Beyond Birth Lactation Services

What’s Your
Breastfeeding Intelligence Quotient (B.Q.)?

Arming yourself with accurate breastfeeding information before you give birth
can make all the difference for you and your baby! Most new and prospective parents know breastfeeding is better for the baby. Most understand that breastfeeding is how human infants were meant to be fed. But did you know that it shouldn’t be terribly painful, even during the first few weeks? Did you know that infant formula actually isn’t the second best thing to breastfeeding, but a distant fourth best, according to the World Health Organization? How much do you really know about the risks of not breastfeeding, and once you learn how important breastfeeding is, what can you do to prevent common difficulties from occurring, or overcome them once they occur? Read on to enhance your B.Q.!

Getting the Facts Straight – Debunking the Myths about Breastfeeding
10 Important Breastfeeding Facts

1. Sore nipples are not caused by nursing too long or too often. Your nipples can be sore even if the latch looks good, but that doesn't mean the pain is normal - a variety of things can contribute to pain while breastfeeding, such as improper latch, improper suck, infection, and anatomical differences.
   
   

   Experts disagree about whether slight initial discomfort can be normal. However, it is never normal to experience severe pain, persistent sore nipples, or any cracks or bleeding while breastfeeding. It is not possible for anyone to determine, simply by observing a feeding, that latch is fine even though it is painful. On the contrary, the presence of pain means there is a problem.

   The cause of pain can be something subtle and it can be something that not everyone would catch, nonetheless, severe pain with breastfeeding is not normal, and in most cases it can be addressed. Some possible causes of excruciating pain with breastfeeding, besides poor latch or positioning, include:

   • Birth trauma (not always obvious) that causes a tight jaw, restricted tongue movement, or dis-coordinated suck/tongue motions
   • Short or tight lingual (tongue) or labial (lip) frenulum (often not recognized by physicians, and sometimes even by lactation specialists)
   • High palate, bubble palate, channel palate or other palatal anomaly or difference (difficult to catch without a skilled person doing a digital-oral exam (finger in mouth)
   • Neurological impairment of baby (temporary but long-lasting - can be up to several weeks at least) from labor medications
   • Yeast infection (not always visible)
   • Eczema, dermatitis, or bacterial skin infection of nipple (not always visible)
   • Vasospasm of nipple (sometimes co-existing with another cause)
   • Very large nipples/small baby combination
   • Long nipples, short palate
   • Short tongue
   • Receding chin
   • Hypotonia or hypertonia
   • Early introduction of artificial nipples - pacifier or bottle (even once for some babies)
   • Cheap, ineffective pump, incorrect size of pump flanges, or suction too high on pump
   • Low milk supply, which causes unrelieved negative pressure and ensuing nipple damage
   • Forceful milk ejection reflex (letdown) or abundant milk supply, which can cause a baby to clamp down to slow the flow
   These are just some of the many ways that pain can result from breastfeeding in the early days. Usually there are several co-existing factors, and usually, it is just a latch issue, but one that isn't apparent from the outside, thus the common experience of "the nurse said my latch looked fine and it shouldn't hurt." There are many ways to address the above issues, and therefore anyone who is experiencing excruciating pain should keep asking for help, preferably from an International Board Certified Lactation Consultant, until someone is able to help. Nobody should have to endure such pain in order to feed their baby the way human infants were designed to be fed.
   
   
2. The more you nurse, the more milk you make.
   Breastmilk is produced by milk-producing cells (alveoli) in the breast, in response to breast emptying. Although there is a common misconception that one must wait for the breasts to refill, in actuality, this approach can lead to a downward spiraling milk supply. The more often and the more thoroughly a baby drains the breast, the more rapidly and abundantly more milk is produced. If milk supply is a problem, and frequent nursing doesn’t improve supply, then it is time to get help from a qualified professional to look at other reasons for compromised milk supply.
   
