Breastfeeding Q&A

20 Breastfeeding Questions and Answers
(All citations are from: The Womanly Art of Breastfeeding, 8th ed. published by La Leche League International)

 1.   How important is breastfeeding for the child? (Chapter 1)

Being breastfed will profoundly affect the child emotionally and physically.
  Breastmilk has every vitamin, mineral, and other nutritional element that the baby’s body needs, including many that haven’t been discovered or named yet. Breastmilk changes subtly through the meal, the day, and the year to match the child’s changes in requirements. Living cells unique to the mother’s breastmilk inhibit the growth of bacteria and viruses in his system. Breastmilk has powerful interferon to inhibit virus replication and interleukins to fight infections and regulate the immune system’s responses.

2.   What are the risks of formula-feeding an infant? (Chapter 1)

Without breastmilk, the child is at higher risk of ear infections, intestinal upsets, respiratory problems, allergies, dental problems, vision and nerve underdevelopment, and intestinal underdevelopment. A formula-fed infant’s kidneys and liver works harder to process the waste products from formula; he needs more medication to achieve the same effect; his immune system’s response to vaccinations is less effective; and his risk of SIDS and infant death from other causes is higher. As an adult, he is at greater risk of Crohn’s disease, ulcerative colitis, type 1 diabetes, heart disease, and certain cancers. He is more likely to have higher blood pressure, more negative responses to stress, and a higher risk of obesity, type 2 diabetes, heart disease, and osteoporosis. His IQ will be lower than adults who were breastfed.

3.   How important is breastfeeding for the mother? (Chapter 1)

Breastfeeding contracts the uterus, slows bleeding, and decreases the risk of hemorrhage in third stage labor. Breastfeeding keeps the mother’s period from returning for six months or more. Breastfeeding helps mothers lose pregnancy weight more readily. Women who have not breastfed are at greater risk for high blood pressure, auto immune diseases such as rheumatoid arthritis, metabolic syndrome, risk factors for heart disease and diabetes, osteoporosis, bone fractures, and cancers of the breast, uterus, and cervix. Nursing a baby releases oxytocin and prolactin to help the mother connect and want to nurture, touch, and interact more with her baby.

4.   How important to breastfeeding success is a support network, and who can be a part of that network?  (Chapter 2)

A support network is very important to the success of the breastfeeding relationship and in smoothing the road to parenthood. Being a mother is a twenty-four-hour-a-day job, and it can be hard. Many mothers feel outraged and shell-shocked by the challenge of taking care of a new baby. A support network is important so the mother has people who will take care of her so that she can mother her baby. La Leche League meetings can become a big part of a mother’s support network and can provide a community where breastfeeding is normal. Support can also come from the new mother’s partner, relatives, close friends, paid doulas or nannies, local religious or community groups for new parents, online support forums, and supportive health care professionals.

5.   How does having a natural birth affect the breastfeeding relationship? (Chapter 3)

A medicated birth tends to disrupt a mother’s sense of motherhood and impede a baby’s ability to breastfeed easily. The added fluids increase breast engorgement in the mother and weight loss in the baby. All medications, including those in epidurals, reach the baby through the placenta, affecting his ability to find the breast, latch, and suck effectively after he’s born. These effects can last from a few days to a few weeks. Pain-relieving drugs reduce the mother’s production of endorphins, which increase the baby’s discomfort before and after the birth. Without these endorphins, mother and baby feel “flatter” emotionally, making it harder for each to respond to the other. Epidurals cause mother and baby’s temperature to rise, which may lead to the baby needing observation in the nursery and antibiotics in case he has an infection. Epidurals also can significantly reduce blood pressure, which means fluids will be pumped through an IV to help keep it in the normal range. IV fluids change the shape of the mother’s breast and nipple, making latching difficult even with professional help.

6.   How is an unmedicated labor similar to other physical work? (Chapter 3)

If you’ve ever helped move a mattress up a flight of stairs, worked up a better-than-usual sweat at the gym, or ridden a bike up one last hill, then you’ve already “labored.” You didn’t always get a break when you wanted to, but you did get periodic rests. And if you didn’t, your muscles gave out and made you stop. Muscles just can’t work beyond their own ability. It is the same with labor. Natural contractions always stop within your ability to cope, because it’s your own unmedicated muscles that are doing the work. You get a break after every surge of work. And you relax from each surge almost instantly, just as you do at the gym. It’s very different from an injury-based pain. Labor is an effort-based pain, nothing more.

