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The Womanly Art of Breastfeeding: Completely Revised and Updated 8th Edition Paperback – July 13, 2010
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About the Author
Since 1955, when La Leche League started in the Chicago suburbs with seven women intent on spreading information about the benefits of breastfeeding, it has grown into the leading breastfeeding advocacy organization in the world. La Leche League International regularly holds seminars and workshops for health-care professionals and parents, and publishes more than twenty books on child care.
Excerpt. © Reprinted by permission. All rights reserved.
"When I was two, my mother came home from the hospital cradling two mysterious bundles wrapped in soft blue blankets. One was my new baby brother. She handed me the other. Underneath the folds of that soft blanket was a beautiful doll, which my mother explained would be my special baby. My father followed her with a red wooden rocking chair that he placed near my mother's rocking chair. I vividly recall watching my mother breastfeed my brother, and I followed her every move to be sure that I was feeding my own baby properly, even though my breasts looked nothing like hers. My mother and baby brother gazed at each other adoringly during the feeding. I looked down at my own doll, whose eyes closed when she lay on her back. I wanted that lifeless doll to be real. I told myself, "I can't WAIT to grow up so I can feed my own baby!"
"Twenty--five years later I gave birth to my first child. The day I came home, I sat in our wooden rocking chair, and as I held my son close and nursed him, he opened his eyes to gaze at me. At once, an overpowering recollection of that early childhood memory returned, and tears began to flow as I realized, "THIS is what I have waited my whole life to do!" --Cathy, remembering 1981
WELCOME TO OUR "La Leche League meeting in a book"! At a real meeting, you'd see a mix of pregnant women, mothers with new babies, and moms with older babies or children. You'd hear questions from women at different stages of motherhood. Some of it would sound right to you, some of it would answer questions you didn't know you had, and some of it you'd shrug and leave behind. We hope you'll do the same with this book.
The cornerstone of La Leche League (LLL) meetings is addressing questions. While a book can never match sitting around with other mothers, we can address some of the typical questions at different stages, and tell you what mothers often share from their experience, along with the research behind it all.
This first chapter of our "meeting in a book" begins with the questions pregnant mothers often have about breastfeeding. Even if you've already had your baby, the answers to these questions should make you feel good about what you're doing and tell you more about why breastfeeding is such a great thing to do.
"The newborn baby has only three demands. They are warmth in the arms of [his] mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three."
--Grantly Dick--Read, MD, from Childbirth Without Fear, 1955
Is Breastfeeding Right for Me?
The closer you are to meeting your new baby, the more you're probably thinking about what comes after birth. You're "nesting"--gathering the things your baby will need and making a place for him in your home. Those outfits are so cute! That changing table is precious! But while you're out shopping, your body is quietly preparing the real "nest" your baby will need--your breasts. They'll be all he really needs at first--his go--to place for warmth, security, comfort, love, and, yes, food. As cute as the outfits and decor are, what your baby will care most about is the way you and your body protect and nurture him.
Breastfeeding is far more than just a way to feed your baby. It's the way you're naturally designed to begin your mothering experience. So why doesn't it always come naturally? Some of your friends may have told you all about their tough experiences. Maybe your mother couldn't breastfeed and you wonder if you'll have trouble, too. The great news is that we've learned a lot since your mother tried. We've learned more about understanding and respecting the instincts that you and your baby both have. We've learned that the fewer interventions you have during birth, the easier these instincts will be to tap into. And La Leche League is always here to help you work through any issues that come up.
Maybe you want to breastfeed because you know it's best; science keeps finding new ways breastfeeding helps babies reach their potential and protect their mothers' health. Maybe you want to because it just feels right; every mother finds for herself all the little ways that breastfeeding brings her close to her children. Whether the urge comes from your head or your heart, breastfeeding is right for you. And it's definitely right for your baby.
How Important Is Breastfeeding, Really?
Extremely! There is almost nothing you can do for your child in his whole life that will affect him both emotionally and physically as profoundly as breastfeeding.
Breastfeeding is also important to our own bodies. We can't think of an aspect of your baby's health that isn't affected by breastfeeding, and it affects a surprising number of your own health issues as well. This would be a much longer book if we described all the ways that breastfeeding is valuable for you, your baby, and your family, but here are a few highlights.
Your Milk Is Your Baby's Normal Food
There's no formula that comes even close to the milk your body creates. Your milk has every vitamin, mineral, and other nutritional element that your baby's body needs, including many that haven't been discovered or named yet, and it changes subtly through the meal, day, and year, to match subtle changes in his requirements. Living cells that are unique to your milk inhibit the growth of harmful bacteria and viruses in his still--maturing system. And it's more than just living cells. For instance, interferon and interleukins are powerful anti--infectives. If you could buy them, they'd cost the moon. Your milk throws them in, free of charge. A squirt of your milk can even treat eye infections and speed the healing of skin problems!
