid=31210902}}</ref> As such, [[Centers for Disease Control and Prevention|CDC]] recommends against breastfeeding when mothers have HTLV Types I or II.<ref name="Eglash_2020" />{{rp|15–17}}<ref>{{cite web|title=Recommendations for Counseling Persons Infected with Human T-Lymphotrophic Virus, Types I and II *|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00021234.htm|access-date=11 November 2021|website=www.cdc.gov}}</ref> Recognizing the importance of breastfeeding in more resource-poor areas of the world, the [[World Health Organization]] recommends shortening the duration of breastfeeding, or avoiding breastfeeding where possible.<ref name="auto2"/>

===== Hemorrhagic viral disease ([[Marburg virus disease|Marburg virus]], [[Ebola]]) =====
Mothers with Marburg virus or Ebola should not breastfeed their infants or feed them with expressed breastmilk.<ref name="CDC-2021f">{{cite web|last=CDC|date=10 August 2021|title=When breastfeeding or feeding expressed milk is not recommended.|url=https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/contraindications-to-breastfeeding.html|access-date=19 November 2021|website=Centers for Disease Control and Prevention|language=en-us}}</ref><ref name = "Lawrence_2021" />{{rp|738–753}}

===== [[Tuberculosis]] =====
Infants whose mothers have suspected untreated tuberculosis (TB) should be isolated from their mothers to reduce risk of transmission. As such, these infants should not be breastfed during this time and until the mother has been treated appropriately for 2 weeks and is no longer contagious.<ref name="CDC-2021f" /><ref name = "Lawrence_2021" />{{rp|411–313}}<ref name="HealthyChildren-2021">{{cite web|title=Serious Illnesses and Breastfeeding|url=https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Serious-Illnesses-and-Breastfeeding.aspx|access-date=19 November 2021|website=HealthyChildren.org|date=2 November 2009 }}</ref> However, these infants may be fed expressed breastmilk from their mother.<ref name="CDC-2021f" /><ref name = "Lawrence_2021" />{{rp|411–313}}<ref name="HealthyChildren-2021" /> Transmission of TB through breastmilk, without an isolated breast infection caused by the Tuberculosis bacteria (''[[Mycobacterium tuberculosis]]''), has never been documented in the scientific literature.<ref name = "Lawrence_2021" />{{rp|411–313}} Mothers who do have an isolated breast infection caused by ''Mycobacterium tuberculosis'', termed '''tuberculous mastitis''', should not feed their infants with their own breastmilk, even if it is fed by bottle.<ref name = "Lawrence_2021" />{{rp|411–313}}

===== [[Herpes simplex]] =====
Herpes simplex virus (HSV) is the virus that causes genital herpes and oral cold sores, and it can be very dangerous to infants.<ref name="auto1">{{cite web|last=CDC|date=2 October 2020|title=Herpes simplex virus (HSV)|url=https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/herpes.html|access-date=11 November 2021|website=Centers for Disease Control and Prevention|language=en-us}}</ref> The CDC advises to continue breastfeeding if there are no open/active lesions on the breast and other lesions covered.<ref name="auto1"/>

===== [[Herpes zoster]] (chickenpox and shingles) =====
Varicella zoster is the virus responsible for chickenpox and shingles (also known as herpes zoster).<ref name="CDC-2021">{{cite web|date=11 August 2021|title=Shingles {{!}} Breastfeeding {{!}} CDC|url=https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/shingles.html|access-date=11 November 2021|website=www.cdc.gov|language=en-us}}</ref> The [[Centers for Disease Control and Prevention|CDC]] advises that breastfeeding is safe to continue as long as the breasts are clear of lesions, also emphasizing that if pumping or [[Hand expression of breast milk|hand expressing milk]], proper [[Hand washing|hand-hygiene]] should be used to minimize transfer.<ref name="Eglash_2020" />{{rp|15–17}}<ref name="CDC-2021" />
[[File:WHO EN women with COVID-19 can breastfeed COVID-19.png|thumb|An infographic from the [[World Health Organization]] on COVID-19 preventive measures to be taken while breastfeeding]]

===== [[COVID-19]] (no contraindication) =====
In May 2020, [[World Health Organization|WHO]] and [[UNICEF]] stressed that the ongoing [[COVID-19 pandemic]] was not a reason to discontinue breastfeeding.  They recommend that women should continue to breastfeed during the pandemic even if they have confirmed or suspected COVID-19 because evidence indicates that it is not likely that COVID-19 can be transmitted through breast milk.<ref>{{cite journal | vauthors = Walker KF, O'Donoghue K, Grace N, Dorling J, Comeau JL, Li W, Thornton JG | title = Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis | journal = BJOG | volume = 127 | issue = 11 | pages = 1324–1336 | date = October 2020 | pmid = 32531146 | pmc = 7323034 | doi = 10.1111/1471-0528.16362 }}</ref> A study published in 2021 found that, while [[SARS-CoV-2]] [[RNA]] may be found in some samples of breastmilk from recently infected mothers, the breastmilk does not contain infectious virus and is not considered a transmission risk factor.<ref>{{cite journal | vauthors = Krogstad P, Contreras D, Ng H, Tobin N, Chambers CD, Bertrand K, Bode L, Aldrovandi GM | title = No infectious SARS-CoV-2 in breast milk from a cohort of 110 lactating women | journal = Pediatric Research | pages = 1140–1145 | date = January 2022 | volume = 92 | issue = 4 | pmid = 35042956 | doi = 10.1038/s41390-021-01902-y | pmc = 9586866 | s2cid = 246018031 }}</ref> Mothers who have suspected or confirmed diagnoses of COVID-19 should thoroughly wash their hands and wear a well-fitting mask prior to breastfeeding their infant, or express breastmilk and feed the infant by bottle.<ref>{{cite web|last=CDC|date=9 December 2021|title=Breastfeeding and Caring for Newborns if You Have COVID-19|url=https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/pregnancy-breastfeeding.html|access-date=17 January 2022|website=Centers for Disease Control and Prevention|language=en-us}}</ref>

==== Substance use ====
{{main|Breastfeeding difficulties#Substance use}}

=====Alcohol=====
{{also|Alcohol and pregnancy}}

Moderate [[alcohol (drug)|alcohol]] consumption by breastfeeding mothers can significantly affect infants. Even one or two drinks, including beer, may reduce milk intake by 20 to 23%, leading to increased agitation and poor sleep patterns. Regular heavy drinking (more than two drinks daily) can shorten breastfeeding duration and cause issues in infants, such as excessive sedation, fluid retention, and hormonal imbalances. Additionally, higher alcohol consumption may negatively impact children's [[academic achievement]].<ref>{{cite journal |title=Alcohol. |date=2006 |pmid=30000529}}</ref>

When breastfeeding, alcohol may be consumed in moderation and does not require "Pumping-and-Dumping" (pumping and discarding breastmilk).<ref name="Eglash_2020" />{{rp|105–109}}<ref>{{cite web|date=8 April 2014|title=Alcohol and breastfeeding|url=https://www.laleche.org.uk/alcohol-and-breastfeeding/|access-date=15 November 2021|website=La Leche League GB|language=en-GB}}</ref> Alcohol crosses from the blood to the breastmilk by [[diffusion]]. Thus, the concentration of alcohol in the breastmilk is approximately equal to the concentration in the maternal bloodstream at any given time.<ref name="Eglash_2020" />{{rp|105–109}}<ref name="Haastrup_2014">{{cite journal|vauthors=Haastrup MB, Pottegård A, Damkier P|date=February 2014|title=Alcohol and breastfeeding|journal=Basic & Clinical Pharmacology & Toxicology|volume=114|issue=2|pages=168–173|doi=10.1111/bcpt.12149|pmid=24118767}}</ref> As the mother's liver processes the alcohol, more and more alcohol is pulled out of the breastmilk and back into the bloodstream.<ref name="Eglash_2020" />{{rp|105–109}} Thus, it is suggested to wait 2 hours after drinking before nursing or pumping.<ref name="Eglash_2020" />{{rp|105–109}}<ref name="AA Peds-2017">{{cite web|author=American Academy of Pediatrics|title=Fetal Alcohol Spectrum Disorders Toolkit Frequently Asked Questions|url=https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/fetal-alcohol-spectrum-disorders-toolkit/Pages/Frequently-Asked-Questions.aspx#ques24|access-date=15 November 2017}}</ref> In the case of infrequent binge drinking, it has been shown that infants consume through breastmilk only a fraction of the alcohol their mothers have ingested. While a minute, clinically insignificant amount of alcohol may be absorbed into the infant's bloodstream, it is unlikely that this amount would cause any noticeable cognitive or neuromotor effects.<ref name="Haastrup_2014" />

=====Marijuana=====
The data on the use of [[Cannabis (drug)|marijuana]] during breastfeeding is limited, however, in part due to our lack of knowledge in this area, the CDC recommends against using marijuana or marijuana-containing products, including [[CBD Oil|CBD]], during breastfeeding.<ref>{{cite web|last=CDC|date=10 August 2021|title=Marijuana and Breastfeeding|url=https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/vaccinations-medications-drugs/marijuana.html|access-date=14 November 2021|website=Centers for Disease Control and Prevention|language=en-us}}</ref><ref name="NLM-2006">{{citation|title=Cannabis|date=2006|url=http://www.ncbi.nlm.nih.gov/books/NBK501587/|work=Drugs and Lactation Database (LactMed)|place=Bethesda (MD)|publisher=National Library of Medicine (US)|pmid=30000647|access-date=14 November 2021}}</ref> The main active ingredient in marijuana, [[Tetrahydrocannabinol|tetrahydrocannabinol (THC)]], can be found in breastmilk anywhere from six days to more than six weeks after marijuana use.<ref name="NLM-2006" /> There is limited data on the long term effects of this exposure on the infant, however some studies have voiced concern regarding delayed motor development in infants exposed to THC.<ref name="NLM-2006" />

=====Tobacco=====
Mothers who smoke or use other [[tobacco]] products can breastfeed their infants, according to [[La Leche League]], the [[Centers for Disease Control and Prevention|CDC]], and the [[Royal Women's Hospital]] (Australia).<ref name="CDC-2021d">{{cite web|last=CDC|date=16 February 2021|title=Tobacco, E-Cigarettes and Breastfeeding|url=https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/vaccinations-medications-drugs/tobacco-and-e-cigarettes.html|access-date=12 November 2021|website=Centers for Disease Control and Prevention|language=en-us}}</ref><ref>{{cite web|title=Smoking and Breastfeeding|url=https://www.llli.org/breastfeeding-info/smoking-and-breastfeeding/|access-date=12 November 2021|website=La Leche League International|language=en-US}}</ref><ref>{{cite web|last=Hospital|first=The Royal Women's|title=Breastfeeding & cigarette smoke|url=https://www.thewomens.org.au/health-information/breastfeeding/medicines-drugs-and-breastfeeding/breastfeeding-and-cigarette-smoke|access-date=12 November 2021|website=The Royal Women's Hospital|language=en}}</ref> However, it is important to note that maternal tobacco use may decrease milk supply.<ref name="Eglash_2020" />{{rp|105–109}} Additionally, tobacco smoking, regardless of feeding method, increases risk of SIDS and respiratory illnesses.<ref name="CDC-2021d" /><ref name="Eglash_2020" />{{rp|105–109}} Thus, attempting to decrease tobacco use or even cease helps to minimize tobacco exposure to infants and maximize the benefits of breastfeeding.<ref name="Eglash_2020" />{{rp|105–109}} [[Smoking cessation|Tobacco cessation products]], such as [[nicotine patch]]es and other medications, like [[bupropion]], are able to be used by breastfeeding mothers.<ref name="Eglash_2020" />{{rp|105–109}}

=====Other recreational drugs=====
Mothers utilizing recreational drugs, such as cocaine, methamphetamines, PCP, and heroin, should not breastfeed.<ref name="CDC-2021e">{{cite web|last=CDC|date=10 August 2021|title=When breastfeeding or feeding expressed milk is not recommended.|url=https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/contraindications-to-breastfeeding.html|access-date=14 November 2021|website=Centers for Disease Control and Prevention|language=en-us}}</ref><ref name="Eglash_2020" />{{rp|17}}

==== Medication use ====
Most medications are compatible with continuing to breastfeed.<ref name="Eglash_2020" />{{rp|17}}<ref name="Eglash_2020" />{{rp|105–109}} Many medicines pass into breastmilk in small amounts, however, very few medications actually reach the infant and are absorbed in a way that would actually impact the infant.<ref name="Eglash_2020" />{{rp|105–109}} Several characteristics of medications, including size and pH of the medication molecule and how well the medication is absorbed in the GI tract, influence how much of a medication may reach, and may ultimately be absorbed, by the infant.<ref name="Eglash_2020" />{{rp|105–109}} In addition to the effects on the infant, many medications are known to significantly suppress milk production, including [[pseudoephedrine]], [[diuretic]]s, and [[contraceptive]]s that contain [[estrogen]].{{sfn|Lawrence|Lawrence|2015|pp=390–392}}<ref name="Eglash_2020" />{{rp|105–109}}

There are several resources to assist medical professionals in determining which medications are safe for pregnancy and breastfeeding. While patients are able to use these resources as well, they are targeted toward medical professionals. Patients should be encouraged to consult a lactation specialist or a medical provider trained in breastfeeding medicine if any concerns arise. Two helpful resources are listed below.

# LactMed @ NIH (Drugs and Lactation Database (LactMed))<ref>{{cite book|url=https://www.ncbi.nlm.nih.gov/books/NBK501922/|title=Drugs and Lactation Database (LactMed)|date=2006|publisher=National Library of Medicine (US)}}</ref>
# InfantRisk App (InfantRisk Center at Texas Tech University Health Sciences Center)<ref>{{cite web|title=InfantRisk Center|url=https://www.infantrisk.com/|access-date=14 November 2021|website=www.infantrisk.com}}</ref>

===== Pumping-and-dumping =====
"Pumping-and-dumping" is the concept of expressing breastmilk and discarding it due to a medication or substance "tainting" the breastmilk.<ref name="NW Med-2021">{{cite web | author = Northwestern Medicine|title=Pumping and Dumping Myths|url= https://www.nm.org/healthbeat/healthy-tips/pumping-and-dumping-myths |access-date=14 November 2021|website=Northwestern Medicine|language=en-US}}</ref> It was once believed that drinking alcohol or taking any medications, even medicines like ibuprofen, required pumping-and-dumping.<ref name="NW Med-2021" /> However, this is no longer the case. Pumping-and-dumping, or stopping breastfeeding altogether, is only required in very rare circumstances, such as with radioactive medications or chemotherapy.<ref name="LLLI-2018">{{cite web|date=17 December 2018|title=Cancer and Breastfeeding|url=https://www.llli.org/cancer-and-breastfeeding/|access-date=14 November 2021|website=La Leche League International|language=en-US}}</ref><ref name="Eglash_2020" />{{rp|105–109}}

If a parent is concerned with a possible milk contaminant, they can express and save the breastmilk until they are able to consult with a lactation specialist or another medical professional trained in breastfeeding medicine.

=== Infantile contraindications ===

==== [[Galactosemia]] ====
Galactosemia is a [[metabolic disorder]] that prevents the infant from breaking down [[galactose]], which is one of the two components of [[lactose]], a type of sugar found in milk. Lactose is also found in breastmilk, so infants with galactosemia should not breastfeed.<ref name="pmid20301691">{{cite book | vauthors = Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJ, Mirzaa G, Amemiya A, Berry GT | chapter = Classic Galactosemia and Clinical Variant Galactosemia | title = GeneReviews | year = 1993 | volume = | pages = | pmid = 20301691 | place=Seattle (WA)|publisher=University of Washington, Seattle |url=http://www.ncbi.nlm.nih.gov/books/NBK1518/ | veditors = Adam MP, Ardinger HH, Pagon RA, Wallace SE }}</ref><ref name="Eglash_2020" />{{rp|15}}<ref name="CDC-2021e" />

== Methods ==
{{anchor|Protocols|Use|Feeding protocols}}

[[File:Formula and breastmilk.jpg|thumb|[[Infant formula|Formula]] and pumped breastmilk side by side. Note that the formula is of uniform consistency and color, while the expressed breast milk exhibits properties of an organic solution by separating into a layer of fat at the top (the "creamline"), followed by the milk, and then a watery blue-colored layer at the bottom.]]

