Parenting Advice
Breastfeeding Myths
Most expectant and new mothers know that breastfeeding is recommended as
the healthiest way to feed a baby, with approximately 70 percent of U.S.
mothers now opting to nurse their newborns. Yet myths and misinformation about
breastfeeding still abound and contribute to the diverse barriers that prevent
some women from beginning or continuing to breastfeed. Understanding what's
fact and what's fiction can help you give your baby the best possible start in
life.
Dads Can Help, Too
Myth #1: Fathers can't help much if you're breastfeeding.
Fact: While it's true that only a mother can nurse her infant, direct help
and encouragement from the baby's father can be a decisive factor in the
success of breastfeeding. One of the best ways that fathers can help out is to
appreciate their critical role as doula -- one who "mothers" the mother and
empowers her to fulfill her unique breastfeeding role. A father's emotional
support and encouragement is critical,especially during the early weeks after
giving birth when a new mom is often weary and physically depleted.
Dad also can help create a relaxed feeding environment for mom -- pouring her
a glass of water, bringing a nursing pillow, or giving her a backrub. His support can be invaluable during middle-of-the-night feedings, when he can
minimize mom's loss of sleep by bringing the baby to her for nursing, changing
the diaper, and settling the infant at the end of the feeding. Taking charge
of household duties can also conserve mom's energy and keep her spirits up
during the early weeks of frequent feedings.
Fathers soon discover many ways to form their own intimate bond with their
baby, such as bathing, massaging, rocking, and playing with her. Once
breastfeeding is well established (usually after three to four weeks), fathers
can begin giving expressed breast milk by bottle when a nursing mother must be
away. Dad also can take responsibility for washing the breast pump collection
containers, as well as the baby's bottles and nipples.
(Breast) Size Doesn't Matter
Myth #2: Women with small breasts produce less milk.
Fact: Breast size depends more on the amount of fatty tissue in the breast
than the number of milk glands, and no direct link exists between prepregnancy
breast size and daily milk production. Because breast size is
related to the storage capacity of the breasts, women with smaller breasts may
need to nurse or pump more often than large-busted women.
The breasts undergo remarkable development of the milk glands and ducts
in pregnancy under the influence of estrogen and progesterone, with each
breast nearly doubling in weight. The breasts enlarge still further when a
mother's milk comes in, usually on the third postpartum day. Thus, most women
with smaller breasts prior to pregnancy find their breasts have enlarged
considerably by the time milk production begins. If breasts are still small at
this point, it can be a cause for concern, and should be discussed with your
health care practitioner.
Some breast variations can complicate nursing. Inverted nipples can make it
more difficult for an infant to latch on properly, and may require extra
instruction from a lactation consultant or certain breastfeeding techniques.
(For example, using a breast pump before nursing can often make inverted
nipples temporarily protrude.)
While nearly half of all women have a visible degree of breast asymmetry, a
marked difference in breast size can be a warning sign of insufficient milk,
especially when the smaller breast does not enlarge much in pregnancy or
when the milk comes in. Cosmetic and diagnostic breast surgery, particularly
procedures that involve a surgical incision at the margin of the areola -- can
also put moms at an increased risk for an insufficient milk supply as these
incisions may sever the milk ducts.
Every woman should have a prenatal breast exam by her obstetrical care
practitioner, both to detect and diagnose breast lumps, as well as to screen
for variations that may adversely affect breastfeeding. If risk factors
are identified, your doctor can refer you to a lactation consultant for
assistance. Fortunately, lactation is a very robust process, and most women
are capable of producing more than enough milk to nourish their babies.
Switch 'Em Up
Myth #3: Babies should nurse about the same time on each breast at each
feeding.
Fact: New mothers are often advised to nurse their infants for "10 to 15
minutes on each side," which implies that feedings should be timed and that
babies take about the same amount of milk from each breast at each feeding,
which is seldom true. Not only do individual babies display highly variable
breastfeeding styles, but the same baby can have different nursing patterns,
depending upon whether she is ravenously hungry or nursing for comfort.
Babies don't take equal amounts of milk from each breast at a feeding -- most
infants nurse more vigorously at the first breast and obtain about two-thirds
of the milk for the feeding from that side. Because less milk is taken from
the second breast, it's recommended to alternate the side on which feedings
are begun. Although the milk a baby obtains at the beginning of a feeding
is relatively low in fat, the fat content steadily increases throughout the
session. So it's important to nurse on the first breast until it's welldrained
(for at least ten minutes) to give your baby access to the rich, highfat
hind milk.