7.   What are the World Health Organization’s and UNICEF’s Ten Steps to Successful Breastfeeding? (Chapter 3)

Every facility providing maternity services and care for newborn infants should: 1.) Have a written breastfeeding policy that is routinely communicated to all health care staff. 2.) Train all health care staff in skills necessary to implement this policy. 3.) Inform all pregnant women about the benefits and management of breastfeeding. 4.) Help mothers initiate breastfeeding within half an hour of birth. 5.) Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants. 6.) Give newborn infants no food or drink other than breast milk, unless medically indicated. 7.) Practice rooming-in (that is, allow mothers and infants to remain together) 24 hours a day. 8.) Encourage breastfeeding on demand. 9.) Give no artificial teats or pacifiers to breastfeeding infants. 10.) Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

8.   What are the benefits to having a homebirth? (Chapter 3)

Research finds that a home birth is just as safe as hospital birth for low-risk pregnancies with a lower rate of interventions and higher rates of breastfeeding success and maternal satisfaction. (Fullerton, J.T. et al. 2007. Outcomes of planned home birth: an integrative review. J Midwifery Women’s Health 52(4):323-333. Johnson, K. and B.A. Daviss. 2005 Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 330(7808):1416. Symon, A. et al. 2009. Outcomes for births booked under an independent midwife and births in NHS maternity units: matched comparison study. BMJ 338:b2060.) Midwives are skilled in handling common problems, and the time it takes to transport you to a hospital in a true emergency is generally about the same as the wait for an operating room setup if you’re already there. A hospital has more equipment for overcoming problems, but the hospital environment is what causes many of those problems in the first place. At home, you get to decide who will be with you for the birth; there are no institutional routines to separate mother and baby after a birth at home. It is important to keep baby’s bare skin against your bare skin for the first few hours before passing him to others to make sure he is thoroughly colonized with your “friendly” bacteria.

9.   Does the World Health Organization recommend limiting inductions, and what are some helpful ideas if an induction is recommended? (Chapter 3)

Yes, the World Health Organization recommends limiting medical inductions to those that are truly necessary, fewer than 10 percent of all births. If an induction is recommended, the following ideas are helpful: 1.) Ask what will happen if you don’t induce, what is the worst case scenario, how long can you wait, and what is the doctor’s plan if the induction doesn’t work. 2.) Find out how the medications involved will affect your baby by using Thomas Hale’s Medications and Mother’s Milk. 3.) Ask that misoprostol/Cytotec not be used. 4.) Ask that artificial oxytocin be given at intervals instead of continuously. 5.) Ask the doctor or midwife not to rupture your membranes. 6.) Understand how good a job your uterus is prepared to do to keep your baby in because the uterus may not have yet developed additional oxytocin receptors which allow oxytocin or artificial Pitocin to stimulate contractions.

10. What approach to nursing helps the newborn use her instincts? (Chapter 4)

“Laid-back breastfeeding” uses the baby’s instincts and reflexes to help him crawl to the nipple and latch on. The mother should be reclining at a comfortable angle with the baby lying on top of her, front to front, with a towel to dry her, and a blanket over them both for warmth. Gravity will paste the baby’s entire front against the mother’s front, leaving her hands are free to rub and stroke him wherever she likes. Usually sometime in the first hour, the baby will begin to think about nursing. He may drool, make sucking movements with his lips, or bring his fist to his mouth. After a while, he may lift his head and bob his face on and off of the mother’s skin. The mother can help the baby by moving him closer to the breast or by supporting him as he finds his own way. At some point, when the baby’s face is near the nipple, he will lift his head, open his mouth wide, latch, and begin to suck. Baby can nurse as long as the mother and baby both want. Most likely, the baby will fall asleep with the nipple in his mouth or let go and fall asleep. The baby is designed to expect frequent feedings.

