**5. Attachment parenting**

which promotes breastfeeding and rooming in for every newborn resulting in an increase in breastfeeding initiations. Many college educated mothers are cognizant of numerous benefits

Majority of nations have ratified the International Code of Marketing of Breast Milk Substitutes, however there are serious violations of marketing by formula industry and court challenges to overturn the marketing code. It is not unusual to hear that some unscrupulous providers in 3rd world countries will give samples of formula to the mothers upon delivery to feed their newborn and deprive the newborn from the benefits of colostrum feeding and

There are many obstacles to exclusive breastfeeding of a newborn in US hospitals, some of which are due to flawed hospital policies for newborn jaundice and neonatal hypoglycemia. Some physicians wrongly believe that exclusive breastfeeding will place the newborn at risk of developing hypoglycemia as well as severe jaundice which may lead to kernicterus. Other obstacles to exclusive breastfeeding include the use of pacifiers, nipple shields and providing the mothers with a breast pump to give the breast milk via a bottle to feed the newborn infants.

The high rate of cesarean section in some countries is an obstacle to breastfeeding, because of reduced oxytocin and delayed lactation [6]. Additionally epidural block may result in lower oxytocin release due to the inhibitory effect on Ferguson reflex [6]. Pitocin infusion may result in reduced release of oxytocin via a feed-back inhibitory effect [6]. Therefore it is clear that natural child-birth without epidural block and pain medications result in better outcomes immediately after birth with the newborn latching on and suckling at the mother' breast. Infants born vaginally have higher oxytocin level than infants born by cesarean section, 69 pg/ml vs.

Newborns placed on the mother's chest latch on to the mother's breast, attracted to the Montgomery glands around the nipples, which secrete a lubricating liquid. Newborns latch on to both nipples, however when one nipple is washed with soap and water the newborn would latch on only to the unwashed nipple. When the mother's amniotic fluid was applied to the washed nipple, the newborn latched to that nipple. It is generally believed that the liquid discharge from the Montgomery glands have the scent of the mother's amniotic fluid [7]. We have also encountered the statement from the breastfeeding mothers that for the first

There is strong and convincing evidence that attachment and bonding between the mother and infant is associated with the release of oxytocin from hypothalamic nuclei, peri-ventricular and supra-optic and its binding to peri-aqueductal gray (PAG), insula, inferior and posterior

Oxytocin and many of the maternal hormones are present in the mother's breast milk. However the concentration of breast milk oxytocin is very low and decreases quickly. Oxytocin is probably digested in the infant's stomach and is not absorbed from the intestinal tract into the circulation. However oxytocin activates cholecystokinin which then activates sensory vagal nerves which release oxytocin from the infant's hypothalamic nuclei [6]. Sucking in the newborn is associated with infant's oxytocin release. Furthermore sensory interactions between

2–3 weeks their infants refuse to breastfeed immediately after a shower.

of breastfeeding and choose to breastfeed their infants.

later breastfeeding.

30 Selected Topics in Breastfeeding

33 pg/ml [6].

temporal nuclei [8].

During the early and mid twentieth century there was a gradual decline in breastfeeding rate in industrialized nations. This decline is attributed to the global conflicts when bread-winners went to war and the women went to work. The infants and young children were left with a relative to care for them and the majority were given breast milk substitute (formula) or cow's milk. In England, majority of infants and young children were placed in large nurseries in the countryside away from London during World War II. The mothers were allowed to visit their children occasionally. Many children were noted to develop behavior problems and maladjustment as they grew older. The emotional and behavioral problems were attributed to maternal deprivation. Several prominent psychologists and psychiatrists promoted the concept of maternal separation as the root cause of delinquent and maladaptive behavior. Sir John Bowlby who was a member of an aristocratic family was the most prominent of these researchers who was personally affected by maternal deprivation. It was customary in the aristocratic families in England to employ a nanny to take care of the infants and young children. They believed that close contact between the mother and their infants and young children would spoil them. Sir John Bowlby writes that he was only allowed to see his mother for an hour after her evening tea. Naturally he developed attachment to his nanny and when she suddenly left the household when he was only 4 years old, he was quite devastated like losing a mother. Bowlby states that his early life experiences provided the idea of what he later called the theory of attachment parenting. When he was 10 years old he was sent to a boarding school, which was common in aristocratic families in England. After completion of high school he studied psychology, medicine and psychiatry. John Bowlby wrote his first paper in 1958, titled, the nature of the child's tie to his mother, which was followed by a number of papers and books on attachment parenting. However his writings do not include the benefits of breastfeeding, primarily because of the lack of knowledge regarding young infants' nutrition at the time. Subsequently there have been a great number of articles and books which have been published on the subject of attachment parenting which still lack the prominent role of breastfeeding and its role in mother-baby bonding. A number of researchers including Marshall Klaus and later John Kennel have published articles and books regarding the benefit of breastfeeding in bonding and attachment between mother and her newborns [9, 10]. They recommended that the newborns should stay with their mothers and breastfeed as soon as possible after they are born. They also stated that early breastfeeding enhance the motherinfant bonding, increase the likelihood of breastfeeding, improves child development and prevent child abuse and neglect. Furthermore Klaus stated that early mother-baby bonding is the result of the rise in oxytocin in both mother and infant's brain [10]. Critics had made comments regarding the feeling of guilt by the parents who were not able to bond with their newborns in the hospital and to breastfeed their babies [11].

