The art of breastfeeding has been passed down many generations. Unfortunately, this comes with a lot of misinformation and inaccurate advice. This article aims to address some of these common myths:
MYTH 1: Breastfeeding is easy – my baby (and I) will know what to do
FACT: Breastfeeding is natural, but not in any way easy. The first six weeks can be physically and mentally draining for parents. Many women and babies struggle with breastfeeding. It is a skill that is learnt by both mother and her baby, and like any other skill, gets better with practice.
Support with your doctor, lactation consultants and other healthcare professionals is necessary throughout your breastfeeding journey to make it a success for you and your baby.
MYTH 2: Pain is normal when breastfeeding
FACT: The lactating breast is an organ full of complex connections of blood vessels, lymphatics, nerves, with glandular tissue, fat and muscle cells interspersed. The breast undergoes significant growth and change during pregnancy and lactation. It’s no wonder breast and nipple pain are so common during pregnancy and breastfeeding. However, common does not mean normal. Nipple soreness is experienced by many in the first few weeks, however, persistent pain or cracked nipples are a cause of concern and need to be assessed by your doctor and/or lactation professional. Similarly, breast engorgement, clots, breast skin changes and infections need to be evaluated and managed by your healthcare provider.
MYTH 3: Smaller breasts will have low milk supply
FACT: Breast size has no impact on milk supply. Milk production is dependant on the glandular tissue in breasts – some small breasts may have a lot of glandular tissue, while, some larger breasts may not have much.
True low milk supply needs to be investigated and appropriately managed by your doctor, often together with the support of lactation consultants.
MYTH 4: Supplementing with formula in the initial newborn period is necessary
FACT: In the first few days after birth, the baby’s stomach size is very small (the size of a cherry and later progressing to that of a walnut). Baby does not need much volume of milk. The colostrum produced in the early days is the perfect nutrition for your baby and they do not require supplementation with formula.
MYTH 5: Breastfed babies should be fed every 3 hours
FACT: Frequent cue-based breastfeeding, with no longer than 3-hour intervals between feeds, especially until your baby is back to their birth weight, is best. Breastmilk production is based on supply and demand – i.e., the more stimulation at the breast, the more milk there will be. Newborns will require at least 10 – 12 feeds per 24 hours. Older babies may also feed every 2 – 3 hours.
MYTH 6: Breastfed babies should sleep through the night by 4 months old / Baby needs formula at night to sleep better
FACT: Breastmilk production requires stimulation – either by a baby or a breast pump. This is especially true at night, when prolactin – a hormone that tells your breast to make milk – is higher. Breastfeeding at night continues stimulation for prolactin and ensures to keep breastmilk production sustained.
All babies are different, with different sleeping patterns. Sleep training a very young baby, or, giving formula at night to ‘help’ them sleep longer is not always appropriate. Babies are meant to wake up at night and feed – this is a natural physiological process and helps to optimize breastmilk production.
If your baby naturally sleeps long periods at night, is growing well with adequate weight gain and reaching appropriate developmental milestones, there is usually no need to worry. However, if sleep for you and your baby has been difficult, we understand how tough this period can be. Please discuss with your doctor the best way to manage these concerns.
MYTH 7: Baby is always at the breast, so baby must be hungry / Baby is crying, so must be hungry. Baby will be spoilt if I hold them often
FACT: A baby at the breast may not always mean ‘nutritive sucking’. Non-nutritive sucking is when a baby sucks without receiving any nutrition. This is a natural reflex to help them be soothed.
Secondly, babies cry. This crying can often be worse after the 2nd week of birth. Babies have a natural physiological need to be held closely.
Both these mechanisms of help in two ways – releasing prolactin (as discussed earlier) and releasing oxytocin (the ‘love’ hormone).
Prolactin is a major hormone important in breastmilk production, but it also, helps to make a mother feel relaxed.
Oxytocin produces letdown reflex. It starts working when a mother feeds her baby, but also, has an effect when mother touches, smells, sees, hears or even thinks lovingly about her baby. So, keeping your baby close to you and holding your baby will not spoil them, and in fact, it will enhance your relationship with them and have a positive impact towards your breastfeeding.
MYTH 8: Baby should only breastfeed for X amount of time / Limit baby to 1 breast per feed
FACT: In general, there is no time limit for baby to be at the breast, nor, should they be restricted to 1 breast, or, be forced for both breasts at each feed.