11. What are the benefits to laid-back breastfeeding? (Chapter 4)

There is no long list of instructions to remember or to do. Gravity “sticks” the baby against the mother so she doesn’t have to worry about a precise hold. The mother gets to decide on her position, the baby’s position, how much each of them wears, whether or not to hold or move her breast, and whether or not to move the baby. The mother’s torso “opens up” so that the baby can lie in any position on it, instead of having to lie across the mother’s lap because there is nowhere else to go; if the mother is “laid back”, she has no lap, and the number of arrangements becomes limitless! Gravity gives the baby full, consistent, comforting support–no gaps or pressure points. Gravity brings the baby toward the breast as he bobs, instead of gravity pulling his head away from the breast as can happen with the mother sitting up. The baby’s whole body touches yours, triggering more instinctive responses in both mother and child. The baby isn’t likely to flail his arms and get in his own way because he feels secure against the mother. The mother can be totally relaxed–no tight shoulders or aching wrists. The mother can have at least one hand free to stroke the baby or to hold a glass of water or her partner’s hand.

12. What are the benefits to skin-to-skin contact in the baby’s first hours? (Chapter 4)

Skin-to-skin contact after birth helps to: stabilize the baby’s heart rate, breathing and temperature; stabilize the mother’s temperature; prevent postpartum depression later on; reduce the baby’s stress; reduce the baby’s pain from medical procedures; reduce the mother’s stress; increase interactions between mother and baby; and increase the likelihood and length of breastfeeding.

13. How long does the World Health Organization and other organizations recommend a baby be exclusively breastfeed and continued to be breastfed thereafter? (Chapter 11)

The World Health Organization recommends the following: “Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.” The American Academy of Pediatrics recommends the following: “Introduction of complementary feedings before six months of age generally does not increase total caloric intake or rate of growth and only substitutes foods that lack the protective components of human milk.” The Canadian Paediatric Society states: “Recommends for the first six months of life for healthy, term infants. Breastmilk is the optimum food for infants, and breastfeeding may continue for up to two years and beyond.” The United Kingdom’s Minister for Public Health gives the following recommendation: “Breastmilk is the best form of nutrition for infants. Exclusive breastfeeding is recommended for the first six months (26 weeks) of an infant’s life, as it provides all the nutrients a baby needs. Breastfeeding … should continue beyond the first six months along with appropriate types and amounts of solid foods.”

14. What are some benefits to nursing beyond eighteen months? (Chapter 11)

Continued nursing promotes normal jaw development and palate expansion. The toddler brain needs a lot of tactile and emotional stimulation, both of which are met with nursing. The toddler brain needs a diet with a hefty amount of human milk to stimulate human brain growth. The level of antibodies and immune factors increases with age. Breastfeeding keeps young children with immature digestive systems fed while they continue the transition to solid foods and keeps them well-fed during any illnesses. Nursing is a time to reconnect with an on-the-go child. Nursing makes bedtime easier.

15. How important is shared sleep to breastfeeding? (Chapter 12)

A British study found that babies who had been randomly assigned to sleep apart from their mothers in the first few days after birth were about half as likely to be breastfeeding at four months as those who had been assigned to sleep with their mothers. babies assigned to sleep in sidecars in those early days were more likely to be nursing at four months than babies sleeping completely separately, but less likely than babies in their mothers’ beds. babies in bassinets have to rouse and fuss more to get their mothers’ attention, which means they take longer to settle; mothers whose babies slept in bassinets did not get more sleep according to research. Co-sleeping babies breastfeed more frequently and for longer periods of time at night than babies who sleep alone, but mothers who have their babies in their beds actually get more total sleep than those who have their babies in another room, despite spending more time breastfeeding.

