|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 ensure
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Unfortunately, outdated hospital routines based on bottle feeding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:
1. 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 baby's latch
is good despite your having very sore nipples, be skeptical, 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 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 the 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
2. 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 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.
Incidentally, many babies do not latch on and breastfeed during this
time. Generally, this is not a problem, and there is no harm in
waiting for the baby to start breastfeeding. The skin to skin contact
is good for the baby and the mother even if the baby does not latch
3. 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
- 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'
- 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, the mother
is 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.
4. 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 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
5. No restriction on length or frequency of
breastfeeding. 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.
6. 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.
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 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.