=== Expressed milk ===

[[File:Manual Breast Pump 2005 SeanMcClean.jpg|thumb|right|Manual breast pump]]

A mother may ''express'' milk (remove milk from breasts) for [[Breastmilk storage and handling|storage]] and later use. Expression may occur manually with hand expression, or by using a [[breast pump]].<ref name="Lawrence_2021" />{{Rp|page=220}}<ref name="Eglash-2017">{{cite journal | vauthors = Eglash A, Simon L | title = ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants, Revised 2017 | journal = Breastfeeding Medicine | volume = 12 | issue = 7 | pages = 390–395 | date = September 2017 | pmid = 29624432 | doi = 10.1089/bfm.2017.29047.aje }}</ref>

Mothers express milk for multiple reasons. Expressing breast milk can maintain a mother's milk supply when mother and child are apart. A sick baby who is unable to nurse can take expressed milk through a [[nasogastric tube]]. Some babies are unable or unwilling to nurse. Maternal breastmilk is the food of choice for [[premature babies]]; these infants may be fed maternal milk through tubes, [[supplemental nursing systems]], bottles, spoons or cups until they develop satisfactory ability to suck and swallow breast milk.<ref name="Lawrence_2021" />{{Rp|pages=502–545}}  Some women donate expressed breast milk (EBM) to others, either directly or through a [[Human milk bank|milk bank]]. This allows mothers who cannot breastfeed to give their baby the benefits of breast milk. While informally-shared breastmilk does carry the nutritional benefits of breastmilk, this breastmilk is most often not pasteurized or screened, and thus carries with it the risk of transmitting diseases or medications that are unsafe for infants.<ref name="Sriraman-2018">{{cite journal | vauthors = Sriraman NK, Evans AE, Lawrence R, Noble L | title = Academy of Breastfeeding Medicine's 2017 Position Statement on Informal Breast Milk Sharing for the Term Healthy Infant | journal = Breastfeeding Medicine | volume = 13 | issue = 1 | pages = 2–4 | date = 2018 | pmid = 29634294 | doi = 10.1089/bfm.2017.29064.nks | s2cid = 4778146 }}</ref> Parents considering directed or informal milk sharing should discuss this option with their doctor, and they should be familiar with the donors medical history and milk handling practices.<ref name="Sriraman-2018" /> Use of informally-shared (unscreened, not pasteurized) milk from an anonymous donor is discouraged by the Academy of Breastfeeding Medicine.<ref name="Sriraman-2018" />

Babies feed differently with artificial nipples than from a breast. With the breast, the infant's tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth. Drinking from a bottle takes less effort and the milk may come more rapidly, potentially causing the baby to lose desire for the breast. This is often referred to as ''nipple confusion'' or ''nipple preference''.<ref name="Lawrence_2021" />{{Rp|page=241}} While some infants do experience this preference for the bottle, many infants do not and will be able to alternate between bottle and breast without issue.<ref name="Lawrence_2021" />{{Rp|page=241}}

"Exclusively expressing" and "exclusively pumping" are terms for a mother who exclusively feeds a baby expressed milk. Exclusively pumping is poorly studied in the literature, especially in recent years. However, from available evidence, it appears to be fairly uncommon, with only approximately 7% of study participants reporting exclusive pumping.<ref>{{cite journal | vauthors = Keim SA, Boone KM, Oza-Frank R, Geraghty SR | title = Pumping Milk Without Ever Feeding at the Breast in the Moms2Moms Study | journal = Breastfeeding Medicine | volume = 12 | issue = 7 | pages = 422–429 | date = September 2017 | pmid = 28727931 | pmc = 5646745 | doi = 10.1089/bfm.2017.0025 }}</ref>

==== Storage of expressed breastmilk ====
{{See also|Breastmilk storage and handling}}
Breastmilk may be stored for various amounts of time depending on storage temperature and conditions. The content and quality of expressed milk changes over time as it is stored, particularly when frozen.<ref name="Eglash-2017" /> For example, there is a decrease in the ability of breastmilk to kill bacteria when it is stored in the refrigerator for more than 48 hours.<ref name="Eglash-2017" /> Additionally, the quantity of fat, protein, and calories in breastmilk decreases when the milk is frozen for more than 3 months. While several components of breastmilk change over time, inflammatory factors (cytokines) and maternal antibodies, and growth factors are thought to be stable for at least 6 months when the breastmilk is frozen.<ref name="Eglash-2017" /> Storage guidelines, according to the [[Centers for Disease Control and Prevention|CDC]], [[La Leche League International]] and the Academy of Breastfeeding Medicine, are noted in the table below.
{| class="wikitable mw-collapsible"
|+Storage of Expressed Breastmilk
!Storage Location
!Optimal Storage Time
!Acceptable Storage Time
!Source
|-
|Countertop
|4 hours
|8 hours
|<ref name="LLLI-2021a">{{cite web|title=Storing Human Milk|url=https://www.llli.org/breastfeeding-info/storingmilk/|access-date=28 December 2021|website=La Leche League International|language=en-US}}</ref><ref name="Eglash-2017" />
|-
|Insulated bag with icepack
|24 hours
|
|<ref name="LLLI-2021a" /><ref name="CDC-2021a">{{cite web|last=CDC|date=11 June 2021|title=Proper Storage and Preparation of Breast Milk|url=https://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm|access-date=28 December 2021|website=Centers for Disease Control and Prevention|language=en-us}}</ref>
|-
|Refrigerator
|4 days
|5 days
|<ref name="Eglash-2017" /><ref name="CDC-2021a"/><ref name="LLLI-2021a" />
|-
|Freezer compartment of minifridge
|2 weeks
|
|<ref name="LLLI-2021a" />
|-
|Standard Freezer
|6 months
|12 months
|<ref name="Eglash-2017" /><ref name="CDC-2021a"/><ref name="LLLI-2021a" />
|-
|Deep Freezer (usually separate from refrigerator)
|6–12 months
|
|<ref name="Eglash-2017" /><ref name="LLLI-2021a" />
|}

==== Breastmilk storage containers ====
{{See also|Breastmilk storage and handling}}
Expressed breastmilk can be stored in freezer storage bags, containers made specifically for breastmilk, a [[supplemental nursing system]], or a [[baby bottle|bottle]] ready for use. Parents should avoid using storage containers which contain [[BPA-free|bisphenol A (BPA)]].<ref name="CDC-2021a" /> Additionally, use of [[Polyethylene|polyethylene containers]] have been shown to decrease the immune benefits of breastmilk, including its ability to kill bacteria and the maternal antibodies it contains, by up to 60%.<ref name="Eglash-2017" />

=== Shared nursing ===
{{anchor|Shared breastfeeding}}
{{Main|Wet nurse}}

It is not only a mother who may breastfeed a child. Parents may hire another person to do so (a [[wet nurse]]), or  may share childcare with another mother (cross-nursing). Both of these were common throughout history. It remains popular in some [[developing nation]]s, including those in Africa, for more than one woman to breastfeed a child. Shared breastfeeding is a risk factor for [[HIV]] infection in infants.<ref>{{cite news | vauthors = Alcorn K |title = Shared breastfeeding identified as new risk factor for HIV |publisher = [[aidsmap]] |date = 24 August 2004 |url = http://www.aidsmap.com/en/news/72E08565-12B7-43CF-A71E-7A57292B30DF.asp |access-date = 10 April 2007 |url-status = live |archive-url = https://web.archive.org/web/20070406022432/http://www.aidsmap.com/en/news/72E08565-12B7-43CF-A71E-7A57292B30DF.asp |archive-date = 6 April 2007 }}</ref> Shared nursing can sometimes provoke negative social reactions in the [[English-speaking world]].<ref>{{cite news |url = https://www.theguardian.com/g2/story/0,,1983285,00.html |title = Not your mother's milk | vauthors = Groskop V |date = 5 January 2007 | newspaper = The Guardian }}</ref><ref>{{cite web | vauthors = Baumgardner J | title = Breast Friends | url =  http://www.babble.com/content/articles/features/personalessays/baumgardner/breastfriends/ | website = Babble | archive-url = https://archive.today/20080724123751/http://www.babble.com/content/articles/features/personalessays/baumgardner/breastfriends/ | url-status = dead | archive-date = 24 July 2008 | date = 24 July 2008 }}</ref>

=== Tandem nursing ===

It is possible for a mother to continue breastfeeding an older sibling while also breastfeeding a new baby; this is called ''tandem nursing''. During the late stages of pregnancy, the milk changes to colostrum. While some children continue to breastfeed even with this change, others may [[wean]]. Most mothers can produce enough milk for tandem nursing, but the new baby should be nursed first for at least the first few days after delivery to ensure that it receives enough colostrum.{{sfn|Lawrence |Lawrence|2015|pp=707–708}}

Breastfeeding [[multiple birth|triplets or larger broods]] is a challenge given babies' varying appetites. Breasts can respond to the demand and produce larger milk quantities; mothers have breastfed triplets successfully.<ref name="Grunberg_1992">{{cite journal |vauthors = Grunberg R |title = Breastfeeding multiples: Breastfeeding triplets |journal = New Beginnings |year = 1992 |volume = 9 |issue = 5 |pages = 135–136 |url = http://www.lalecheleague.org/NB/NBSepOct92p135.html |url-status = dead |archive-url = https://web.archive.org/web/20041012041330/http://www.lalecheleague.org/NB/NBSepOct92p135.html |archive-date = 12 October 2004 }}</ref><ref name="ABA">{{cite web|url=https://www.breastfeeding.asn.au/bf-info/higher|title=Breastfeeding triplets, quads and higher|date=13 July 2011|publisher=Australian Breastfeeding Association|access-date=23 January 2020}}</ref><ref name="Brown, S">{{cite web | publisher = Association of Radical Midwives | url = http://www.radmid.demon.co.uk/tripletsbf.htm | title = Breastfeeding triplets | archive-url = https://web.archive.org/web/20071020150022/http://www.radmid.demon.co.uk/tripletsbf.htm | archive-date = 20 October 2007  | url-status = dead }}</ref>
<gallery>
File:Breastfeeding newborn twins.jpg|Newborn twins being breastfed
File:Breastfeeding 2 year old twins.jpg|Woman breastfeeds 2 year old twins whilst reading them a book.
File:Tandem breastfeeding toddler and baby.jpg|Woman tandem nurses an infant and a toddler.
</gallery>

=== Re-lactation and induced lactation ===
{{See also|Lactation#Without pregnancy, induced lactation, relactation}}

Re-lactation is the process of restarting breastfeeding.<ref name="Wambach" /> In developing countries, mothers may restart breastfeeding after a weaning as part of an [[oral rehydration]] treatment for [[diarrhea]]. In developed countries, re-lactation is common after early medical problems are resolved, or because a mother changes her mind about breastfeeding.

Re-lactation is most easily accomplished with a newborn or with a baby that was previously breastfeeding; if the baby was initially bottle-fed, the baby may refuse to suckle. If the mother has recently stopped breastfeeding, chances are higher that the milk supply will return and be adequate. Although some mothers successfully re-lactate after months-long interruptions, success is higher for shorter interruptions.<ref name="Wambach">{{cite book | vauthors = Morrison B, Wambach K |chapter-url={{google books |plainurl=y |id=lDb3BQAAQBAJ|page=581}} | veditors = Wambach K, Riordan J |title= Breastfeeding and Human Lactation | publisher=Jones & Bartlett Publishers |year=2014 |isbn=978-1-4496-9729-7 |pages=581–588 |edition=5th |chapter=Women's Health and Breastfeeding  }}</ref>

Techniques to promote lactation use frequent attempts to breastfeed, extensive skin-to-skin contact with the baby, and frequent, long pumping sessions.<ref name="Wambach" /> Suckling may be encouraged with a tube filled with infant formula, so that the baby associates suckling at the breast with food. A dropper or syringe without the needle may be used to place milk onto the breast while the baby suckles.  The mother should allow the infant to suckle at least ten times during 24 hours, and more times if the baby is interested.  These times can include every two hours, whenever the baby seems interested, longer at each breast, and when the baby is sleepy when they might suckle more readily.  In keeping with increasing contact between mother and child, including increasing skin-to-skin contact, grandmothers should pull back and help in other ways. Later on, grandmothers can again provide more direct care for the infant.<ref name="TreatmentOfDiarrhoea-WHO-2005">{{cite book | url = http://whqlibdoc.who.int/publications/2005/9241593180.pdf | title = The Treatment Of Diarrhoea, A Manual For Physicians And Other Senior Health Workers | archive-url =  https://web.archive.org/web/20111019172153/http://whqlibdoc.who.int/publications/2005/9241593180.pdf | archive-date = 19 October 2011 | publisher = World Health Organization | date = 2005 | page = 41 | quote = ''Helping mothers to breastfeed'' by F. Savage King. Revised edition 1992. African Medical and Research Foundation (AMREF), Nairobi, Kenya. Indian adaptation by R.K. Anand, Bombay }}</ref>

These techniques require the mother's commitment over a period of weeks or months. However, even when lactation is established, the supply may not be large enough to breastfeed exclusively. A supportive social environment improves the likelihood of success.<ref name="Wambach" /> As the mother's milk production increases, other feeding can decrease. Parents and other family members should watch the baby's weight gain and urine output to assess nutritional adequacy.<ref name="TreatmentOfDiarrhoea-WHO-2005" />

A WHO manual for physicians and senior health workers citing a 1992 source states:  "If a baby has been breastfeeding sometimes, the breastmilk supply increases in a few days. If a baby has stopped breastfeeding, it may take 1–2 weeks or more before much breastmilk comes."<ref name="TreatmentOfDiarrhoea-WHO-2005" />

Induced lactation, also called ''adoptive lactation'', is the process of starting breastfeeding in a woman who did not give birth.<ref name="Wambach" /> This usually requires the adoptive mother to take hormones and other drugs to stimulate breast development and promote milk production. In some cultures, breastfeeding an adoptive child creates [[milk kinship]] that builds community bonds across class and other hierarchal bonds.<ref name="Wambach" />

== Health effects ==
[[File:Bloco Popular Fora Temer - Otros Carnavales • 24-02-2017 • Rio de Janeiro (33088497186).jpg|thumb|A mom using a baby carrier to support a feeding baby in Rio de Janeiro]]
Support for breastfeeding is universal among major health and children's organizations. WHO states, "Breast milk is the ideal food for the healthy growth and development of infants; breastfeeding is also an integral part of the reproductive process with important implications for the health of mothers."<ref name="World Health Organization">{{cite web |url =https://www.who.int/features/qa/21/en/ |title = Up to what age can a baby stay well nourished by just being breastfed? |publisher = WHO |date = July 2013 <!--(Reviewed)--> |access-date = 7 February 2015 |url-status=dead |archive-url = https://web.archive.org/web/20150208124642/http://www.who.int/features/qa/21/en/ |archive-date = 8 February 2015 }}</ref>

Breastfeeding is associated with a lowered risk of a number of diseases in both mothers and babies.<ref>{{cite journal | vauthors = Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J | title = Breastfeeding and maternal and infant health outcomes in developed countries | journal = Evidence Report/Technology Assessment | issue = 153 | pages = 1–186 | date = April 2007 | pmid = 17764214 | pmc = 4781366 }}</ref>  Comparing infants  that were exclusively breastfed for at least 3 months with never-breastfed infants, the [[American Academy of Pediatrics]]  reported that in the first year of life breastfed babies averaged about  $400 in savings of health care costs.<ref>{{cite web |title=Breastfeeding Saves Money on Health Care Costs |url=https://breastfeeding-magazine.com/saves-money.html |website=Breastfeeding Magazine |date=4 August 2017 |access-date=May 20, 2022 |archive-date=7 January 2023 |archive-url=https://web.archive.org/web/20230107090704/https://breastfeeding-magazine.com/saves-money.html |url-status=dead }}</ref>

=== Baby ===

Early breastfeeding is associated with fewer nighttime feeding problems.<ref>{{cite journal | vauthors = Renfrew MJ, Lang S, Woolridge MW | title = Early versus delayed initiation of breastfeeding | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD000043 | year = 2000 | pmid = 10796101 | doi = 10.1002/14651858.CD000043 | doi-broken-date = 1 November 2024 }}</ref> Early skin-to-skin contact between mother and baby improves breastfeeding outcomes and increases cardio-respiratory stability.<ref>{{cite journal | vauthors = Moore ER, Bergman N, Anderson GC, Medley N | title = Early skin-to-skin contact for mothers and their healthy newborn infants | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 11 | pages = CD003519 | date = November 2016 | pmid = 27885658 | pmc = 3979156 | doi = 10.1002/14651858.CD003519.pub4 }}</ref> Some studies show that breastfeeding aids general health, growth and development in the infant. Infants who are not breastfed are at mildly increased risk of developing acute and chronic diseases, including lower [[respiratory infection]], [[Otitis media|ear infections]], [[bacteremia]], [[bacterial meningitis]], [[botulism]], [[urinary tract infection]] and [[necrotizing enterocolitis]].<ref name="WHO_2007">{{cite book |title = Evidence on the long-term effects of breastfeeding: systematic reviews and meta-analyses |vauthors = Horta BL, Bahl R, Martines JC, Victora CG |year = 2007 |publisher = World Health Organization |location = Geneva, Switzerland |isbn = 978-92-4-159523-0 |url = http://whqlibdoc.who.int/publications/2007/9789241595230_eng.pdf |access-date = 5 April 2010 |url-status = live |archive-url = https://web.archive.org/web/20091229015411/http://whqlibdoc.who.int/publications/2007/9789241595230_eng.pdf |archive-date = 29 December 2009 }}</ref><ref name="AHRQ_2007">{{cite book | vauthors = Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J | title = Breastfeeding and maternal and infant health outcomes in developed countries | journal = Evidence Report/Technology Assessment | issue = 153 | pages = [https://archive.org/details/breastfeedingmat00ipst/page/1 1–186] | date = April 2007 | pmid = 17764214 | pmc = 4781366 | url = https://archive.org/details/breastfeedingmat00ipst/page/1 | isbn = 978-1-58763-242-6 | publisher = Agency for Healthcare Research and Quality (US) | url-access = registration }}</ref> Breastfeeding may protect against [[sudden infant death syndrome]],<ref>{{cite journal | vauthors = Hauck FR, Thompson JM, Tanabe KO, Moon RY, Vennemann MM | title = Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis | journal = Pediatrics | volume = 128 | issue = 1 | pages = 103–110 | date = July 2011 | pmid = 21669892 | doi = 10.1542/peds.2010-3000 | s2cid = 1257376 }}</ref> [[insulin-dependent diabetes mellitus]], [[Crohn's disease]], [[ulcerative colitis]], childhood [[lymphoma]], allergic diseases, digestive diseases,<ref name="Gartner_2005"/> obesity, or childhood leukemia later in life.<ref>{{cite web|url=https://familydoctor.org/breastfeeding-hints-to-help-you-get-off-to-a-good-start/?adfree=true|title=Breastfeeding: Hints to Help You Get Off to a Good Start | publisher=American Academy of Family Physicians | website=familydoctor.org| date=1 September 2000|access-date=25 November 2018}}</ref> and may enhance [[cognitive development]].<ref name="Gartner_2005"/><ref>{{cite journal | vauthors = Huang J, Peters KE, Vaughn MG, Witko C | title = Breastfeeding and trajectories of children's cognitive development | journal = Developmental Science | volume = 17 | issue = 3 | pages = 452–461 | date = May 2014 | pmid = 24410811 | pmc = 3997588 | doi = 10.1111/desc.12136 }}</ref> The CDC reports that infants who are breastfed have reduced risks of ear infections, obesity, type 1 diabetes, asthma, [[Sudden infant death syndrome|SIDS]], and lower respiratory, and gastrointestinal infections.<ref>{{cite web |title=Breastfeeding Is an Investment in Health, Not Just a Lifestyle Decision |url=https://www.cdc.gov/breastfeeding/about-breastfeeding/why-it-matters.html |website=CDC |date=23 August 2021 |access-date=11 January 2022}}</ref>
It is hard however to distinguish the importance of breastfeeding per se and other correlated socioeconomic factors (breastfeeding is more frequent in richer families with higher educations). Comparing breastfed and non-breastfed siblings in a given family drastically decreases the association between breastfeeding and long-term child well-being.<ref name="Colen_2014" />

