Colostrum -- the Gold Standard for Newborns

(Note:  I have added some information to this post since it was first written.  You might see it again in later posts.  I felt it was important to compile this information in case a reader clicked on only this post for information on colostrum).  

Colostrum, the first milk mother provides for her baby, is more like medicine than food.  It's thick, rich consistency and yellow-gold color sets it apart from more mature breast milk.  The nutrients are present in different ratios than those in more mature breast milk.  But, those ratios are perfect for the needs of the just born baby. As the needs of the baby changes, so will the nutrient ratios.  Just a reminder:  formula can not do that!  

Newborns receive pure colostrum for approximately 3 to 4 days before the colostrum begins transitioning to mature breast milk.  This transition period of mixed colostrum and mature milk occurs from approximately day 6 to day 14.  At that point, mothers produce "mature" milk. 

Many women who are uninformed will express concern that they do not have enough milk, yet, in reality, they have more than enough.  Colostrum which has let down from deep in the breast to the area of the nipples at the time of birth, is ready to deliver that first inoculation to the vulnerable newborn.  From that point, small amounts of colostrum are made at a time because only small amounts are required per feeding.

With Proper Breastfeeding Practices, Mom's Milk Supply for Each Feeding Grows as Baby's Stomach Grows.

Photo/Chart is by Katie Wickham BScN, RN, IBCLC, BCLS of Babies First Lactation.  Used with permission.

The size of a newborn's stomach is about the size of a small marble, or the tip of your thumb to the first joint.  Infants take in about 2 to 10 milliliters (less than 1 teaspoon up to 2 teaspoons) of colostrum at a time during the first day or two.  Even though newborns consume such small amounts, there is no need to worry about dehydration in the healthy baby.  God, not surprisingly, has already worked this out perfectly!

Newborns arrive with an extra fluid load of 10 to 15 percent.  This "water storage" keeps them hydrated for the first days.  If breastfeeding is managed as it should be managed, as the newborn's extra fluid is used up, his nursing will become more thirst driven.  This works out great, because this is about the time mom's milk supply is increasing and beginning the change to mature milk.  This hungry/thirsty baby will take in more more milk, thus preventing or relieving engorgement in its mother.

We will cover some breastfeeding management and feeding recommendations in a later blog. One of those issues will be the OVERhydration of women (and subsequently, their babies) during labor.  Such babies are born with more than the 10 - 15% extra fluid -- and this leads to unnecessary supplementation in many cases.  But, for now, I want to discuss just some of the very active, health protecting factors found in colostrum.  In addition, we will see how the type of birth experience plus the type of early food the baby ingests affects its current and future health.

Among many components, colostrum contains

• Abundant antioxidants, antibodies, and immunoglobulins like sIgA (10 times the amount found in mature breastmilk).  sIgA inhibits the inflammatory effects of other immunoglobulins.  This allows the immunoglobulins to attack illness producing organisms without damaging the baby's G.I. tract. It also prevents pathogenic organisms from attaching to the baby's G.I. tract. Another antioxidant in colostrum is beta carotene, a powerful antioxidant which gives colostrum its  distinctive color. Beta carotene is much higher in colostrum than in mature milk.

• Interferron, which works as an anti-viral.

• Fibronectin, which causes phagocytes, (microbe eating cells) to become so aggressive that they attack and "eat" microbes even when those organisms are not tagged by an antibody, which is a normal identifier trigger for phagocytic action.

• Pancreatic secretory trypsin inhibitor (PSTI), a peptide found in the pancrease which protects it from being damaged by the digestive enzymes it produces.  It is seven times higher in colostrum than in mature breastmilk.  PSTI stimulates cell movement and proliferation in the G.I. tract by three times the normal.  This reduces cell death in damaged intestinal cells by 70-80%.  PSTI protects and repairs the newborns delicate intestines.  This helps to prepare it to receive future foods.

• Components which contribute to the establishment of bifidus flora in the baby's intestines. Flora refers to the living microorganism found in and on the body. Bifidus organisms promote a lower pH, or slightly acidic enviroment, which further inhibits growth of illness causing bacteria.

