I was lucky enough to be a part of the generation who was consistently told from day one that “smoking is bad for you.” I consider myself lucky because I always had the confidence to say “no” and I never felt the desire to even try a cigarette. Despite this, it would be foolish to believe that no one of my generation, or those in child-bearing ages, do not smoke currently. We know the health risks, we know we shouldn’t, but many still do and it has great impacts on not only their health but the health of their children.

You might ask how this relates to breastfeeding? Well, many women believe that because they smoke, they cannot also breastfeed. While it is strongly encouraged that women quit once they become pregnant, we must live within some people’s realities. If a woman smoked during her entire pregnancy and then gives birth, we cannot expect her to magically not be addicted on the day of delivery. So, what are the impacts of smoking on breastfeeding and lactation?

Research has found that smoking mothers are less likely to continue breastfeeding. This may be because of a lower motivation to continue, as well as the perception of harmful effects on the quality and quantity of their breast milk.

Nicotine, from smoking, does transfer into a mother’s milk. Smoking 20 cigarettes daily increases the nicotine in a mother’s milk to harmful doses and may cause nausea and vomiting in the infant. Other possible side-effects in infants include fussiness, shock, rapid heart rate and restlessness.

The American Academy of Pediatrics (AAP) states that maternal smoking is not absolutely contraindicated but is strongly discouraged (AAP, 2013). Concerns cited within this policy also cause some anxiety in pregnant and breastfeeding mothers, which cause them to choose not to breastfeed. Those listed are concerns with: respiratory infections, sudden infant death syndrome, low milk production, and low weight gain.

So, what do you do if you smoke? Understand your options.

• You should attempt to quit smoking before you give birth
• Find a smoking cessation program before and during pregnancy, and continue while breastfeeding
• Talk with you obstetrician and your baby’s pediatrician about it

What is important is the management of smoking, if you continue, during pregnancy and after baby is born. Second-hand smoke is linked to many issues with children, and therefore smoking around your child is strongly discouraged. Nicotine intake from second hand smoke is much greater than nicotine intake from breastfeeding.
​
Children who are exposed to smoke within the home may have:

• Higher risk of respiratory infections and illness
• Higher risk of asthma
• Higher risk of neurobehavioral problems
• Decreased performance in school
• Higher risk of ear infections
• Higher risk of sudden infant death syndrome

If you continue to smoke after birth, do not do it inside of the home, in the car, or anywhere that may confine your child to be exposed to the smoke. Go outside, wear a “smoking jacket” or change your clothing after you smoke, and wash your hands thoroughly before interacting with your baby again. Also, try to time out your smoking with feedings. Feed your baby before you have a cigarette and then perform all the previously stated to even further decrease your child’s exposure.

Mothers who continue to smoke during pregnancy and breastfeeding often feel guilty. The best thing is to understand that you are not alone and to make the best decisions that fit the needs of both yourself and your baby. It is better for a baby of a smoking mother, or a baby who is exposed to second hand smoke, to be breastfed as they receive protection from breastfeeding that they would otherwise not get. We are all trying to do our best as parents, and we must work within our own realities. You got this mama.

Source Credit: Lauwers, J., & Swisher, A. (2016). Counseling the nursing mother: a lactation consultants guide. Burlington, MA: Jones & Bartlett Learning.

​
Humans evolved and survived by breastfeeding.  If it weren’t for breastfeeding, you would not be reading this blog right now.  You might say “well that’s not true, my grandmother, mother, and I were all formula-fed, and I’m sitting here.” While recent generations may have been formula-fed and survived, historically the only way for babies to survive prior to that was by being breastfed.

Humans are among 5,000 other types of mammals which use their own milk to feed their babies.  Human babies have been traditionally fed mothers milk or the milk of another human woman.  It is only recently in our history that human babies have begun to consume milk of other mammals. In early colonial America, it was known that women would feed their infants “through their second summer.”  Therefore, the child would be two years old or just about two years old (which is on par with current AAP and WHO recommendations!).

By the 1800’s is when we saw the shift from human babies consuming human milk to human babies consuming cows milk, and it wasn’t long before physicians of that era began to “decry the trouble and dangers of artificial feeding.” Once this shift occurred, most mothers began to wean their children before three months of age, much like current trends in the United States.  Most often during this time period, wealthy or royal family members would choose artificial feeding methods, formula or wet nurses, to “stay beautiful or to get pregnant again.”  High formula usage has maintained as a norm in the United States, but around the world breastfeeding is still the primary source of nutrition for infants.

What is a wet nurse? Wet nursing is defined as “the act of a woman nursing a baby other than her own.”  This practice dates back to 2000 BC and was commonly used when a woman could not produce enough milk and her infant was likely to die without intervention. Also, in the same class, is a common practice of cross-nursing.  Cross-nursing is when mothers in a community nurse each other’s babies. 

It was not until the 18th and 19th centuries that technology changed the terms of artificial feeding and created the products we now call “infant formula.”  During this time, it was noted a greater number of infant deaths occurred. Then, instead of focusing efforts on increasing breastfeeding rates, the focus shifted to improving artificial substitutes. 

An obstetrician, Pierre Budin, who founded the study of neonatology, recognized the association of increased infant death and illness resulting from contaminated cows milk during the 19th century.  He then started the well-baby visits (so we can thank him for those frequent doctor trips!) and focused his attention on education of mothers on the benefits of breastfeeding for infant health. 

Formula use continued to increase through the 20th century and was promoted as “modern,” “civilized,” and “a sign of wealth.” Breastfeeding therefore became associated with lower social classes and looked down upon.  By 1971, breastfeeding rates in the United States were at an all-time low, with 24% of mothers ever having breastfed before leaving the hospital. 

Early in the 20th century, medical schools began to shift their focus on advocating for medical students to spend more time studying breastfeeding and infant nutrition versus artificial feeding methods.  During this same time, it can be noted that studies began emerging showing the correlation between breastfeeding and increased IQ.  It was shown that babies who were studied and had an IQ of 130 were all breastfed. 

The feminist movement during the 1960’s spurred many social reforms and breastfeeding was an intrinsic part of it.  We continue to see a movement back to breastfeeding, which closely mimics the movement away from it during our early history.  Breastfeeding is now known as the best way to feed a baby, although it is not always followed. The focus of current trends shows a respect for the rights of both mother and baby while promoting the best possible health comes for both.

Source Credit: Lauwers, J., & Swisher, A. (2016). Counseling the nursing mother: a lactation consultants guide. Burlington, MA: Jones & Bartlett Learning.