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 cowís 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 Unfortunately, outdated hospital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 smallóthe 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 motherís
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 motherís 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.
2. 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
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
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 donít
have to be a rocket scientist to figure that one out, though many
health professionals, who are supposed to be helping you, donít
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 handout #5 Using a Lactation Aid, and handout #8 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 babyís latch, and use compression to get the baby more milk
(handout #15 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 handout #5), 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 donít know what a proper latch is.
If you are being told your two day oldís latch is good despite your
having very sore nipples, be skeptical, and ask for help from someone
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 (openópauseóclose 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 werenít 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.
Handout #1. Breastfeeding Starting
Out Right. Revised January 1998
Written by Jack Newman, MD, FRCPC
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