==== Growth ====

The average breastfed baby doubles its birth weight in 5–6 months. By one year, a typical breastfed baby weighs about {{frac|2|1|2}} times its birth weight. At one year, breastfed babies tend to be leaner than formula-fed babies, which improves long-run health.<ref name="Kingdom of Bahrain Ministry of Health Health Promotion Council">{{cite web |url = http://familymedicine.moh.gov.bh/PDF/child%20screening%20Guideline.pdf |title = Guideline for Management of Child Screening in Primary Care Settings and Outpatient Clinics in the Kingdom of Bahrain |publisher = Kingdom of Bahrain Ministry of Health Health Promotion Council |access-date = 23 February 2015 |author = Ministry of Health Health Promotion Council |url-status = dead |archive-url = https://web.archive.org/web/20150223172813/http://familymedicine.moh.gov.bh/PDF/child%20screening%20Guideline.pdf |archive-date = 23 February 2015 }}</ref>

The Davis Area Research on Lactation, Infant Nutrition and Growth (DARLING) study reported that breastfed and formula-fed groups had similar weight gain during the first 3 months, but the breastfed babies began to drop below the median beginning at 6 to 8 months and were significantly lower weight than the formula-fed group between 6 and 18 months. Length gain and head circumference values were similar between groups, suggesting that the breastfed babies were leaner.<ref name="Pediatrics Journal">{{cite journal | vauthors = Dewey KG, Heinig MJ, Nommsen LA, Peerson JM, Lönnerdal B | title = Growth of breast-fed and formula-fed infants from 0 to 18 months: the DARLING Study | journal = Pediatrics | volume = 89 | issue = 6 Pt 1 | pages = 1035–1041 | date = June 1992 | doi = 10.1542/peds.89.6.1035 | pmid = 1594343 | s2cid = 24423059 | url = http://pediatrics.aappublications.org/content/89/6/1035 | access-date = 23 February 2015 | url-status = live | archive-url = https://web.archive.org/web/20151204094950/http://pediatrics.aappublications.org/content/89/6/1035 | archive-date = 4 December 2015 }}</ref>

==== Infections ====
{{main|Human milk immunity}}

Breast milk contains several [[Infection control|anti-infective]] factors such as [[Bile salt dependent lipase|bile salt stimulated lipase]] (protecting against [[Amoeba|amoebic]] infections) and [[lactoferrin]] (which binds to iron and inhibits the growth of [[Gut flora|intestinal bacteria]]).<ref name="pmid10394490">{{cite journal | vauthors = Kunz C, Rodriguez-Palmero M, Koletzko B, Jensen R | title = Nutritional and biochemical properties of human milk, Part I: General aspects, proteins, and carbohydrates | journal = Clinics in Perinatology | volume = 26 | issue = 2 | pages = 307–333 | date = June 1999 | pmid = 10394490 | doi = 10.1016/S0095-5108(18)30055-1 }}</ref><ref name="pmid10394491">{{cite journal | vauthors = Rodriguez-Palmero M, Koletzko B, Kunz C, Jensen R | title = Nutritional and biochemical properties of human milk: II. Lipids, micronutrients, and bioactive factors | journal = Clinics in Perinatology | volume = 26 | issue = 2 | pages = 335–359 | date = June 1999 | pmid = 10394491 | doi = 10.1016/S0095-5108(18)30056-3 }}</ref>

Exclusive breastfeeding until six months of age helps to protect an infant from gastrointestinal infections in both developing and industrialized countries.  The risk of death due to diarrhea and other infections increases when babies are either partially breastfed or not breastfed at all.<ref name="WHO20142" /> Infants who are exclusively breastfed for the first six months are less likely to die of [[gastrointestinal]] infections than infants who switched from exclusive to partial breastfeeding at three to four months.<ref name="Kramer_2012" />

During breastfeeding, approximately 0.25–0.5 grams per day of secretory [[IgA antibodies]] pass to the baby via milk.<ref>{{cite journal | vauthors = Hanson LA, Söderström T | title = Human milk: Defense against infection | journal = Progress in Clinical and Biological Research | volume = 61 | pages = 147–159 | year = 1981 | pmid = 6798576 }}</ref><ref name="CDC">{{cite journal | vauthors = Van de Perre P | title = Transfer of antibody via mother's milk | journal = Vaccine | volume = 21 | issue = 24 | pages = 3374–3376 | date = July 2003 | pmid = 12850343 | doi = 10.1016/S0264-410X(03)00336-0 }}</ref> This is one of the important features of colostrum.<ref name="Immune">{{cite journal | vauthors = Jackson KM, Nazar AM | title = Breastfeeding, the immune response, and long-term health | journal = The Journal of the American Osteopathic Association | volume = 106 | issue = 4 | pages = 203–207 | date = April 2006 | pmid = 16627775 }}</ref> The main target for these antibodies are probably microorganisms in the baby's [[intestine]]. The rest of the body displays some uptake of IgA,<ref>{{cite journal | vauthors = Vukavic T | title = Intestinal absorption of IgA in the newborn | journal = Journal of Pediatric Gastroenterology and Nutrition | volume = 2 | issue = 2 | pages = 248–251 | date = May 1983 | pmid = 6875749 | doi = 10.1097/00005176-198305000-00006 }}</ref> but this amount is relatively small.<ref>{{cite journal |title = The ontogeny of serum IgA in the newborn |year = 1991 |vauthors = Weaver LT, Wadd N, Taylor CE, Greenwell J, Toms GL |journal = Pediatric Allergy and Immunology |volume = 2 |issue = 2 |pages = 72–75 |doi = 10.1111/j.1399-3038.1991.tb00185.x |s2cid = 71842218 }}</ref>

Maternal vaccinations while breastfeeding is safe for almost all vaccines. Additionally, the mother's immunity obtained by vaccination against [[tetanus]], [[diphtheria]], [[whooping cough]] and [[influenza]] can protect the baby from these diseases, and breastfeeding can reduce fever rate after infant immunization. However, [[smallpox]] and [[yellow fever]] vaccines increase the risk of infants developing [[vaccinia]] and [[encephalitis]].<ref name="breastfedvaccine">{{cite news |title = Many Drugs Found Safe for Breast-Feeding Mothers | vauthors = Winslow R | url = https://www.wsj.com/articles/SB10001424127887324906304579035050801549032?mod=rss_Health |newspaper = Wall Street Journal |date = 26 August 2013 |access-date = 2 September 2013 }}</ref><ref name="breastfeddrug">{{cite journal | vauthors = Sachs HC | title = The transfer of drugs and therapeutics into human breast milk: an update on selected topics | journal = Pediatrics | volume = 132 | issue = 3 | pages = e796–e809 | date = September 2013 | pmid = 23979084 | doi = 10.1542/peds.2013-1985 | s2cid = 175438 | doi-access = free }}</ref>

Several studies have suggested that breast milk can pass antibodies to the infant for as long as the child continues to nurse.  The antibodies may be in the mother's system as a result of being ill or they may be acquired by drinking milk from a mother who has recently been vaccinated for a particular disease. One small study done on nursing mothers who had received the 
COVID-19 vaccine found that breastmilk continued to contain antibodies for as long as 80 days after receiving the vaccine.<ref>{{cite web |title=For breastfeeding moms, COVID-19 vaccinations may also protect babies |url=https://source.wustl.edu/2021/04/for-breastfeeding-moms-covid-19-vaccinations-may-also-protect-babies/ |website=Washington University in St. Louis |date=6 April 2021 |access-date=March 26, 2023}}</ref>

==== Mortality ====

The World Health Organization reports that babies who receive no breast milk are almost six times more likely to die by the age of one month than those who are partially or fully breastfed. Access to healthcare is the single critical determinant of survival or death for the infant.<ref>WHO [http://apps.who.int/iris/bitstream/10665/42815/1/9241591064.pdf "Strategic directions for improving the health and development of children and adolescents"], WHO/FCH/CAH/02.21, Geneva: Department of Child and Adolescent Health and Development, World Health Organization.</ref>

==== Childhood obesity ====
{{Main|Childhood obesity}}

The protective effect of breastfeeding against obesity is consistent, though small, across many studies.<ref name="WHO_2007" /><ref name="AHRQ_2007" /><ref>{{cite journal | vauthors = Arenz S, Rückerl R, Koletzko B, von Kries R | title = Breast-feeding and childhood obesity{{snd}}a systematic review | journal = International Journal of Obesity and Related Metabolic Disorders | volume = 28 | issue = 10 | pages = 1247–1256 | date = October 2004 | pmid = 15314625 | doi = 10.1038/sj.ijo.0802758 | s2cid = 25205202 }}</ref> A 2013 [[longitudinal study]] reported less obesity at ages two and four years among infants who were breastfed for at least four months.<ref>{{cite journal | vauthors = Moss BG, Yeaton WH | title = Early childhood healthy and obese weight status: potentially protective benefits of breastfeeding and delaying solid foods | journal = Maternal and Child Health Journal | volume = 18 | issue = 5 | pages = 1224–1232 | date = July 2014 | pmid = 24057991 | doi = 10.1007/s10995-013-1357-z | s2cid = 19203449 }}</ref>

==== Allergic diseases ====

In children who are at risk for developing allergic diseases (defined as at least one parent or sibling having [[atopy]]), atopic syndrome can be prevented or delayed through 4-month exclusive breastfeeding, though these benefits may not persist.<ref name="pmid18166574">{{cite journal | vauthors = Greer FR, Sicherer SH, Burks AW | title = Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas | journal = Pediatrics | volume = 121 | issue = 1 | pages = 183–191 | date = January 2008 | pmid = 18166574 | doi = 10.1542/peds.2007-3022 | s2cid = 219206967 | url = https://cdr.lib.unc.edu/downloads/xs55mf27x }}</ref>

==== Backwash effect ====
The backwash effect in breastfeeding refers to the process where an infant's saliva flows back into the mother's breast during nursing. This backward flow may introduce the baby's saliva into the mammary gland, potentially prompting the mother's body to produce tailored immune responses in her breast milk to meet the infant's specific needs.<ref>{{cite journal |doi=10.1542/peds.113.2.361 |title=Ultrasound Imaging of Milk Ejection in the Breast of Lactating Women |date=2004 |last1=Ramsay |first1=Donna T. |last2=Kent |first2=Jacqueline C. |last3=Owens |first3=Robyn A. |last4=Hartmann |first4=Peter E. |journal=Pediatrics |volume=113 |issue=2 |pages=361–367 |pmid=14754950 }}</ref><ref name="hassiotou2013">{{cite journal |doi=10.1177/0890334413477242 |title=Cells in Human Milk |date=2013 |last1=Hassiotou |first1=Foteini |last2=Geddes |first2=Donna T. |last3=Hartmann |first3=Peter E. |journal=Journal of Human Lactation |volume=29 |issue=2 |pages=171–182 |pmid=23515088 }}</ref>

==== Other health effects ====

Breastfeeding may reduce the risk of necrotizing enterocolitis (NEC) in premature babies.<ref name="AHRQ_2007" />

Breastfeeding or introduction of gluten while breastfeeding does not protect against [[celiac disease]] among at-risk children. Breast milk of healthy human mothers who eat [[gluten]]-containing foods presents high levels of non-degraded [[gliadin]] (the main gluten protein). Early introduction of traces of gluten in babies to potentially induce tolerance does not reduce the risk of developing celiac disease. Delaying the introduction of gluten does not prevent, but is associated with a delayed onset of the disease.<ref name="SzajewskaShamir">{{cite journal | vauthors = Szajewska H, Shamir R, Chmielewska A, Pieścik-Lech M, Auricchio R, Ivarsson A, Kolacek S, Koletzko S, Korponay-Szabo I, Mearin ML, Ribes-Koninckx C, Troncone R | title = Systematic review with meta-analysis: early infant feeding and coeliac disease| journal = Alimentary Pharmacology & Therapeutics | volume = 41 | issue = 11 | pages = 1038–1054 | date = June 2015 | pmid = 25819114 | doi = 10.1111/apt.13163 | s2cid = 22628343 | doi-access = free }}</ref><ref name="BethuneKhosla2008">{{cite journal | vauthors = Bethune MT, Khosla C | title = Parallels between pathogens and gluten peptides in celiac sprue | journal = PLOS Pathogens | volume = 4 | issue = 2 | pages = e34 | date = February 2008 | pmid = 18425213 | pmc = 2323203 | doi = 10.1371/journal.ppat.0040034 | doi-access = free }}</ref>

About 14 to 19 percent of leukemia cases may be prevented by breastfeeding for six months or longer.<ref>{{cite journal | vauthors = Amitay EL, Keinan-Boker L | title = Breastfeeding and Childhood Leukemia Incidence: A Meta-analysis and Systematic Review | journal = JAMA Pediatrics | volume = 169 | issue = 6 | pages = e151025 | date = June 2015 | pmid = 26030516 | doi = 10.1001/jamapediatrics.2015.1025 | doi-access = free }}</ref>  However, breastfeeding is also the primary cause of [[adult T-cell leukemia/lymphoma]], as the [[HTLV-1]] virus is transmitted through breastmilk.<ref>{{cite journal | vauthors = Eusebio-Ponce E, Candel FJ, Anguita E | title = Human T-Cell Lymphotropic Virus Type 1 and associated diseases in Latin America | journal = Tropical Medicine & International Health | volume = 24 | issue = 8 | pages = 934–953 | date = August 2019 | pmid = 31183938 | doi = 10.1111/tmi.13278 | s2cid = 184485435 | doi-access = free }}</ref>

Breastfeeding is associated with a lower chance of developing [[diabetes mellitus type 1]] in the offspring.<ref name="AHRQ_2007" /> Breastfed babies also appear to have a lower likelihood of developing [[diabetes mellitus type 2]] later in life.<ref name="WHO_2007" /><ref name="AHRQ_2007" /><ref name="pmid17093156">{{cite journal | vauthors = Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG | title = Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence | journal = The American Journal of Clinical Nutrition | volume = 84 | issue = 5 | pages = 1043–1054 | date = November 2006 | pmid = 17093156 | doi = 10.1093/ajcn/84.5.1043 | doi-access = free }}</ref>

Breastfeeding may decrease the risk of [[cardiovascular disease]] in later life, as indicated by lower [[cholesterol]] and [[C-reactive protein]] levels in breastfed adult women.<ref name="WHO_2007" />  Breastfed infants have somewhat lower blood pressure later in life, but it is unclear how much practical benefit this provides.<ref name="WHO_2007" /><ref name="AHRQ_2007" />

A 1998 study suggested that breastfed babies have a better chance of good dental health than formula-fed infants because of the developmental effects of breastfeeding on the [[oral cavity]] and [[airway]]. It was thought that with fewer [[malocclusion]]s, breastfed children may have a reduced need for [[orthodontic]] intervention. The report suggested that children with a well rounded, "U-shaped" [[dental arch]], which is found more commonly in breastfed children, may have fewer problems with snoring and [[sleep apnea]] in later life.<ref>{{cite journal | vauthors = Palmer B | title = The influence of breastfeeding on the development of the oral cavity: a commentary | journal = Journal of Human Lactation | volume = 14 | issue = 2 | pages = 93–98 | date = June 1998 | pmid = 9775838 | doi = 10.1177/089033449801400203 | url = http://www.brianpalmerdds.com/bfeed_oralcavity.htm | url-status = live | s2cid = 29129955 | archive-url = https://web.archive.org/web/20130316024901/http://www.brianpalmerdds.com/bfeed_oralcavity.htm | archive-date = 16 March 2013 }}</ref> A 2016 review found that breastfeeding protected against malocclusions.<ref name="Victora_2016" />

Breastfeeding duration has been correlated with child maltreatment outcomes, including neglect and sexual abuse.<ref name="Kremer_2018">{{cite journal | vauthors = Kremer KP, Kremer TR | title = Breastfeeding Is Associated with Decreased Childhood Maltreatment | journal = Breastfeeding Medicine | volume = 13 | issue = 1 | pages = 18–22 | date = January 2018 | pmid = 29125322 | doi = 10.1089/bfm.2017.0105 }}</ref>

