New Under the Sun:
Volume 7, Issue 3
Natural Parenting, Part 2
Contented infants live in an environment where two primary conditions are present. First, the contented infant is in constant physical contact with another human while being held, carried in a sling, or sleeping. This other human can be an older sibling or cousin, or any willing adult. A father who wishes to be actively involved in his infantís life and who wants to make an impact on the infantís health and well-being will choose to carry his infant as much as possible. In addition, the father will want the infant to sleep with both parents. Bodily contact is necessary for the contented infant. Among neonatologists this is known as kangaroo mothering. Although valuable for all infants, it has been found to be particularly beneficial when used with premature infants because the body heat of the one holding the infant acts as an incubator, while that individualís heart beat and breathing help to regulate those of the infantís, thereby improving the infantís chances to thrive. Second, the contented infant is able to nurse at will. Fathers should encourage mothers to breastfeed and provide the necessary support to make it as convenient as possible for the mother to do so. Breastfed infants cry much less than those who are bottle fed, or both bottle and breastfed, probably because they are able to control their food intake. While this generally means the mother needs to maintain close contact with the infant, on occasion another nursing mother can substitute for the infantís own mother. This can only be a stopgap measure unless the substitute mother has lost her own infant since breastfeeding is a major drain on caloric resources. The necessity to nurse two infants can put both infants at risk. Multiple births will be discussed later in this newsletter.
Breastfeeding is important to infant contentment not only because it provides the needed bodily contact, but because it does more to ensure that the infant remains healthy than do other forms of infant nourishment. Research has shown that infants who are exclusively breastfed have significantly fewer serious illnesses than do infants who are bottle fed or who receive supplemental foods during the first six months of life. This is in part due to the natural immune substances passed from the mother to the infant via breast milk which provide the infant with immunity to a variety of illnesses until the infantís own immune system begins functioning later in the first year of life. This natural immune system via breast milk can be disrupted by supplemental feedings. Increased incidence of illnesses is directly correlated with the introduction of supplemental foods prior to six months, even if breastfeeding continues. This may be because the infant is obtaining less breast milk than previously. Fewer illnesses among breastfed infants are also the result of lessened contact with potential allergens in cowís milk and supplemental foods, and impurities in formulas, especially when the formula is made with impure water. Since death from serious illness is a major factor in infant mortality, breastfeeding may have as important a role to play as does birth weight in reducing the infant mortality gap between African-American infants and European-American infants. Breast feeding is much less frequent among African-American mothers compared to European-American mothers. As more mothers breast feed their infants, infant mortality rates should decline.
Very-low-birth-weight (weighing less than 1500 g) and premature infants are subject to a number of health and developmental problems, one of which is a deficit in intelligence compared to normal weight, full-term infants. This deficit is reduced in infants who are breastfed compared to those who are not. The longer an infant is breastfed, the better the results when intelligence is measured by various tests at later ages. Therefore it is doubly important that low-birth-weight and/or preterm infants be breastfed since it not only reduces the risk of serious illness that could lead to death, but may also increase the probability that these infants will develop into children with normal intelligence levels.
Breastfed infants also may be less prone to obesity than are bottle fed infants. While there are many factors related to the development of obesity including poor diet and lack of exercise, whether or not an infant was breastfed and the duration of breastfeeding may also play a role. After adjusting for a number of physical, lifestyle, and socio-economic factors, researchers found that among adolescents, those who had been breastfed longer than seven months were significantly less likely to be overweight than were those who had not been breastfed or were breastfed for less than three months. A possible reason given for this outcome is that breastfed infants regulate their food intake from breastfeeding while bottle fed infants are frequently fed until the bottle is empty, thereby disrupting the infantís natural control mechanisms and setting the stage for overeating throughout life.
Breast cancer is associated with whether or not a woman has breastfed during her life. Women who have breastfed have a lower risk of breast cancer than those who have not. Further, the longer a woman breastfeeds, the lower her risk. Therefore, not only is breastfeeding best for the infant, it can be shown that breastfeeding also benefits the motherís health. This is further supported by research which found that mothers who breastfed had higher bone mineral density once lactation ended than did mothers who did not breast feed. This was also true of teen mothers who themselves were still growing. Breastfeeding does a body good.
