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Breastfeeding—Starting Out Right
Handout #1. Breastfeeding—Starting Out Right.
Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005
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 assure 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 Unfortunately, outdated hospital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:
- 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 websites www.breastfeedingonline.com/newman.shtml
for 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 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.
- 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).
- 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 are 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.
- 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?
- 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.
- 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.
- 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?
see
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
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