PREGNANCY

Barb, now mother of two university-aged sons, still bristles as she recalls her mother-in-law keeping her bawling newborn away from her because it hadn’t been four hours since his last feeding. The mother-in-law was a firm believer in scheduled feedings; Barb, at 24 years of age, was too intimidated to ask for her child back, though she preferred to nurse him on demand.

Lindsey had read that she should always nurse from both breasts — ten minutes a side — or she’d wind up “lopsided.”

Kelly found herself nursing her newborn every two hours. Though the baby seemed healthy and was gaining weight, her sister was convinced that he fed so frequently because Kelly didn’t have enough milk. Bottles, she insisted, were the answer. Kelly refused — the public health nurse she’d consulted informed her that only rarely do moms produce insufficient milk — but her confidence was shaken.

Everyone has an opinion about a new mother’s breasts — what they should be doing, how they should be doing it and for how long. Whether the mom asks for advice, she’s likely to get any number of differing opinions — from other moms, relatives, nurses and doctors, some of whom may have wacky ideas about breastfeeding.

To cut through the confusion, we’ve gone straight to the real experts: those who work regularly with nursing mothers and possess the most up-to-date information. Here’s how they sort out the facts from some of the most common — and sometimes misguided — advice new moms receive. And remember: Even the best advice goes down better with a hefty dose of your own judgment.

“You shouldn’t breastfeed because…”
Many women are told that they can’t breastfeed for any number of reasons: Their breasts are small, their nipples are inverted, they’re pregnant again, they’re on medication, they aren’t producing enough milk, they have to go back to work early, they smoke. The truth is that very few conditions preclude nursing, according to paediatrician Jack Newman, a breastfeeding expert and author of The Ultimate Breastfeeding Book of Answers. It’s OK to nurse while pregnant or on many medications; always check with your doctor about which ones are safe. (You can also find information about drugs and breastfeeding at motherisk.org.) Even a mother who smokes cigarettes can nurse; of course, it’s better if she quits, but the benefits of breastfeeding can actually decrease the negative effects of smoke on a baby’s lungs.

The key is consulting a breastfeeding expert — your doctor may or may not be one. A better bet is a lactation consultant (you can find them through your public health unit or hospital breastfeeding clinic) who has plenty of experience supporting nursing moms. She’ll be able to tell you whether there is any reason you shouldn’t breastfeed.

“Just relax and it’ll come naturally.”
Perhaps the biggest breastfeeding myth of all is how easy it is. Sure it’s natural to feed your baby with the food your body provides. But easy? For lots of moms, nursing, at least in the first few weeks, requires determination and time.

“It’s a learned activity,” points out Marg LaSalle, a public health nurse and lactation consulant with the Middlesex-London Health Unit in London, Ontario. “Doing it is the best teacher, but moms need support.” She notes that even women who have breastfed before can have difficulties with a new baby. “You’ve got a new partner,” she says. “It’s an intricate dance between mom and baby.” If you’re struggling, find an expert whose philosophy meshes with yours.

And if, even with help, the struggle is too much? Ann Douglas, a mother of four in Peterborough, Ontario, and author of The Mother of All Baby Books, notes that breastfeeding is undoubtedly the best choice for you and your baby. However, she adds, while you don’t want to regret giving up too soon, you also don’t want angry memories of having to persevere long after you’d rather have stopped. She recommends taking some time to think it through and determine how important breastfeeding is to you before you decide whether to switch to bottles. It won’t necessarily prevent you from feeling sadness or guilt, but you will know that you made the best decision you could.

“Your latch is all wrong.”
If your baby is feeding well, seems satisfied (with six to eight wet diapers and two or three bowel movements in a 24-hour period) and you have only tenderness, not pain, during the early days of breastfeeding, the latch is probably fine. However, when a problem does arise, a poor latch is usually the culprit.

A good latch starts with positioning, says LaSalle. She tells moms to make sure they’re comfortable and supported because they’re going to have to remain in that position for up to an hour. The baby must be positioned so that he can keep the breast in his mouth — he shouldn’t have to reach or turn his head, which interferes with swallowing. Tuck his body in close and place your hand at his neck and shoulders, not the back of his head. With your other hand, support your breast in a C position far back from the nipple so the baby can get a deep latch. “It’s breastfeeding, not nipple feeding,” reminds LaSalle.

Wait for the baby to open wide, like a yawn, then put his mouth on your breast, aiming the nipple at the roof of his mouth. You should feel a tugging sensation at first as baby pulls the nipple to the back of his mouth. If you feel pain or a pinching on your nipple rather than the areola, slip your little finger into the corner of his mouth to break the suction, take the baby off the breast and start again. Otherwise your nipples will suffer. “It can sometimes take four to six weeks for both baby and mom to get it right,” says LaSalle. Once the baby is latched on, look for deep jaw movements; the base of the ears will wiggle as he gulps and swallows.

Lori spent much of her first week of nursing in tears of frustration and pain. “I was so determined to do it that I just kept calling the public health nurses, going to breastfeeding clinics until I got it right.” For her, it was a matter of finding a position in which the baby could latch on properly. The “football hold,” with the baby tucked under one arm at her side, ultimately worked. LaSalle recommends that moms and babies try different positions until they find the one that works for them.

