Breastfeeding and work

Throughout times and all over the world women and mothers have worked and economies would collapse if the work of women was to stop being carried out.  What makes it different in our time and place is the fact that we separate mothers and children, more so, we exclude children almost completely from our societal view. Children are supposed to belong strictly to the private world and if they are taken out in the world, special services make sure they are kept out of the sight of adults and their attention as possible. For mothers who work outside of house this poses an extra problem. First, they will have to extract the feeding part from the breastfeeding relation, outsource the relation part, and collect the food in an alternative way. Next comes the even bigger problem that in our society we don’t want to be exposed to the knowledge that some women will have to bend themselves backwards and do odd things in order to take care of their children who are made invisible. Collecting the milk becomes, even if in our country in theory it’s legally taken care off quite nicely, a Hercules Task to perform in daily practice. Research all over the world shows that returning to work turns down duration and incidence of breastfeeding and the longer working hours, the less breastfeeding performed. Good counseling and preparation will help a bit, but what really does make a difference is a boss who cares and actively provides for a breastfeeding friendly work place. Companies that provide for a in-company lactation program will ensure more moms breastfeeding longer. Earlier research already showed that women who feel supported in their intention to breastfeed turn out to be more loyal and more reliable employees.
Mandal B, Roe BE, Beck Fein S: The differential effects of full-time and part-time work status on breastfeeding. Health policy (Amsterdam, Netherlands), 2010, 97(1):79-86.
Chao-Hua Chuang, Pei-Jen Chang, Yi-Chun Chen, Wu-Shiun Hsieh, Baai-Shyun Hurng, Shio-Jean Lin, Pau-Chung Chen: Maternal return to work and breastfeeding: A population-based cohort study. International journal of nursing studies, 2010, 47(4):461-474.
Ortiz J, McGilligan K, Kelly P: Duration of Breast Milk Expression Among Working Mothers Enrolled in an Employer-Sponsored Lactation Program. PEDIATRIC NURSING, 2004, 30(2)

Formula marketing: Misguidance or exemplary?

Pregnant women and new moms are the target public for infant formula manufacturers and their marketing will thus be found were they come, look and read. (In The Netherlands marketing for breastfeeding substitutes up to 6 months is legally prohibited, but advertising #2 formulae towards the same public does the trick as well.) Stang et al studied the tools used in advertisements to sell their products. Often these turned out to be health claims: this or that formula brand will ensure better brain development or eyefunction, less tummy problems or decreases allergies. Stacks of research already exist to deny all those claims: formula always scores lower on the healthoutcomes than breastfeeding and the differences between brands are marginal.
Another disturbing development is the increasing offer of breastfeeding hotlines by formula manufacturers. This is expecially dangerous because it will create a ‘’feel-good’’ attitude of mothers towards the manufacturers: don’t they themselves admit that breast is best; even better than their own products?
With the WBW 2011 theme in mind it might be a good idea for people who want to positively communicate breastfeeding to take a look in the breastfeeding substitute marketeers’ kitchens. To allow breastfeeding it deserves, that the health of children and women deserves, we might want to exercise the same utterly successful method of communication.
Stang J, Hoss K, Story M: Health Statements Made in Infant Formula Advertisements in Pregnancy and Early Parenting Magazines. ICAN: Infant, Child, & Adolescent Nutrition  February 2010   vol. 2  no. 1  16-25
http://tumblingboobs.tumblr.com/post/1065910428/its-not-just-parenting-websites-promoting-similacs
http://dou-la-la.blogspot.com/2010/09/breast-is-best-sponsored-by-simfamil.html
http://www.borstvoeding.com/columns/een-kijkje-in-de-keuken.html

WABA Announces the WBW 2011 Theme

Taken from http://www.worldbreastfeedingweek.org/:

WABA is pleased to announce the World Breastfeeding Week theme for 2011 focusing on engaging and mobilising youth intergenerational work with the catchy slogan of: "Talk to me! Breastfeeding - a 3D Experience". The theme deals with communication at various levels and between various sectors.
Why 3D?
When we look at breastfeeding support, we tend to see it in two-dimensions: time (from pre-pregnancy to weaning) and place (the home, community, health care system, etc). But neither has much impact without a THIRD dimension – communication!
Communication is an essential part of protecting, promoting and supporting breastfeeding. We live in a world where individuals and global communities connect across small and great distances at an instant’s notice. New lines of communication are being created every day, and we have the ability to use these information channels to broaden our horizons and spread breastfeeding information beyond our immediate time and place to activate important dialogue.
This third dimension includes cross-generation, cross-sector, cross-gender, and cross-culture communication and encourages the sharing of knowledge and experience, thus enabling wider outreach.