It appears that a number of health issues among certain populations could be improved if more infants were breastfed. The infant mortality rate could be reduced if more low-birth-weight and preterm infants received their motherís immune substances via exclusive breastfeeding for at least six months. Deficits in intelligence among very-low-birth-weight and preterm infants could be limited if these infants were exclusively breastfed for six months. Obesity and its associated problems of Type 2 diabetes and heart disease could be reduced if infants were exclusively breast fed for six months and then continued to be breast fed for some months beyond that while receiving nutritious supplemental foods. Breast cancer rates, particularly among women younger than age 40, could be lowered if the women breastfed any children they had. Breast feeding our infants is our natural adaptation and is an important component of good health, both for the infants and their mothers.
Letís get real. Since breastfeeding is so important, our society must make some changes to accommodate mothers, especially mothers who work outside the home and who wish to breastfeed. The optimal solution would be for mothers working outside the home to receive six months paid maternity leave and for employers to provide on-sight daycare for infants and children six months and older. Since this optimal solution will probably occur in few businesses in the United States, although it is provided in other industrialized countries, the next-best solution would be to allow mothers to bring their infants younger than six months of age to work with them. The mother could carry the infant in a sling on her chest or back as women in other cultures do. As mentioned earlier, infants who are constantly carried and who can nurse at will are very contented and cry little, if at all. Therefore, although this solution would require some changes in work dress and a general acceptance of nursing in public, the behavior of the infant herself would not be a factor.
Benefits of Breastfeeding
One on One
There is an odd excitement in this country when a woman gives birth to multiple offspring. The larger the number of offspring, the greater the excitement when the births are announced. Although multiple births are usually accidental and unplanned, new reproductive technologies are changing this by allowing the implantation of multiple embryos into a womanís uterus. This is of great concern because women are adapted to having only one offspring with each pregnancy.
When compared with our nearest relatives the chimpanzees, human infants born at full term are actually premature. This is because there are constraints on the female pelvis between the adaptations for successful bipedality and those for successful delivery of an infant. By about two million years ago, the human pelvis had reached the limits of the changes that could be made to enlarge the pelvis in order to deliver larger infants while also maintaining an adequate angle of the femur for efficient walking.
Chimpanzees have a brain size about one-third of ours. A chimp infant born at full-term (about eight months gestation) has a brain size 75% of its adult size, with growth of the brain continuing slowly after birth. The chimp infant is also advanced in motor skills compared to a human infant, able to hold its head up, sit up, and creep within the first month. A human infant is born with a brain size about 50% of what it will be as an adult, but brain growth remains on a fast trajectory after birth, slowing down at about two years of age. However, because of this limited brain growth at birth, the human infant also has limited motor abilities. It is not until approximately one year after birth that the human infant achieves the same motor abilities that the chimp infant achieves soon after birth. Therefore, humans are considered to have a nine month in utero gestation and a twelve month ex utero gestation. The reason for this extended ex utero gestation is that the human female birth canal formed by the pelvic bones simply cannot accommodate a larger infant than that delivered after a nine month in utero gestation. In order for humans to develop their large brains, rapid infant brain growth had to continue after birth instead of being completed prior to birth as is the case with chimpanzees. The problem with this solution is that humans give birth to what are in essence premature infants, even when they are born after a full nine monthsí gestation. Premature infants require much more intensive care than do more developed infants. Therefore, an infant born to our ancient ancestral mother placed a much heavier burden on her resources than was the case of an infant born to a chimpanzee mother.
Chimpanzee mothers, as is true with all apes, generally have only one offspring with each pregnancy, but they do occasionally give birth to twins. Despite their greater physical development than is true of human infants, twins place a tremendous burden on the chimpanzee mother. Two infants are clinging to her; two infants must nurse; she must find even more food to make up for this caloric drain, but this is harder to do when she must carry two infants everywhere. Generally, one or both infants die soon after birth because the burden on the mother is just too great.
The burden of twins on our ancestors would have been much, much greater than that on the chimpanzee mothers, even if others in the human group helped out. This is because, unlike the chimpanzee mother, the human mother would be coping with physically and neurologically premature infants. Since twins tend to be born prior to full term anyway, the prematurity would be greatly exacerbated. As with chimpanzee twins, it is probable that one or both of the human twin infants would die soon after birth simply because the drain on the motherís resources would be unbearably burdensome, even if she received help from others. Even now, in the 21st century, with all our technological advances and social support systems, multiple births place tremendous burdens not only on the mother, but on her family and society.
