Breastfeeding

Guided by warmth and smell, newborn babies, when lying on their mother’s stomach or breast, usually find their way to the nipple within half an hour after birth. The first sucking movements stimulate milk production and influence the baby’s sucking behavior. Despite this instinctive finding of mother and child, many mothers doubt their ability to breastfeed.
The decisive factors for the motivation and success of breastfeeding are therefore counselling already during pregnancy (1, 2), counseling in the first hours after birth, and having counselling and assistance available during the entire breastfeeding period.

The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend exclusively breastfeeding for six months. According to these organizations, breastfeeding can be continued until the second birthday and beyond (3). Their recommendation takes into account the health significance of mother’s milk nutrition in the first six months of life, which has been proven by a high level of evidence. When breastfeeding for more than six months, relationship aspects between mother, child and family come to the fore. Social, cultural and professional constellations can extend or shorten the breastfeeding relationship. A need for proximity, boundaries or stress reduction can be reasons for extensive breastfeeding. Just as introducing new foods can initiate the transition from infant to toddler, so also can mother and child learn to “satisfy” their need for closeness and other emotional needs independently of food intake. Therefore, the interactions between mother – child – partner (missing partner) – siblings and other people influencing the family system should be understood and taken into account in counselling. The presence of the partner, especially during the first breastfeeding meals, strengthens the bond with the child. In this way he can promote the breastfeeding relationship, empathetically support mother and child in crises and take an outside perspective supported by understanding if they get caught up in difficulties.

In addition to the traditional introduction of pureed foods, parents today choose the path of “baby-led weaning”. This means that the baby gradually stops breastfeeding, by taking a selection of suitable foods at the family table. Every kind of supplementary food is better tolerated if breastfeeding continues during the transition phase (4).

The newborn baby connects with the world in three ways immediately after birth:
through sense impressions,
through breathing,
through ingesting nourishment.

The place of food intake shifts from the navel (in the case of the unborn child) to the head (in the case of the newborn). The food source shifts from the mother’s uterus to the breast. The nutritional process thus rises from the metabolic region into the area of the rhythmic system. When breastfeeding, the substance flow of the milk connects with the child’s consciousness “from the middle outwards” via the child’s senses. The breast is the physical starting point for a complex event: for the rhythm of hunger and satiation (body), the interplay of giving and receiving (soul) as well as the interplay of I and you (spirit).

The baby as a sensory being

A baby is first of all entirely a sensory being, which is expressed by the infant’s very large head in relation to the rest of the body.
Every breastfeeding encounter is a stimulation for all the senses. Warmth, touch, coordination of movement, balance, smell and taste, satiation and hunger, sight and hearing are all involved.
The low protein and calcium content in human milk, compared to animal milk, is adapted to the long period of physical growth in human beings, which continues for two decades. The high and differentiated sugar content of human milk, on the other hand, emphasizes rapid availability of sugar for the functioning of the nervous system. Rudolf Steiner characterized the importance of mother’s milk nutrition for newborn babies, including the way in which mother’s milk awakens the sleeping spirit in the human being (5). The highly varied and interweaving sensory impressions stimulated by breastfeeding support the neuroplasticity of the brain, i.e., the formation and differentiation of nerve connections.
The mother’s undivided attention to her baby and the breastfeeding meal, as well as the mother’s amazement at her baby’s awakening interest in the world, constitute the most important care-giving gesture that accompanies breastfeeding (gesture of awakening). It is made possible by protecting against external disturbances that may distract the child’s attention, such as the use of a smartphone while breastfeeding (gesture of protection).

For an overview of the use of gestures in care-giving, see also: https://www.anthromedics.org/PRA-0615-EN

Rhythms

At birth, the continuous flow of nutrients provided via the placenta and umbilical cord is interrupted. The same applies to gas exchange, which becomes the rhythm of inhalation and exhalation after birth. Neither the rhythm of nutrition, nor the rhythm of breathing, nor the rhythm of waking and sleeping are pre-formed at birth. They only emerge during the years that follow. The physical and emotional needs of the child must be reconciled with those of the social environment – e.g., family, profession. This is obvious in breastfeeding, where the child’s nutritional needs directly stimulate the production of breast milk. The amount of milk thus adapts flexibly to the growing need for food. An essential stimulus for this is sucking at the breast. Other factors that increase milk production are rest, sufficient drinking, warm relaxed shoulders, support for the mother and the mother’s empathic relationship with her child. Milk formation is reduced (possibly to the point of inflammatory milk congestion) by sorrow, social stress, pain, distraction, lack of sleep and too little fluid intake. This makes it clear that mother and child must first find each other in a rhythm. This usually happens within the first six weeks. If the baby’s or mother’s life circumstances change, the rhythm must be readjusted.
Confidence that a harmonious breastfeeding relationship will emerge – sometimes passing through crises on the way – is the strongest foundation for finding a good rhythm.

Nutritional rhythm is the physical model for the rhythm of sleeping and waking, as well as that of being alone and being together. On the other hand, a harmonious rhythm of sleeping and waking (of mother and child) has just as positive an effect on the breastfeeding relationship as a successful rhythm of times of being alone and being together. Having confidence also means that if breastfeeding is not possible, for whatever reason, there will still be healthy physical and mental development if tenderness, reliability and careful selection of food promote it. “Affirming” is the gesture in which mother and child experience that a healthy relationship of giving and receiving can succeed, sometimes with outside support.

It is crucial that order be established in time and space.
Temporal order results from rituals and good habits; spatial order, for instance, from differentiating between playrooms and bedrooms. The gesture of “creating order, creating space” is a special challenge in times of increasing mobility and decreasing experience of seasonal or daily rhythms, such as happens with home office work or short holidays. “Creating order” has a harmonizing effect on rhythms and living conditions.

