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Online Guide to Breastfeeding
"Starting Out Right"
By Jack Newman, MD, FRCPC
Starting Out Right
Breastfeeding is the natural, physiologic way of feeding infants and young children milk, and human
milk is the milk made specifically for human infants. Formulas made from cow's milk or soy beans
(most of them) 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 four
to six months. In fact, most mothers produce more than enough milk. Unfortunately, outdated
hospital routines based on bottle feeding still predominate in many health care institutions and make
breastfeeding difficult, even impossible, for some mothers and babies. For breastfeeding to be well
and properly established, a good 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 difficulty getting milk, especially if the supply is low. A poor
latch is similar to giving a baby a bottle with a nipple hole which 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. Here are a few ways breastfeeding can be made easy:
1. The baby should be at the breast immediately after birth. The vast majority of newborns can
be put to breast within minutes of birth. Indeed, research has shown that, given the chance, babies
only minutes old will often crawl up to the breast from the mother's abdomen, 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 labor 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.
2. The mother and baby should room in together. There is absolutely no medial reason for
healthy mothers and babies to be separated from each other, even for short periods. Health facilities
which 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 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.
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.
3. Artificial nipples should not be given to the baby. There seems to be some controversy about
whether "nipple confusion" exists. Babies will take whatever method gives them a rapid flow of fluid
and may refuse others that do not. Thus, in the first few days, when the mother is producing only a
little milk (as nature intended), and the baby gets a bottle (as nature intended?) from which he gets
rapid flow, he 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. Nipple confusion includes not just the baby refusing the breast, but also
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
Using a Lactation Aid, and Finger Feeding) why use an artificial nipple?
4. 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 which is available. Get help to fix the baby's latch, and use compression to get the
baby more milk (see Breast Compression). This, not a pacifier, not a bottle, not taking the
baby to the nursery, will help.
5. 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 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
usually supplements are suggested for the convenience of the hospital staff. If supplements are
required, they should be given by lactation aid (see Using a Lactation Aid), not cup, finger feeding, syringe or
bottle. The best supplement is your own colostrum. It can be mixed with sugar water if you are not
able to express much at first. Formula is hardly ever necessary in the first few days.
6. 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 skeptical, and
ask for help from someone 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—pause—close type of suck). If you and the baby are leaving hospital not knowing this,
get help quickly.
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 very 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 your milk well. 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 easier 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.
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Reprinted with permission. The information contained on these pages is provided as a courtesy to My ParenTime's visitors. My ParenTime makes no representations or guarantees concerning the effectiveness of such information. In no event shall My ParenTime be held liable for any failure of such safety information.
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