by Donna Walls, RN, BSN, ICCE, IBCLC, ANLC
Many, probably most new mothers, are looking for information and answers to their questions on the internet. The internet is often the first source they turn to when wondering how often a baby nurses or what the red lump in their breast could be. But are the answers they find correct? Is the information going to be helpful or could it be incorrect or even possibly cause harm? I decided to do some investigating, looking into some frequently used sources of breastfeeding support on the internet. I was saddened to find so much “misguided” or downright false information. Here are some examples of misinformation on the internet:
Advice: Numerous references still recommend adherence to a scheduled feeding pattern rather than cue feeding, or baby led feeding. Many state that babies should never go more than 2-3 hours without feeding. Also, some recommend not letting a baby sleep more than three to four hours, often encouraging mothers to set an alarm clock to prevent the infant from “over-sleeping.” Thinking of the number of feedings each 24 hours rather than the strict interpretation of “every X hours” supports a more physiologic pattern of feedings, especially in the first days and weeks. Advice: Many resources still refer to fore milk and hind milk- especially the myth that the foremilk is mostly water or protein and that the rich fats only come at the end of the feeding in the hindmilk. Mothers are told that the first part of the feeding provides the foremilk and the high fat, “dessert” hind milk comes at the end of the feeding. This often comes with the advice to breastfeed for a specified amount of time which might require a mother “forcing” an infant to continue nursing after they were satisfied, full and have come off the breast contentedly. Reality: We have known for a long time that mothers of very effective feeders have letdowns early in the feeding, with higher fat content in the foremilk. Some milk has higher fat content mid-feeding and some later in the feeding. Giving advice to mothers based on the idea that the milk fat only comes forward at the “end” of the feeding is not evidence-based. Mothers instead need to understand their infant’s satiety (feeling full and satisfied) cues, not allowing arbitrary time frames to determine the length of each feeding. Recommending the newborn or infant continue nursing for at least 10 minutes (or 15 minutes) or to remove a nursing infant from the breast after “X” minutes ignores the fact that infants have varying needs. Breastfeeding infants are not little machines we can wind up and set for a specific amount of time! Another misguided bit of advice is that the infant will “just use the mother for a pacifier”. Babies do love to be at the breast, it is comforting, soothing and pacifying, part of the nurturing needed to promote the best infant health. I found one reference that recommended new mothers to nurse for 15 minutes after the letdown (which letdown? Mothers have several letdowns throughout the feeding). If the newborn won’t nurse for that specific amount of time it will result in frustration for both mother and baby!
Advice: Breastfed babies need to burp after each breast or at the end of the feeding. Reality: Some breastfed infants may need to burp, some not at all. Some new parents will pat or rub and if no burp is produced an aggressive burping will ensue, all to satisfy the unsubstantiated old wives tale that all babies must burp. A gentle rubbing or patting is enough to produce a burp if needed but aggressive burping is not warranted.
Advice: For proper latch the baby must have their mouth covering the entire areola. Reality: This one is may be the funniest. Most of you have probably seen those women with large areolas that can easily measure 5-6 inches in diameter. Even a large newborn with the widest gape physically possible could not entirely cover these areolas- but they certainly can still have an effective latch. For proper latch look for a wide open mouth, lips flanged outward on the breast, full round cheeks, an symmetric latch (the infant looks “off-center” with the mouth further down on the areola and more areola visible above the top lip) and active swallowing).
Advice: There are still those who tell mothers there are prescribed positions for the first days. It also varies between advisors, but there seems to be a “must” position for best latch and maximum comfort. Some prescribe the cradle hold, others side lying, reclining or it might be the clutch or “football hold”. Reality: Each mother and baby are unique and quickly find the position that is best for them. There is no one magic position that is best for all new nursing couplets. Some positions might be more effective if there are problems or special circumstances, but as a general rule mothers need the freedom to choose the position that is most comfortable for her and her baby.
Advice: You should feel a tingling sensation when you have “the” letdown. Reality: Some moms may feel a mild tingling or pressure with a letdown, but certainly not all mothers. By continuing this myth many mothers fear their infant may not be getting the milk they need because they don’t “feel” the letdown. This may also perpetuate the myth of having only one letdown rather that the reality of having many letdowns during each feeding.