==== Intelligence ====

It is unclear whether breastfeeding improves [[intelligence]] later in life. Several studies found no relationship after controlling for [[confounding]] factors like maternal intelligence (smarter mothers were more likely to breastfeed their babies).<ref name="AHRQ_2007" /><ref name="pmid17020911">{{cite journal | vauthors = Der G, Batty GD, Deary IJ | title = Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis | journal = BMJ | volume = 333 | issue = 7575 | pages = 945 | date = November 2006 | pmid = 17020911 | pmc = 1633819 | doi = 10.1136/bmj.38978.699583.55 }}</ref> However, other studies concluded that breastfeeding was associated with increased cognitive development in childhood, although the cause may be increased mother–child interaction rather than nutrition.<ref name="WHO_2007" /><ref>{{cite journal | vauthors = Huang J, Vaughn MG, Kremer KP | title = Breastfeeding and child development outcomes: an investigation of the nurturing hypothesis | journal = Maternal & Child Nutrition | volume = 12 | issue = 4 | pages = 757–767 | date = October 2016 | pmid = 26194444 | pmc = 5087141 | doi = 10.1111/mcn.12200 }}</ref>

=== Mother ===
{{anchor|Benefits for mothers}}

==== Maternal bond ====

[[Oxytocin]], a hormone released during breastfeeding, may play a role in maternal-infant attachment and bonding, potentially via decreased anxiety and stress.<ref>{{cite journal | vauthors = Bell AF, Erickson EN, Carter CS | title = Beyond labor: the role of natural and synthetic oxytocin in the transition to motherhood | journal = Journal of Midwifery & Women's Health | volume = 59 | issue = 1 | pages = 35–42: quiz 108 | date = 2014 | pmid = 24472136 | pmc = 3947469 | doi = 10.1111/jmwh.12101 }}</ref>

==== Fertility ====
{{Main|Lactational amenorrhea}}

Exclusive breastfeeding usually delays the return of fertility through [[lactational amenorrhea]],<ref name="Chowdhury_2015">{{cite journal | vauthors = Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, Bahl R, Martines J | title = Breastfeeding and maternal health outcomes: a systematic review and meta-analysis | journal = Acta Paediatrica | volume = 104 | issue = 467 | pages = 96–113 | date = December 2015 | pmid = 26172878 | pmc = 4670483 | doi = 10.1111/apa.13102 }}</ref><ref>{{cite journal | vauthors = Kramer MS, Kakuma R | title = Optimal duration of exclusive breastfeeding | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | issue = 8 | pages = CD003517 | date = August 2012 | pmid = 22895934 | pmc = 7154583 | doi = 10.1002/14651858.CD003517.pub2 | collaboration = Cochrane Pregnancy and Childbirth Group }}</ref> although it does not provide reliable [[birth control]]. Breastfeeding may delay the return to fertility for some women by suppressing ovulation. Mothers may not [[ovulate]], or have regular periods, during the entire lactation period. The non-ovulating period varies by individual. This has been used as natural contraception, with greater than 98% effectiveness during the first six months after birth if specific nursing behaviors are followed.<ref name="Price_&Robinson_2004">{{cite book | vauthors = Price C, Robinson S | title=Birth|url={{google books |plainurl=y |id=PMn-zeaZN9wC | page = 489}}|publisher=Pan Macmillan Australia|isbn=978-1-74334-890-1 | year = 2004 }}</ref>

==== Postpartum bleeding ====

During the third stage of labor, the time between the delivery of the baby and the passage of the placenta, and the fourth, the final stage of birth, excessive blood loss can endanger the life of the mother.  When the newborn nurses  the mother secretes [[oxytocin]] which causes  the uterus to cramp and reduce blood loss. Nursing also causes the uterus to cramp for a number of days postpartum, helping it to return to its pre-pregnancy size.   Some women report moderate to severe pain, especially women who have given birth several times, during a nursing session  for the first few days following delivery.<ref>{{cite journal | vauthors = Holdcroft A, Snidvongs S, Cason A, Doré CJ, Berkley KJ | title = Pain and uterine contractions during breast feeding in the immediate post-partum period increase with parity | journal = Pain | volume = 104 | issue = 3 | pages = 589–596 | date = August 2003 | pmid = 12927631 | doi = 10.1016/S0304-3959(03)00116-7 | s2cid = 11478005 }}</ref><ref>{{cite journal |title=Breastfeeding the newborn or nipple stimulation for reducing postpartum haemorrhage in the third stage of labour |url=https://www.cochrane.org/CD010845/PREG_breastfeeding-newborn-or-nipple-stimulation-reducing-postpartum-haemorrhage-third-stage-labour |journal=The Cochrane Database of Systematic Reviews |year=2016 |doi=10.1002/14651858.CD010845.pub2 |pmid=26816300 |access-date=12 January 2021|last1=Abedi |first1=P. |last2=Jahanfar |first2=S. |last3=Namvar |first3=F. |last4=Lee |first4=J. |volume=2016 |issue=1 |pages=CD010845 |pmc=6718231 }}</ref>

====Weight retention====

It is unclear whether breastfeeding causes mothers to lose weight after giving birth.<ref name="Chowdhury_2015" /><ref>{{cite journal | vauthors = He X, Zhu M, Hu C, Tao X, Li Y, Wang Q, Liu Y | title = Breast-feeding and postpartum weight retention: a systematic review and meta-analysis | journal = Public Health Nutrition | volume = 18 | issue = 18 | pages = 3308–3316 | date = December 2015 | pmid = 25895506 | doi = 10.1017/S1368980015000828 | pmc = 10271764 | s2cid = 24962601 }}</ref><ref>{{cite journal | vauthors = Neville CE, McKinley MC, Holmes VA, Spence D, Woodside JV | title = The relationship between breastfeeding and postpartum weight change – a systematic review and critical evaluation | journal = International Journal of Obesity | volume = 38 | issue = 4 | pages = 577–590 | date = April 2014 | pmid = 23892523 | doi = 10.1038/ijo.2013.132 | s2cid = 6127250 }}</ref><ref name= "Feltner_2018">{{cite journal| vauthors = Feltner C, Weber RP, Stuebe A, Grodensky C, Orr C, Viswanathan M |date=18 July 2018|title=Breastfeeding Programs and Policies, Breastfeeding Uptake, and Maternal Health Outcomes in Developed Countries |journal=AHRQ Publication| id = No. 18-EHC014-EF|doi=10.23970/ahrqepccer210|s2cid=56834158|doi-access=free}}</ref> The National Institutes of Health states that it may help with weight loss.<ref>{{cite web|url=https://www.womenshealth.gov/breastfeeding/making-decision-breastfeed/#3|title=Making the decision to breastfeed {{!}} womenshealth.gov|website=womenshealth.gov|language=en|access-date=2 December 2017|date=23 January 2017}}</ref>

==== Chronic conditions ====
Breastfeeding is also associated with a lower risk of type 2 diabetes among mothers who practice it.<ref name="Aune_2014">{{cite journal | vauthors = Aune D, Norat T, Romundstad P, Vatten LJ | title = Breastfeeding and the maternal risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies | journal = Nutrition, Metabolism, and Cardiovascular Diseases | volume = 24 | issue = 2 | pages = 107–115 | date = February 2014 | pmid = 24439841 | doi = 10.1016/j.numecd.2013.10.028 }}</ref> Longer duration of breastfeeding is associated with reduced risk of hypertension.<ref name="Feltner_2018" />

For breastfeeding women, long-term health benefits include reduced risk of [[breast cancer]], [[ovarian cancer]], and [[endometrial cancer]].<ref name="Chowdhury_2015" /><ref>{{cite journal | title = Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease | journal = Lancet | volume = 360 | issue = 9328 | pages = 187–195 | date = July 2002 | pmid = 12133652 | doi = 10.1016/S0140-6736(02)09454-0 | s2cid = 25250519 | author1 = Collaborative Group on Hormonal Factors in Breast Cancer }}</ref> According to the [[American Heart Association]], breastfeeding also reduces the risk of maternal heart disease and stroke.<ref>{{cite web |title=Breastfeeding reduces mothers' cardiovascular disease risk |url=https://www.sciencedaily.com/releases/2022/01/220111091356.htm |website=ScienceDaily |language=en}}</ref>

A 2011 review found it unclear whether breastfeeding affects the risk of [[postpartum depression]].<ref>{{cite journal | vauthors = Miller LJ, LaRusso EM | title = Preventing postpartum depression | journal = The Psychiatric Clinics of North America | volume = 34 | issue = 1 | pages = 53–65 | date = March 2011 | pmid = 21333839 | doi = 10.1016/j.psc.2010.11.010 }}</ref> Later reviews have found tentative evidence of a lower risk among mothers who successfully breastfeed, though it is unknown whether breastfeeding decreases depression, or whether depression decreases breastfeeding.<ref>{{cite journal | vauthors = Figueiredo B, Dias CC, Brandão S, Canário C, Nunes-Costa R | title = Breastfeeding and postpartum depression: state of the art review | journal = Jornal de Pediatria | volume = 89 | issue = 4 | pages = 332–338 | year = 2013 | pmid = 23791236 | doi = 10.1016/j.jped.2012.12.002 | s2cid = 6578686 | doi-access = free | hdl = 10216/102955 | hdl-access = free }}</ref><ref>{{cite journal | vauthors = Dias CC, Figueiredo B | title = Breastfeeding and depression: a systematic review of the literature | journal = Journal of Affective Disorders | volume = 171 | pages = 142–154 | date = January 2015 | pmid = 25305429 | doi = 10.1016/j.jad.2014.09.022 | hdl = 1822/41376 | hdl-access = free }}</ref>

====Dysphoric milk ejection reflex====

{{Main|Dysphoric milk ejection reflex}}

Dysphoric milk ejection reflex (D-MER) is a condition in which breastfeeding women develop negative emotions that begin just before the milk letdown reflex and last less than a few minutes. 
It may recur with every letdown, including unexpected letdowns when the baby is not feeding.  It presents as an emotional reaction but may also produce physical feelings such as nausea. It is different from postpartum depression and other known psychological conditions.  A 2019 study reported a prevalence rate of 9.1%.  As of 2021, very little research has been done and many health care providers and lactation practitioners remain barely able to recognize the syndrome.  An October 2021 review of literature published to that date suggested that the lack of up-to-date information "makes it necessary to educate mothers because educated mothers are usually better at handling postpartum situations if they are prepared in advance."  There is as yet no medication to treat the symptoms although women have reported that they have found it of benefit to learn that they are not alone and that the symptoms were not "just in their head".<ref>{{cite web |title=What is D-MER |url=https://www.llli.org/what-is-d-mer/ |website=Le Leche League |date=5 November 2018 |access-date=14 January 2022}}</ref><ref>{{cite journal | vauthors = Ureño TL, Berry-Cabán CS, Adams A, Buchheit TL, Hopkinson SG | title = Dysphoric Milk Ejection Reflex: A Descriptive Study | journal = Breastfeeding Medicine | volume = 14 | issue = 9 | pages = 666–673 | date = November 2019 | pmid = 31393168 | doi = 10.1089/bfm.2019.0091 | s2cid = 199504292 }}</ref><ref>{{cite journal | vauthors = Deif R, Burch EM, Azar J, Yonis N, Abou Gabal M, El Kramani N, DakhlAllah D | title = Dysphoric Milk Ejection Reflex: The Psychoneurobiology of the Breastfeeding Experience | journal = Frontiers in Global Women's Health | volume = 2 | pages = 669826 | year = 2021 | pmid = 34816221 | pmc = 8594038 | doi = 10.3389/fgwh.2021.669826 | doi-access = free }}</ref>

== Social factors ==
{{Main|Breastfeeding difficulties}}

The majority of mothers intend to breastfeed at birth. Many factors can disrupt this intent. Research done in the US shows that information about breastfeeding is rarely provided by a women's obstetricians during their prenatal visits and some health professionals incorrectly believe that commercially prepared formula is nutritionally equivalent to breast milk.<ref name="U.S. Department of Health and Human Services">{{cite web |url = http://www.llli.org/docs/0000000111_LLLIeNews/calltoactiontosupportbreastfeeding.pdf |title = The Surgeon General's Call to Action to Support Breastfeeding |publisher = U.S. Department of Health and Human Services |access-date = 12 December 2015 |url-status = live |archive-url = https://web.archive.org/web/20151222105130/http://www.llli.org/docs/0000000111_LLLIeNews/calltoactiontosupportbreastfeeding.pdf |archive-date = 22 December 2015 }}</ref>  Many hospitals have instituted practices that encourage breastfeeding, however a 2012 survey in the US found that 24% of maternity services were still providing supplements of commercial infant formula as a general practice in the first 48 hours after birth.<ref name="Johnston_2012" /> ''The [[Surgeon General of the United States|Surgeon General]]'s Call to Action to Support Breastfeeding'' attempts to educate practitioners.<ref name="pmid21886320">{{cite journal | vauthors = Benjamin RM | title = Public health in action: give mothers support for breastfeeding | journal = Public Health Reports | volume = 126 | issue = 5 | pages = 622–623 | year = 2011 | pmid = 21886320 | pmc = 3151176 | doi = 10.1177/003335491112600502 }}</ref>

=== Social support ===
{{See also|Postpartum confinement}}

A review found that when effective forms of support are offered to women, exclusive breastfeeding and duration of breastfeeding are increased. Characteristics of effective support includes ongoing, face-to-face support tailored to fit their needs. It may be offered by lay/peer supporters, professional supporters, or a combination of both.<ref>{{Cite journal |last1=Gavine |first1=Anna |last2=Shinwell |first2=Shona C. |last3=Buchanan |first3=Phyll |last4=Farre |first4=Albert |last5=Wade |first5=Angela |last6=Lynn |first6=Fiona |last7=Marshall |first7=Joyce |last8=Cumming |first8=Sara E. |last9=Dare |first9=Shadrach |last10=McFadden |first10=Alison |date=2022-10-25 |title=Support for healthy breastfeeding mothers with healthy term babies |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=10 |pages=CD001141 |doi=10.1002/14651858.CD001141.pub6 |issn=1469-493X |pmc=9595242 |pmid=36282618}}</ref>  This review contrasts with another large review that looked at education programs alone, which found no conclusive evidence of initiation of breastfeeding or the proportion of women breastfeeding either exclusively or partially at 3 months and 6 months.<ref name="Lumbiganon_2016">{{cite journal | vauthors = Lumbiganon P, Martis R, Laopaiboon M, Festin MR, Ho JJ, Hakimi M | title = Antenatal breastfeeding education for increasing breastfeeding duration | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 12 | pages = CD006425 | date = December 2016 | pmid = 27922724 | pmc = 4164447 | doi = 10.1002/14651858.CD006425.pub4 }}</ref>

Positive social support in essential relationships of new mothers plays a central role in the promotion of breastfeeding outside of the confines of medical centers. Social support can come in many incarnations, including tangible, affectionate, social interaction, and emotional and informational support. An increase in these capacities of support has shown to greatly positively effect breastfeeding rates, especially among women with education below a high school level.<ref name="Laugen_2016">{{cite journal | vauthors = Laugen CM, Islam N, Janssen PA | title = Social Support and Exclusive Breast feeding among Canadian Women | journal = Paediatric and Perinatal Epidemiology | volume = 30 | issue = 5 | pages = 430–438 | date = September 2016 | pmid = 27271342 | doi = 10.1111/ppe.12303 }}</ref>
Some mothers that have used lactation rooms have taken to leaving sticky notes to not only thank the businesses that have provided them but to support, encourage, and praise the nursing mothers who use them.<ref name="washingtonpost.com">{{cite news|title=Someone left a heartfelt note in an airport breast-feeding pod. Now there are thousands like it across the country.|url=https://www.washingtonpost.com/travel/2019/12/05/someone-left-heartfelt-note-an-airport-breastfeeding-pod-now-there-are-thousands-like-it-across-country/|access-date=23 December 2019|newspaper=The Washington Post|vauthors=Sampson H}}</ref>

In the social circles surrounding the mother, support is most crucial from the male partner, the mother's mother, and her family and friends.<ref>{{cite journal | vauthors = Raj VK, Plichta SB | title = The role of social support in breastfeeding promotion: a literature review | journal = Journal of Human Lactation | volume = 14 | issue = 1 | pages = 41–45 | date = March 1998 | pmid = 9543958 | doi = 10.1177/089033449801400114 | s2cid = 24061441 }}</ref> Research has shown that the closest relationships to the mother have the strongest impact on breastfeeding rates, while negative perspectives on breastfeeding from close relatives hinder its prevalence.<ref name="Laugen_2016" />
* Mother – Adolescence is a risk factor for low breastfeeding rates, although classes, books and personal counseling (professional or lay) can help compensate.<ref name="Woods_2013">{{cite journal | vauthors = Woods NK, Chesser AK, Wipperman J | title = Describing adolescent breastfeeding environments through focus groups in an urban community | journal = Journal of Primary Care & Community Health | volume = 4 | issue = 4 | pages = 307–310 | date = October 2013 | pmid = 23799673 | doi = 10.1177/2150131913487380 | s2cid = 20835985 | doi-access = free }}</ref>  Some women fear that breastfeeding will negatively impact the look of their breasts. However, a 2008 study found that breastfeeding had no effect on the breasts; other factors did contribute to [[Ptosis (breasts)|"drooping" of the breasts]], such as advanced age, number of pregnancies and smoking behavior.<ref>{{cite web |url = http://www.livestrong.com/article/496659-will-my-breasts-be-ruined-after-breastfeeding/#ixzz2J73k55Hy |title = Will My Breasts Be Ruined After Breastfeeding? | vauthors = Ireland J |website = LiveStrong.com |date = 20 July 2011 |access-date = 27 January 2013 |url-status = live |archive-url = https://web.archive.org/web/20130408043302/http://www.livestrong.com/article/496659-will-my-breasts-be-ruined-after-breastfeeding/#ixzz2J73k55Hy |archive-date = 8 April 2013 }}</ref>
* Partner – Partners may lack knowledge of breastfeeding and their role in the practice.
* [[Wet nursing]] – Social and cultural attitudes towards breastfeeding in the African-American community are also influenced by the legacy of forced wet-nursing during slavery.<ref name="Lutenbacher_2016">{{cite journal | vauthors = Lutenbacher M, Karp SM, Moore ER | title = Reflections of Black Women Who Choose to Breastfeed: Influences, Challenges and Supports | journal = Maternal and Child Health Journal | volume = 20 | issue = 2 | pages = 231–239 | date = February 2016 | pmid = 26496988 | doi = 10.1007/s10995-015-1822-y | s2cid = 23422281 }}</ref>

