I’m going to start with a question.

What are the most common fears couples report when they discover they are about to become parents?

The first worry many people will admit to having is…the sleepless nights.

We’ve all heard the horrific stories of our friends who had babies before us; we’ve all seen the movies…

So let’s start here.

What does the research tell us about the dreaded nights?

Well breastfeeding - contrary to what many people believe - has actually been linked with easier nights.

In fact, it has been shown that breastfeeding can improve not only the quality of sleep but also its overall duration of it (1)(2).

Despite mothers waking more often to their infant’s nighttime signal, they tend to have shorter awakenings while also being able to fall back to sleep more rapidly when compared to non-breastfeeding mothers (3)(4).

Curiously, although maternal sleep efficiency predicts postnatal depression (5) the frequency of infant nocturnal signaling does not (6).
This means that it’s not about how many times you actually wake up during the night but of what you’re doing when you’re up.

But it’s pretty intuitive, if you think about it. Try comparing grabbing your baby (possibly within arm’s reach) and pulling up your shirt with sterilizing, boiling, measuring, mixing and cooling - all the while holding a screaming baby at 4 am.

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I’m just gonna throw here a link for the World Health Organization’s recommendation on how to correctly prepare formula, as I recently learned that I myself did it all wrong.

https://iris.who.int/bitstream/handle/10665/43659/9789241595414_eng.pdf?sequence=1

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So, what other situations are the parents-to-be usually scared about?

The germs!

The permanent runny noses and coughs and diarrheas and whatnot.

Well, when it comes to infectious diseases the evidence is simply overwhelming and it has been there for decades, actually.

There are at least 66 different papers, including three randomized controlled trials, that show that breastfeeding protects against diarrhea and common respiratory infections (7).
And not just slightly: we’re talking about half of all diarrhea episodes and a third of respiratory infections that would be avoided by breastfeeding (7).

This feeding method is also protective against otitis, a simple yet very painful condition that still affects too many kids (8).

In so-called “pre-term babies” breastmilk can literally be life-saving when it comes to preventing NEC (Necrotizing Entercolitis), a devastating condition that can sometimes affect babies who were born before their time(9).

Breastfeeding also cuts the risk of Sudden Infant Death Syndrome (SIDS), commonly known as "cot death," in half. (10)

- This post is admittedly a bit morbid, I know, but these things need to be said! -

Everyone has a right to know that the feeding method they choose has the potential to literally save lives; with exclusively breastfed infants having only 12% of the global risk of death compared with those who were not breastfed (11).

The reason I’m writing with such emphasis today is because yesterday I came across an article on the Guardian about a woman who claimed to have regained her libido after stopping breastfeeding…and I just find it so frustrating to see how easily the importance of breastfeeding can be undermined.

Not to say libido is less important, to the contrary. It’s just simply inaccurate to imply that interrupting breastfeeding will boost your libido. Plus, I also want to add, libido can effectively be assessed and eventually treated while breastfeeding; there’s no need to infer that the two matters are mutually exclusive.

Things can just be approached more thoughtfully.

Anyway, back to my ode on the benefits of breastfeeding to lift my spirits.

So the leading causes of death globally are cardiovascular diseases and cancer (12).

And this is where breastfeeding, to me, almost seems magical…

It lowers the chance of both cancer AND cardiovascular diseases in both the baby AND the mother!!!

One intervention, two people benefiting from it, on many levels. I mean, what’s more efficient than this?

Children of breastfed babies are less likely to become overweight or obese (13), and mothers who breastfeed show lower rates of both cardiovascular diseases and type 2 diabetes(11)(14).

Based on current meta-analyses results, 14% to 19% of all childhood leukemia cases, one of the most common cancers of the pediatric age, may be prevented by breastfeeding for 6 months or more (15). In the mother it lowers the chance of breast and ovarian cancers (16).

It’s hard to believe all of this is true, right?
I mean it’s not something that you hear everyday.

This field is still heavily overlooked even by health professionals …to the point that in the protocol published by the National Health Authority of Portugal (DGS) in 2021 on strategies to reduce the rates of cancer in the population breastfeeding was not even mentioned (17).

So all the scientists worldwide who have probably devoted their entire life to proving the protective effect of breastfeeding on various cancers …well, they can just screw themselves, I guess.

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Anyways, to end on a lighter note, I want to tell you about one of my favorite fun facts about breastfeeding.

It’s about an article published n 2015 on the Lancet, one of the most influential medical journals (18).

Basically, exactly 42 years ago, in 1982, a group of researchers went to five different maternity hospitals in Pelotas, a city in Brazil, and interviewed 5914 mothers who had just given birth to healthy babies.

Their newborns were included in the study as participants.

Many pieces of information about the dyad were recollected by trained professionals. Types of delivery, smoking habits during pregnancy, pre-pregnancy body mass index, maternal age but also family income, maternal education, maternal IQ and many other facts were recorded.

Information about the feeding method of the participants (breastfeeding VS formula) was collected at various moments months (and in some cases years) later.

30 years laters: 3493 participants (68% of the initial ones) were interviewed and subjected to cognitive testing (IQ test).

The researchers checked, through thorough statistical analysis, that those factors mentioned earlier (p.e. maternal IQ or method of delivery) did not influence the outcome they observed.

Which was, guess…participants who were breastfed for 12 months or more had significantly higher IQ scores (!!!) along with more years of education and higher monthly incomes than did those who were breastfed for less than 1 month.

Isn’t this astonishing?

Breastfeeding can make your kids smarter and give them a brighter future!

And mind that this is not the only study that has shown this (19), one study can even proudly declare to have included 13.889 participants (20)!

How are all these miracles possible on a biological level?

