Dr. Colin Michie has worked as a paediatrician in the United Kingdom, Africa, the Caribbean and the Middle East. He is specialised in nutrition, haematology and infectious diseases. Now the Associate Academic Dean for the American University of the Caribbean Medical School in St. Maarten, he has written this article with Nandi Hodge Mussington, a midwife from the Louis Constance Fleming Hospital in Marigot, St Martin.

Feeding your baby: Breast milk is all you need

Babies are special for many so many reasons. One of the joys that draw all of us to them is that this newborn person requires total care: he or she lacks skills. We are entranced as they change and grow. After 12 months, an infant is likely to be toddling and trying to communicate with everyone around them. This is brain development in action. This is what our species is good at.

The most rapidly growing part of an infant in the first year of life is the brain. Brain growth in the newborn period is one of the main differences between humans and primates. This growth requires special food: Mother’s milk. Some may think that it is normal to feed babies with formula milk, but this is second-best. Formula milk is prepared from cow’s milk. Calves do not demonstrate the massive brain growth seen in humans.

Mother’s milk has evolved over several hundreds of thousands of years to do this in our babies. The building blocks and growth factors for nerve cells, their insulation and their connecting synaptic links are all found in her milk. Further, the physical contact of mother and baby during feeding has significant benefits to both, and ensures the sharing of healthy microbes which also improve infant development.

But is breast milk really all that is needed for babies? Yes! We know this from studies across the world of many thousands of different mothers and babies over long periods of time. Breast milk certainly contains different proportions of some nutrients depending on where you live. Whether you nurse your baby in South Africa or Japan, breast milk reduces the risk of their death.

Last year, the World Health Organisation estimated that 823,000 infants under five years of age could have been saved around the world by improving breast-feeding practices (https://www.who.int/news-room/commentaries/detail/world-breastfeeding-week-2018). The patterns of baby growth predict brain performance and cardiac health. Breastfeeding protects infants from the risks of obesity, diabetes (both types 1 and 2) and high blood pressure. It sets babies up for long-term health benefits. 

At the same time, breast milk protects our rather helpless infants against infections in the gut, lungs and ears in particular. The risks of leukaemia in a baby are reduced by breastfeeding. The longer you feed your infant, the greater the protection, although the benefits become less for breast-feeding after the baby is a year of age. Milk is a live substance, which protects your infant. Protection given by human milk is like layers on an onion: There are many of them and milk is a food that is more than the sum of its parts. We do not yet fully understand all of its biological powers.

In the first few days of feeding, breast milk is full of cells and many protective factors – this milk is named colostrum. It is a living liquid. In Arabic, breast milk is referred to as “white blood” – a rather good name because of the cells and substances found in it. The cells include stem cells that help repair and develop baby’s tissues – how sophisticated is that! The milk includes mother’s antibodies that act a little like an antiseptic paint inside the baby. Importantly, human breast milk contains abundant signalling molecules too that regulate immunity throughout baby’s body.

Milk contains oligosaccharides. These differ from Mum to Mum, but are found in high levels in her milk. They improve gut function and prevent bacterial infections. Oligosaccharides are small: they get into the blood and so protect the infant from the inside – they reach the lungs, ears, brain and bladder to protect them. The molecules are also prebiotic. That is, they act as food for certain good bacteria that an infant requires in its bowel. These oligosaccharides are not found in cow’s milk.

As Edward Kofi Louis wrote:

Like a house without hands,

Give your baby breastmilk to keep the child healthy;

For out of the blessings of the Creator you've got this child.

The door is now open on you,

The truth is now set for you,

The care is now in your own hands,

But your child really needs this milk.

Protecting your infant is one thing, but as a nursing mother, your health is very important. It is not an accident that breastfeeding decreases a mother’s risk of post-partum depression, type 2 diabetes, breast cancer, ovarian cancer, and type 2 diabetes. Your health benefits from feeding your infant – six months to a year of breastfeeding is ideal.

Because breast milk is such a powerful protector of the health and lives of mothers and their infants, it follows that there is a responsibility for us all to support breastfeeding. By increasing the time mothers have to breastfeed their babies, we can reduce the numbers of cases of infection and cancer in those infants and their mothers. For this reason, a nursing mother in Europe is legally permitted an hour a day to feed her infant. If this is not possible, she can take time to express and collect milk, store this in a refrigerator and feed her infant with it later.

Milk can be kept for several days in a refrigerator and up to four months in a freezer. Would your workplace in St. Martin support your feeding an infant? What barriers are there to your returning to work and feeding your baby? These are important questions that should be addressed by all of us to be fair and promote health. At a more personal level, although breast-feeding is best, it not always easy for today’s mothers. A mother will dream and think about feeding her infant when she is pregnant.

Breastfeeding can be a challenge in the first weeks. How, when and where can she feed the baby? Who will give her good advice? An accoucheuse, feeding counsellor or a supportive midwife from a hospital may assist. There are many websites and some excellent phone apps too (https://www.bestbeginnings.org.uk/ with a telephone app called Baby Buddy, or http://www.mothering.com/articles/breastfeeding-champion-chele-marmet/). A relative may be practical. Will this support allow you to continue to feed your baby after one, two or four months? Do you need advice about feeing your baby if you have to go back to work? Who can do this? Clinics on the island are keen to help.

You will see many advertisements in all media relating to the benefits of formula feeding. Advertisements influence all of us. A major step was taken in the UK this week by the British Medical Journals. The publishers decided to stop advertising formula milk (http://www.babymilkaction.org/) – this represents an advance. Medical professionals should not promote these feeds in any way as the alternative of more breast milk for infants is so much healthier. Pregnant mothers need accurate information about feeding. They need help in the hospitals. They need support from fathers, grandparents, bosses, religious leaders, fellow workers, doualas, nurses and friends.

Breastfeeding is a valuable part of our community’s health; it is not a simple alternative to bottle feeding: it is an investment in the future. Our infants do not require cow’s milk when they are small. Breastfeeding mothers need education, support, help and encouragement. On a small island such as ours, we do not have many babies. Imagine what we might achieve! If it takes a village, St. Martin, let us be that village.

I will nurse her in my home,

I will nurse her when I roam.

Leave me be, lads; leave me be, ma’am.

I will nurse her; MOM I am.