====Maternity leave====

Work is the most commonly cited reason for not breastfeeding.<ref>{{cite journal | vauthors = Galson SK | title = Mothers and children benefit from breastfeeding | journal = Journal of the American Dietetic Association | volume = 108 | issue = 7 | pages = 1106 | date = July 2008 | pmid = 18589012 | doi = 10.1016/j.jada.2008.04.028 | url = http://www.womenshealth.gov/breastfeeding/SG_081508.pdf | url-status = live | archive-url = https://web.archive.org/web/20120814232217/http://www.womenshealth.gov/breastfeeding/SG_081508.pdf | archive-date = 14 August 2012 }}</ref> In 2012 [[Save the Children]] examined [[maternity leave]] laws, ranking 36 industrialized countries according to their support for breastfeeding. Norway ranked first, while the United States came in last.<ref name="savethechildren.org">{{cite web | url = http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/STATE-OF-THE-WORLDS-MOTHERS-REPORT-2012-FINAL.PDF | title = State of the World's Mothers 2012 | archive-url = https://web.archive.org/web/20120523015344/http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/STATE-OF-THE-WORLDS-MOTHERS-REPORT-2012-FINAL.PDF | archive-date = 23 May 2012 | publisher = Save the Children | date = May 2012 }}</ref> [[Maternity leave in the United States|Maternity leave in the US]] varies widely, including by state. The United States does not mandate paid maternity leave for any employee however the [[Family Medical Leave Act]] (FMLA) guarantees qualifying mothers up to 12 weeks unpaid leave although the majority of US mothers resume work earlier. A large 2011 study found that women who returned to work at or after 13 weeks after childbirth were more likely to predominantly breastfeed beyond three months.<ref>{{cite journal | vauthors = Ogbuanu C, Glover S, Probst J, Liu J, Hussey J | title = The effect of maternity leave length and time of return to work on breastfeeding | journal = Pediatrics | volume = 127 | issue = 6 | pages = e1414–e1427 | date = June 2011 | pmid = 21624878 | pmc = 3387873 | doi = 10.1542/peds.2010-0459 }}</ref>

=== Healthcare ===
====Caesarean section====
Women are less likely to start breastfeeding after caesarean delivery compared with vaginal delivery.<ref>{{cite journal | vauthors = Prior E, Santhakumaran S, Gale C, Philipps LH, Modi N, Hyde MJ | title = Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature | journal = The American Journal of Clinical Nutrition | volume = 95 | issue = 5 | pages = 1113–1135 | date = May 2012 | pmid = 22456657 | doi = 10.3945/ajcn.111.030254 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Zhao J, Zhao Y, Du M, Binns CW, Lee AH | title = Does Caesarean Section Affect Breastfeeding Practices in China? A Systematic Review and Meta-Analysis | journal = Maternal and Child Health Journal | volume = 21 | issue = 11 | pages = 2008–2024 | date = November 2017 | pmid = 29019000 | doi = 10.1007/s10995-017-2369-x | s2cid = 22446389 }}</ref>

====Breast surgery====
Breastfeeding can generally be attempted after breast augmentation or reduction surgery,{{sfn|Lawrence|Lawrence|2015|pp=615-616}} however prior breast surgery is a risk factor for [[low milk supply]].{{sfn|Lawrence|Lawrence|2015|p=231}}

A 2014 review found that women who have [[breast implant]] surgery were less likely to exclusively breast feed, however it was based on only three small studies and the reasons for the correlation were not clear.<ref>{{cite journal | vauthors = Schiff M, Algert CS, Ampt A, Sywak MS, Roberts CL | title = The impact of cosmetic breast implants on breastfeeding: a systematic review and meta-analysis | journal = International Breastfeeding Journal | volume = 9 | pages = 17 | date = 2014 | pmid = 25332722 | pmc = 4203468 | doi = 10.1186/1746-4358-9-17 | doi-access = free }}</ref>
A large follow-up study done in 2014 found a reduced rate of breastfeeding in women who had undergone breast augmentation surgery, however again the reasons were unclear.  The authors suggested that women contemplating augmentation should be provided with information related to the rates of successful breastfeeding as part of informed decision making when contemplating surgery.<ref>{{cite journal | vauthors = Roberts CL, Ampt AJ, Algert CS, Sywak MS, Chen JS | title = Reduced breast milk feeding subsequent to cosmetic breast augmentation surgery | journal = The Medical Journal of Australia | volume = 202 | issue = 6 | pages = 324–328 | date = April 2015 | pmid = 25832160 | doi = 10.5694/mja14.01386 | s2cid = 19130798 }}</ref>

Prior [[breast reduction surgery]] is strongly associated with an increased probability of [[low milk supply]] due to disruption to tissues and nerves.{{sfn|Lawrence|Lawrence|2015|pp=231, 616}} Some surgical techniques for breast reduction appear to be more successful than others in preserving the tissues that generate and channel milk to the nipple. A 2017 review found that women were more likely to have success with breastfeeding with these techniques.<ref>{{cite journal | vauthors = Kraut RY, Brown E, Korownyk C, Katz LS, Vandermeer B, Babenko O, Gross MS, Campbell S, Allan GM | title = The impact of breast reduction surgery on breastfeeding: Systematic review of observational studies | journal = PLOS ONE | volume = 12 | issue = 10 | pages = e0186591 | date = 2017 | pmid = 29049351 | pmc = 5648284 | doi = 10.1371/journal.pone.0186591 | doi-access = free | bibcode = 2017PLoSO..1286591K }}</ref>

==== Medications ====

Breastfeeding mothers should inform their healthcare provider about all of the medications they are taking, including herbal products. Nursing mothers may be immunized and may take most [[over-the-counter drugs]] and [[prescription drugs]] without risk to the baby but certain drugs, including some [[analgesic|painkillers]] and some [[psychiatric drugs]], may pose a risk.<ref>{{cite web|title=Drug Use During Breastfeeding – Women's Health Issues|url=https://www.msdmanuals.com/home/women-s-health-issues/drug-use-during-pregnancy/drug-use-during-breastfeeding|access-date=23 February 2021|website=MSD Manual Consumer Version|language=en}}</ref>

The [[US National Library of Medicine]] publishes "LactMed," an up-to-date online database of information on drugs and lactation. Geared to both healthcare practitioners and nursing mothers, LactMed contains over 450 drug records with information such as potential drug effects and alternative drugs to consider.<ref name="breastfeddrug" /><ref name="American Academy of Pediatrics">{{cite web |url = https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Advises-Most-Medications-are-Safe-for-Breastfeeding-Mothers.aspx |title = AAP Advises Most Medications Are Safe for Breastfeeding Mothers |publisher = American Academy of Pediatrics |date = 26 August 2013 |access-date = 11 July 2015 |url-status = live |archive-url = https://web.archive.org/web/20150712182948/https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Advises-Most-Medications-are-Safe-for-Breastfeeding-Mothers.aspx |archive-date = 12 July 2015 }}</ref>

Some substances in the mother's food and drink are passed to the baby through breast milk, including [[Mercury (element)|mercury]] (found in some [[carnivorous]] fish),<ref>{{cite journal | vauthors = Myers GJ, [[Sally Thurston|Thurston SW]], Pearson AT, Davidson PW, Cox C, Shamlaye CF, Cernichiari E, Clarkson TW | title = Postnatal exposure to methyl mercury from fish consumption: a review and new data from the Seychelles Child Development Study | journal = Neurotoxicology | volume = 30 | issue = 3 | pages = 338–349 | date = May 2009 | pmid = 19442817 | pmc = 2743883 | doi = 10.1016/j.neuro.2009.01.005 | bibcode = 2009NeuTx..30..338M }}</ref> [[caffeine]],<ref>{{cite journal | vauthors = Howard CR, Lawrence RA | title = Breast-feeding and drug exposure | journal = Obstetrics and Gynecology Clinics of North America | volume = 25 | issue = 1 | pages = 195–217 | date = March 1998 | pmid = 9547767 | doi = 10.1016/S0889-8545(05)70365-X }}</ref> and [[bisphenol A]].<ref>{{cite journal | vauthors = Sun Y, Irie M, Kishikawa N, Wada M, Kuroda N, Nakashima K | title = Determination of bisphenol A in human breast milk by HPLC with column-switching and fluorescence detection | journal = Biomedical Chromatography | volume = 18 | issue = 8 | pages = 501–507 | date = October 2004 | pmid = 15386523 | doi = 10.1002/bmc.345 }}</ref><ref>{{cite journal | vauthors = Ye X, Kuklenyik Z, Needham LL, Calafat AM | title = Measuring environmental phenols and chlorinated organic chemicals in breast milk using automated on-line column-switching-high performance liquid chromatography-isotope dilution tandem mass spectrometry | journal = Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences | volume = 831 | issue = 1–2 | pages = 110–115 | date = February 2006 | pmid = 16377264 | doi = 10.1016/j.jchromb.2005.11.050 | url = https://zenodo.org/record/1259095 }}</ref>

==== Medical conditions ====

Undiagnosed maternal [[Coeliac disease|celiac disease]] may cause a short duration of the breastfeeding period. Treatment with the [[gluten-free diet]] can increase its duration and restore it to the average value of the healthy women.<ref name="TersigniCastellani2014">{{cite journal | vauthors = Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A, Scambia G, Di Simone N | title = Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms | journal = Human Reproduction Update | volume = 20 | issue = 4 | pages = 582–593 | year = 2014 | pmid = 24619876 | doi = 10.1093/humupd/dmu007 | hdl = 10807/56796 | doi-access = free | hdl-access = free }}{{free access}}</ref>

Mothers with all types of [[diabetes mellitus]] normally use insulin to control their blood sugar, as the safety of other [[antidiabetic drugs]] while breastfeeding is unknown.<ref>{{cite journal | vauthors = Gouveri E, Papanas N, Hatzitolios AI, Maltezos E | title = Breastfeeding and diabetes | journal = Current Diabetes Reviews | volume = 7 | issue = 2 | pages = 135–142 | date = March 2011 | pmid = 21348815 | doi = 10.2174/157339911794940684 }}</ref>

Women with [[polycystic ovary syndrome]], which is associated with some hormonal differences and obesity, may have greater difficulty with producing a sufficient supply to support exclusive breastfeeding, especially during the first weeks.<ref>{{cite journal | vauthors = Bever Babendure J, Reifsnider E, Mendias E, Moramarco MW, Davila YR | title = Reduced breastfeeding rates among obese mothers: a review of contributing factors, clinical considerations and future directions | journal = International Breastfeeding Journal | volume = 10 | pages = 21 | date = 2015 | pmid = 26140049 | pmc = 4488037 | doi = 10.1186/s13006-015-0046-5 | doi-access = free }}</ref>

=== Ethnicity and socioeconomic status ===

The rates of breastfeeding in the African-American community remain much lower than any other race, for a variety of proposed reasons. These include the legacy of [[wet nursing]] during slavery, higher rates of poor perinatal health, higher stress levels, less access to support, and less flexibility in the workplace.<ref name="Johnson">{{cite journal | vauthors = Johnson A, Kirk R, Rosenblum KL, Muzik M | title = Enhancing breastfeeding rates among African American women: a systematic review of current psychosocial interventions | journal = Breastfeeding Medicine | volume = 10 | issue = 1 | pages = 45–62 | date = 1 February 2015 | pmid = 25423601 | pmc = 4307211 | doi = 10.1089/bfm.2014.0023 }}</ref> While for other races as socio-economic class raises rates of breastfeeding also go up, for the African-American community breastfeeding rates remain consistently low regardless of socio-economic class.<ref name="Reeves_2015">{{cite journal | vauthors = Reeves EA, Woods-Giscombé CL | title = Infant-feeding practices among African American women: social-ecological analysis and implications for practice | journal = Journal of Transcultural Nursing | volume = 26 | issue = 3 | pages = 219–226 | date = May 2015 | pmid = 24810518 | doi = 10.1177/1043659614526244 | s2cid = 19406044 }}</ref>

There are also racial disparities in access to maternity care practices that support breastfeeding. In the US, primarily African-American neighborhoods are more likely to have facilities (such as hospitals and female healthcare clinics) that do not support breastfeeding, contributing to the low rate of breastfeeding in the African-American community. Comparing facilities in primarily African American neighborhoods to ones in primarily European-American neighborhoods, the rates of practices that support or discourage breastfeeding were: limited use of supplements (13.1% compared with 25.8%) and rooming-in (27.7–39.4%)<ref>{{cite journal | vauthors = Lind JN, Perrine CG, Li R, Scanlon KS, Grummer-Strawn LM | title = Racial disparities in access to maternity care practices that support breastfeeding – United States, 2011 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 63 | issue = 33 | pages = 725–728 | date = August 2014 | pmid = 25144543 | pmc = 5779438 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6333a2.htm | url-status = live | archive-url = https://web.archive.org/web/20170427102102/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6333a2.htm | archive-date = 27 April 2017 }}</ref>

Low-income mothers are more likely to have unintended pregnancies.<ref name="surgeongeneral.gov">{{cite news |title=The Surgeon General's Call to Action to Support Breastfeeding |url=https://www.bbc.co.uk/news/health-44436686 |publisher=U.S. Department of Health and Human Services |access-date=11 October 2018 |date=2011| archive-url = https://web.archive.org/web/20130217034104/http://www.surgeongeneral.gov/library/calls/breastfeeding/calltoactiontosupportbreastfeeding.pdf | url-status = live | archive-date = 17 February 2013 |newspaper=BBC News }}</ref> Mothers whose pregnancies are unintended are less likely to breastfeed.<ref name="HP2020FP">{{cite web |title = Family Planning – Healthy People 2020 |url = http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=13 |access-date = 18 August 2011 |url-status = live |archive-url = https://web.archive.org/web/20101228012908/http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=13 |archive-date = 28 December 2010 }}</ref>

Especially the combination of powdered formula with unclean water can be very harmful to the health of babies. In the late 1970s, there was a boycott against Nestle due to the great number of baby deaths due to formula. [[Michele Barry|Dr. Michele Barry]] explains that breastfeeding is most imperative in poverty environments due to the lack of access of clean water for the formula. A Lancet study in 2016 found that universal breastfeeding would prevent the deaths of 800,000 children as well as save $300,000,000.<ref name="Rabin_2018">{{cite news|date=9 July 2018|title=Trump Stance on Breast-Feeding and Formula Criticized by Medical Experts|newspaper=The New York Times|url=https://www.nytimes.com/2018/07/09/well/breastfeeding-trump-resolution.html|access-date=29 July 2018|vauthors=Rabin RC}}</ref>

=== Social acceptance ===
{{Main|Breastfeeding in public}}

[[File:Nursing area sign.png|thumb|Sign for a private nursing area at a museum using the [[international breastfeeding symbol]]]]

Some women feel discomfort when breastfeeding in public.<ref name="Boyer_2011">{{cite journal | vauthors = Boyer K | title = "The way to break the taboo is to do the taboo thing" breastfeeding in public and citizen-activism in the UK | journal = Health & Place | volume = 17 | issue = 2 | pages = 430–437 | date = March 2011 | pmid = 20655272 | doi = 10.1016/j.healthplace.2010.06.013 | s2cid = 5425056 }}</ref>  Public breastfeeding may be forbidden in some [[jurisdiction|places]], not addressed by law in others, and a legal right in others. Even given a legal right, some mothers are reluctant to breastfeed,<ref name="Wolf_2008">{{cite journal | vauthors = Wolf JH | title = Got milk? Not in public! | journal = International Breastfeeding Journal | volume = 3 | issue = 1 | pages = 11 | date = August 2008 | pmid = 18680578 | pmc = 2518137 | doi = 10.1186/1746-4358-3-11 | doi-access = free }}</ref><ref name="Vance_2005">{{cite journal |title = Breastfeeding Legislation in the United States: A General Overview and Implications for Helping Mothers |journal = LEAVEN |year = 2005 |volume = 41 |issue = 3 |pages = 51–54 |url = http://www.llli.org/llleaderweb/LV/LVJunJul05p51.html |url-status = dead |archive-url = https://web.archive.org/web/20070331220518/http://www.llli.org/llleaderweb/LV/LVJunJul05p51.html |archive-date = 31 March 2007 }}</ref> while others may object to the practice.<ref name="Jordan_2002">{{cite book | veditors = Jordan T, Pile S |title=Social Change|url={{google books |plainurl=y |id=juMyCZF-VZ4C|page=233}}|page=233|publisher=Blackwell|year=2002|isbn=978-0-631-23311-4}}</ref>

