Common Myths and Realities About Early Breastfeeding

Sorting out the facts

Common Myths and Realities About Early Breastfeeding MYTH: He can't be hungry again. He just finished feeding a while ago.

FACT: Breastfed babies, especially newborns just learning to nurse, may appear to have fed well, without actually having taken much milk. It can be hard to tell whether a nursing infant consumed an adequate amount of milk, since the breasts don't have calibrations on them. If your baby acts hungry a short while after feeding, it's best to assume that he genuinely is hungry. Going by the clock ("He shouldn't be due to eat again") isn't as reliable an indicator of the need to nurse again as your baby's obvious hunger signs. Instead of concluding "He shouldn't be hungry again already," consider this possibility: "He must not have taken all he needed last time. He acts like he wants to try again."

MYTH: I must not have sufficient (or rich enough) milk. He wants to eat every couple of hours.

FACT: Breastfed babies feed at closer intervals than bottle-fed babies because breast milk is digested faster. This design probably was nature's way to assure that babies would get their mothers' attention every couple of hours around the clock. Breastfed newborns typically nurse every two to three hours from the beginning of one feeding to the beginning of the next. This frequent feeding pattern can make new breastfeeding mothers doubt the adequacy of their milk. Review the criteria for adequate breastfeeding before attri-buting your baby's frequent feeding to a deficiency in the quality or quantity of your milk. Abnormalities in milk composition are exceedingly rare. Almost all mothers make milk that is sufficiently rich in nutrients.

MYTH: You should expect some pain with breastfeeding. It's not easy, you know. You'll just have to tough it out.

FACT: During the early days of breastfeeding, some nipple discomfort at the beginning of feedings is not uncommon. Variable degrees of breast tenderness also can occur during the period of engorgement when the breasts become full and firm. Once your milk has come in and is flowing well, nipple pain and breast tenderness usually diminish. By the end of the first week, breastfeeding generally should be comfortable. Nipple pain that persists beyond a week, that lasts throughout a feeding, or that causes you to dread nursing your baby is distinctly abnormal. Such pain probably means that your baby is latched on incorrectly to your breast or is sucking in an inappropriate fashion. You need to seek help right away. Ask your baby's doctor to evaluate your breastfeeding technique, or to refer you to a lactation consultant or other breastfeeding specialist who can assist you with breastfeeding. Remember, improper infant positioning at the breast not only creates nipple pain, but it also prevents the baby from obtaining sufficient milk. Thus, sore nipples often go hand in hand with a low milk supply and a fussy, hungry baby. Just as chronic or severe nipple pain shouldn't be considered a normal part of breastfeeding, persistent or extreme breast tenderness also is abnormal and can signal a treatable problem like a breast infection.

MYTH: Don't worry if nursing isn't going well at first. It usually takes four to six weeks for breastfeeding to get well established.

FACT: The popular statement that breastfeeding takes many weeks to become well established probably originated as a tactic to encourage women having early problems not to become disillusioned and give up. The truth is that early problems don't always work themselves out, just given a few more weeks. While it might take four weeks for feeding routines to become more predictable and nursings to be more efficient, the hallmarks of successful breastfeeding usually are evident within a week postpartum. When warning signs are present, delays in seeking help often lead to diminished milk supply and worsening of the infant's status. The false belief that many weeks must pass before breastfeeding should be going smoothly does women and their babies a disservice. It fosters a risky wait-and-see approach that contributes to inappropriate delays in seeking help for breastfeeding problems.

MYTH: I'm so glad I chose the natural way to feed my baby. Breastfeeding's sure to be convenient, and I won't have to spend a penny.

FACT: While I'm all for enthusiastically promoting the benefits of breastfeeding, this Pollyanna approach to nursing can set a woman up for disappointment. Certainly, in the long run, breastfeeding usually proves to be highly convenient, enormously enjoyable, and cost effective. In the early weeks, however, mothers with unrealistic expectations may find it more difficult than they had counted on. Feedings seem less convenient when no one else can do them. Nursing seems less "natural" when it involves uncomfortable engorgement and sore nipples. Instead of being totally cost-free, breastfeeding may require that you spend money for nursing bras, breast pads, a rental breast pump, other breastfeeding aids, and professional consultation. Don't get me wrong. I definitely believe any extra investment of time, effort, or money is well worth it. I just think women should be given a realistic view of the commitment breastfeeding requires-especially in the early weeks.

More common myths and realitiesMYTH: You're so lucky your new baby already sleeps through the night! Think of all the extra rest you're getting.

FACT: Contrary to popular belief, a breastfed newborn who sleeps through the night (longer than a single five-hour stretch) is not a blessing. With rare exception, such an infant is unlikely to gain sufficient weight or to stimulate an adequate milk supply in the mother. Nighttime feedings are a natural, normal part of early breastfeeding. Round-the-clock feedings are necessary to bring in and preserve an abundant milk supply. Newborns need to receive nighttime nutrition, and the breasts need to be emptied regularly, including at night. If your new baby sleeps longer than five hours at night, you should try to arouse him and entice him to nurse.

MYTH: Don't worry about using formula supplements now and then to keep nursing from tying you down. An occa-sional bottle will give you a break, and it won't interfere with breastfeeding.

FACT: Supplemental bottles can interfere with the success of breastfeeding by upsetting the delicate law of supply and demand. Simply stated, the law goes like this: "The more milk the baby takes, the more milk the mother makes." If a baby drinks a bottle of formula instead of taking breast milk, the mother's breasts will not get the normal amount of stimulation and emptying. Her supply probably will decline in proportion to the supplement she gives, making her dependent on the continued use of formula. What starts out as a "convenience" bottle can result in a great inconvenience-the undermining of successful breastfeeding. If you want to offer an occasional bottle after three to four weeks, use expressed breast milk whenever possible.

MYTH: Don't give formula or use a bottle at any cost. Nipple confusion can occur with even a single bottle-feeding, and giving any supplement will ruin your chances to succeed at breastfeeding.

FACT: This is the type of dogmatic advice that has placed some babies in jeopardy. Certainly, offering unnecessary formula or giving bottles as a matter of convenience should be discouraged. These practices are known to threaten the success of breastfeeding. But it is a gross oversimplification to insist that no breastfed baby should be given formula or a bottle. The inescapable truth is that some breastfed babies are unable to obtain sufficient milk by nursing to meet their fluid or nutrient requirements. Although uncommon, some breastfed babies have lost an excessive amount of weight and become dangerously dehydrated or malnourished. Our first priority always must be the baby's well-being. A healthy, well-nourished baby is more likely to breastfeed effectively than an undernourished baby in a debilitated state. Formula and bottles are not anathema when they are used to restore a baby to good health. If supplements truly are required, you can be sure that you also need to obtain consultation to improve breastfeeding. A rental-grade electric pump will likely be needed to increase your milk supply. Numerous other breastfeeding aids are available to help solve breastfeeding problems.

MYTH: Don't worry about your baby's slow weight gain. Everyone knows bottle-fed infants grow much faster than breastfed babies do.

FACT: When breastfeeding is off to a good start, young infants obtain plenty of milk and gain weight rapidly-about an ounce each day during the early months of life. Young breastfed infants typically grow above the average on national growth curves. Only after the first three months do breastfed babies taper in their rate of growth compared to bottle-fed infants. If a young breastfed infant is not gaining weight well, it is very likely that the baby is not obtaining sufficient milk by nursing. Not only is the baby at risk for being undernourished and chronically hungry, but the mother's milk supply can be jeopardized. Early intervention to improve breastfeeding will help the baby gain weight more rapidly and increase the mother's milk supply.


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