The theory of attachment parenting is based on psychological principles and lack of solid scientific foundation. The massive data in the past 2 decades have provided strong and convincing evidence that long term breastfeeding and providing an enriched environment result in every child achieving his fullest potential.

neuroendocrine stress signaling and anxiety and depression symptoms [22]. Activation of beta estrogen receptors increases oxytocin gene transcription and reduces anxiety-related behavior [22]. Endogenous oxytocin can suppress corticotrophin releasing factor, CRF, and therefore

The Influence of Breastfeeding and the Infant's Social Environment on Neuroplasticity and Brain…

http://dx.doi.org/10.5772/intechopen.73209

33

Oxytocin is a neurotransmitter for oxytocinergic system and therefore involved in homeostatic processes [22]. Adults who were breastfed during infancy have lower total and LDL

The onset of labor begins with a decrease in maternal progesterone blood level, which results in a rise of maternal estrogens to progesterone ratio. Estrogens are transcriptional promoters of oxytocin gene which initiate uterine contractions. Furthermore estrogens are also transcriptional promoters of oxytocin genes in SON and PVN nuclei in the maternal central nervous system. Oxytocin is transported to the posterior pituitary which then enters the maternal

Estrogens in the breast milk enter the newborn's circulation and cross the blood brain barrier. Estrogens act as transcriptional promoter for oxytocin gene in the hypothalamic SON and PVN nuclei. Oxytocin is then transported to a number of oxytocin receptors in the newborn's brain. Imaging studies comparing the activation of oxytocin receptor sites in breastfeeding and formula feeding mothers demonstrate significant enhancement of oxytocin receptors in breastfeeding mothers, which correlates with greater neural response [8] (**Figure 1**) Additionally plasma and salivary concentration of oxytocin are reported to be higher in breastfeeding compared to formula feeding mothers, 36% in plasma and 23% in saliva, respectively [23]. Furthermore the 24 hour urine concentration of oxytocin in breastfeeding mothers is significantly higher compared to formula-feeding mothers [8] (**Figure 2**). Postpartum depression appears to be associated with formula feeding and there is an association between Edinburgh postpartum depression scale and urinary oxytocin concentration [8] (**Figure 3**). Similarly other neuropsychiatric disorders which are highly associated with depression and

There is significant evidence that maternal bonding is mediated by oxytocin and the periaqueductal gray matter (PAG), the limbic system and the lateral orbitofrontal cortex are identified with maternal behavior [8]. There is strong evidence that an enriched environment result in increased release of oxytocin from the hypothalamic nuclei and have permanent effects on the physiology and behavior of mammalian species [9, 24–27]. Furthermore the oxytocinergic system appears to regulate the sensory, emotional, motivational and cognitive

Steroid hormones have significant roles in pregnancy. Progesterone is important in maintenance of gestation and estrogens play a significant role in parturition and lactation. The mother provides the first messenger, estrogens during the labor, via the placenta, to the unborn

pathways which are affected in individuals with neurodevelopmental disorders.

reduce the activation of HPA axis and reduce the ACTH and cortisol levels [22].

cholesterol, lower blood pressure and lower risk of cardiovascular disorders [13].

**7. First and second messengers**

circulation and result in the milk ejection from the breast.

anxiety may share the low oxytocin levels [3].