Colostrum functions as anti-infective medication.  It's biochemical composition also lends itself to having a laxative effect on the baby.  Meconium is the thick, tarry stool present in the baby's gut at birth.  It has high levels of bilirubin, a byproduct of the breakdown of unneeded red blood cells.  If it remains in the baby's body too long, the baby will reabsorb bilirubin, causing a yellowish tinge to the skin and eyes, known as "jaundice". The sooner the meconium is passed from the baby's gut, the less jaundiced the baby will become.

Some jaundice is normal.  Excessively high levels over a prolonged period can cause problems in the baby's brain.  The laxative effect of colostrum reduces the chance for development of jaundice from this cause.

Why is colostrum so vital as a first food?

When a baby is born, it's G.I. tract is still in transition.  It changes and matures rapidly following birth.  Microorganisms are introduced and start colonizing along the gut.  Colostrum's protective nature properly guides the colonization of the baby's gut so that the environment is perfect for nutritive and protective functions.

Colostrum continues the process started in the womb of developing the villi which line the intestines.  

Leaky Gut Syndrome occurs when villi is damaged and gaps exist between them.  The gaps allows bacteria and other foreign matter in the intestines to enter the bloodstream and other tissues in the body.

Anything other than colostrum or colostrum/mature milk mix will affect the proper development of the lining of the intestines.  Formula will predispose most infants to lifelong issues which can arise from this defect.  These include diabetes, allergies, colitis, Crohn's disease, and so on.

One thing which affects the colonization of the G.I. tract is the type of delivery.  A baby which is born vaginally picks up his mother's organisms during birth.  Cesarean born infants are more likely to pick up organisms found in the OR, air, hospital staff, and so on, before being colonized with mother's flora.  These babies have more pathogens like Clostridium difficle (aka C. Diff -- one very nasty bug). 

Also, there is a significant absence of Bifidobacterium species (certain bacteria which help to develop a protected G.I. environment).  These "friendly" bacteria are present in large numbers in the intestines of vaginally delivered babies.

This "set-up" of bacterial colonies can have long term effects on the baby's health.  Intestinal organisms play an important role as to how well the baby's immune system develops.  If the direction is toward a less than optimal environment in the gut, the baby can be more vulnerable to a number of diseases and conditions, including autoimmune disorders which can develop years later.  These disorders include asthma and juvenile onset or type I diabetes.  Infant formula, as well as the method of birth, can lead to establishing an abnormal environment in the baby's G.I. tract.

A baby born by C-section, who is not breastfed, faces more health challenges than one who receives human milk.  Breast milk can help re-establish a properly functioning G.I. tract, although it can takes weeks or months.

I have heard a well educated lactation consultant wonder if it might be beneficial for a health care provider who is not performing the surgery, to reach down, and with a sterile glove on his or her hand, swipe the vaginal opening and then rub the baby's lips and skin before beginning any further procedures. 

I have also read that vaginal swabs should be done and then swab rubbed onto mother's nipples when a C-section if done.  In either case, the baby would be innoculated with mother's microbes.  This is the first step in setting up the infant's gut and respiratory microbiome, which is a vital part of the infant's immune system.
  
Something else which helps with colonizing the C-section baby with its mother's flora is to place the

Baby breastfeeding while mom's C/S is being completed.

baby skin to skin on the mother's chest before it is taken to any other part of the operating room.  A light baby blanket can be placed over the baby.  Dad or other family member can stand by to make sure the baby does not roll off.  When this is done, many babies will latch on and begin nursing while the doctor is doing the repair work!  Otherwise, there is a longer period of time where the baby is exposed to other, less friendly, organisms.

Infants born by C-section have a increased chance of 20% of developing asthma, according to one very large compilation study (meta-analysis -- a study of the the data from several studies).  Another study showed a 20% increase in the risk of childhood type 1 diabetes after a C-section delivery.  Again, breastfeeding will provide some protection for the baby born under these circumstances.

As a childbirth educator, let me interject something here.  Cesarean sections are not simply an alternative method of delivery.  The risk of a serious complication in a vaginal delivery is 1%.  In a C-section, it rises to 3% -- 3 times as much.  That is for serious complications, including life threatening ones.  This risks of more common complications, including failure to successfully breastfeed, is higher. (One could argue, too, that this is also a serious complication -- especially if it contributes to serious and/or life long health problems for the infant, the mother, or both!)  Cesarean birth is associated with a delay in the initiation of breast milk production,  Many women who do not have adequate information and support will give up too quickly, thinking they are not able to produce enough milk to feed their babies over the long term.