Without his normal food, a baby is at higher risk of ear infections, intestinal upsets, and respiratory problems. Allergies and dental problems are more common. Vision, nerves, and intestines don't develop fully. Because of all these differences (and many others not listed here), a formula--fed baby has a different metabolism and a different development, and gains weight differently during his first year. His kidneys and liver work harder to process the waste products from formula. He needs more of any medication to get the same effect. His immune system's response to vaccinations is less effective. The risk of SIDS (sudden infant death syndrome or crib death) and infant death from many other causes is higher if a baby isn't breastfed.
As an older child or adult, he is at a greater risk of Crohn's disease, ulcerative colitis, type 1 diabetes, heart disease, and certain cancers. He responds to stress more negatively and has higher blood pressure, both as an infant and in later life. There's a higher risk of obesity, type 2 diabetes, heart disease, and osteoporosis in later years. There are numerous IQ studies showing deficits in children who didn't breastfeed, or who didn't breastfeed for long.
Colostrum, the milk you produce in small amounts in the first couple of days after your baby is born (and which you started producing during your pregnancy), has concentrated immunological properties that are your baby's first protection against all the germs he is suddenly exposed to. This "first milk" contains high concentrations of secretory immunoglobulin A, or SIgA, an anti--infective agent that coats his intestines to protect against the passage of germs and foreign proteins that could create allergic sensitivities. Scientists have also recently discovered a new ingredient in human milk called pancreatic secretory trypsin inhibitor (PSTI), which protects and repairs the infant intestine. It's present in all human milk, but it's seven times higher in colostrum, providing extra protection to that delicate and vulnerable newborn intestine. Think of colostrum as a complex paint designed to seal those brand--new intestinal walls (which were, of course, designed to receive it).
Colostrum has an acid level that encourages a baby's intestines to welcome just the right mix of beneficial bacteria. And colostrum is a laxative that gets his intestines up and running and helps clean out all the tar--like stool called meconium that built up in his system before birth.
Mature milk, which phases in during the first two weeks, has a still--unknown number of ingredients that contribute to lifelong health. Along with the interferon, interleukins, white blood cells, and SIgA, the breastfed baby gains an immune system nearly as sturdy as his mother's. Human growth factor continues to develop those intestines, bones, and other organs. Insulin for digestion, long--chain fatty acids for a healthy heart, lactose for brain development--it's all there. And just as important, it's there in forms that are available to a baby. Iron is added to formulas in forms that the baby can't readily use and which can actually be harmful since it increases the risk of intestinal infection, intestinal bleeding, and anemia.
The mechanics of breastfeeding are important, too. When your baby breastfeeds, the muscles in his jaws are exercised and massaged in a way that causes the bones in his face and jaw to develop more fully. The jaw that results from bottle--feeding and pacifiers is narrower, with a higher palate that's more likely to restrict nose breathing. Babies who use pacifiers, instead of soothing themselves at the breast, are more likely to need speech therapy later. The child who breastfeeds for less than a year is much more likely to need orthodontia later on. Snoring and related breathing problems are more common as well.
Your baby can design his own meal to suit his needs. If he's thirsty, he nurses for a shorter amount of time and gets a lower fat milk. Still thirsty? He asks to switch sides sooner and gets another thirstquencher from the other side. Extra hungry? He stays longer on the first side or nurses more vigorously, to pull down more highercalorie fat globules. Going through a growth spurt? If your baby takes more milk than usual, he'll have more milk available the very next time he nurses. If he drinks less than usual, your milk production scales back. Is he moving into toddlerhood and nursing less often? There will be more immune factors in your milk to keep him covered. Did he pick up some germs from the grocery cart handle? He communicates those germs to your breast at his next nursing, and it starts cranking out specialized antibodies. In a whole lot of different ways, your breast is Health Central for your baby.
Breastfeeding Helps Keep You Healthy, Too
Breastfeeding is the natural next step in the reproduction sequence: pregnancy ' birth ' lactation. When your newborn takes your breast soon after delivery, your uterus contracts and bleeding slows. Hemorrhage is a greater risk with formula--feeding, and your belly stays larger longer.
If you breastfeed exclusively (without giving water, solids, or formula) and your baby nurses often, including at least once during the night, then your periods most likely won't come back for at least six months. Your chances of getting pregnant again will be extremely low during that time, too (see Chapter 8 for details).
Breastfeeding helps many (not all) women lose weight readily. Nature gave you some of that pregnancy weight just for the purpose of making milk in the first few months. The natural design is for it to melt away by the time your baby is well started on solids.
Women who haven't breastfed are at greater risk for metabolic syndrome, a cluster of risk factors that makes heart disease and diabetes more likely. If you already have insulin--dependent diabetes, you're likely to need less insulin while you're a nursing mother.
Breastfeeding is also an insurance policy against breast, uterine, and cervical cancer. (It may be that the lower estrogen level of lactation provides the protection; the longer you breastfeed, the stronger your insurance.) This doesn't mean it's impossible for you to get these cancers if you breastfeed, but you are less susceptible to them. Osteoporosis and fractures are also more common in women who didn't breastfeed.