There are many articles (every day more :D ) and books written on the subject, but I’ll try to sum up the most important factors.

Breastfeeding does wonders for health through various routes, some related to the composition of breastmilk while others due to the behaviors associated with breastfeeding. (7).

Breastmilk contains substances with antimicrobial and immunological properties including anti-inflammatory factors, hormones, digestive enzymes and growth modulators that protect against infections (21).

Breastfeeding also provides long-chain polyunsaturated fatty acids and other essential nutrients crucial for brain development. These nutrients might influence how the body responds to insulin and stores fat, potentially linking breastfeeding to longer-term outcomes like obesity, diet-related diseases, and IQ (22). Differing levels of protein intake and taste preferences among breastfed children may also affect long-term outcomes. The specific mechanic movements of sucking and swallowing associated with breastfeeding have a role in reducing the risk of otitis media in children who are breastfed (23).

The health benefits to breastfeeding mothers are thought to be linked to the hormonal effects of prolonged milk production (24).

That's why the World Health Organization (WHO) and all the other leading health entities advise exclusive breastfeeding for the first six months of a baby's life. This ensures they get the best start in growth, development, and health. After that, as babies' needs change, it's recommended to introduce safe and nutritious solid foods while still breastfeeding until at least 2 years old, or longer if desired and feasible for the mother.

References:

1. Doan, T., Gay, C.L., Kennedy, H.P., Newman, J., & Lee, K.A (2014). Nighttime breastfeeding behavior is associated with more nocturnal sleep among first-time mothers at one month postpartum. Journal of Clinical Sleep Medicine, 10, 313–319.

2. Doan T, et al. (2007). Breastfeeding increases sleep duration of new parents. J Perinatal Neonatal Nurs

3. Dennis, C.L., & McQueen, K. (2009). The relationship between infant feeding outcomes and postpartum depression: A qualitative systematic review. Pediatrics, 123, 736.

4. Kendall-Tackett, K., Cong, Z., & Hale, T.W. (2011). The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation, 2(2), 22–26.

5. Dorheim, S., Bondevik, G., Eberhard-Gran, M., & Bjorvatn, B. (2009). Sleep and depression in postpartum women: A population-based study. Sleep, 32, 847–855.

6. Warren, S.L., Howe, G., Simmens, S.J., & Dahl, R.E. (2006). Maternal depressive symptoms and child sleep: Models of mutual influence over time. Development and Psychopathology, 18(1), 1–16. doi:10.1017/s0954579406060019

7. Horta BL, Victora CG. Short-term effects of breastfeeding: a systematic review of the benefits of breastfeeding on diarhoea and pneumonia mortality. Geneva: World Health Organization, 2013.

8. Lodge CJ, Bowatte G, Matheson MC, et al. The role of breastfeeding in childhood otitis media. Curr Allergy Asthm. 2016;R16:1–8.

9. Cristofalo E.A., Schanler R.J., Blanco C.L., Sullivan S., Trawoeger R., Kiechl-Kohlendorfer U., Dudell G., Rechtman D.J., Lee M.L., Lucas A., et al. Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants. J. Pediatr. 2013;163:1592–1595. doi: 10.1016/j.jpeds.2013.07.011

10. Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Yücesan K, Sauerland C, Mitchell EA; GeSID Study Group. Does breastfeeding reduce the risk of sudden infant death syndrome? Pediatrics. 2009 Mar;123(3):e406-10. doi: 10.1542/peds.2008-2145. PMID: 19254976.

11. Victora CG, Bahl R, Barros AJ, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475–90

12. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

13. Horta BL, Rollins N, Dias M, Garcez V, Pérez-Escamilla R. Systematic review and meta-analysis of breastfeeding and later overweight or obesity expands on previous study for World Health Organization. Acta Paediatr 2022;

14. Sankar MJ, Sinha B, Chowdhury R, et al. Optimal breastfeeding practices and infant and child mortality. A systematic review and meta-analysis. Acta Paediatr 2015; published online Aug 7. DOI:10.1111/apa.13147.

15. Amitay EL, Keinan-Boker L. Breastfeeding and childhood leukemia incidence: a meta-analysis and systematic review. JAMA Pediatr 2015; 169: e151025.

16. Louis-Jacques AF, Stuebe AM. Enabling breastfeeding to support lifelong health for mother and child. Obstet Gynecol Clin North Am 2020; 47: 363–81.

17. DGS, Estratégia Nacional De Luta Contra o Cancro - 2021-2030;https://www.consultalex.gov.pt/ConsultaPublica_Detail.aspx?Consulta_Id=248

18. Victora CG, Horta BL, Loret de Mola C, Quevedo L, Pinheiro RT, Gigante DP, Gonçalves H, Barros FC. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. Lancet Glob Health. 2015 Apr;3(4):e199-205

19. Brion MJ, Lawlor DA, Matijasevich A, et al. What are the causal effects of breastfeeding on IQ, obesity and blood pressure? Evidence from comparing high-income with middle-income cohorts. Int J Epidemiol 2011Jun; 40(3):670-80

20. Kramer MS, Aboud F, Mironova E, et al. Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry 2008; 65: 578–84.

21. Bowatte G, Tham R, Allen KJ, Tan DJ, Lau M, Dai X, Lodge CJ. Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatrica. 2015; 104(S467):85–95.

22. Horta BL, Victora CG. Long-term effects of breastfeeding-a systematic review. Geneva: World Health Organization; 2013.

23. Peres KG, Barros AJ, Peres MA, Victora CG. Effects of breastfeeding and sucking habits on malocclusion in a birth cohort study. Rev Saude Publica. 2007;41(3):343-50.

24. Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, et al. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatrica. 2015; 104(S467):96–113