16. How safe is sharing sleep? (Chapter 12)

The highest rates of SIDS are in places in which shared sleep is not the cultural norm, and the lowest SIDS rates are in places that routinely bed-share.  Having the baby sleep on his back is perhaps the single best protection against SIDS, and that’s the position babies naturally assume when they sleep with their mothers. Formula-feeding is also linked to an increase in SIDS. Also, there is no clear research to link bed-sharing to SIDS. Sleeping with the baby at breast height has very low risk of suffocation, especially since breastfeeding mothers spend most of the night facing the baby and putting her leg up and her lower elbow forward, creating a protective “fort” for her baby. A sober, non-smoking breastfeeding mother sleeping on a regular mattress and not taking anything that might make her extra sleepy has most of the potential bed-sharing concerns covered. Precautions for sleep-sharing include the following: don’t have anyone in the bed who has been drinking or taking drugs that can impair alertness; don’t have anyone in the bed who smokes, even if he or she doesn’t smoke in bed; don’t have anyone in bed who is too exhausted or ill to return to normal consciousness quickly; don’t sleep with your baby on a couch, sofa, recliner, armchair, soft or saggy mattress, or waterbed; don’t use a thick duvet or comforter; don’t put your baby’s head on a pillow; make sure the sheets fit snugly; keep pets off the bed; make sure there are no spaces between the mattress and frame or between the bed and the wall; don’t have an older child in the bed unless an adult sleeps between the baby and the older child; don’t swaddle the baby; don’t leave your baby alone in or on your bed; and dress your baby about as warmly as you dress yourself.

17. Is nursing your baby to sleep a bad habit? (Chapter 12)

The natural design is for babies to nurse and often fall asleep at the breast; this is not a learned behavior or a bad habit. Babies tend to fall asleep when they have a full tummy, feel warm and secure, and feel tired. Breastfeeding provides the full tummy, warmth, and security, and it increases a baby’s sleep-inducing hormones.

18. What is mastitis, its symptoms, and its treatments? (Chapter 18)

Mastitis symptoms include a warm, red, sensitive area on one breast, a slight fever, and flu-like aches and chills. Mastitis is inflammation in the breasts, maybe with or maybe without an inflection; the physiological process that causes pain, redness, fever, and chills is the body trying to head off an infection before it starts or before it gets too bad. Non-infection-based mastitis usually clears on its own in two to four days, and infection-based mastitis will clear within a day of starting the right antibiotic. Typical causes of mastitis are nipple damage that lets bacteria in, milk that isn’t removed regularly and well, and a body that’s just too rundown. Usually this means a baby isn’t latching well, a mother isn’t nursing frequently or efficiently enough, a mother’s clothing and/or underwire are pressing on certain milk ducts, or the mother is trying to do too much on too little sleep with too little food. Treating mastitis includes emptying the breast and resting a lot for the first twenty-four hours. If the treatment appears to be working, continue it for another twenty-four hours. If the condition is not improving, consider taking an antibiotic, remembering to take it all even if you feel better immediately.

19. What are signs that a baby is getting too much foremilk and not enough creamy hind milk? (Chapter 20)

The baby chokes, gulps, and sputters when nursing. Mother’s breasts always feel full or spray when milk releases. The baby wrestles with the breast, pulling off, crying, tugging, or arching. The baby has lots of wet and dirty diapers. The baby is colicky, gassy, or spits up frequently. The baby sometimes or always has frothy or greenish stools. The baby gained weight rapidly or grew fast at first with a weight gain dropping as fussiness increased. The baby rarely falls asleep at the breast, and nursing is an athletic event. The baby will nurse only for food, not for comfort. The baby grimaces when she nurses. The baby often seems to have uncomfortable intestines. The mother tries to always nurse on both breasts at each nursing. The mother looks for some cause for fussiness other than hunger if it has been less than two hours since a feeding.

To remedy this, a mother can offer to nurse whenever the baby shows interest, even after just a few minutes; and a mother can leave the baby on one breast for more than one nursing (as long as the baby is happy on that one side) until that side is nice and soft afterward. The two ideas that may have started this problem is making a point of switching sides at feedings and delaying feedings.

20. What should a mother do if her baby refuses or cannot latch? (Chapter 4)

A full-term, healthy baby does not need any food or liquids for at least twenty-four to thirty-six hours, so it is important to be patient and know that the baby will “get it” even if it takes some time. The mother should remember the “Three Keeps”: keep your milk flowing because these early days are when your breasts are planning for future milk production; keep your baby fed, even if he only gets a few drops from a plastic spoon or medicine dropper; and keep your baby close with skin-to-skin contact so he will not have to burn precious calories trying to say warm or keep a steady heart rate and breathing pace. A mother should also keep in touch with someone who really understands breastfeeding and whose style and approach complement the mother’s goals.