A formula--feeding mother's blood pressure is likely to be higher, probably because her neurological and endocrine responses are more pronounced than those of a nursing mother. Her overall physical and mental health take a hit as well, and in later years she remains at an increased risk of developing such autoimmune diseases as rheumatoid arthritis.
"I didn't realize what immeasurable joy breastfeeding could give ME. I thought it was supposed to be about giving to the baby, not to the mother. Those hormones just poured into me and I was in a blissed--out, euphoric state when I was breastfeeding. And, I have to say, it gave this very un--confident mom something I could finally feel confident and proud of myself for." --Samantha
How Reliable Is Breastfeeding Research?
You've probably heard that breastfeeding reduces the risk of infection and a bunch of childhood and adult illnesses and diseases, that it reduces the risk of allergy, and that it even raises IQ. But (are you sitting down?) none of it is true!
Here's why: Let's say we're testing a new drug. We focus on the people who get the drug, with a group of ordinary people to compare them with. That's how we know what the drug did. It made things better or worse than normal. Accurate science focuses on the experiment, not the normal thing. Now think about most of the research on breastfeeding. Exactly--it's research on breastfeeding! And that means that virtually all our recent research was done backward, evaluating what's normal (breastfeeding) instead of evaluating the experiment (formula). It makes the high rates of formula--fed illness seem like normal baby health and breastfeeding seem like bonus points.
Breastfeeding doesn't reduce the risk of infection, illness, and disease. It doesn't add IQ points. Breastfeeding results in normal good health and normal IQ. When babies aren't breastfed--and this is using the same information from the same studies, just shifting the focus to the true experimental group--they are at increased risk for all those short--term and long--term illnesses and diseases.
Researchers have inadvertently hidden formula problems from us by focusing on the apparently fabulous "benefits" of human milk and breastfeeding, almost as if breastfeeding is a nice but unnecessary "extra." That's starting to change. More and more research articles are using the normal breastfed baby as the starting point, as good science requires, and are looking at what happens to babies when their normal system is altered. It can be a scary way for the public to look at infant feeding--to see a list of risks instead of a list of "benefits." But it's a more honest, accurate approach, and it's the one we've used.
Breastfeeding doesn't give you brownie points. It's simply the normal way to raise a baby.
"Breastfeeding is a 'safety net' against the worst effects of poverty..."
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Without a doubt, this book gives an unrealistic image of the ease of breastfeeding, particularly in the immediate postpartum period. According to the authors, breastfeeding comes naturally, if you only let it. Any attempts to interfere with the process (including labor "interventions") will only sabotage your efforts. Before I had my baby, I liked this message because it was empowering, in a way—I appreciated someone telling me that I could just trust my body and my baby to do what was needed. "Trusting your body" is a common trope in the crunchy community, and yes, sometimes you can trust your body, except when you can't. If you need any guidance at all in the shell-shocked hours and days after birth, this book WILL leave you high and dry.
This statement on page 67 is indicative of the problem with this attitude: "Imagine shoving a puppy at his mother's nipple. You'd probably just confuse him!" Have any of these authors been around newborn puppies?! Sometimes puppies can't nurse effectively. Do you want to know what happens to those puppies? Unless a human steps in, they die. We humans tend to get a bit more attached to our offspring than that. Sometimes, for whatever reason, nursing does not go well. Maybe you'll need extra help by trying different nursing holds, nipple shields, etc. But anything that doesn't fit into this "natural" framework, the book discusses only dismissively, does not discuss it at all, or strongly warns you off it.
It does acknowledge that for some high-risk pregnancies, certain interventions will be unavoidable. Aren't these babies the ones who could benefit from breastmilk the most? Yet, again, the information here is very lacking. I will agree with them on one point—the benefits of breastmilk are undeniable. Wouldn't it be better to give women the tools to succeed in the most likely circumstances, rather than what the authors consider to be most ideal? I had a high-risk pregnancy and a difficult birth, and this book was as good as useless to me in the weeks following that experience. Thankfully I was able to overcome the anxiety this book gave me about breastfeeding interventions, and my growth-restricted infant is thriving on my milk, and we have a great breastfeeding relationship. But that was all thanks to friends, my mother, and the lactation consultants that were willing to meet me in the circumstances I was in, and not what they thought they should be.
Another huge problem with this book is some of the statement it treats as fact. It doesn't include all the references used, so you might go to look up a certain recommendation in the bibliography and find nothing supporting it. Some of the statements are just wrong. For example, the authors are adamant that any labor interventions will negatively impact breastfeeding, possibly irreversibly. Yet according to Emily Oster, author of "Expecting Better," "at the very least, we can say there is no affirmative evidence that nursing is impacted by the epidural" (229). There is, however, affirmative evidence that babies whose mothers receive epidurals do NOT have lower APGAR scores (228).
I'm still going to keep the book around; my money's long gone, and some of the later chapters might be helpful to me. But please consider just passing on this one.