In the beginning, there was breastfeeding…and that was pretty much it. If that didn’t work out, your baby died. Apparently, some people find infant mortality objectionable, so over the past several thousand years, we’ve come up with other solutions. And, given the number of women who died during childbirth, it’s a good thing we did. We’ve come a long way since then–and while breast milk is still the ideal source of infant nutrition, our infant formulas are better than they’ve ever been.
A few thousand years ago, somebody brilliant realized that if one mom couldn’t make enough breast milk–or if the mom died during childbirth (which wasn’t uncommon), another mom could help her out. It was called “wet nursing,” and it was the first donor breast milk–just with a more direct delivery system. This practice began out of necessity, but in some cultures became a luxury, with wet nurses being hired (or sometimes enslaved) to provide milk for infants of the well-to-do. Often, these nurses would assume many other aspects of the maternal role as well. (A lady can’t be bah-thuhed by caring for her baby.) I found it interesting to note that many of the reasons that mothers choose not to breastfeed today aren’t new; they’ve been around at least since the 1700’s:
It was unusual for aristocratic women to breastfeed because the practice was considered unfashionable and because the women worried it would ruin their figures. Breastfeeding also prevented many women from wearing the socially acceptable clothing of the time, and it interfered with social activities such as playing cards and attending theater performances. The wives of merchants, lawyers, and doctors also did not breastfeed because it was less expensive to employ a wet nurse than it was to hire a woman to run their husband’s business or take care of the household in their place.
Many of these factors–societal expectations, concerns about personal appearance, and interference with social/employment activities–persist today. Of course, there are numerous other reasons that parents today choose not to breastfeed, and sometimes they try but it just doesn’t work out. Fortunately, with the infant formula available today (at least in the developed world), this is a perfectly acceptable option.
The practice of using a bottle to feed infants has also been around for thousands of years. Various devices made from wood, clay, animal horns, or other materials were used for centuries, but they were impossible to clean and up to a third of infants who used them died. I hear they caused a lot of colic, too–Dr. Brown would have been ashamed. The mid-1800’s saw great advancements in bottle design, and glass bottles with rubber nipples became available. But what to put in them remained an issue.
Historically, animal milk was used as a replacement for human milk, and the animal of choice was pretty much whatever you had around–goats, cows, donkeys, camels…you can milk anything with nipples. But, as it turns out, not all milk is created equal. Animal milk and human milk have some important differences. In 1865, the first infant formula became available. It was created from cow’s milk (probably just because cows were readily available), with added flour, sugar, malt, potassium bicarbonate in an attempt to create the ideal infant food. As you can imagine, it fell short, and it was replaced by DIY formulas, in which parents would mix varying percentages of animal milk, water, cream, and honey. The specific recipes varied based on the child’s physician (or which Pinterest boards the mother followed).
Advances in infant formula continued throughout the 20th century. Powdered formulas (starting with simple evaporated milk) first became popular because the lack of refrigeration resulted in milk spoilage–and more than a few infant deaths. Soy formula was introduced in 1929 as an option for children with allergies to cow’s milk. In the early half of the 20th century, various nutritional deficiencies were attributed to formula (important ones like scurvy, rickets, pellagra, and beriberi)–problems that were addressed by adding cod liver oil, juice, and vitamin D. By 1950, we had managed to convince ourselves that we had arrived; formula was just as good as breast milk. And in the early 1970’s, breastfeeding rates reached a record low–only 22% of infants were breastfed when sent home from the hospital.
Somewhere along the way, we realized that we weren’t as perfect as we thought. There have been numerous changes to infant formula in the past 50 years, as well as a renewed push for breastfeeding. We’ve changed the casein:whey ratio to more closely resemble human milk. We’ve added supplemental iron, taurine, nucleotides, and polyunsaturated fatty acids. We’re starting to see formulas containing prebiotics and probiotics, and formula companies are constantly trying to one-up each other by getting a little closer to replicating human milk.
The irony of modern medicine is that we have become so good at some things that the need for them is no longer apparent. The most notable casualty of this phenomenon is vaccines, where steep declines in the incidence of vaccine-preventable diseases make vaccines seem obsolete–until parents decide to stop vaccinating and we experience outbreaks. In many ways, but on a smaller scale, formula has experienced a similar fate. A preference for a “natural” lifestyle, coupled with the relative rarity of severe nutritional deficiencies, has led some parents to reject centuries of advancement and return to pure animal milk. Currently, one of the most popular practices is to feed raw goat milk instead of infant formula. In theory, goat milk may be better than cow’s milk–slightly less lactose, fats that are more easily broken down, and slightly reduced risk for allergy. But it’s also been associated with significant nutritional deficiencies, dangerous electrolyte abnormalities, stroke, and death. When given in its raw (unpasteurized) state, it also carries a high risk for infections that can be fatal in vulnerable newborns.
While modern formula isn’t perfect–and never will be, we have reached a point at which it does a great job of providing the calories and nutrition that infants need for growth and development (assuming that you live in a developed nation where a clean water supply isn’t an issue). And most importantly, we now have enough options to confuse even the most educated parent. In my next post, I’ll go over of the key differences that you need to understand when choosing a formula for your baby.
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