It is estimated that around 63% of mothers across the world have publicly breast-fed.<ref>{{Cite book |last=Cox |first=Sue |url=https://archive.org/details/breastfeedingwit00suec |title=Breast Feeding With Confidence |publisher=Meadowbrook Press |year=2002 |isbn=978-0684040059 |location=United States |url-access=registration}}</ref> The media have reported a number of incidents in which workers or members of the public have objected to or forbidden women breastfeeding.<ref>{{cite web |date=September 18, 2012 |title=Places Moms Have Been Shamed For Breastfeeding |url=https://www.huffingtonpost.com/2012/09/18/dawn-holland-breastfeeding_n_1893681.html#slide=start |url-status=live |archive-url=https://web.archive.org/web/20150929013228/http://www.huffingtonpost.com/2012/09/18/dawn-holland-breastfeeding_n_1893681.html#slide=start |archive-date=29 September 2015 |access-date=28 September 2015 |publisher=Huffington Post}}</ref> Some mothers avoid the negative attention and choose to move to another location. But some mothers have protested their treatment, and have taken legal action or engaged in protests.<ref>{{cite web |date=September 18, 2012 |title=Dawn Holland, Breastfeeding Mom, Asked To Nurse In Applebee's Bathroom |url=https://www.huffingtonpost.com/2012/09/18/dawn-holland-breastfeeding_n_1893681.html |url-status=live |archive-url=https://web.archive.org/web/20150929013228/http://www.huffingtonpost.com/2012/09/18/dawn-holland-breastfeeding_n_1893681.html |archive-date=29 September 2015 |access-date=28 September 2015 |publisher=Huffington Post}}</ref> Protests have included a public [[boycott]] of the offender's business, organizing a "nurse-in" or a breastfeeding [[flash mob]], in which groups of nursing mothers gather at the location where the complaint originated and nursed their babies at the same time. In response, some companies have apologised and instituted reforms.<ref name="legoland">{{cite news |date=February 3, 2012 |title=Legoland Apologizes To Kelly Sabourin, Breastfeeding Mom Told To Move |url=https://www.huffingtonpost.com/2012/02/03/legoland-kelly-sabourin_n_1253276.html |url-status=live |archive-url=https://web.archive.org/web/20150929005048/http://www.huffingtonpost.com/2012/02/03/legoland-kelly-sabourin_n_1253276.html |archive-date=29 September 2015 |access-date=28 September 2015}}</ref>

The use of infant formula was thought to be a way for western culture to adapt to negative perceptions of breastfeeding.<ref name="Hausman, B. L. 2007">{{cite journal | vauthors = Hausman BL | date = 1 January 2007 | title = Things (Not) to Do with Breasts in Public: Maternal Embodiment and the Biocultural Politics of Infant Feeding | journal = New Literary History | volume = 38 | issue = 3 | pages = 479–504 | doi=10.1353/nlh.2007.0039| hdl = 10919/25465 | s2cid = 144811498 | url = http://muse.jhu.edu/journals/nlh/summary/v038/38.3hausman.html | hdl-access = free }}</ref> The breast pump offered a way for mothers to supply breast milk with most of formula feeding's convenience and without enduring possible disapproval of nursing.<ref name="Boyer, K. 2010">{{cite journal | vauthors = Boyer K | date = 1 January 2010 | title = Of care and commodities: breast milk and the new politics of mobile biosubstances | journal = Progress in Human Geography | volume = 34 | issue = 1 | pages = 5–20 | doi=10.1177/0309132509105003| s2cid = 143449458 }}</ref>  Some may object to breastfeeding because of the implicit association between infant feeding and sex.<ref>{{cite news | vauthors = Al-Awadi AR |title = Draft International Code of Marketing of Breastmilk substitutes |work = Thirty-fourth World Health Assembly, Agenda item 23.2 |agency = World Health Organization(Organisation Mondiale de la Sante) |url = http://apps.who.int/iris/bitstream/10665/156528/1/WHA34_Inf.Doc-9_eng.pdf?ua=1 |publisher = World Health Organization |date = 14 May 1981 |url-status = live |archive-url = https://web.archive.org/web/20160611104338/http://apps.who.int/iris/bitstream/10665/156528/1/WHA34_Inf.Doc-9_eng.pdf?ua=1 |archive-date = 11 June 2016 }}</ref> These negative cultural connotations may reduce breastfeeding duration.<ref name="Wolf_2008" /><ref>{{cite news | vauthors = Harmon A | date = 7 June 2005 | url = https://www.nytimes.com/2005/06/07/nyregion/07nurse.html | title = 'Lactivists' Taking Their Cause, and Their Babies, to the Streets | newspaper = The New York Times }}</ref><ref>{{cite journal | vauthors = Battersby S | title = Understanding the social and cultural influences on breast-feeding today | journal = The Journal of Family Health Care | volume = 20 | issue = 4 | pages = 128–131 | year = 2010 | pmid = 21053661 }}</ref><ref name="Spencer_2015">{{cite journal | vauthors = Spencer B, Wambach K, Domain EW | title = African American Women's Breastfeeding Experiences: Cultural, Personal, and Political Voices | journal = Qualitative Health Research | volume = 25 | issue = 7 | pages = 974–987 | date = July 2015 | pmid = 25288408 | doi = 10.1177/1049732314554097 | s2cid = 22245122 }}</ref>
Maternal guilt and shame is often affected by how a mother feeds an infant. These emotions occur in both bottle- and breast- feeding mothers, although for different reasons. Bottle feeding mothers may feel that they should be breastfeeding.<ref name="Taylor_Wallace_2012">{{cite journal |vauthors = Taylor EN, Wallace LE |title = For Shame: Feminism, Breastfeeding Advocacy, and Maternal Guilt |journal = Hypatia |year = 2012 |volume = 27 |issue = 1 |pages = 76–98 |doi = 10.1111/j.1527-2001.2011.01238.x |s2cid = 144203268 }}</ref> Conversely, breastfeeding mothers may feel forced to feed in uncomfortable circumstances. Some may see breastfeeding as, "indecent, disgusting, animalistic, sexual, and even possibly a perverse act."<ref name="Forbes_2003">{{cite journal|year=2003|title=Perceptions of the Woman Who Breastfeeds: The Role of Erotophobia, Sexism, and Attitudinal Variables|journal=Sex Roles|volume=49|issue=7/8|pages=379–388|doi=10.1023/A:1025116305434|vauthors=Forbes GB, Adams-Curtis LE, Hamm NR, White KB|s2cid=140745639}}</ref> Advocates (known by the [[neologism]] "lactivists") use "[[sit-in|nurse-ins]]" to show support for breastfeeding in public.<ref name="Boyer_2011" />  One study that approached the subject from a feminist viewpoint suggested that both nursing and non-nursing mothers often feel maternal guilt and shame with formula feeding mothers feeling  that they are not living up to the ideals of motherhood and nursing mothers concerned that they are transgressing "cultural expectations regarding feminine modesty."  The authors advocate that women be provided with education on breastfeeding's benefits as well as problem-solving skills,<ref name="Taylor_Wallace_2012" /> however there is no conclusive evidence that breastfeeding education alone improves initiation of breastfeeding or the proportion of women breastfeeding either exclusively or partially at 3 months and 6 months.<ref name="Lumbiganon_2016" />

===Location===
{{Globalize|section|United States|United Kingdom|date=December 2024}}
In the [[United States]], all fifty [[U.S. state|states]], along with the [[District of Columbia]], [[Puerto Rico]] and the [[U.S. Virgin Islands]], have laws that allow a mother to breastfeed a baby in any public or private location.<ref>{{cite web|title=Breastfeeding State Laws|url=https://www.ncsl.org/research/health/breastfeeding-state-laws.aspx|access-date=5 March 2021|website=www.ncsl.org}}</ref> In that country, the Friendly Airports for Mothers (FAM) Act was signed into law in 2019, and the requirements went into effects in 2021. This law requires that all large and medium hub airports in the U.S. provide a private, non-bathroom lactation space in each terminal building.<ref>{{cite web|date=11 May 2017|title=S.1110 – 115th Congress (2017–2018): Friendly Airports for Mothers Act of 2017|url=https://www.congress.gov/bill/115th-congress/senate-bill/1110|access-date=5 March 2021|website=www.congress.gov|vauthors=Duckworth T}}</ref>

Some commercial establishments in the U.S. provide breastfeeding rooms, although laws generally specify that mothers may breastfeed anywhere without requiring a special area. Despite these laws, many women in the United States continue to be publicly shamed or asked to refrain from breastfeeding in public.<ref>{{cite web|title=Barriers to Breastfeeding in the United States – the Surgeon General's Call to Action to Support Breastfeeding|url=https://www.ncbi.nlm.nih.gov/books/NBK52688/|access-date=13 January 2019|website=National Center for Biotechnology Information|publisher=Office of the Surgeon General (US); Centers for Disease Control and Prevention (US); Office on Women's Health (US).|ref=NBK52688}}</ref> In the [[United Kingdom]], the [[Equality Act 2010]] makes the prevention of breastfeeding in any public place [[Anti-discrimination law|discrimination]] under the law.<ref name="uk">{{cite web|title=Breastfeeding in Public Places|url=https://www.maternityaction.org.uk/advice-2/mums-dads-scenarios/6-breastfeeding-rights/breastfeeding-in-public-places/|access-date=25 June 2018|publisher=Maternity Action}}</ref> In [[Scotland]], it is a criminal offense for one to attempt to prevent another from feeding a child under 24 months in public.<ref name="uk"/>

While laws in the U.S. were passed in 2010 which required that nursing mothers who had returned to work be given a non-bathroom space to express milk and a reasonable break time to do so, as of 2016 the majority of American women still did not have access to both accommodations.<ref name="Breastfeeding: The Illusion of Choi">{{cite journal|vauthors=Dinour LM, Bai YK|date=September 2016|title=Breastfeeding: The Illusion of Choice|journal=Women's Health Issues|volume=26|issue=5|pages=479–482|doi=10.1016/j.whi.2016.06.002|pmid=27444340|doi-access=free}}</ref>
  
In 2014, newly elected [[Pope Francis]] drew worldwide commentary when he encouraged mothers to breastfeed babies in church. During a papal [[baptism]], he said that mothers "should not stand on ceremony" if their children were hungry. "If they are hungry, mothers, feed them, without thinking twice," he said, smiling. "Because they are the most important people here."<ref>{{cite news|date=12 January 2014|title=Pope Francis encourages mothers to breastfeed – even in the Sistine Chapel|newspaper=The Guardian|url=https://www.theguardian.com/world/2014/jan/12/pope-mothers-breastfeeding-children-sistine-chapel|url-status=live|archive-url=https://web.archive.org/web/20170213165955/https://www.theguardian.com/world/2014/jan/12/pope-mothers-breastfeeding-children-sistine-chapel|archive-date=13 February 2017|vauthors=Davies L}}</ref>

== Prevalence ==

[[File:BreastFeedingPrevalence6months.png|thumb|upright=0.75|Percentage of babies exclusively breastfed for the first six months of life. Data from 2004 to 2011.<ref>{{cite web |title = Infants exclusively breastfed for the first six months of life (%) |url = http://data.un.org/Data.aspx?d=WHO&f=MEASURE_CODE%3aWHOSIS_000006 |publisher = World Health Organization |access-date = 27 July 2015 |url-status = live |archive-url = https://web.archive.org/web/20160326054120/http://data.un.org/Data.aspx?d=WHO&f=MEASURE_CODE%3AWHOSIS_000006 |archive-date = 26 March 2016 }}</ref>
[[File:CaptionBreastFeeding.png|center]]]]
[[File:Breastfeeding chart.svg|thumb|upright=0.75|Percentage of US infants breastfeeding by month since birth in 2008.<br />Dotted line: Exclusive breastfeeding<br />Dashed line Any breastfeeding<br />* Estimated at 7 days after birth]]

In 2012 37.1% of infants under six months of age were breastfeeding exclusively which rose to 48% in 2022. The Sustainable Development Goals target is to achieve 70% by 2030.<ref name="WHO20142" /><ref name=":3">{{Cite book |last1=FAO |url=https://openknowledge.fao.org/handle/20.500.14283/cd1254en |title=The State of Food Security and Nutrition in the World 2024 |last2=IFAD |last3=UNICEF |last4=WFP |last5=WHO |date=2024 |publisher=FAO; IFAD; UNICEF; WFP; WHO |isbn=978-92-5-138882-2 |language=English |doi=10.4060/cd1254en}}</ref>

In the United States, the rate of women beginning to breastfeed was 76% in 2009 increasing to 83% in 2015 with 58% still breastfeeding at 6 months, although only 25% were still breastfeeding exclusively.<ref name="CDC2018Rate">{{cite journal|date=1 August 2018|title=Results: Breastfeeding Rates|url=https://www.cdc.gov/breastfeeding/data/nis_data/results.html|access-date=9 December 2018|website=CDC|language=en-us}}</ref> African-American women have persistently low rates of breastfeeding compared to White and Hispanic American women. In 2014, 58.1% of African-American women breastfeed in the early postpartum period, compared to 77.7% of White women and 80.6% of Hispanic women.<ref name="Reeves_2015" />  In 2019, 84.1% of U.S women giving birth initiated breastfeeding, with 87.4%, 85.5%, 73.6%, 90.3% and 83.1%  of Hispanic, White, African-American, Asian and Multiracial mothers initiating, respectively. Rates of initiation among African-American mothers varied widely by state, with lows under 53% and highs over 90%.<ref>{{cite journal|url=https://www.cdc.gov/mmwr/volumes/70/wr/mm7021a1.htm#T1_down|title=Racial and Ethnic Disparities in Breastfeeding Initiation – United States, 2019, Table 1|author1=Katelyn V. Chiang|author2=Ruowei Li|author3= Erica H. Anstey|author4= Cria G. Perrine|journal=Morbidity and Mortality Weekly Report|date=May 28, 2021|pages=769–774|volume=70| issue=21 |doi=10.15585/mmwr.mm7021a1| pmid=34043611 | pmc=8158892 }}</ref>

Breastfeeding rates in different parts of China vary considerably.<ref name="XuQiu2009">{{cite journal | vauthors = Xu F, Qiu L, Binns CW, Liu X | title = Breastfeeding in China: a review | journal = International Breastfeeding Journal | volume = 4 | issue = 1 | pages = 6 | date = June 2009 | pmid = 19531253 | pmc = 2706212 | doi = 10.1186/1746-4358-4-6 | doi-access = free }}</ref>

Rates in the United Kingdom were the lowest in the world in 2015 with only 0.5% of mothers still breastfeeding at a year, while in Germany 23% are doing so, 56% in Brazil and 99% in Senegal.<ref>{{cite news |title = UK 'world's worst' at breastfeeding |url = https://www.bbc.co.uk/news/health-35438049 |access-date = 30 January 2016 |publisher = BBC |date = 29 January 2016 |url-status = live |archive-url = https://web.archive.org/web/20160129190218/http://www.bbc.co.uk/news/health-35438049 |archive-date = 29 January 2016 }}</ref>

In Australia, for children born in 2004, more than 90% were initially breastfed.<ref>{{cite web|url =http://bonyata.com/wp-content/uploads/2012/05/Australia_BF_rates2004.png|title =Australia – Breastfeeding rates for children born in 2004|url-status =usurped|archive-url =https://web.archive.org/web/20160603205203/http://bonyata.com/wp-content/uploads/2012/05/Australia_BF_rates2004.png|archive-date =3 June 2016 }}</ref> In Canada for children born in 2005–06, more than 50% were only breastfed and more than 15% received both breastmilk and other liquids, by the age of 3 months.<ref>{{cite web |url = http://kellymom.com/fun/trivia/bf-rates-2004/ |title = A Comparison of Breastfeeding Rates by Country • KellyMom.com |date = 14 May 2012 |website = KellyMom.com |language = en-US |access-date = 4 May 2016 |url-status = live |archive-url = https://web.archive.org/web/20160502174435/http://kellymom.com/fun/trivia/bf-rates-2004/ |archive-date = 2 May 2016 }}</ref>

== History ==
{{Main|History and culture of breastfeeding}}
{{See also|Wet nurse}}

In the [[Ancient Egypt|Egyptian]], [[Ancient Greece|Greek]] and [[Roman Empire]]s, women usually fed only their own children.{{Citation needed|date=December 2017}} However, breastfeeding began to be seen as something too common to be done by royalty, and wet nurses were employed to breastfeed the children of the royal families. This extended over time, particularly in western Europe, where [[nobility|noble women]] often made use of wet nurses. Lower-class women breastfed their infants and used a wet nurse only if they were unable to feed their own infant. Attempts were made in 15th-century Europe to use cow or goat milk, but these attempts were not successful. In the 18th century, flour or cereal mixed with broth were introduced as substitutes for breastfeeding, but this provided inadequate nutrition.{{Citation needed|date=December 2017}} The appearance of improved infant formulas in the mid 19th century and its increased use caused a decrease in breastfeeding rates, which accelerated after [[World War II]], and for some in the US, Canada, and UK, breastfeeding was seen as uncultured. From the 1960s onwards, breastfeeding experienced a revival which continued into the 2000s, though negative attitudes towards the practice were still entrenched in some countries up to the 1990s.<ref name="naoo">{{cite book | vauthors = Nathoo T, Ostry A |title=The One Best Way?: Breastfeeding History, Politics, and Policy in Canada|url={{google books |plainurl=y |id=NxnaAgAAQBAJ&|page=4}}|year= 2011|publisher=Wilfrid Laurier Univ. Press|isbn=978-1-55458-758-2|pages=4–}}</ref>