Breastfeeding, pain and bonding

Maternal response towards infant distress has an important impact on infant development. In animals it is established that lactation and pup suckling plays an important role in maintaining maternal responses. Pearson et al observed both breast and formula feeding women and found that those who breastfeed were more attentive towards their children’s distress than their formula feeding counterparts. This difference was not clear in testing prior to delivery in women choosing to start breast or bottle feeding. The authors presume therefor that is the act of breastfeeding that changes the maternal behavior, not the intention to start breastfeeding after birth. From  an evolutionary point of view this is an important piece of knowledge and one may presume that such important behavior is not easily undermined. Yet many women in the qualitative study Kelleher carried out report moderate to severe pain and discomfort during breastfeeding, sometimes to the extend of wishing to stop breastfeeding or feeling a negative effect on their bonding experience. Based on the knowledge that breastfeeding is so important for both the physical ande the psychological health of child and mother one can state that the experience of so much pain and discomfort in so many women should be unusual. One may even wonder if something is wrong with the way women are taught to breastfeed. 
Pearson RM, Lightman SL, Evans J: The impact of breastfeeding on mothers' attentional sensitivity towards infant distress. Infant Behavior and Development, In Press, Corrected Proof, Available online 24 December 2010, ISSN 0163-6383
Kelleher CM: The physical challenges of early breastfeeding. Social Science & Medicine, 2006, 63(10):2727-2738.

Osteoporosis

It has been since long assumed that pregnancy and lactation are detrimental to the bone density in women. Apart from the obvious un-logic of this assumption (the survival of the species to be detrimental to the individuals assigned to implement said survival) research shows the assumption to be false. Women who have been pregnant and have been lactating have bone densities similar to or even higher than women who did not do so.  In Japan Kurabayashi et al studied the course of changes in bone mineralization in pregnant and lactating women up to 5-10 years postpartum. Thy found a decrease in bone density towards the end of pregnancy and during lactation, but an increase up to starting levels or more around the time of weaning. These levels stayed at a stable level in the subsequent years. Women with low bone density to start with did not get better levels through lactation. Karlsson et al in Sweden did similar research and found a 5% decrease in bone mineralization during pregnancy and lactation, but were unable to put this onto the account of pregnancy and lactation per se, as too many factors play their roles in the total picture. The acknowledge previous findings of increase bone density up to normal levels after weaning and concur with conclusions that multiple pregnancies and prolonged breastfeeding pose no increased risk for osteoporosis.
Kurabayashi T, Tamura R, Hata Y, Nishijima S, Tsuneki I, Tamura M, Yanase T: Secondary osteoporosis UPDATE. Bone metabolic change and osteoporosis during pregnancy and lactation. Clin Calcium. 2010 May;20(5):672-81.
Karlsson MK, Ahlborg HG, Karlsson C: Pregnancy and lactation are not risk factors for osteoporosis or fractures. Lakartidningen. 2005 Jan 31-Feb 6;102(5):290-3.
Lenora J, Lekamwasam S, Karlsson MK: Effects of multiparity and prolonged breast-feeding on maternal bone mineral density: a community-based cross-sectional study. BMC Womens Health. 2009 Jul 1;9:19.

Ear infections

Next to offering a child all nutrition in the right amounts and balance it needs for healthy growth and development, human milk is filled up with factors that protect a child for, amongst others, all kinds of infections. Infections of the respiratory tract and the ears are being protected by human milk and breastfeeding in multitude ways, including avoidance of irritating substances (because human milk is a substance that is recognized as its own by the baby’s body and thus is not an irritant to the lungs), the avoidance of exposure to allergens, and the active local attack to pathogens. Otitis media is seen more often in children who are fed by bottle and in lying posture (Mumtaz et al 2009). Ladomenou et al found in their well-designed study thet the protection breastfeeding offers is seen primarily in children who are according to WHO directions exclusivelu breastfed for 6 months.
Ladomenou F, Moschandreas J, Kafatos A, Tselentis Y, Galanakis E: Protective effect of exclusive breastfeeding against infections during infancy: a prospective study. Arch Dis Child archdischild 2010, doi:10.1136/adc.2009.169912
Mumtaz Y, Habib F, Jahangeer A, Habib A: DETERMINANTS OF ACUTE OTITIS MEDIA IN INFANTS. JDUHS 2009, Vol. 3(1): 10-15