Some experts recommend staying on one breast for the whole feeding to get more
of the hind milk, but I've found the majority of infants thrive best when
nursing from both breasts. This is because your baby can get the greatest
amount of milk within the first ten minutes on one breast. When she starts to
suck less vigorously on the first side or begins to doze off, you can burp
her, change her diaper, and arouse her for the second side. Let her stay on
this side as long as she wants, although she will likely drain less milk and
may fall asleep.
As babies get older and the milk ejection reflex (the "let-down") becomes well
conditioned, many learn to nurse very efficiently, taking the bulk of their
feeding in only four to seven minutes per breast. If you'd like to leave her
on one breast longer to access more hind milk, then give it a try. But if
there's any concern that your baby isn't eating enough, it's more important to
switch to the second side for the greater volume of milk.
Talk to your doctor or lactation consultant if your baby has either very brief
(less than 10 minutes total) or very long (more than 50 minutes) feeding
sessions, as either may be cause for concern.
A Well-Fed Baby
Myth #4: You can't tell how much milk a baby gets when breastfeeding.
Fact: It's true that the breasts don't have calibrations to allow a mother to
know how much milk her baby takes when nursing. While a pediatrician can tell
if an infant is getting enough milk by monitoring weight gain (a thriving baby
should gain approximately one ounce a day for the first three months of life),
new moms must rely on indirect measurements. In the newborn period (the first
month of life), the following signs indicate that a baby is eating enough:
four or more yellow, seedy bowel movements; six to eight wet diapers daily;
and eight to twelve feedings a day. Other signs of successful breastfeeding
are: rhythmic suckling and audible swallowing; the mother's sense of let-down
or evidence of dripping milk; a decrease in breast fullness at the end of a
feeding session; and apparent infant satisfaction after nursing.
If problems arise, new moms should know that there's also an additional tool
to evaluate breastfeeding. Known as infant feeding test-weights, the technique
involves weighing an infant on a highly accurate electronic scale before and
after a breastfeeding session. The change in the baby's pre- and post-feeding weight represents the quantity of milk he has consumed. So if the infant's
weight increases by two ounces after a feeding, you can assume that he's just
taken two ounces of milk. Keep in mind that for this procedure to be accurate,
the infant must be weighed in the same clothing for the pre- and post-feed
weights. If the baby has a bowel movement or wets during the measured feeding
session, the test-weight will still be accurate, provided you don't change the
baby's diaper.
While new moms can have a test-weight at a pediatrician's or lactation
consultant's office, this reliable method can also be performed at home, with
a highly-accurate rental baby scale. These portable, user-friendly, electronic
scales are available from lactation consultants and pump rental stations.
Mothers of high-risk babies such as twins, preterm infants, or babies
with birth defects can use a rental scale to take the guesswork out of
breastfeeding an at-risk infant. (In many instances, insurance will cover
the cost.) But it's also an option for moms who want additional reassurance
about their nursing progress. Of course, test-weights taken at home should
be discussed with your baby's doctor and jointly interpreted with her. Even
if you don't rent a scale, it's important to know that you can call your
pediatrician's office -- as often as you like -- and request to take your baby
in to be weighed so you can monitor her growth.
Nursing's Not a Nuisance
Myth #5: If you had trouble breastfeeding your first baby, you can expect to
have problems with the second.
Fact: Contrary to what many people assume, a mother's breastfeeding experience
is not necessarily similar with each of her babies. For example, a woman's
personal health and well-being, knowledge and experience, access to expert
help at the hospital, and practical assistance at home can vary with the birth
of each child. Even more important, each baby differs in size and maturity,
medical status, and innate skill in latching on to the breast correctly and
nursing effectively. If you had an unsatisfying breastfeeding experience with
a previous baby, chances are excellent that you can enjoy a positive outcome
this time around.
Begin by becoming as knowledgeable as possible about breastfeeding, reading
printed materials, and attending a prenatal breastfeeding class with your
partner. Review your past experience with your physician or a lactation
consultant who can identify risk factors in you or your baby and help you
avoid a recurrence of the problem. For example, latch-on difficulties are
a common cause of severe sore nipples and inadequate breastfeeding. Often
these problems can be averted by obtaining skilled bedside assistance in the
hospital and, if possible, delaying the introduction of a pacifier or bottle
until your baby is at least 1 month of age.