== Society and culture ==

[[File:Stanisław Wyspiański, Macierzyństwo.jpg|thumb|right|''Macierzyństwo'' ("Maternity"), a 1902 painting by [[Stanisław Wyspiański]]]]

=== Financial considerations ===

Breastfeeding is less costly than alternatives, but the mother generally must eat more food than would otherwise be necessary. In the US, the extra money spent on food (about US ${{Inflation|US|8|1993}} each week{{fact|date=February 2025}}) is usually about half as much money as the cost of infant formula.<ref name="APP_19972"/> According to the CDC, breastfeeding mothers need an extra 450 to 500 calories per day compared to their pre-pregnancy caloric intake.<ref>{{cite web |title=Do mothers need more calories while breastfeeding? |url=https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/diet-and-micronutrients/maternal-diet.html |website=Centers for Disease Control and Prevention |access-date=1 September 2021}}</ref>

Breastfeeding reduces health care costs and the cost of caring for sick babies. Parents of breastfed babies are less likely to miss work and lose income because their babies are sick.<ref name="APP_19972"/>  Looking at three of the most common infant illnesses, lower respiratory tract illnesses, [[otitis media]], and gastrointestinal illness, one study compared infants that had been exclusively breastfed for at least three months to those who had not.  It found that in the first year of life there were 2033 excess office visits, 212 excess days of hospitalization, and 609 excess prescriptions for these three illnesses per 1000 never-breastfed infants compared with 1000 infants exclusively breastfed for at least 3 months.<ref name="Ball_1999">{{cite journal | vauthors = Ball TM, Wright AL | title = Health care costs of formula-feeding in the first year of life | journal = Pediatrics | volume = 103 | issue = 4 Pt 2 | pages = 870–876 | date = April 1999 | doi = 10.1542/peds.103.S1.870 | pmid = 10103324 | s2cid = 5703407 }}</ref><ref>{{cite book|title = Research Handbook on the Economics of Family Law| vauthors = Cohen LR, Wright JD |url={{google books |plainurl=y |id=AyepK0yUgUgC|page=185}}|publisher = Edward Elgar Publishing|year = 2011|isbn = 978-0-85793-064-4|pages = 185}}</ref> However, in a study of over 140,000 newborns in the first month of life, exclusively breastfed newborns had higher hospital readmission rates than those exclusively formula fed, and those exclusively breastfed also had more neonatal outpatient visits compared to those exclusively formula fed.<ref>{{cite journal | vauthors = Flaherman V, Schaefer EW, Kuzniewicz MW, Li SX, Walsh EM, Paul IM | title = Health Care Utilization in the First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding | journal = Academic Pediatrics | volume = 18 | issue = 6 | pages = 677–684 | date = August 2018 | pmid = 29191700 | doi = 10.1016/j.acap.2017.11.005 | s2cid = 46799402 }}</ref>

===Criticism of breastfeeding advocacy===

[[File:"See It" project, Iceland, installation in 2011 by Fiann Paul.jpg|thumb|"See It", a project by [[Fiann Paul]] dedicated to promoting awareness of breastfeeding in [[Reykjavík|Reykjavík, Iceland]],

in 2011<ref>{{cite web |url = http://www.pressan.is/pressupennar/lesa_Ingibj%25C3%25B6rgB/brjostagjafavikan-2011-sjaumst- |title = Pressan.is | vauthors = Baldursdóttir I |website = www.pressan.is |access-date = 26 August 2016 |url-status = live |archive-url = https://web.archive.org/web/20160914034633/http://www.pressan.is/pressupennar/lesa_Ingibj%25C3%25B6rgB/brjostagjafavikan-2011-sjaumst- |archive-date = 14 September 2016 }}</ref>]]

There are controversies and ethical considerations surrounding the means used by public campaigns which attempt to increase breastfeeding rates, relating to pressure put on women, and potential feeling of guilt and shame of women who fail to breastfeed; and social condemnation of women who use formula.<ref>{{cite news |url = https://www.bbc.com/news/magazine-19054045 |title = Formula v breastfeeding: Should the state step in? | vauthors = Dailey K |date = 7 August 2012 |url-status = live |archive-url = https://web.archive.org/web/20160131194140/http://www.bbc.com/news/magazine-19054045 |archive-date = 31 January 2016 |newspaper = BBC News }}</ref><ref>{{cite news |url = https://www.theguardian.com/lifeandstyle/2014/jan/03/parents-too-much-guilt-breastfeeding-work |title = Parents 'face too much guilt over breastfeeding and work' | vauthors = Mason R |date = 3 January 2014 | newspaper = The Guardian |url-status = live | archive-url = https://web.archive.org/web/20170510234843/https://www.theguardian.com/lifeandstyle/2014/jan/03/parents-too-much-guilt-breastfeeding-work |archive-date = 10 May 2017 }}</ref><ref>{{cite news |url = https://www.telegraph.co.uk/women/mother-tongue/9877692/Breastfeeding-may-be-best-but-bottles-of-formula-milk-arent-the-end-of-the-world.html |title = Breastfeeding may be best, but bottles of formula milk aren't the end of the world |url-status = live |archive-url = https://web.archive.org/web/20151224135254/http://www.telegraph.co.uk/women/mother-tongue/9877692/Breastfeeding-may-be-best-but-bottles-of-formula-milk-arent-the-end-of-the-world.html |archive-date = 24 December 2015 |date = 18 February 2013 | vauthors = Maxted A }}</ref><ref>{{cite web |url = http://www.huffingtonpost.com/entry/on-breastfeeding-my-body-my-choice_us_57a376a5e4b0f019c3e4f062 |title = You Can't Call Yourself A Feminist If You Shame Women Who Don't Breastfeed | vauthors = Curzer M |website = [[HuffPost]] |date = 4 August 2016 |url-status = live |archive-url = https://web.archive.org/web/20161002152240/http://www.huffingtonpost.com/entry/on-breastfeeding-my-body-my-choice_us_57a376a5e4b0f019c3e4f062 |archive-date = 2 October 2016 }}</ref> In addition to this, there is also the moral question as to what degree the state or medical community can interfere with a person's self-determination: for example in the [[United Arab Emirates]] the law requires women to breastfeed babies for at least 2 years and allows husbands to sue them if they do not.<ref>{{cite news |url = https://www.theguardian.com/world/2014/feb/07/uae-law-mothers-breastfeed-first-two-years |title = UAE law requires mothers to breastfeed for first two years | vauthors = Graham-Harrison E |date = 7 February 2014 |url-status = live |archive-url = https://web.archive.org/web/20161126115351/https://www.theguardian.com/world/2014/feb/07/uae-law-mothers-breastfeed-first-two-years |archive-date = 26 November 2016 |newspaper = The Guardian }}</ref><ref>{{cite web |url = http://www.huffingtonpost.co.uk/the-conversation-uk/breastfeeding_b_4822843.html |title = Forcing Mothers to Breastfeed Is No Way to Help Children – Huffington Post |url-status = live |archive-url = https://web.archive.org/web/20151223080222/http://www.huffingtonpost.co.uk/the-conversation-uk/breastfeeding_b_4822843.html |archive-date = 23 December 2015 |date = 20 February 2014 }}</ref>

It is widely assumed that if women's healthcare providers encourage them to breastfeed, those who choose not to will experience more guilt. Evidence does not support this assumption. On the contrary, a study on the effects of prenatal breastfeeding counselling found that those who had received such counselling and chosen to formula-feed denied experiencing feelings of guilt. Women were equally comfortable with their subsequent choices for feeding their infant regardless of whether they had received encouragement to breastfeed.{{sfn|Lawrence|Lawrence|2015|pp=210—211}}

Preventing a situation where women are denied agency or stigmatized for formula use is also seen as important. In 2018, in the UK, a policy statement from the [[Royal College of Midwives]] said that women should be supported and not stigmatized, if  after being given advice and information, they choose to formula feed.<ref>{{cite news |title=Bottle feeding is a woman's right, midwives told |url=https://www.bbc.co.uk/news/health-44436686 |newspaper=BBC News |access-date=11 October 2018 |date=12 June 2018}}</ref>

=== Social marketing ===
Social marketing is a marketing approach intended to change people's behavior to benefit both individuals and society.<ref>{{cite web | url = http://www.thensmc.com/content/what-social-marketing-1|title=What is social marketing? {{!}} The NSMC|website=www.thensmc.com|language=en|access-date=27 November 2017}}</ref> When applied to breastfeeding promotion, social marketing works to provide positive messages and images of breastfeeding to increase visibility. Social marketing in the context of breastfeeding has shown efficacy in media campaigns.<ref>{{cite web | url = https://wicbreastfeeding.fns.usda.gov/ | title = Loving Support: Make Breastfeeding Work | publisher = United States Department of Agriculture | access-date = 28 November 2017 | archive-date = 1 December 2017 | archive-url = https://web.archive.org/web/20171201031414/https://lovingsupport.fns.usda.gov/ | url-status = live }}</ref><ref>{{cite web | url = http://texasmotherfriendly.org/ | title = Mother-Friendly Worksite Program | publisher = Texas Mother-Friendly Worksite Policy Initiative }}</ref><ref>{{cite web | url = https://www.fns.usda.gov/wic/fathers-supporting-breastfeeding | archive-url = https://web.archive.org/web/20170428070744/https://www.fns.usda.gov/wic/fathers-supporting-breastfeeding | archive-date = 28 April 2017 | url-status = dead | title = Fathers Supporting Breastfeeding | publisher = United States Department of Agriculture }}</ref><ref>{{cite web | url = http://www.bestforbabes.org/champions-for-moms/ | title = Champions for Moms | publisher = Best for Babes Foundation | access-date = 28 November 2017 | archive-date = 1 March 2018 | archive-url = https://web.archive.org/web/20180301042224/http://www.bestforbabes.org/champions-for-moms/ | url-status = usurped }}</ref><ref name="CDC_Breatfeeeing_Guide">{{cite journal | author = Center for Disease Control and Prevention | date=2013 | title = Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies|url=https://www.cdc.gov/breastfeeding/pdf/bf-guide-508.pdf | journal=US Department of Health and Human Services }}</ref><ref name="Wakefield_2010">{{cite journal | vauthors = Wakefield MA, Loken B, Hornik RC | title = Use of mass media campaigns to change health behaviour | journal = Lancet | volume = 376 | issue = 9748 | pages = 1261–1271 | date = October 2010 | pmid = 20933263 | pmc = 4248563 | doi = 10.1016/S0140-6736(10)60809-4 }}</ref>
Some oppose the marketing of infant formula, especially in developing countries. They are concerned that mothers who use formula will stop breastfeeding and become dependent upon substitutes that are unaffordable or less safe.<ref name="Moorhead_2007">{{cite news | url = https://www.theguardian.com/medicine/story/0,,2079757,00.html | title = Milking it | vauthors = Moorhead J | newspaper = The Guardian | date = 15 May 2007}}</ref><ref>{{cite news | url = https://www.theguardian.com/world/2013/feb/15/babies-health-formula-indonesia-breastfeeding | title = Baby health crisis in Indonesia as formula companies push products | archive-url =  https://web.archive.org/web/20160502150942/http://www.theguardian.com/world/2013/feb/15/babies-health-formula-indonesia-breastfeeding | archive-date = 2 May 2016 | url-status = dead | newspaper = The Guardian | vauthors = Williams Z | date = 15 February 2013 }}</ref> Through efforts including the [[Nestlé boycott]], they have advocated for bans on free samples of infant formula and for the adoption of pro-breastfeeding codes such as the [[International Code of Marketing of Breast-milk Substitutes]] by the [[World Health Assembly]] in 1981 and the Innocenti Declaration by WHO and UNICEF policy-makers in August 1990.<ref name="Moorhead_2007" />  Additionally, formula companies have spent millions internationally on campaigns to promote the use of formula as an alternative to mother's milk.<ref>{{cite journal | vauthors = Kaplan DL, Graff KM | title = Marketing breastfeeding – reversing corporate influence on infant feeding practices | journal = Journal of Urban Health | volume = 85 | issue = 4 | pages = 486–504 | date = July 2008 | pmid = 18463985 | pmc = 2443254 | doi = 10.1007/s11524-008-9279-6 }}</ref>  Giving out gift bags that contain infant formula to women as they leave the hospital is also a marketing strategy.  The U.S. Government Accountability Office has reported that women who receive formula samples at discharge are associated with lower breastfeeding rates than those who did not receive gift bags.<ref>{{cite web |title=Strategy 9. Addressing the Marketing of Infant Formula |url=https://www.cdc.gov/breastfeeding/pdf/strategy9-addressing-marketing-infant-formula.pdf |website=National Alliance for Breastfeeding Advocacy: Research, Education, and Legal Branch |access-date=14 January 2022}}</ref>

=== Baby Friendly Hospital Initiative ===
{{Main|Baby Friendly Hospital Initiative}}
The Baby Friendly Hospital Initiative (BFHI) is a program launched by the [[World Health Organization]] (WHO) in conjunction with [[UNICEF UK|UNICEF]] in order to promote infant feeding and maternal bonding through certified hospitals and birthing centers. BFHI was developed as a response to the influence held by formula companies in private and public maternal health care. The initiative has two core tenets: the Ten Steps to Successful Breastfeeding and the [[International Code of Marketing of Breast-milk Substitutes]].<ref>{{cite web |title=Revised Ten Steps to Successful Breastfeeding |url=http://www.tnpatientsafety.com/pubfiles/Initiatives/ADE/Medication%20Safety%20Webinar%20Series/Dr%20Morad%20BFTHA2018.pdf |website=Vanderbilt University Medical Center |access-date=29 July 2018 |archive-date=24 February 2021 |archive-url=https://web.archive.org/web/20210224235119/http://www.tnpatientsafety.com/pubfiles/Initiatives/ADE/Medication%20Safety%20Webinar%20Series/Dr%20Morad%20BFTHA2018.pdf |url-status=dead }}</ref> The BFHI has especially targeted hospitals and birthing centers in the developing world, as these facilities are most at risk to the detrimental effects of reduced breastfeeding rates. As of 2018, 530 hospitals in the United States hold the "Baby-Friendly" title in all 50 states. Globally, there are more than 20,000 "Baby-Friendly" hospitals worldwide in over 150 countries.<ref>{{cite web|url=https://www.babyfriendlyusa.org/find-facilities|title=Baby-Friendly USA|website=www.babyfriendlyusa.org|access-date=27 November 2017}}</ref>

=== Representation on television ===
The first depiction of breastfeeding on television was in the children's program ''[[Sesame Street]]'', in 1977.<ref name="Sen_2018">{{cite news | url = https://hazlitt.net/feature/short-lived-normalization-breastfeeding-television | title = The Short-Lived Normalization of Breastfeeding on Television | vauthors = Sen M |date=22 January 2018|work=Hazlitt|access-date=28 January 2018 }}</ref> With few exceptions since that time, breastfeeding on television has either been portrayed as strange, disgusting, or a source of comedy, or it has been omitted entirely in favor of bottle feeding.<ref name="Sen_2018" />

===Religion===
[[File:GhazanBeingBreastfed.jpg|thumb|[[Ilkhanate]] prince [[Ghazan]] being breastfed]]
{{See also|Milk kinship|Mahram}}
In some cultures, people who have been breastfed by the same woman are milk-siblings who are equal in legal and social standing to a consanguineous sibling.<ref>{{cite journal | vauthors = Altorki S | title = Milk-kinship in Arab society: An unexplored problem in the ethnography of marriage | journal = Ethnology | volume = 19 | issue = 2 | date = 1980 | pages = 233–244 | jstor = 3773273 | doi = 10.2307/3773273 }}</ref> Islam has a complex system of rules regarding this, known as ''[[Rada (fiqh)]]''. Like the Christian practice of [[godparent]]ing, milk kinship established a second family that could take responsibility for a child whose biological parents came to harm. "Milk kinship in Islam thus appears to be a culturally distinctive, but by no means unique, institutional form of adoptive kinship."<ref>{{cite journal | vauthors = Parkes P | title = Milk Kinship in Islam: Substance, Structure, History | journal = Social Anthropology | date = October 2005 | volume = 13 | issue = 3 | pages = 307–329 | doi = 10.1111/j.1469-8676.2005.tb00015.x }}</ref>

