Posted on 3rd September 2019
By Dr Jacinta Vu, Oral Medicine Specialist
Breastfeeding is something that is, and has been, literally and metaphorically, close to my heart over the past four years and counting, as I continue my breastfeeding journey with my third and fourth children – eight-month-old twin girls. Dentists are not usually taught much about breastfeeding at dental school, and are very likely to come across patients, employees, friends, family or colleagues who are pregnant or lactating. Moreover, there are substantial numbers of females of childbearing age within the dental workforce, and like myself they may be currently breastfeeding, or planning to breastfeed, whilst working.
More than ever before, it is known that breastmilk offers unique nutritional and non-nutritional benefits that optimise infant growth and development, as well as conferring lifelong improved infant and maternal health outcomes.
Australia’s infant feeding guidelines recommend exclusive breastfeeding (meaning breastmilk only without any other type of liquid intake) of infants to around six months of age when solid foods are introduced, and continued breastfeeding until the age of 12 months and beyond, if both mother and infant wish. Unfortunately, we are falling short of this recommendation.
In Western Australia, exclusive breastfeeding is initiated for the majority of infants, but decreases to 64.9% at one month and down to 12.3% at 6 months. Breastfeeding may be considered natural, but it is certainly not easy, particularly in the first 2 – 3 months when milk supply is being established, new mothers are trying to cope with exhaustion and are coming to terms with the life change that parenthood entails. Factors such as a lack of support and education, pain, latch issues, impaired milk transfer by the infant and insufficient milk supply are a few possible contributors to the decline in breastfeeding rates.
General Health Benefits of Breastfeeding
The reported health benefits of breastfeeding for infants includes decreased risk of: Sudden Infant Death Syndrome (SIDS), gastrointestinal and respiratory infections, acute otitis media, necrotising enterocolitis, asthma, childhood obesity, development of Type 1 and 2 diabetes later in life and leukaemia in childhood. Additionally, the transfer of maternal antibodies provides some protection prior to immunisation.
For mothers, the health benefits include decreased risk of: breast and ovarian cancer, hyperlipidaemia, hypertension and cardiovascular disease, type 2 diabetes, maternal and post-partum depression and increases periods of amenorrhoea. Reportedly, breastfeeding is also associated with enhanced slow-wave sleep and reduced reactivity to stress in lactating mothers.
Oral Health & Breastfeeding
Apart from general health benefits, breastfeeding can impact on the oral health of children.
Breastfeeding involves active sucking by the baby and, in theory can shape the development of the facial bones and musculature. A recent review found that there is some evidence to support a protective effect of breastfeeding on non-specific malocclusions in the primary dentition. The subtypes of malocclusion were not well defined in the papers included in the review. The authors also noted that there was insufficient evidence to demonstrate the same protective effect for the mixed and permanent dentitions.
Early childhood caries is a prevalent but preventable childhood disease. Breastfeeding for up to 12 months appears to have a protective effect against dental caries; however, breastfeeding for longer periods (>18 – 24 months) or with high frequency potentially increases caries risk. To reduce caries risk without losing the other benefits of breastfeeding, a reduction in the frequency and nocturnal breastfeeding after 12 months of age has been suggested. However, it should be noted that the studies included for review did not account for dietary exposure to sugars, or oral hygiene practices which are confounding factors. Dentists should provide dietary and oral hygiene advice prior to the eruption of the first tooth, in order to best protect children against the development of dental caries.
Breastfeeding in the Workplace
In June 2019, 51.8% of all dental practitioners (dentists, dental specialists, oral health therapists, dental hygienists, dental therapists and dental prosthetists) nationally were female. In WA, that figure is even higher at 58.1%.
These figures do not include dental assistants or receptionists, with the vast majority of these positions being filled by women as well. Women with a higher education level are more likely to initiate and continue breastfeeding for the minimum recommended six months than those with lower levels of education. This means that female dental practitioners who are breastfeeding are very likely to wish to continue if they are returning to work within the first year of maternity leave.
According to Australian Federal Law breastfeeding is a right, not a privilege. Under the federal Sex Discrimination Act 1984, it is illegal in Australia to discriminate against a person either directly or indirectly on the grounds of breastfeeding. This includes women who need to express milk by hand or using a pump. Breastfeeding mothers can be supported by allowing breaks for breastfeeding or expressing at work. If milk is not removed frequently from the breast, there may be the potential for the mother to develop mastitis, or even a significant decrease in milk supply. For those mothers who need to express, a clean, private area with a sink and power point (not a toilet), access to a fridge or freezer to store the milk and somewhere to store pumping equipment would be helpful.
On a practice level, by supporting breastfeeding in the workplace, women are more likely to return to work and return earlier, which improves retention rates and helps those employees to maintain their skills. Breastfeeding women are also less likely to have frequent or lengthy non-attendance at work due to baby-related illnesses being less common and less severe. Research has shown that these women are also more likely to have higher morale and improved concentration, resulting in increased productivity. It can be extremely difficult and daunting to return to work and continue breastfeeding. I can attest to the fact that my return to work has been made much easier with the support of my colleagues and other employees at the practice, and strategies in place to manage expressing.
In summary, breastfeeding is an important positive health behaviour, and should be encouraged, whilst recognising that it may not be the most appropriate option for all mothers.
Dentists have many opportunities to protect, promote and support breastfeeding in order to improve the health of mothers and babies.
References available by email: firstname.lastname@example.org