In some instances, such as, true low milk production or a very sleepy newborn, we may ask the mother and baby to focus on nutritive sucking, and hence, limit the time on each breast for nutritive feeding. Similarly, in cases of overproduction of breastmilk, there may be a need to feed from 1 breast per feeding session. Your doctor can help you assess and manage these unique situations.
MYTH 9: Breastfed babies need larger volumes as they get older
FACT: The composition of breastmilk changes as a baby grows. Breastfed babies require the same volume of breastmilk as they grow older. The average ‘full milk supply’ is 24 – 32 ounces in a 24-hour period, which means the average milk output from both breasts combined is usually 1 – 1 ¼ ounces per hour.
MYTH 10: Breasts need to be completely emptied after each feed / You have to deeply massage breasts to prevent and/or treat clots
FACT: Breastmilk production depends on frequent emptying of the breasts. If you are direct latching, your baby is gaining weight appropriately, then once the baby has fed from the breasts, you do not need to empty breasts further.
If you are using a breast pump, you only need to pump as much as your baby feeds. Over-production of milk can lead to several problems, such as breast discomfort, clots, mastitis and even infant reflux, gassiness and frequent stools.
Breasts are glands. They are not meant to be deeply massaged – it can damage the underlying breast tissue. If you have noticed clots or experience breast discomfort, please speak to your doctor and/or a lactation professional to get the most appropriate help.
MYTH 11: Medications are not compatible with breastfeeding
FACT: Most medications are safe to take while breastfeeding. Discuss your medical history and medications with your family doctor, who can advise you on safely taking your medications while breastfeeding.
MYTH 12: Pump and dump after alcohol
FACT: Alcohol can affect breastmilk and breast production in two ways:
i. Breastmilk alcohol levels depend very much on mother’s blood alcohol levels. Alcohol is detectable in breastmilk for up to 2 – 3 hours after consumption. Ideally, you should avoid drinking alcohol while breastfeeding. However, in reality we understand that can be hard. It is safest to have no more than 2 drinks in a day and not drink alcohol daily. If you can, please consume your alcoholic drink over 2 – 3 hours and eat food when drinking to delay absorption of alcohol into your blood.
ii. Alcohol does decrease oxytocin levels, and hence, can potentially decrease breastmilk supply.
Nonetheless, it is not usually necessary to pump and dump breastmilk if you’ve consumed alcohol within limits. Please speak to your doctor if you would like further clarification.
MYTH 13: Breastfeeding mums need to avoid certain foods if baby is fussy or to avoid baby getting gassy
FACT: Babies can be ‘fussy’ for many different reasons – hunger, pain, light sensitivity, colic, tiredness, sensory stimulation being a few common ones. Many cultures advise mums to avoid certain foods so baby is not fussy or gassy. However, there is not much evidence for this.
In some instances, we may advise breastfeeding mothers to eliminate certain foods from their diet. This will be recommended after a thorough assessment with a detailed history of mum and baby, baby’s growth and development.
MYTH 14: Breastfeeding mums need to build the freezer stash
FACT: Breastfeeding mums who choose to provide milk by expression for their baby do not need to build up a large freezer stash. If you expressing breastmilk and returning to work, you only need enough milk for the first day back to work and a little extra for emergencies.
It is important to match your breastmilk production to your baby’s needs. This involves an active discussion between you and your baby’s caregiver on the appropriate timing between feeds, the use of paced-bottle feeding and managing your baby’s caregivers’ expectations on settling your baby between feeds.
Some women tend to express plenty of milk, sometimes more than their baby’s needs. While this sounds great on paper, there can be many negative sequelae of this cycle, especially frequent clots, mastitis.
MYTH 15: Breastfeeding mums always lose weight
FACT: Some women may lose weight with breastfeeding; however, every woman is different and their body responds differently to breastfeeding. Like pregnancy, a calorie-restricted diet is not recommended whilst breastfeeding as breastfeeding women require 300 – 500 calories extra per day to support breastfeeding. However, breastfeeding women should continue to eat a variety of nutritious foods. Breastfeeding women should also continue to perform light – moderate exercise, as they are comfortable.
Dr Trisha is a British trained family doctor who is based at Osler Health Star Vista clinic.
For appointments call: T: 63392727