Diabetes

Type1 Diabetes is an autoimmune disease where the function of insulin release is impaired by damage to the Langerhans Islets. Multiple theories try to explain how this happens, including the hypothesis that in infants who have to put too much strain while defecating damage will be done to the pancreas innervation. Exposure to infant formula and/or too early introduction of cow’s milk can cause obstipation and thus the need to use too much pressure to move stools (Quinn, 2010). In their study aimed at finding out what environmental factors predict prediabetes among school-aged children Skrodenienė c.s. found that along with intake of medicine during pregnancy, and indoor smoking of family members, early introduction of cow’s milk and cereal, are risk factors that predict the development of prediabetes among Lithuanian children. Preventing the use of mediction during pregnancy as much as possible and banning smokers from the child’s living envornment and to strive for an adequate duration of exclusive breastfeeding (6 months according to WHO) might protect children from developing Type 1 Biabtes during childhood.
Quinn MJ: Diabetes, diet and autonomic denervation. Medical hypotheses 1 February 2010, 74(2):232-234.
Skrodenienė E, Marčiulionytė D, Padaiga1 Z, Jašinskienė E,
Sadauskaitė-Kuehne V, Ludvigsson J: Environmental risk factors in prediction of childhood prediabetes. Medicina (Kaunas) 2008; 44(1)

SIDS

Human infants are not made to be alone. Their vital functions need human company to keep on track and the need for frequent feeding necessitates the constant proximity of their mothers as source of food. Yet, almost everywhere in the industrialized world parents are advise to leave their children alone to sleep. Isn’t it strange to put a child in a cot to prevent *cot*death?  Despite the sometimes aggressive information campaigns to not co-sleep parents do take their children in their beds, but not always in a safe way. If implicated safely, co-sleeping is not risk-increasing; it increases breastfeeding. Breastfeeding is a major protective factor for SIDS. As far ago as 1993 Ford et al found a significant reduction in SIDS in breastfed children, as compared to formula fed children, even after correcting for confounding factors. These results were repeated by the German GeSID Study Group (Vonnemean et al 2009). They found that children who were not breastfed had a doubled risk of dying of SIDS and they strongly recommend to prominently include breastfeeding as a preventive measure for SIDS.
McKenna JJ, McDade T: Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatric respiratory reviews, 2005, 6(2):134-152
Ford RPK, Taylor BJ, Mitchell EA, Enright SA, Stewart AW, Becroft DMO, Scragg R, Hassall IB, Barry DMJ, Allen EM, Roberts AP: Breastfeeding and the Risk of Sudden Infant Death Syndrome Int. J. Epidemiol. (1993) 22(5):885-890
Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Yucesan K, Sauerland C, Mitchell EA en de GeSID Study Group: Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome? Pediatrics 2009 123: e406-e410

Consequences of not breastfeeding

Freedom of choice is great good, which should be protected at all times. Still, parents have added responsibilities when their choices affect their children’s health and well-being. Infant feeding, both contents and way of delivery, is one of those not so free choices, as this will have influence on the child’s health and development. Non-breastfed children have increased risks of illness right now and later on in life. Where in the early days of breastfeeding research the protection from infection was thought to be mainly a concern in circumstances with no clean water, bad sanitary conditions and low standard healthcare, more recent research keeps endorsing again and again that in well-equipped societies children who are not breastfed will suffer more infections. Ladomenou and colleagues for instance found that exclusively breastfed infants have far less episodes of infections and the infections they do get are less severe. Bartick & Reinhold calculated that if 90% of USA children would be exclusively breastfed (as recommended by WHO, governments and many physicians associations), health care costs in the USA would drop by $13 billion a year and 911 lives, mostly children’s, would be saved annually. European breastfeeding statistics don’t that much from those in the USA, so it is valid to assume that in our country as well probably children do die for not being breastfed.
Bartick M, Reinhold A: The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. Pediatrics 2010 125: e1048-e1056
Ladomenou F, Moschandreas J, Kafatos A, Tselentis Y, Galanakis E: Protective effect of exclusive breastfeeding against infections during infancy: a prospective study. Arch Dis Child archdischild 2010,

Earlier, later – just in time!?