   
3. You can feed your baby as often as he wants. You cannot overfeed a breastfed baby, and frequent holding and feeding do not spoil a baby!
   Human babies are biologically designed to be carried constantly and nursed frequently throughout the day. Human milk is relatively low in fat, compared to some other species that leave their young to go hunt or forage. This fat profile makes for milk feedings that are relatively rapidly digested. Human infant stomachs are the size of a marble at birth and quickly grow, but only to the size of a golf ball! Imagine trying to double your weight in 6 months, with a stomach the size of a golf ball! You’d have to eat pretty frequently, wouldn’t you? In addition, breastfeeding is much more than food – babies nurse when they are thirsty, hungry, tired, needing comfort, just needing to suck, and for many other reasons. In fact, in some cultures where babies are carried in slings or other baby-wearing carriers most of the day, they nurse as frequently as every few minutes around the clock. Although this pattern doesn’t fit with most American lifestyles, and it isn’t necessary to do this to succeed at breastfeeding, it can be helpful to understand what is biologically normal for a human baby, before making choices based on culture. You cannot spoil a baby by holding or feeding him/her to often, but you can damage your milk supply by scheduling feedings rather than following your baby’s breastfeeding cues.
   
   
4. Returning to work does not mean you have to stop breastfeeding.
   Many women successfully combine working and breastfeeding. Moms often feel that continuing breastfeeding after returning to work allows them to stay connected to their baby in a way they would miss terribly if they stopped breastfeeding. A baby whose mother is away at work or school many hours a week benefits from the physical closeness when mom and baby are together, and from the immune support provided by breastfeeding, especially if the baby is in daycare. In addition, continuing to breastfeed after returning to work helps protect your baby from a variety of risk-factors associated with artificial (formula) feeding, including diabetes mellitus, childhood cancers, asthma, allergies, SIDS, poor oral development, impaired visual acuity, lower I.Q., diarrhea, obesity, and a host of other potential problems.
   
   
5. What you eat and how much water you drink has very little effect on milk volume or composition, and the amount of breastmilk your baby takes does not change very much after about 6 weeks of age, even as baby grows.
   Mothers all over the world are able to provide plenty of breastmilk for their babies, and even mothers who are literally starving (living in famine zones) can nourish their babies with their breastmilk. Our bodies are amazing in their capacity to protect and provide for our offspring! The nutritional profile of breastmilk does not vary much from mother to mother, and although many mothers are led to doubt the “quality” of breastmilk, this is rarely a valid concern. If a baby is failing to thrive on breastfeeding, professional help is needed to assess the real reason or reasons. Drinking to thirst (not waiting until you are thirsty) should ensure that a mother is adequately hydrated to produce plenty of breastmilk. Mothers and health care providers often assume that as a baby grows, he needs increasing amounts of breastmilk to survive and thrive. Recent research has shown this to be untrue. While a smaller newborn will take less milk at the breast than a larger newborn, after about 6 weeks of age, a baby’s intake of breastmilk at the breast increases only slightly (10-15% at about 6 months over 6 week intake volumes), if at all. This speaks to the specificity of breastmilk – which changes in its fat and protein balance and nutritional composition, in just the right ways for your specific baby, as baby grows.
   
   
6. Babies are never allergic to their mother's milk.
   Babies can sometimes be sensitive or allergic to a foreign protein in their mother’s milk, but once the mother stops consuming those foods, the baby usually does well. It can be difficult to pinpoint the source of allergies and sensitivities, and often that is not the real problem to begin with. However for some babies, these sensitivities are real and cause a variety of problems. Switching to formula is not the answer, however. Allergic babies usually do worse on formulas than on breastmilk, and even the hypoallergenic formulas can cause problems. Most importantly, artificial infant milk (formula) is not a living fluid like breastmilk, and contains no protections against viruses, bacteria, or the long list of conditions and diseases that breastmilk is known to protect against.
   