From an attachment to a relationship

Nutrition is the basis for building up the body. The newborn uses all her strength to get what she needs for her development through food and attention. Her complete physical dependence corresponds on a psychological level to her complete orientation towards the person or people who are ensuring that she can live. In the mother or other caregiver, this dependent relationship corresponds to caring instincts and love. This interrelation is called attachment. Before birth, this bond via the uterus and umbilical cord is inseparable. Birth initiates a process of “cutting the cord” of many physical, mental and social bonds. Initially, the baby’s physical, mental and social needs are satisfied through breastfeeding. Already in the first days after birth the needs of the infant differentiate and the mother learns other forms of providing care and attention. Such provision of care can also be brought by other caregivers. It creates spaces of independence and autonomy for the child and the family system. This is how the transition of an attachment into a relationship takes place. Too much independence can lead to neglect of relationships or to relapse into regressive attachment patterns.

Breastfeeding is a “hotspot” for the development of attachment and relationships.  It can, in fact, become a projection screen for conflicts that have nothing to do with breastfeeding. A successful breastfeeding relationship is both an expression of and a preparation for a good start in life.
The two nursing gestures that shape the path from attachment to relationship are “enveloping” and “uprightness”.
In the gesture of enveloping, we use warmth, skin contact and security to rebuild the attachment that had been severed at birth when the uterus was left behind and the umbilical cord was cut. In the gesture of “uprightness” appears a free, responsible human being as the goal of the child’s development. The paternal quality of the relationship emphasizes uprightness, stepping out into the world, the maternal quality tends to provide an enveloping quality. These gestures arise from the upright decision of the parents to confidently take care of their child and to release him step by step into independence.

For an overview of the use of gestures in care-giving, see also: https://www.anthromedics.org/PRA-0615-EN

Positive effects of breastfeeding

Breastfeeding has many positive effects on the developing immune systems of newborns. For example, breast milk contains immunoregulatory factors such as nano-sized vesicles called exosomes. In 2014, a Swedish research group investigated whether allergic sensitization and an anthroposophic lifestyle could influence the exosome profile. The result was that the phenotype of exosomes in breast milk varied with maternal sensitization and lifestyle, which may influence allergy development in children (6).
In addition, current studies point to complex microbial interactions between breastfeeding mothers and their infants. In the TEDDY study, with 903 children aged between 3 and 46 months, receiving breast milk, either exclusively or partially, was the most important factor associated with the child’s microbial structure (7).
A selective literature search published in 2016 lists further advantages of breastfeeding and breastfeeding duration: “In 100 babies breastfed for more than 6 months, approximately 13 cases of acute otitis media (incidence 27%) could be prevented, compared to bottle-fed babies. [...] The risk of acute gastroenteritis could be reduced by half to one third. Six-month breastfeeding of 100 babies can prevent 15–63 diarrheal diseases [...] and 2–6 hospital stays. The SIDS mortality rate of breastfed infants is 15 to 36% lower. [...] Meta-analyses of comparative cohort studies show a significant risk reduction for later diseases [such as ...] prevention of about 2 asthma diseases per100 breastfed children [...] about 3 eczema diseases per100 breastfed children [...] about 3 obesity cases per 100 breastfed children” (8), (9, p. 220–235).

1 The results of a 2017 breastfeeding study are available in German at: https://lansinoh.de/tipps-infos/lansinoh-stillstudie-2017 (07.06.2019)

2 See Breastfeeding Promotion Switzerland at: http://www.stillfoerderung.ch/logicio/client/stillen/summary.php?lang_iso639=en (07.06.2019) 3 Information in German available at: https://www.babyfreundlich.org (07.06.2019)

4 Fewtrell M, Bronsky J, Campoy C, Domellöf M, Embleton N, Fidler Mis N, Hojsak I, Hulst JM, Indrio F, Lapillonne A, Molgaard C. Complementary feeding: A position paper by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition 2017;64(1):119–132. [Crossref]

5 Steiner R. Allgemeine Menschenkunde als Grundlage der Pädagogik. GA 293. Lecture of Sept. 2, 1919. 9th ed. Dornach: Rudolf Steiner Verlag; 1992. English translation: Steiner R. The foundations of human experience. Great Barrington: Anthroposophic Press; 1996.

6 Torregrosa Paredes P, Gutzeit C, Johansson S, Admyre C, Stenius F, Alm J, Scheynius A, Gabrielsson S. Differences in exosome populations in human breast milk in relation to allergic sensitization and lifestyle. Allergy. European Journal of Allergy and Clinical Immunology Allergy 2014;69(4):463–471. [Crossref]

7 Stewart CJ, Ajami NJ, O’Brien JL et al. Temporal development of the gut microbiome in early childhood from the TEDDY study. Nature 2018;562:583–588. [Crossref]

8 Prell C, Koletzko B. Stillen und Beikost. Empfehlungen für die Säuglingsernährung. Deutsches Ärzteblatt 2016;113(25): 435–444. [Crossref]

9 Soldner G, Stellmann HM. Individuelle Pädiatrie. Leibliche, seelische und geistige Aspekte in Diagnostik und Beratung. Anthroposophisch-homöopathische Therapie. 5th ed. Stuttgart: Wissenschaftliche Verlagsgesellschaft; 2018. English translation: Soldner G, Stellmann HM. Individual paediatrics. Physical, emotional and spiritual aspects of diagnosis and counseling. Stuttgart: Wissenschaftliche Verlagsgesellschaft; 2014.