The breastfeeding world was startled by an article in The Guardian, discussing an article in the authorative British Medical Journal. The researchers state in this article that the worldwide advice to delay the introduction of solids to 6 months at minimum is wrong. Extensive review of the literature leads to a more of certain allergic symptoms if solids are not introduced before the age of 6 months, according to the researchers, who as adamantly deny any influence on their opinion from the connection more than half of them have with the jarred baby-food industry. Opposite to the European guidelines that solids are to be introduced only from the age of 6 months, many jars with fruit of vegetable mush are labeled as suitable from 4 months. (Also  in contradiction with European guidelines in many European countries solids are introduced as early as 4 or even 3 months of age. Formula fed children will receive solids at average a month before breastfed children, Belgian children the earliest of all. Most at risk for too early introduction to solid food are those whose mothers are young or from a low socio-economic status or who smoke.) The emphasis of researchers on the onset of allergies in order to decrease the age of introduction of solids is not to be compared to the vast risks of early introduction of solids, or rather early sessation of exclusive brestfeeding. For instance, early introduction of solids is strongly liked to later overweight and the risk to get some types of cancer rise with the decrease of months of exclusive breastfeeding.
Fresh review of evidence contradicts WHO guidance leaving campaigners outraged and mothers baffled
Boseley S: Six months of breastfeeding alone could harm babies, scientists now say. The Guardian, 14 January 2011
Seach KA, Dharmage SC, Lowe AJ, Dixon JB: Delayed introduction of solid feeding reduces child overweight and obesity at 10 years. Int J Obes, 2010, http://dx.doi.org/10.1038/ijo.2010.101
Schiess S, Grote V, Scaglioni S, Luque V, Martin F, Stolarczyk A, Vecchi F, Koletzko B, for the European Childhood Obesity Project: Introduction of Complementary Feeding in 5 European Countries. JPGN 2010, 50(1):92–98

Pre- and postnatal influences on metabolism and weight

According to research done by Aaltonen et al, the feeding pattern during pregnancy and the kind of infant food are both factors in metabolic health at age 6 months. Children of mothers who received prenatal food counseling and probiotic supplements and children who were breastfed showed better metabolic health when compared to children of mothers who did not receive the extras during pregnancy and formula fed infants. A healthy metabolism ensures good food processing and a balance between energy intake and use. This is why metabolism is a factor in weight gain. Many researchers claim that breastfeeding is an important factor in later overweight issues. Indeed, infant feeding and health of weight are strongly connected, but other factors play important roles as well, like maternal and paternal weight, parental smoking, birth weight and rapid weight gain in the early stages of infancy, socio-economic characteristics of the family, family size, and later on the amount of waking time spent in sedentary activity. Next to infant feeding the dietary habits of the family are an important factor, Butte in his study, however, concludes that infant feeding practices may form a solid basis for futher positive factors.
Aaltonen J,  Ojala T, Laitinen K, Poussa T, Ozanne S, Isolauri E: Impact of maternal diet during pregnancy and breastfeeding on infant metabolic programming: a prospective randomized controlled study. Eur J Clin Nutr 2011, 65(1):10-19
Butte NF: Impact of Infant Feeding Practices on Childhood Obesity J. Nutr. February 2009 139(2):412S-416S

Parenthood

Parenthood is an innate function of reproducing humans. A stabile relation with the biological father of the child has been evolutionary profitable for mothers and children. Quinlan & Quinlan found in their studies a strong relation between the bond in biological parents and the duration of breastfeeding, independent from the ability of the mother to secure support of female kin. Allo-parenting is good for the health of offspring, because it extends the protection breastfeeding offers. The total mean duration of breastfeeding amongst humans, however, is much shorter than what is to be expected when compared to that of our closest related other primates. Obviously earlier weaning provided an evolutionary profit above breastfeeding until the age of eruption of permanent teeth. According to Kennedy this probably has a relation to the development of the brain being served better by a higher protein adult diet. Sellen adds, that it may be a flexibility in adjusting the duration of lactation to meet both infant and maternal needs, whichever needs protection most in the survival of the species.
Quinlan R, Quinlan M: Human Lactation, Pair-bonds, and Alloparents. 2008, 1991):87-102.
Kennedy GE: From the ape's dilemma to the weanling's dilemma: early weaning and its evolutionary context. Journal of Human Evolution, 2005, 48(2):123-145.
Sellen DW: Evolution of Infant and Young Child Feeding: Implications for Contemporary Public Health. Annual Review of Nutrition, 27:123 -148

