Breastfeeding delivers important health benefits to both mother and child, yet only 1 in 4 babies are exclusively breastfed for the first six months of their lives, as recommended by the American Academy of Pediatrics. Among the reasons for this are the difficulties some new mothers have producing enough milk to feed their newborns, and for an estimated 25 percent of nursing women, mastitis, a painful infection of the breast.
Intriguingly, billions of dollars have been invested on research to help lactating mothers overcome these barriers, yet women have not benefited from these findings. Why? Because the studies were conducted in dairy cows.
For over a century, dairy scientists and veterinarians have been searching for strategies to improve cow lactation. As early as 1917, The Journal of Dairy Science began publishing the first of the ultimately thousands of studies from the industry focused on preventing mastitis in cows. In a stark contrast with longstanding efforts to prevent mastitis in cows, only a few hundred studies of mastitis in women were published until the surge of interest in women’s health research in the 2000s.
Dairy science’s longstanding research efforts have produced a wide range of evidence-based practices to reduce mastitis risk and increase milk production in cows. These findings have not been applied to women. As a physician and scholar of species-spanning medicine, I want to change that.
The basic biology and physiology of lactation in mammals — including humans and cows — has been largely conserved over evolutionary time. While there are some differences across species, women and cows share similar milk synthesis and transport mechanisms as well as mammary duct biology and let-down responses to oxytocin. In both species the risk of milk ducts becoming blocked and infected is significant.
To deal with this, dairy farms follow simple yet evidence-based practices — practices that could also reduce mastitis and speed recovery from infection for breastfeeding women. First, there is a non-invasive "cow-side" diagnostic test (literally a few drops of milk mixed with a reagent) that is extremely effective at detecting the earliest signs of mastitis. If the test result is positive, the cow is milked more frequently and for shorter periods of time to flush the mastitis pathogen out of her system.
In addition, farmers allow the cow’s nipples to remain open to the air for 30 minutes after lactation. Dairy scientists have found that milk ducts aren’t fully closed until that long after milking, and mastitis-causing bacteria can enter through an open duct. Thus, cows are kept from lying down until the ducts have closed to reduce the risk of mastitis. While the precise time it takes for a woman’s breast ducts to close after feeding hasn’t been the focus of significant research, a similar approach could help prevent mastitis in breastfeeding women. If dairy farmers can use these measures to reduce the incidence of mastitis and also detect and treat infection before it becomes a chronic issue, it begs the question: Why can’t these low-tech, low-cost, highly effective strategies be integrated into human lactation practices?
Dairy science provides many insights for producing adequate milk. Nutrition is one of them. Before my own children were born, my ob/gyn advised me only to eat a balanced diet and stay hydrated. Compare those general guidelines to the specific practices followed by the dairy industry: Three weeks before delivery, pregnant cows are fed a highly specialized diet designed to ensure a healthy milk supply while protecting the mother’s bones from calcium loss. The dairy industry has invested billions of dollars to pinpoint the precise combination of protein, fiber, carbohydrates, and other nutrients required to maintain maternal health and strong milk production. It’s time that human maternal nutrition research receives a similarly intensive level of attention that the dairy industry has focused on cows over the past 100 years. Larger clinical trials are needed; insights from veterinary and dairy science experience can help guide these efforts.
Dairy scientists, veterinarians, and farmers also recognize that healthy milk production is impossible without something they call “cow comfort.”
Joel Speiller, DVM, an experienced dairy veterinarian in central California, understands the importance of cow comfort, a term that encapsulates the ideal conditions for strong milk production including a calm and comfortable environment and in which a pain-free female can relax and lactate. He leverages his knowledge of oxytocin — its central role in the let down reflex and flow of milk and how important touch, community, and bonding are to its release — to create physical and social environments that promote milk production. Speiller offers that the goal isn’t just to make the cows comfortable. It is to make lactation a pleasurable experience for them. As he explained to me, no one can force a 1,200 pound cow to enter a milking barn if she doesn’t want to.
Dairy farms have transformed milking into a carefully timed and choreographed routine intended to create a soothing environment for their cows. To promote optimal milk production, the process emphasizes the following elements:
- A predictable daily routine
- Sufficient rest
- Low-stress conditions: Is the cow relaxed and chewing its cud?
- A quiet and comfortable place to live, eat, and drink
- An inviting space to lie down: Research has pinpointed the precise number of hours a cow should stay off her feet to create a healthy milk supply.
- The ideal temperature and humidity index that allows the cow to reserve her energy for making milk, promoting milk letdown
Imagine if breastfeeding women could stroll into a temperature-controlled, quiet, calm zone, where comfort was the North Star. Imagine how much more pleasurable breastfeeding would be — and perhaps how much longer women might breastfeed. Given the importance of rest and calm to lactation success, it is startling to consider that women with breastfeeding challenges are given a list of things they should do. Creating lactating environments for women that have the same kinds of “cow comforts” found in a dairy farm would be a great start.
That said, significant concerns have been raised about commercial farming and its treatment of animals bred to feed us. These issues merit deep discussion as the needs of humans are balanced with the welfare of animals. At the same time, over a century of highly relevant knowledge from dairy science has the power to help countless women and children by removing barriers to breastfeeding — one of our species’ most effective health-promoting practices.
I argue that the medical field should pursue clinical trials to identify practices that ease breastfeeding for new mothers, including members of its own profession. According to a 2022 AAMC report, 37% of active physicians in the U.S. and 47% of residents and fellows were women. The hectic nature of a medical career — skipped meals, poor sleep, unpredictable schedules, long hours on one’s feet — wreaks havoc on a breastfeeding routine. Given the lifelong health benefits breastfeeding provides to mother and infant, it’s time for us to do a better job of looking after our own, as well as our patients.
The human medical field has long overlooked insights from the world of veterinarians and other animal experts. Well-studied practices identified by dairy scientists seem to offer an excellent chance of being effective in breastfeeding women — reducing mastitis risk, helping them produce a healthy milk supply, and making the experience more comfortable and even pleasurable — thereby extending the breastfeeding period to help mothers and their children enjoy lifelong health benefits.
What would you like to see changed about the current state of breastfeeding?
Dr. Barbara Natterson-Horowitz is a professor of medicine in cardiology at UCLA Health and founding co-director of the UCLA Evolutionary Medicine Program. She studies the natural world for insights for human challenges. At Harvard University, she is a faculty member in medicine and human evolutionary biology. She coauthored the New York Times bestselling book, Zoobiquity: The Astonishing Connections Between Human and Animal Health. Learn more about her research at www.bnatterson-horowitz.com or follow her on Twitter at @BNHorowitzMD.
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