“You’re feeding too often.”
This will be familiar advice to the mom who’s still feeding every two hours, a schedule that is neither unusual nor unhealthy. Some new — and well-known — books are currently promoting scheduled feeding, usually every four hours whether or not the baby shows more frequent hunger cues. But Marg LaSalle wants us to remember that the baby has never known hunger in the womb. “Babies aren’t necessarily convenient,” she points out. She advises following the baby’s feeding cues, which can appear even in a light sleep — a sucking or rooting motion, rapid eye movement, moving arms and legs. “Crying is the last cue,” she says, “and a crying baby is one who doesn’t latch on easily.” A newborn should have no fewer than eight feeds a day and must be gaining weight. However, by eight weeks — or whenever you feel you’ve firmly established breastfeeding — if the two-hour feeds are really getting to you, there’s no harm in pumping milk and having someone else give her a bottle to give yourself a break now and again.

“Get your baby used to a bottle right away, so she’ll take both.”
Babies who are given an artificial nipple learn quickly that the flow is faster and the tongue action required is easier. “A baby who is only bottle-fed for the first two weeks of life will usually refuse to take the breast, even if the mother has an abundant supply,” says Jack Newman. However, nursing mothers who want to introduce a bottle for expressed breastmilk might encounter resistance if they wait too long. “A baby who has had only the breast for three or four months is unlikely to take the bottle,” Newman says.

As LaSalle points out, “Some babies never experience nipple preference, others do.” So how can you avoid problems if you want to use bottles occasionally? She recommends taking four to six weeks to establish breastfeeding. After that, if all is going well, you could try introducing a bottle or pacifier once or twice a week. If the baby takes both bottle and breast easily, you should then be able to offer them interchangeably. If problems do crop up — the baby seems to fuss at the breast or your nipples are becoming sore from a poor latch — put the bottles away until breastfeeding is back on track. If you exclusively breastfeed your baby for six months, you can often introduce solids and a cup at that point.

“You should only nurse your baby on one side per feeding.”
Our experts say the recommendations here vary with the stage. At first, nurse on both breasts to build up the supply in both. After the milk comes in, let the baby drain at least one breast per feed. If he still seems hungry after one breast is emptied (it’ll feel loose and flabby rather than full and hard), then offer the second. The baby may only nurse for a few minutes on the other side. Another important thing to note is that the composition of the milk changes during a feed and you want your baby to get the thirst-quenching fore milk, the rich hind milk and everything in between.

That said, some moms find it more comfortable to feed their babies on both sides at each feed. You choose; as long as the baby is thriving, it’s no big deal.

“If you get mastitis, you’ll have to stop nursing.”
Mastitis is an inflammation of the breast. Although it can be quite serious, less than ten percent of nursing moms get it, usually during the first month of breastfeeding. If you’re one of the unlucky few, mastitis is definitely not a reason to stop nursing; on the contrary. One cause is plugged milk ducts due to the milk not moving through the breast. Sometimes it’s because of restrictive clothing or bras; sometimes cracked nipples allow infection to enter. Symptoms include breasts with red patches that are hot and tender to the touch, fever, chills and fatigue. It’s important that you keep milk moving through the breast, so try to feed your baby at least every two hours from the affected side. Apply warm, moist cloths to the area and massage the breast. Then either feed the baby or pump. And do check in with your doctor at the earliest opportunity. She may simply tell you to rest, or may prescribe antibiotics.

Thrush, a type of yeast infection, can occur in the baby’s mouth when antibiotics upset the balance of bacteria. A mild case may not need treatment; if it’s bothersome, both mom and baby are usually treated with an antifungal agent.

“Breastfeeding makes your boobs sag.”
Blame pregnancy and aging for that, not nursing.

“You should nurse your baby for a full year.”
You should nurse your baby as long as it’s working for the two of you. Both the World Health Organization and Canadian Paediatric Society now recommend that babies be given breastmilk exclusively for six months with complementary foods added at that time. Then they recommend continuing to breastfeed for the baby’s first year and beyond. LaSalle points out that the average weaning age in the world is four years old and cites the benefits of nursing an older baby, which may include a decreased risk of obesity, diabetes, eczema and night blindness, as well as lower cholesterol and decreased risk of heart disease. “The long-term effects carry on into adulthood,” she says.

Thanks now to our longer maternity leave, it’s easier for moms to nurse for at least a year. But that’s your decision. Ann Douglas, who nursed her first child for six months and her fourth for 2½ years, recommends nursing “as long as both mother and baby are willing.” And, she adds, the length of time you choose is “nobody’s business. It’s between mother and baby.”

Will nursing reduce my breast cancer risk?

By: John Hoffman

Last July, a new study confirmed what some experts have been saying for many years: breastfeeding, especially over a long period, decreases a woman’s risk of breast cancer. The report, which pooled data from 47 different studies, found that the probability of getting breast cancer was reduced by 4.3 percent for every 12 months of nursing.

So what does that mean for individual women? As usual with statistical studies, there’s no quick prescription. First, it’s important to remember that most women willl never get breast cancer, and that some who breastfeed will get it while some who don’t, won’t. However, study author Valerie Beral, an epidemiologist, points out that the research showed lower rates of breast cancer to be clearly associated with duration of breastfeeding. “Among women who have more children than average and breastfeed them much longer than average the effect is substantial.” (The average length of nursing in developed countries is 8.7 months over a woman’s lifetime.)

This year there will be approximately 20,500 new cases of breast cancer in Canada. Beral estimates that if Canadian women, on average, breastfed for one year longer (in total for all children) than they do now, that number would fall by 882.

October 2002