Between 1980 and 1997, when in vitro fertilization (IVF) became more common, the rate of multiple births increased dramatically, with twin births jumping 42% and triplet or higher births skyrocketing 370%. Prior to the widespread development of perinatal intensive care facilities in the 1970s, many of the triplet and higher multiple births would have died because of their extreme prematurity due to being born well prior to 40 weeks gestation. While currently many, if not most, of these infants may survive, they suffer from much higher rates of neurological and developmental problems than is true of singleton, full term infants. Cerebral palsy is 20 times more probable among triplet than singleton births.
Low birth weight (weighing less than 2,500 g) is associated with higher rates of infant mortality and increased developmental problems. The average birth weight for twin births is about 2,300 g, while that for triplet births is about 1,600 g. With increasing number of fetuses, there is a decreasing birth weight. Number of fetuses per pregnancy is also associated with gestation length. Full term gestation averages about 40 weeks; twin gestation is about 36 weeks; while that for triplets is 33 weeks. Again, with increasing number of fetuses, there is decreasing gestation length. Among triplets, neonatal deaths occur at about three times the rate of twin deaths, even with our advances in neonatal intensive care.
Twin births, the most common of multiple births, are associated with several fetal and maternal problems, even leading to death for both mother and fetuses. Despite our improved technologies and treatments, such births are not without risks. The older the mother, the more these risks worsen. The optimal age for a first pregnancy is between 18 and 24, while the optimal age for subsequent pregnancies is between 25 and 34. During these age spans, the risks to both the fetus and the mother are smallest and the outcomes are the best. However, due to a variety of factors, many women are now delaying reproducing into their 30s or even 40s. This is problematic since the risk of poor outcomes for both fetus and mother rise rapidly after age 35. One of the sources of poor outcome is the higher rate of preeclampsia associated with a rise in maternal blood pressure and fluid retention. It frequently leads to preterm labor, but can also result in fetal and/or maternal death. Preeclampsia has increased 40% over the past decade, perhaps as a result of delaying reproduction and increasing use of IVF. Preeclampsia occurs most frequently in older women and those carrying multiple fetuses, along with those with pre-existing high blood pressure or diabetes.
Fertility rapidly declines past age 35. Delaying reproduction into the mid-30s and beyond not only increases the chances of a poor outcome, it also increases the probability of being unable to achieve pregnancy without the intervention of IVF. As mentioned before, IVF is associated with the dramatic rise in multiple births due to implantation of multiple embryos. Even in the absence of IVF, twinning occurs at higher frequency among women aged 40 and older than among younger women. This is particularly true of women for whom this is their first pregnancy, or who have had four prior pregnancies.
Women who become pregnant for the first time after age 35 are known as elderly primiparas, and for good reason. Although in todayís society a woman at 35 or 40 is still relatively young and healthy in many ways, in terms of reproduction, she is a senior citizen. The number of viable eggs in her ovaries is drastically reduced compared to a woman in her 20s, and on the downward plunge to menopause. Of those eggs that remain, there is an increased risk of problems occurring during cell division that could result in a variety of abnormalities, some of which are incompatible with life. The older woman is more likely to suffer preeclampsia and, past age 40, more likely to have a multiple birth with all its attendant problems, including an increased probability of an operative delivery.
Despite the odds, many women will have a successful outcome. However, the energy level of the average woman at 40 is much lower than that of a woman at 20. If we add a twin birth into the mix, we can see that it will be quite difficult, if not impossible, for the woman to fulfill each infantís adapted needs. The more infants resulting from a pregnancy, the more improbable it is that the infantsí adapted needs will be fulfilled. Despite the best of intentions, infants in a multiple birth will be short-changed. Even if they are fortunate enough to avoid the health and developmental problems so common in multiple births, they will be unable to claim the full attention they are adapted to require if they are to achieve their full potential. Letís Get Real. Humans are not meant to have litters.
Much more could be said on the subject of natural parenting, particularly concerning older children and adolescents. Fathers can play especially important roles in the lives of their older children and adolescents by modeling appropriate behavior and teaching them various skills. If parents follow the advice laid out in this newsletter concerning pregnancy and parenting during infancy, the foundation will be established for achieving the best possible outcome in parenting: raising offspring to become healthy, intelligent, independent, responsible adults. Following the advice in the previous newsletters on diet, exercise, and sleep will ensure an optimal outcome.
Infants and children cannot be spoiled with appropriate, loving attention. Treat your children as you would treat your best friends, and as you would want your best friends to treat you. This does not mean treating children as adults, but it does mean listening to them seriously, responding to them promptly, and including them in age-appropriate decision-making situations. Infants and children are not bionic toys or superior sorts of pets. They are our future.
© 2001-2009 Kathleen E. Fuller, PhD. All rights reserved.