Fatherhood

When discussing pregnancy, birthing and breastfeeding most often the focus is on women and children. Fathers tend to be at best at the edges of the picture. Traditionally this are pure female business and only for the last few generations fathers want or are supposed to be involved. Partners who actively want to build on their paternal role, will have to form a bond with their child, but often they feel this is hindered by breastfeeding. On the other hand, supporting an promoting breastfeeding is seen as an important fathers’ role. Qualitative research performed by Cleide et al in Brazil showed that although fathers may feel quite ambivalent and even tuned out of the mother and child relation, they do have ideas on how to participate and build their paternal role. They suggested being more involved in pregnancy and childbirth, creating a supportive environment for mother and child and being around when mother breastfeed their child. The American fathers in the rempel & Rempel study came to the same conclusions, but added that in order to activel support breastfeeding they needed to become breastfeeding-wise. A large quantitative study amongst over 50,000 Swedish fathers showed that  having a job and being in the more financially privileged part of society as well as using paternity leave were important factors in prediction breastfeeding duration.
Flacking R, Fiona Dykes F, Ewald U: The influence of fathers’ socioeconomic status and paternity leave on breastfeeding duration: A population-based cohort study. Scand J Public Health, 2010 38: 337-343
Cleide M. Pontes CM, Mônica M. Osório MM, Aline C. Alexandrino AC: Building a place for the father as an ally for breast feeding. Midwifery, 2009, 25(2):195-202
Rempel LA, Rempel JK: The Breastfeeding Team: The Role of Involved Fathers in the Breastfeeding Family J Hum Lact 0890334410390045, first published on December 20, 2010

Motherhood

Women are born with all tools, instincts and possibilities to develop skills to become and be a mother. For ages and ages the blueprint has been improved to guarantee that the vast majority of women is capable to conceive, carry, birth and nurture her offspring into independance. The blueprint, however, does not include the need to actually do this all by herself. DaSilvas’ research shows that very early in human development newborns are much bigger than newborns of comparable primates. The benefits of being born bigger apparently outweigh the downsides of having to carry and feed a very big child. Having big children probably was the reason that humans needed to practice allo-parenting (parenting not by just one parent, but by more members of the social group together) quite early in human development. In cultures where this still is the cultural norm postpartum depression is a rare occurrence, according to Kendall-Tackett. These mothers get help with feeding and nurturing their newborns and with other tasks in the postpartum period.
Kendall-Tackett K: How Other Cultures Prevent Postpartum Depression; Social Structures that Protect New Mothers’ Mental Health. http://www.uppitysciencechick.com/how_other_cultures.pdf
Kendall-Tackett K: A new paradigm for depression in new mothers: the central role of
inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. International Breastfeeding Journal 2007, 2:6.
DeSilva JM: A shift toward birthing relatively large infants early in human evolution. Biological Sciences - Anthropology. PNAS published ahead of print January 3, 2011, doi:10.1073/pnas.1003865108

Mothers’ Milk

For the large majority of children breastfeeding is right choice for feeding and nurturing. For some children direct breastfeeding is (as of yet) not possible. Mothers will have to express their milk for those children in order to be able to feed them. Milk expression can be done by hand, by a manual operated breast pump or an electric breast pump. Ohyama et al studied 11 women who alternated between manual and electric expressing for the first 48 hours after the birth of their premature babies. Hand expression yielde an average of 2 ml per session and electric pumping just above a half milliliter. These seemingly small amount fit just within the observation Santoro et al made in their study of milk intake of exclusively breastfeeding healthy term newborns. They had an average intake of 15ml (plus or minus 11ml) per day, had between 2 and 5 nursing session in each 8 our period and the amount per feeding did not increase over these first 24 hours. Morton c.s. found that mothers who combine manual techniques with electric pumping and found an increase in total milk volume in comparison to only electric pumping. Morton continued following the research subjects and found that mothers who had used hand techniques at least 5 times a day in the first 3 days yielded substantially more milk at 8 weeks (a mean of 829ml without and 955ml with hand techniques in the first days).
Ohyama M, Watabe H, Hayasaka Y: Manual expression and electric breast pumping in the first 48 h after delivery.  2010, 52(1):39-43
Walter Santoro W, Francisco Eulógio Martinez FE, Rubens Garcia Ricco RG, Salim Moysés Jorge SM: Colostrum Ingested during the First Day of Life by Exclusively Breastfed Healthy Newborn Infants. The Journal of pediatrics, 2010, 156(1):29-32
Morton J, Hall J, Wong RJ, Thairu L, Benitz WE, Rhine WD: Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol, 2009, 29(11):757-764