Women who are pregnant would be wise to read good books on childbirth -- books which inform the reader about the natural design for childbirth, pros and cons of interventions, and possible options or alternatives to those interventions.  In my opinion, one of the best ones out there is Pregnancy, Childbirth, and the Newborn by Penny Simkin, et.al.   Get the latest edition, currently the 4th edition.  Some local libraries have it in their stacks.  There is also a website with much of the information found in the book.  It is www.PCNGuide.com 

A great website is EvidenceBasedBirth.com.  Dr. Rebecca Dekker, a researcher by profession, has and continues to evaluate research, using recognized tools.  She writes articles and papers on what the research evidence indicates about a wide variety of birth practices.  I recommend that EVERY expectant mother read the material and discuss it with their physicians or midwives.  Dr. Dekker has some items in a handout format just for this purpose.

Also, locate a childbirth class which supports the parent's right to objective information, as noted above, and which does not simply prepare you to accept the hospital routine without question. Especially if your hospital is a teaching hospital, you may be subject to some interventions because of the need to provide learning opportunities for medical students and residents.  You can face labor better prepared to do incorporate activities and positions which have been shown to promote vaginal delivery.  You will also be more likely to be able to avoid those interventions and processes which steer toward an operative delivery, including C-section. 

Contact your local La Leche League group for suggestions on classes and even hospitals.  You may also want to investigate the pros and cons of birth in a free standing birth center or even with a qualified midwife attended home birth with hospital back up.

Note: a later blog which deals with preparing during pregnancy for breastfeeding after delivery, provides more information than mentioned here.

I will stop here for now.  I have listed only a few, but very important components of colostrum.  God is so detailed in His creation!  Can you imagine pancreatic secretory trypsin inhibitor being added to formula?

It is important to give credit where credit is due. While the above information is found in a variety of sources, some has been well compiled by Marsha Walker in Breastfeeding Management for the Clinician (second edition), published by Jones and Bartlett. 

I have listened to Marsha speak at conferences over the years, and have read many of her journal articles and educational materials.  I also had the opportunity of sitting next to her several years ago as we listened to other speakers at one conference.  We discussed a theory of mine, based on what I was seeing in clinical practice, and she provided great encouragement to continue looking into the issue.  I will probably share what I have observed, including recommended treatments, with you in a later blog.  Marsha is a registered nurse and the executive director for the National Alliance for Breastfeeding Advocacy Board of Directors at the time of publication.  She is a sought after speaker internationally, and champion for the field of lactation consulting -- all because she loves women and babies.

I do not know her spiritual beliefs.  My use of information from her book is not to be construed in any way of her support for the Christian perspective of this blog. I am simply pulling from the researched based information she has complied as I present why breastmilk is so special over the next several blogs.  Marsha has done me a great favor by saving me many, many hours trying to locate many of the individual studies I have read or which have been cited by other authors or speakers over the years by putting a wealth of scientific, researched information in her book.  Thank you, Marsha! 

The recommendations regarding childbirth and breastfeeding soon after C-section birth are also found in several reliable professional sources and are the basis for my comments here.  If this blog were ever to result in a book, it will most likely contain citations by chapter or in an appendix.  In the meantime, I will be careful to share information which is based on research, or from observations by professionals in the field of childbirth or lactation.  

The next few blogs will continue to examine some of the components of breastmilk and how they serve to nourish and protect babies.  Since over 200 components have been identified, with some of them still a mystery regarding their function, I will be selecting a small percentage of them for us to consider!  However, even those few clearly evidence God's power and wisdom in His creation. 

This reminds me of a story I read a couple of years ago.  It seems that a scientist stood before God said to Him, "We can now create a man just like You did!".  So God said, "OK, you may show me how you can do this."  The scientist reached down and picked up some dirt.  God said "Wait a minute!  Get your own dirt!".

Perhaps nutritionists for formula companies think can create a baby milk just like breast milk.  However, they have to use what is available on this earth now, whether it is soybeans or the milk of cows or goats.  God is allowing them to try, knowing they can NEVER come close to duplicating the amazing, precise, living components He put in His NBM (natural baby milk).