   
7. Babies are not lactose intolerant.
   Lactose is the sugar in mother’s milk. It is also the sugar in cow’s milk. A large percentage of the world’s population loses the ability to metabolize lactose sometime around the age of 5. But even among these ethnic groups, lactase (the enzyme that digests lactose) is present in abundance until that age – because if it wasn’t, then before artificial lactose-free formula, the human race would have ceased to exist! Babies with a rare metabolic disorder, Galactosemia, cannot properly metabolize galactose, and will need feeding intervention (these babies will be very sick early on – there will be no doubt that something is very wrong.)
   Healthy breastfed babies can develop “transient lactose intolerance” from damage to the intestinal tract (from antibiotics or other substances that disrupt the protective flora of the gut), or from “lactose overload” caused by limiting feedings at the breast or switching sides before the baby has finished the first breast. This is one reason for the sound advice to “finish the first breast first.” This approach helps ensure that the baby is getting the proper balance of fat, protein, and fluid for his/her growing brain, body and digestive tract. If your baby develops transient lactose intolerance (sometimes called lactose overload), characterized by frequent explosive, foul smelling green or mucousy stools, very fussy and gassy behavior, and sometimes either extremely rapid weight gain or slow weight gain, these issues can often be remedied by simply letting the baby finish the first breast first (assuming the baby is actively nursing and not just sleeping at the breast).
   
   
8. You can breastfeed adopted babies, even if you haven't given birth before.
   Many adoptive mothers are opting to breastfeed now, and with tremendous success! There are many different approaches to adoptive nursing, so it can help tremendously to work with a knowledgeable person (such as an International Board Certified Lactation Consultant or La Leche League Leader) and to prepare yourself with as much information as possible before your baby comes home.
   
   
9. Formula is NOT a close second choice after breastmilk! In fact it is fourth choice!
   While formula is commonly assumed to be the second-choice infant food after breastfeeding, the World Health Organization (WHO) actually states:
   
   • “The second choice is the mother's own milk expressed and given to the infant in some way.
   • The third choice is the milk of another human mother.
   • The fourth and last choice is artificial baby milk (infant formula)”
   Even one bottle of formula alters the infant gut flora for at least a month – rendering it no different from an adult’s or older child’s (eating other foods) gut profile. Just one bottle of formula can set the stage for future allergies, food sensitivities, diabetes mellitus, and a host of other conditions and diseases. While this does not mean that any baby given formula will develop a medical condition, do we really want to risk it with our babies? Of course, in some cases, supplementation is needed, and if the first three options on the WHO’s list are not available, formula is preferable to cow’s milk for a newborn. Feeding the baby is definitely preferable to not feeding the baby, if the baby needs food! But the scientific facts point toward it being well worth the effort to avoid early supplementation with artificial baby milk if at all possible – and it often is possible, with proper information and timely intervention.

   In many cases the risks of artificial feeding are not presented to parents, and this deprives well-meaning parents the opportunity to make an informed choice. If a baby’s blood sugar is low, or if jaundice or other conditions indicate the need for food quickly, often simply working with a lactation consultant to get breastfeeding working as well as possible, and possibly expressing colostrum (early milk) to feed the baby in place of artificial supplement, is all that is needed to remedy the situation.

   Many parents are not aware of the existence of Human Milk Banks, but they do, indeed exist in the United States, and the Human Milk Banking Association of North America makes it possible for those babies whose mothers cannot breastfeed, or who require supplementation, to receive the third best option, as opposed to a distant fourth best. Many insurance companies will cover the cost of banked human milk, especially if a baby is sick, premature, or adopted and there is a legitimate reason the mother cannot produce a full milk supply. The availability of banked human milk (which is pasteurized and thoroughly screened) for non-urgent situations is dependant on the supply of and demand for human milk at any given time. Some hospitals have taken the step of stocking frozen donor human milk for those occasions when a neonate needs supplementation.

10. Most problems can be avoided-those that cannot can usually be overcome.
    The list below of how to prevent difficulties should help you get breastfeeding off to a smooth start. But keep in mind that even if difficulties do arise, very few are insurmountable, with proper help and information. Problems can become more complicated with time, so addressing breastfeeding issues as soon as possible after they arise helps speed resolution.

    As new and prospective parents there is a great deal you can do to ensure that breastfeeding goes smoothly for you and your baby. Informing yourself with accurate breastfeeding information is just a start!

    Copyright 2003 Please do not reproduce without author’s permission.
    Written by Lyla Wolfenstein, B.S., IBCLC, RLC

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