Tongue Tie

The tongue is hold onto its place with a small string of connective tissue to prevent it from sliding into the throat. According to the human blueprint thid frenulum needs to be just about long enough to keep the tongue in place without restriction of movement in all three dimensions. This freedom of movement is needed for food handling, breathing and talking. The development of the oral cavity, the palate and the gums with the set of teeth as well is influenced by the movements of the tongue. In some children the frenulum happens to be too short, too tight or too thick for full functionality. A simple clip will in almost all cases suffice to restore full function, without causing pain and with hardly any bleeding. Against all odds universally physicians are hesitant or even frantically opposed to perform this small intervention that can easily be done in the office without anesthesia. Because of the lack of research doctors may have the impression that indication for frenotomy is difficult and not very nessecary. However, in the research that is done no adverse effects have been reported and in most cases a immediate positive effect on the functionality is noted. The best indication for clipping the frenulum is when its form, size or density decreases or prohibits its function in suckling or in transferring milk and/or if it causes nipple trauma to the mother
Suter VG, Bornstein MM: Ankyloglossia: facts and myths in diagnosis and treatment. J Periodontol. 2009;80(8):1204-19.
Geddes DT, Langton DB, Gollow I, Jacobs LA, Hartmann PE, Simmer K: Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics. 2008;122(1):e188-94.
Cho A, Kelsberg G, Safranek S: Clinical inquiries. When should you treat tongue-tie in a newborn? J Fam Pract. 2010;59(12):712a-b.
Frenulum expert:
http://www.brianpalmerdds.com/frenum.htm
frenulum clipping instructions:
http://www.borstvoeding.com/kindjeaandeborst/kraamtijd/knippen-van-een-te-kort-tongriempje.html

Breast cancer

Asking mothers why they choose to breastfeed their children most answers will be oriented to the health and well-being of their child. But for mom as well breastfeeding is profitable. The uterus will more easily return to its pre-pregnant state and the fat stores aid for breastfeeding during pregnancy will melt away as if by itself and even in the long-term mom’s health prognosis is better. Researchers have found independently that the lifetime amount of months spent breastfeeding is a strong predictive factor for breast cancer risk. De Silva et al (2010) noted that for each 12 months added to total life-time breastfeeding duration breastfeeding risk was strongly reduced: 12-23 months – 66%, 24-35 months – 87%, and 36-47 months -94%. A mean of at least a year breastfeeding per child also showed significant decreased risk. The researched warn that passive smoking increases breast cancer risk. Awatef c.s. (2010), too, noted a significant association with both life-time breastfeeding total as mean breastfeeding duration per child. They showed a significant decrease of risk for both pre- and postmenopausal breast cancer in women who breastfed for 73-108 and more than 108 months. In this study the protective effect was stronger for total life-time months of breastfeeding then for mean duration per child.
De Silva M, Senarath U, Gunatilake M, Lokuhetty D: Prolonged breastfeeding reduces risk of breast cancer in Sri Lankan women: A case-control study. Cancer Epidemiology, 2010, 34(3):267-273
Awatef M, Olfa G, Imed H, Kacem M, Imen C, Rim C, Mohamed B, Slim B: Breastfeeding reduces breast cancer risk: a case–control study in Tunisia. Cancer Causes and Control, 2010, 21(3):393-397.

Primum non nocere

The development in modern medicine and nursing sciences is such that it led to a primarily intervention centered mind set. Symptom  intervention  recovery is the underlying thought. Often it seems that in thinking so the knowledge that symptoms are not the disease, but rather one of the forms a disease or conditions shows is lost out of sight. A major symptom that is looked upon with this point of view is pain. Pain currently is seen as primarily unwanted and is to be eliminated ASAP if not avoided completely to start with. Birthing pain was for centuries seen as inevitable and women learned themselves and each other to cope with it and use it as a means to evaluate the course of labor and delivery. Veringa & van Cranenburgh (2010) state in their essay that amongst other things pain can force significant behavior and influence physiology. Neglecting or even rigorous elimination of this pain may lead to violation of the first adagio of medical practice: primum non nocere (first, do no harm). In breastfeeding, too, pain is often viewed as a standalone problem and symptom-solving pin management seen as the answer. Ointments and covers are pulled out when nipples are hurting and medications for breast inflammation. But a hurting nipple hurts and will continue to hurt unless the cause of it is taken away, no matter how much cream is rubbed in and how many shields are applied. And unless the cause for pain in the breast is taken away, after an apparent recovery following antibiotics the pain will return and more harm than good is done.
Veringa I, van Cranenburgh B: Baringspijn is er niet voor niets. Medisch Contact 2010, 36:1734-1737