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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 pre-pregnancy 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 well-drained (for at least ten minutes) to give your baby access to the rich, high-fat 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 anti-fungal 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.

BabyTalk contributing editor and pediatrician Marianne Neifert, M.D., is the author of Dr. Mom's Guide to Breastfeeding and the mother of five breastfed children.

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