Advice: One of the most common myths is about the foods mothers can’t eat while breastfeeding. Here is a list of foods that have been linked with causing an increased risk for infant gas or colic when breastfeeding. These include: artificial sweeteners, broccoli, cabbage, cauliflower, Brussels sprouts, dairy, garlic, onions, peanut butter, fruits with a laxative effect such as cherries and prunes, any and all “spicy” foods, citrus fruits and their juices, chocolate, and common allergens such as soy, peanuts, dairy, wheat, corn and eggs. You might also find recommendations on how many extra calories are needed to provide nourishing milk. The advice ranges from 500 to 1500 “extra” calories needed daily. Reality: Most mothers need not alter their diet from pregnancy as their infant has been exposed to the tastes and aromas of their normal diets. The idea that certain foods are “gas-forming” come from the misguided idea that if it affects the mother in a certain way, it will affect the baby in the same way. Nutrients are carried by the bloodstream to the alveolar cells (milk making cells) in the breast where milk is produced and transported by the ducts, through the nipples to the infant. As foods are being digested in the mother’s intestines, the digestive process releases “gas”. Only the nutrients (not gas bubbles) are carried through the blood stream to the breasts to make milk. Mothers all over the world, some in cultures whose traditional foods are very spicy, nurse without infant symptoms. It is even worse that the foods often forbidden are nutritious vegetables and fruits, based on old wives tales and myths. In some cases where colic symptoms persist, especially when there is a family history of cow’s milk allergies, it may be helpful to avoid or restrict the intake of cow’s milk. Although most maternal and infant advocates recommend an increase of 300-400 calories per day to assure optimum maternal and infant health, there are and still continue to be situations where women exist on far less than optimal diets and still produce the quantity and quality of milk needed to sustain infant growth and development.
Advice: Oatmeal cookies will increase your milk supply. Reality: There is no evidence to support the use of oatmeal in any form to increase milk production. There does not seem to be any evidence of harm in consuming oatmeal, so it probably won’t hurt but the chances are slim it will be a miracle cure for low milk supply. If there are actual or perceived concerns of low production a lactation care provider should asses the maternal and infant history and observe a feeding for possible problems and provide appropriate interventions or referrals. There are many foods that are traditionally prescribed for new mothers to support their ability to produce milk, most of which are not evidence-based galactagogues (substances thought to increase milk production), but are culturally important traditions of new motherhood.
Advice: It is normal to have sore nipples for the first week of breastfeeding, sometimes it might be 10 days or advice may be that soreness will resolve after 2 weeks. Reality: This one makes me sad as it can easily lead to a mother weaning early because she just cannot tolerate the pain. Breastfeeding should not hurt. Women experience pain in different ways with very different pain tolerances. So, what is pain? Some women may not be able to tolerate a tenderness while others with severely damaged nipples have only mild complaints. Either way, if the mother is experiencing any discomfort it is wise to seek help. Lactation care providers can assess the latch and other possible causes of soreness and may provide interventions to reduce pain and encourage nipple healing or refer to other specialties for treatment. Moms should not have to suffer for any specific period of time before seeking help and support.
Holmes AV. Establishing successful breastfeeding in the newborn period. Pediatr Clin North Am 2013;60:147–168. UNICEF Breastfeeding Initiatives Exchange. The Baby Friendly Hospital Initiative. www.unicef.org/programme/ breastfeeding/baby.htm (accessed October 31, 2013). Bartick, M, et al (2017) Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Maternal & Child Nutrition, Vol 13, Issue 1, DOI: 10.1111/mcn.12366 American Academy of Family Physicians. Family Physicians Supporting Breastfeeding, Position Paper. www.aafp.org/ about/policies/all/breastfeeding-support.html (accessed October 31, 2013). Mekuria G, Edris M. Exclusive breastfeeding and associated factors among mothers in Debre Markos, Northwest Ethiopia: A cross-sectional study. Int Breastfeed J 2015;10:1. Appendix A Task Force Ratings. Guide to clinical preventive services: Report of the U.S. Preventive Services Task Force, 2nd ed. Available at www.ncbi.nlm.nih.gov/ books/NBK15430/ (accessed November 2, 2015). Chowdhury, R. et al (2015). Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 96-113. Association of Women’s Health, Obstetric and Neonatal Nurses. Breastfeeding support: preconception care through the first year. 3rd ed. Washington, DC: AWHONN; 2015 Stuebe AM. Enabling women to achieve their breastfeeding goals. Obstet Gynecol 2014;123:643–52 Otsuka K, Taguri M, Dennis CL, et al. Effectiveness of a breastfeeding self-efﬁcacy intervention: Do hospital practices make a difference? Matern Child Health J 2014; 18:296–306. CDC.gov/breastfeeding Gerd AT, Bergman S, Dahlgren J, Roswall J, Alm B. Factors associated with discontinuation of breastfeeding before 1 month of age. Acta Paediatr. 2011 Jul 18.