Opt for continuous rooming-in to allow you to promptly respond to your baby's
feeding cues and give him lots of practice in latching on. Arrange for an
early follow-up visit within two days of hospital discharge; your pediatrician
can provide a referral to a lactation consultant if necessary. This early
follow-up can be invaluable in identifying problems before the milk supply has
been compromised or a baby has lost excessive weight. You can also obtain an
electric breast pump to remove residual milk after some feedings which will
build up your supply and give you surplus milk for use later. Mother-to-mother support, available from La Leche League or peer counselors, can help as well.
Bottles Aren't All Bad
Myth #6: If a baby doesn't breastfeed well, giving a bottle will only make
things worse.
Fact: There is some truth to this statement. Regularly giving a bottle to
a breastfed newborn can interfere with the breastfeeding law of supply and
demand. A mother's milk supply is dependent on her baby's active suckling;
without it, she'll produce less milk. Because an artificial nipple can be
grasped easily by an infant and milk flows readily from a bottle, a newborn
may initially find it easier than nursing. This phenomenon, which can further
undermine attempts at breastfeeding, has been dubbed "nipple confusion."
While studies do confirm a link between the early use of artificial nipples
by nursing infants and a shortened duration of breastfeeding, the widespread
publicity about "nipple confusion" has led to exaggerated fears about giving
even a single bottle to a breastfed newborn.
Troubled breastfeeding, however, calls for special measures. If a newborn
loses too much weight, your doctor or lactation consultant may recommended
supplemental milk by bottle to provide adequate nutrition and keep the baby
healthy. At this point, it's essential to begin pumping after feedings to
increase your supply. The supplemental milk can be either pumped breast milk
or formula.
As the baby starts gaining weight and the mother's milk supply increases with
the additional stimulation and drainage provided by the pump, the baby's
efforts at direct breastfeeding will become more effective. Once breastfeeding
is well-established, many babies can go back and forth between the breast and
a bottle of expressed milk without any difficulties.
The Truth About Breast Pain
Myth #7: Severe sore nipples are always caused by incorrect breastfeeding
technique.
Fact: It's true that improper infant attachment to the breast and incorrect
infant suckling are leading causes of nipple pain and damaged skin. The most
common mistake is a shallow infant latch-on, where the baby grasps only the
tip of the nipple, rather than the entire nipple plus at least an inch of
surrounding areola. An improper latch-on means that the baby is removing less
milk from the breast, which in turn can cause production to decline. This can
lead to painful nursing, as the baby has to work harder and longer to get more
milk. Nipple pain can also inhibit a woman's let-down, making it harder to
release milk.
But a faulty latch-on is not the only cause of chronic or severe nipple
pain: Infection may be another culprit. Once there is a crack in the skin
of the nipple, the area can easily become infected by bacteria or yeast.
Without treatment (oral antibiotics for bacterial infections or an antifungal
medication for yeast infections), soreness will persist. Your doctor
can diagnose and treat infected nipple wounds, while a lactation consultant
can offer expert help with correct latch-on. In addition to these measures,
moisture-retaining hydrogel dressings that are made for breastfeeding mothers
can help provide cooling comfort for sore nipples while the underlying cause
is being treated. Similarly, ultra-pure lanolin can help soothe and promote
the healing of nipple wounds.
If an infected nipple is not treated, it can lead to mastitis, a painful
breast infection that occurs in about ten percent of lactating mothers. It
causes pain and redness in the affected breast and flu-like symptoms. Mastitis
should be diagnosed promptly and treated with antibiotics; ibuprofen can be
given for pain.
Do not stop breastfeeding if you have mastitis as this can lead to a breast
abscess, an extremely painful localized pocket of pus that requires drainage.
Unless your baby is premature or hospitalized, it's considered safe to
continue breastfeeding (or pumping if it's too painful) from the affected
side. If the milk looks discolored or bloody, you can pump and discard the
milk for a day or two until it appears normal, and give the baby formula.
The memory of breastfeeding my own children ranks among my most enjoyable
and nostalgic parenting experiences, and I count it a privilege to help
today's generation of mothers and babies share the benefits and rewards of
breastfeeding. I have learned that breastfeeding success not only requires
skilled practical assistance and emotional support, it also involves replacing
mistaken popular beliefs with accurate and empowering information.
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