In [[Western world|Western]] countries, differences in breastfeeding practices have also been observed according to the affiliation or practice of [[Christianity|Christian]] religions; unaffiliated and [[Protestantism|Protestant]] women exhibit higher rates of breastfeeding.<ref>{{cite journal | vauthors = Bernard JY, Cohen E, Kramer MS | title = Breast feeding initiation rate across Western countries: does religion matter? An ecological study | journal = BMJ Global Health | volume = 1 | issue = 4 | pages = e000151 | date = November 2016 | pmid = 28588983 | pmc = 5321388 | doi = 10.1136/bmjgh-2016-000151 }}</ref><ref>{{cite journal | vauthors = Burdette AM, Pilkauskas NV | title = Maternal religious involvement and breastfeeding initiation and duration | journal = American Journal of Public Health | volume = 102 | issue = 10 | pages = 1865–1868 | date = October 2012 | pmid = 22897559 | pmc = 3490661 | doi = 10.2105/AJPH.2012.300737 }}</ref><ref>{{cite journal | vauthors = Stroope S, Rackin HM, Stroope JL, Uecker JE | title = Breastfeeding and the Role of Maternal Religion: Results From a National Prospective Cohort Study | journal = Annals of Behavioral Medicine | volume = 52 | issue = 4 | pages = 319–330 | date = March 2018 | pmid = 30084894 | doi = 10.1093/abm/kax013 }}</ref><ref>{{cite journal | vauthors = Bernard JY, Rifas-Shiman SL, Cohen E, Lioret S, de Lauzon-Guillain B, Charles MA, Kramer MS, Oken E | title = Maternal religion and breastfeeding intention and practice in the US Project Viva cohort | journal = Birth | volume = 47 | issue = 2 | pages = 191–201 | date = June 2020 | pmid = 31884716 | pmc = 7245542 | doi = 10.1111/birt.12477 }}</ref>

===Transgender women===
Milk production can be induced in transgender women by the use of hormone medications, although the volume of milk produced is too small to be used as a significant source of nutrition for an infant. In one case report, a transgender woman was able to produce 7 ml of milk per day with hormone treatment.<ref>{{Cite journal|title=Lactation induction in a transgender woman: case report and recommendations for clinical practice|first1=Jojanneke E.|last1=van Amesfoort|first2=Norah M.|last2=Van Mello|first3=Renate|last3=van Genugten|date=11 March 2024|journal=International Breastfeeding Journal|volume=19|issue=1|pages=18|doi=10.1186/s13006-024-00624-1|doi-access=free |pmid=38462609|pmc=10926588}}</ref>

== Workplace ==
[[File:Breastfeeding-icon-med.svg|thumb|left|The [[International breastfeeding symbol]]]]
Many mothers have to return to work a short time after their babies have been born.<ref name=Abd2012>{{cite journal | vauthors = Abdulwadud OA, Snow ME | title = Interventions in the workplace to support breastfeeding for women in employment | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | pages = CD006177 | date = October 2012 | issue = 10 | pmid = 23076920 | pmc = 7388861 | doi = 10.1002/14651858.CD006177.pub3 }}</ref> In the U.S. about 70% of mothers with children younger than three years old work full-time with 1/3 of the mothers returning to work within 3 months and 2/3 returning within 6 months.  Working outside of  the home and full-time work are significantly associated with lower rates of breastfeeding and breastfeeding for a shorter duration of time.<ref name=CDC2018Work>{{cite web |title=Support for Breastfeeding in the Workplace |url=https://www.cdc.gov/breastfeeding/pdf/BF_guide_2.pdf |website=CDC |access-date=19 September 2018}}</ref> 
According to the [[Centers for Disease Control and Prevention]], support for breastfeeding in the workplace includes several types of [[employee benefits]] and services, including writing corporate policies to support breastfeeding women; teaching employees about breastfeeding; providing designated private space for breastfeeding or expressing milk; allowing [[flextime]] to support milk expression during work; giving mothers options for returning to work, such as [[remote work]], [[part-time job]]s, and extended [[maternity leave]]; providing on-site or near-site [[child care]]; providing high-quality [[breast pump]]s; and offering professional [[lactation consultant]]s.<ref name="CDC2018Work" />

Programs to promote and assist nursing mothers have been found to help maintain breastfeeding.<ref>{{cite journal | vauthors = Dinour LM, Szaro JM | title = Employer-Based Programs to Support Breastfeeding Among Working Mothers: A Systematic Review | journal=Breastfeeding Medicine | volume=12 | issue=3 | pages=131–141 | date=April 2017 | pmid=28394659 | doi=10.1089/bfm.2016.0182 }}</ref> In the United States the CDC reports on a study that "examined the effect of corporate lactation programs on breastfeeding behavior among employed women in California [which] included prenatal classes, perinatal counseling, and lactation management after the return to work".  They found that "about 75% of mothers in the lactation programs continued breastfeeding at least 6 months, although nationally only 10% of mothers employed full-time who initiated breastfeeding were still breastfeeding at 6 months."<ref name="CDC2018Work" />

Section 4207 of the United States' [[Patient Protection and Affordable Care Act]] (2010) amended the [[Fair Labor Standards Act]] and required employers to provide a reasonable break time for an hourly employee to breastfeed a child if the child is less than one year old.<ref name="Breastfeedingauto13">{{Cite web|url=http://www.stlamerican.com/news/local_news/pregnant-nursing-mothers-gain-employment-rights-protection/article_1602aa98-9746-11ed-af78-f776ceb31c4a.html|title=Pregnant, nursing mothers gain employment rights protection|first=Alexa Spencer &#124; Word In|last=Black|website=St. Louis American|date=18 January 2023 }}</ref><ref name=ppaca>[http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3590enr.txt.pdf Patient Protection and Affordable Care Act]. ''Government Printing Office''. Page 459.</ref> The employee must be allowed to breastfeed in a private place, other than a bathroom. The employer is not required to pay the employee during the break time.<ref name=ppaca/> Employers with fewer than 50 employees are not required to comply with the law if doing so would impose an undue hardship to the employer based on its size, finances, nature, or structure of its business.<ref>{{cite news |title=Breastfeeding rooms hidden in health care law |work=CNN |date=April 9, 2010 |first=Elizabeth |last=Landau |url=http://www.cnn.com/2010/HEALTH/04/09/breast.feeding.society/index.html?hpt=C2 }}</ref>

A 2016 study found that federal policy does not address lactation space functionality and accessibility, policy only protects a subset of employees, and that the enforcement of the policy requires women to file a complaint with the United States Department of Labor. To address each of these issues, the report recommends additional requirements surrounding lactation space and functionality, mandated coverage of exempt employees, and a requirement that employers develop company-specific lactation policies.<ref name="Breastfeeding: The Illusion of Choi" /> As of 2019 the majority of women still did not have access to both accommodations. Working mother advocate and ''[[Entrepreneur (magazine)|Entrepreneur]]'' writer [[Christine Michel Carter]] documented her experience pumping in a bathroom while working for an employer violating the Fair Labor Standards Act.<ref>{{Cite web |last=Carter |first=Christine Michel |date=2019-04-19 |title=How I Got My Employer to Acknowledge My Nursing Issue |url=https://www.entrepreneur.com/leadership/how-i-got-my-employer-to-acknowledge-my-nursing-issue/332485 |access-date=2023-06-21 |website=Entrepreneur |language=en}}</ref>

In 2022 the Providing Urgent Maternal Protections for Nursing Mothers Act, also known as the PUMP Act, became law in the United States. It mandates that salaried workers who are breastfeeding must have break time and a private space that is not a bathroom. However, employers who do not have 50 or more employees do not have to follow this law if following it would create an undue hardship because of expense or difficulty.<ref>{{Cite web|url=https://www.jdsupra.com/legalnews/the-federal-government-says-mother-3697943/|title=The Federal Government Says, "Mother Knows Best": Expanded Protections for Pregnant and Nursing Workers Under Federal Law|website=JD Supra}}</ref><ref name="Breastfeedingauto13" />

In [[Canada]], [[British Columbia]] and [[Ontario]], provincial Human Rights Codes prevent against workplace discrimination due to breastfeeding.<ref name="infactcanada.ca">{{cite web | title = Sex discrimination – breastfeeding and expressing milk |url=http://www.infactcanada.ca/br_bc_humanrights.htm|archive-url=https://web.archive.org/web/20060203201947/http://www.infactcanada.ca/br_bc_humanrights.htm|url-status=dead|archive-date=3 February 2006| publisher = British Columbia Human Rights Commission |website=www.infactcanada.ca | date = 1 August 2000 }}</ref><ref>{{cite web | date = 29 October 2014  |url=http://www.ohrc.on.ca/en/policy-preventing-discrimination-because-pregnancy-and-breastfeeding |title=Policy on preventing discrimination because of pregnancy and breastfeeding | work = Ontario Human Rights Commission }}</ref> In British Columbia, employers are required to provide accommodation to employees who breastfeed or express breast milk. Although no specific requirements are mandated, under the Human Rights Code, accommodations suggested include paid breaks (not including meal breaks), private facilities that include clean running water, comfortable seating areas, and refrigeration equipment, as well as flexibility in terms of work-related conflicts.<ref name="infactcanada.ca" /> In Ontario, employers are encouraged to accommodate breastfeeding employees by providing additional breaks without fear of discrimination. Unlike in British Columbia, the Ontario Code does not include specific recommendations, and therefore leaves significant flexibility for employers.<ref>{{cite web|url=https://opha.on.ca/OPHA/media/Resources/Resource%20Documents/BreastfeedingFriendlyWorkplace-Sep08.pdf?ext=.pdf|title= Creating a Breastfeeding Friendly Workplace | publisher = Ontario Public Health Association | date = 2008 }}</ref>

== Research ==

Breastfeeding research continues to assess prevalence, HIV transmission, pharmacology, costs, benefits, immunology, contraindications, and comparisons to synthetic breast milk substitutes.<ref name="Kramer_2012" /><ref name="SahaRyan2015">{{cite journal | vauthors = Saha MR, Ryan K, Amir LH | title = Postpartum women's use of medicines and breastfeeding practices: a systematic review | journal = International Breastfeeding Journal | volume = 10 | issue = 1 | pages = 28 | year = 2015 | pmid = 26516340 | pmc = 4625926 | doi = 10.1186/s13006-015-0053-6 | doi-access = free }}</ref> Factors related to the mental health of the nursing mother in the perinatal period have been studied. While cognitive behavior therapy may be the treatment of choice, medications are sometimes used. The use of therapy rather than medication reduces the infant's exposure to medication that may be transmitted through the milk.<ref name="MarchesiOssola2016">{{cite journal | vauthors = Marchesi C, Ossola P, Amerio A, Daniel BD, Tonna M, De Panfilis C | title = Clinical management of perinatal anxiety disorders: A systematic review | journal = Journal of Affective Disorders | volume = 190 | pages = 543–550 | date = January 2016 | pmid = 26571104 | doi = 10.1016/j.jad.2015.11.004 | hdl = 11380/1120657 }}</ref> In coordination with institutional organisms, researchers are also studying the social impact of breastfeeding throughout history. Accordingly, strategies have been developed to foster the increase of the breastfeeding&nbsp;rates in the different countries.<ref>{{cite web|url=http://sior.ub.edu/jspui/cris/socialimpact/socialimpact00555|title=Improved breastfeeding rates. [Social Impact]. Improved breastfeeding rates through evidence-based guideline changes|publisher=SIOR, Social Impact Open Repository|access-date=5 September 2017|archive-date=5 September 2017|archive-url= https://web.archive.org/web/20170905143621/http://sior.ub.edu/jspui/cris/socialimpact/socialimpact00555 |url-status=dead}}</ref>

== See also ==

{{div col|colwidth=22em}}
* [[Baby-led weaning]]
* [[Breast shell]]
* [[Breastfeeding in public]]
* [[Breastfeeding promotion]]
* [[Child development]]
* [[Dairy allergy]]
* [[Breastfeeding and fertility]]
* [[Lactation failure (disambiguation)]]
* [[Lactation room]]
* [[Milk line]]
* [[Nursing chair]]
* [[Public health]]
* [[World Alliance for Breastfeeding Action]]
* [[Breastfeeding and mental health]]
*[[Breastmilk storage and handling]]{{div col end}}

== Sources ==
{{Free-content attribution
| title = The State of Food Security and Nutrition in the World 2024
| author = FAO, IFAD, UNICEF, WFP and WHO
| publisher = FAO
| documentURL = https://openknowledge.fao.org/handle/20.500.14283/cd1254en
| license = CC BY 4.0
}}

== References ==
{{reflist}}

== Bibliography ==
{{Scholia}}
{{refbegin}}
* {{cite book | vauthors = Durham R |title = Maternal-newborn nursing: the critical components of nursing care |publisher = F.A. Davis Company |location = Philadelphia |year = 2014 |isbn = 978-0-8036-3704-7 }}
* {{cite book | vauthors = Henry N |title = RN maternal newborn nursing : review module |publisher = Assessment Technologies Institute |location = Stilwell, KS |year = 2016 |isbn = 978-1-56533-569-1 }}
* {{cite book | vauthors = Davidson M |title = Fast facts for the antepartum and postpartum nurse : a nursing orientation and care guide in a nutshell |publisher = Springer Publishing Company, LLC |location = New York |year = 2014 |isbn = 978-0-8261-6887-0 }}
* {{cite book | vauthors = Lawrence RA, Lawrence RM |title=Breastfeeding: A Guide for the Medical Professional|url={{google books |plainurl=y |id=S6y6CgAAQBAJ|page=227}}|year=2015|pages=227–228|publisher=Elsevier Health Sciences|isbn=978-0-323-39420-8}}
{{refend}}

== Further reading ==
{{refbegin}}
* {{cite journal |last1=Azad |first1=Meghan B. |last2=Nickel |first2=Nathan C. |last3=Bode |first3=Lars |last4=Brockway |first4=Meredith |last5=Brown |first5=Amy |last6=Chambers |first6=Christina |last7=Goldhammer |first7=Camie |last8=Hinde |first8=Katie |last9=McGuire |first9=Michelle |last10=Munblit |first10=Daniel |last11=Patel |first11=Aloka L. |last12=Pérez-Escamilla |first12=Rafael |last13=Rasmussen |first13=Kathleen M. |last14=Shenker |first14=Natalie |last15=Young |first15=Bridget E. |last16=Zuccolo |first16=Luisa |title=Breastfeeding and the origins of health: Interdisciplinary perspectives and priorities |journal=Maternal & Child Nutrition |date=2021 |volume=17 |issue=2 |pages=e13109 |doi=10.1111/mcn.13109 |pmid=33210456 |doi-access=free |pmc=7988860}}
* {{cite journal |last1=Alimoradi |first1=Foad |last2=Javadi |first2=Maryam |last3=Barikani |first3=Ameneh |last4=Kalantari |first4=Naser |last5=Ahmadi |first5=Mohamad |title=An Overview of Importance of Breastfeeding |journal=[[Journal of Comprehensive Pediatrics]] |date=2014 |volume=5 |issue=2 |pages=e14028 |doi=10.17795/compreped-14028 |doi-access=free}}
* {{cite book | vauthors = Baumslag N, Michels DL |title = Milk, money, and madness: the culture and politics of breastfeeding |publisher = Bergin & Garvey |location = Westport, Connecticut |year = 1995 |isbn = 978-0-313-36060-2 }}
* {{cite book| veditors = Cassidy T, El Tom A |title=Ethnographies of Breastfeeding: Cultural Contexts and Confrontations|url={{google books |plainurl=y |id=acbuBQAAQBAJ}}|year=2015|publisher=Bloomsbury Publishing|isbn=978-1-4725-6926-4}} Scholarly essays on a variety of topics such as networks of milk sharing through Facebook, public-health guidelines on infant feeding and HIV in Malawi, and dilemmas involving breastfeeding and bonding for babies born from surrogate mothers.
* {{cite journal | vauthors = Halili HK, Che MN |title = Women's right to breastfeed in the workplace: legal lacunae in Malaysia |journal = [[Asian Women (journal)|Asian Women]] |volume = 30 |issue = 2 |pages = 85–108 |doi = 10.14431/aw.2014.03.30.2.85 |date = June 2014 }}
* {{cite book| vauthors = Hausman BL |title=Mother's Milk: Breastfeeding Controversies in American Culture|url={{google books |plainurl=y |id=h6TKAgAAQBAJ}}|year=2014|publisher=Taylor & Francis|isbn=978-1-135-20826-4}}
* {{cite journal |last1=Lucas |first1=Alan |title=Scientific Evidence for Breastfeeding |journal=Nestlé Nutrition Institute Workshop Series |date=2019 |volume=90 |pages=1–12 |doi=10.1159/000490290 |pmid=30865972|isbn=978-3-318-06340-0 }}
* {{cite journal |last1=Moore |first1=Mary Lou |title=Research Update: Current Research Continues to Support Breastfeeding Benefits |journal=[[Journal of Perinatal Education]] |date=2001 |volume=10 |issue=3 |pages=38–41 |doi=10.1624/105812401X88327 |pmid=17273265 |pmc=1595080}}
* {{cite journal |last1=Shamir |first1=Raanan |title=The Benefits of Breast Feeding |journal=Nestlé Nutrition Institute Workshop Series |date=2016 |volume=86 |pages=67–76 |doi=10.1159/000442724 |pmid=27336781|isbn=978-3-318-05482-8 }}
{{refend}}

== External links ==
{{Wiktionary}}
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{{Library resources box |by=no |onlinebooks=no |others=yes lcheading=Breastfeeding}}

* [https://web.archive.org/web/20061106095742/http://www.llli.org/resources.html Breastfeeding Resources] – La Leche League International (archived 6 November 2006)
* [https://www.who.int/topics/breastfeeding/en/ "Breast-Feeding Content Resources"] – WHO reports on Breast Feeding
* [https://www.nichd.nih.gov/health/topics/breastfeeding/Pages/default.aspx "Breastfeeding and Breast Milk"] – US National Institute of Health
* [https://www.cdc.gov/breastfeeding/index.htm Center for Disease Control and Prevention Breastfeeding]
* [https://www.bfmed.org/about Academy of Breastfeeding Medicine]
* [http://www.waba.org.my/ The World Alliance for Breastfeeding Action]
* [http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT LactMed] – a database of the safety of drugs to which breastfeeding mothers may be exposed by the [[US National Library of Medicine]]

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