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Breastfeeding is the natural,
physiologic way of feeding infants and young
children, and human milk is the milk made
specifically for human infants. Formulas
made from cow’s milk or soybeans (most
formulas, even “designer formulas”)
are only superficially similar, and advertising
which states otherwise is misleading. Breastfeeding
should be easy and trouble free for most
mothers. A good start helps to ensure breastfeeding
is a happy experience for both mother and
baby.
The vast majority of mothers
are perfectly capable of breastfeeding their
babies exclusively for about six months.
In fact, most mothers produce more than
enough milk. Unfortunately, outdated hospital
routines based on bottle feeding still predominate
in too many health care institutions and
make breastfeeding difficult, even impossible,
for too many mothers and babies. For breastfeeding
to be well and properly established, a good
start in the early few days can be crucial.
Admittedly, even with a terrible start,
many mothers and babies manage.
The trick to breastfeeding is getting the
baby to latch on well. A baby who latches
on well, gets milk well. A baby who latches
on poorly has more difficulty getting milk,
especially if the supply is low. A poor
latch is similar to giving a baby a bottle
with a nipple hole that is too small—the
bottle is full of milk, but the baby will
not get much. When a baby is latching on
poorly, he may also cause the mother nipple
pain. And if he does not get milk well,
he will usually stay on the breast for long
periods, thus aggravating the pain. Unfortunately
anyone can say that the baby is latched
on well, even if he isn’t. Too many
people who should know better just don’t
know what a good latch is. Here are a few
ways breastfeeding can be made easy:
1.
A proper latch is crucial to success.
This is the key to successful breastfeeding.
Unfortunately, too many mothers are being
"helped" by people who don’t
know what a proper latch is. If you are
being told your two day old’s latch
is good despite your having very sore nipples,
be sceptical, and ask for help from someone
else who knows. Before you leave the hospital,
you should be shown that your baby is latched
on properly, and that he is actually getting
milk from the breast and that you know how
to know he is getting milk from the breast
(open mouth wide—pause—close mouth
type of suck). See also the videos
on how to latch a baby on (as well as other
videos). If you and the baby are leaving
hospital not knowing this, get experienced
help quickly (see handout When
Latching). Some staff in the hospital
will tell mothers that if the breastfeeding
is painful, the latch is not good (usually
true), so that the mother should take the
baby off and latch him on again. This is
not a good idea. The pain usually settles,
and the latch should be fixed on the other
side or at the next feeding. Taking the
baby off the breast and latching him on
again and again only multiplies the pain
and the damage.
2. The baby should be
at the breast immediately after birth.
The vast majority of newborns can be at
the breast within minutes of birth. Indeed,
research has shown that, given the chance,
many babies only minutes old will crawl
up to the breast from the mother’s
abdomen, latch on and start breastfeeding
all by themselves. This process may take
up to an hour or longer, but the mother
and baby should be given this time together
to start learning about each other. Babies
who "self-attach" run into far
fewer breastfeeding problems. This process
does not take any effort on the mother’s
part, and the excuse that it cannot be done
because the mother is tired after labour
is nonsense, pure and simple. Incidentally,
studies have also shown that skin-to-skin
contact between mothers and babies keeps
the baby as warm as an incubator (see section
on skin to skin contact). Incidentally,
many babies do not latch on and breastfeeding
during this time. Generally, this is not
a problem, and there is no harm in waiting
for the baby to start breastfeeding. The
skin to skin contact is good for the baby
and the mother even if the baby does not
latch on.
3. The mother and baby
should room in together. There is absolutely
no medical reason for healthy mothers and
babies to be separated from each other,
even for short periods.
- Health facilities that have routine
separations of mothers and babies after
birth are years behind the times, and
the reasons for the separation often have
to do with letting parents know who is
in control (the hospital) and who is not
(the parents). Often, bogus reasons are
given for separations. One example is
that the baby passed meconium before birth.
A baby who passes meconium and is fine
a few minutes after birth will be fine
and does not need to be in an incubator
for several hours’ "observation".
- There is no evidence that mothers who
are separated from their babies are better
rested. On the contrary, they are more
rested and less stressed when they are
with their babies. Mothers and babies
learn how to sleep in the same rhythm.
Thus, when the baby starts waking for
a feed, the mother is also starting to
wake up naturally. This is not as tiring
for the mother as being awakened from
deep sleep, as she often is if the baby
is elsewhere when he wakes up. If the
mother is shown how to feed the baby while
both are lying down side by side, the
mother is better rested.
- The baby shows long before he starts
crying that he is ready to feed. His breathing
may change, for example. Or he may start
to stretch. The mother, being in light
sleep, will awaken, her milk will start
to flow and the calm baby will be content
to nurse. A baby who has been crying for
some time before being tried on the breast
may refuse to take the breast even if
he is ravenous. Mothers and babies should
be encouraged to sleep side by side in
hospital. This is a great way for mothers
to rest while the baby nurses. Breastfeeding
should be relaxing, not tiring.
4.
Artificial nipples should not be given to
the baby. There seems to be some controversy
about whether "nipple confusion"
exists. Babies will take whatever gives
them a rapid flow of fluid and may refuse
others that do not. Thus, in the first few
days, when the mother is normally producing
only a little milk (as nature intended),
and the baby gets a bottle (as nature intended?)
from which he gets rapid flow, the baby
will tend to prefer the rapid flow method.
You don’t have to be a rocket scientist
to figure that one out, though many health
professionals, who are supposed to be helping
you, don’t seem to be able to manage
it. Note, it is not the baby who is confused.
Nipple confusion includes a range of problems,
including the baby not taking the breast
as well as he could and thus not getting
milk well and/or the mother getting sore
nipples. Just because a baby will "take
both" does not mean that the bottle
is not having a negative effect. Since there
are now alternatives available if the baby
needs to be supplemented (see handout #5,
Using a Lactation
Aid, and handout #8 Finger
Feeding) why use an artificial nipple?
5. No restriction
on length or frequency of breastfeedings.
A baby who drinks well will not be on the
breast for hours at a time. Thus, if he
is, it is usually because he is not latching
on well and not getting the milk that is
available. Get help to fix the baby’s
latch, and use compression to get the baby
more milk (handout #15, Breast
Compression). Compression works very
well in the first few days to get the colostrum
flowing well. This, not a pacifier, not
a bottle, not taking the baby to the nursery,
will help.
6. Supplements
of water, sugar water, or formula are rarely
needed. Most supplements could be avoided
by getting the baby to take the breast properly
and thus get the milk that is available.
If you are being told you need to supplement
without someone having observed you breastfeeding,
ask for someone to help who knows what they
are doing. There are rare indications for
supplementation, but often supplements are
suggested for the convenience of the hospital
staff. If supplements are required, they
should be given by lactation aid at the
breast (see handout
#5), not cup, finger feeding, syringe
or bottle. The best supplement is your own
colostrum. It can be mixed with 5% sugar
water if you are not able to express much
at first. Formula is hardly ever necessary
in the first few days.
7. Free formula samples
and formula company literature are not gifts.
There is only one purpose for these "gifts"
and that is to get you to use formula. It
is very effective, and it is unethical marketing.
If you get any from any health professional,
you should be wondering about his/her knowledge
of breastfeeding and his/her commitment
to breastfeeding. "But I need formula
because the baby is not getting enough!"
Maybe, but, more likely, you weren’t
given good help and the baby is simply not
getting the milk that is available. Even
if you need formula, nobody should be suggesting
a particular brand and giving you free samples.
Get good help. Formula samples are not help.
Under some circumstances,
it may be impossible to start breastfeeding
early. However, most “medical reasons”
(maternal medication, for example) are not
true reasons for stopping or delaying breastfeeding,
and you are getting misinformation. Get
good help. Premature babies can start breastfeeding
much, much earlier than they do in many
health facilities. In fact, studies are
now quite definite that it is less stressful
for a premature baby to breastfeed than
to bottle feed. Unfortunately, too many
health professionals dealing with premature
babies do not seem to be aware of this.
Questions? (416)
813-5757 (option 3) or drjacknewman@sympatico.ca
or my book Dr. Jack Newman’s Guide
to Breastfeeding (called The Ultimate Breastfeeding
Book of Answers in the USA)
Handout #1. Breastfeeding—Starting
Out Right. Revised January 2005
Written by Jack Newman, MD, FRCPC. ©
2005
This handout may be copied
and distributed without further permission,
on the condition that it is not used in
any context in which the WHO code on the
marketing of breastmilk substitutes is violated
1. Breastfeeding:
Starting out right
a) The
importance of Skin-to-Skin contact
2. Colic in the Breastfed Baby
3. a) Sore Nipples
b) Treatments
for Sore Nipple and Sore Breasts
4. Is my baby getting enough?
5. Using a Lactation Aid
6. Using Gentian Violet
7. Breastfeeding and Jaundice
8. Finger Feeding
9. a) You should continue breastfeeding
(Medications and breastfeeding)
b) You
should continue breastfeeding (Illness in the mother or baby)
10. Breastfeeding and other foods
11. Some breastfeeding myths
12. More breastfeeding myths
13. Still more breastfeeding
myths
14. More and more breastfeeding
myths
15. Breast compression
16. Starting solid foods
17. What to feed the baby when
the mother is working outside the home
18. How to know a health professional
is not supportive of breastfeeding
19. a) Domperidone 1
b) Domperidone
2
20. Fluconazole
21. Breastfeed a toddler –
Why on earth?
22. Blocked ducts and
mastitis
23. Breastfeeding your adopted baby
24. Miscellaneous treatments for problems
25. Slow weight gain after
the first few months
26. When the Baby refuses to
latch on
27. Expressing Milk
28. Toxins and Infant Feeding
How breastmilk protects Newborns
Risks of formula feeding
Breastfeeding and guilt
Candida protocol
Protocol to increase the intake
of Breastmilk by the Baby ("Not enough milk")
When latching
Protocols for Induced Lactation
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