Breastfeeding--starting out right. (Breastfeeding).

Breastfeeding is the natural, physiologic way of feeding infants and young children milk, and human milk is the milk made specifically for human infants. Formulas made from cow's milk or soybeans (most formulas) are only superficially similar, and advertising that states otherwise is misleading. Breastfeeding should be easy and trouble free for most mothers. A good start helps to assure breastfeeding is a happy experience for both mother and baby.

The vast majority of mothers are perfectly capable of breastfeeding their babies exclusively for four to six months. In fact, most mothers produce more than enough milk. Unfortunately, outdated hospital routines based on bottlefeeding still predominate in too many healthcare institutions and make breastfeeding difficult, even impossible, for some mothers and babies. For breastfeeding to be well and properly established, a good early few days can be crucial. Admittedly, even with a difficult 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 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 easier:

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. [Editor's note: The Self-Attachment video is a wonderful video showing a baby crawl up his mother's belly to nurse; it is available from In Joy, [phone].]

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 periods. 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, invalid 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' "observation."

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 or she wakes up.

The baby shows signs long before he starts crying that he is ready to feed. His breathing may change, for example. Or she 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 offered a 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.

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 those that do not. Thus, in the first few days, when the mother is producing only colostrum (as nature intended), and the baby gets a bottle (as nature intended?) from which he gets rapid flow, he 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, don't seem to be able to manage it. 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. Because there are now alternatives available if the baby needs to be supplemented (lactation aids), why use an artificial nipple? [Editor's note: See information about lactation aids at the end of this article.]

There should be no restriction on the length or frequency of breastfeedings. 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 (La Leche League, doula, midwife, lactation consultant) to fix the baby's latch, and use compression to get the baby more milk. This, not a pacifier, not a bottle, not taking the baby to the nursery, will help.

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 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 is experienced with breastfeeding (a lactation consultant or Le Leche League leader). There are rare indications for supplementation, but usually supplements are suggested for the convenience of the hospital staff. If supplements are required, they should be given by lactation aid, not cup, finger feeding, syringe, or bottle. The best supplement is your own colostrum. Formula is hardly ever necessary in the first few days. [Editor's note: One way to know that babies are getting enough is that they have 6 to 8 wet diapers per day.]

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's latch is good despite your having very sore nipples, be skeptical, and ask for help from someone with breastfeeding knowledge, like a Le Leche League leader or a lactation consultant. Before you leave the hospital, it should be confirmed that your baby is latching on properly, and that he is actually getting milk from the breast and that you know how to tell if he is getting milk from the breast (open/pause/close type of suck, hearing him or her swallow). If you and the baby are leaving the hospital not knowing this, get experienced help quickly.

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 very unethical--marketing. If you get any from any health professional, you should be wondering about his or her knowledge of breastfeeding and his or 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. Formula samples are not good help.

Under some circumstances, it may be impossible to start breastfeeding early. However, most medical reasons 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.

Lactation Aids

"A lactation aid is a device which allows a breastfeeding mother to supplement her baby with expressed breastmilk, formula, or glucose water with added colostrum (glucose water alone should only be used, in general, in the first day or two after birth) without using an artificial nipple.... Though artificial nipples do not always cause problems, their use when things are already going badly will rarely make things better, and usually make things worse. The lactation aid is by far the best way to supplement, if the supplement is truly necessary.... it is often possible to avoid the supplement.... It is better than using a syringe, cup feeding, finger feeding, or any other method, since the baby is at the breast and breastfeeding. Babies, like adults, learn by doing. Furthermore, the baby supplemented at the breast is also getting breastmilk from the breast. A lactation aid consists of a container for the supplement--usually a feeding bottle with an enlarged nipple hole--and a long, thin tube leading from this container. Manufactured lactation aids are available and are easier to use in some situations, but not necessarily so. Manufactured lactation aids are particularly useful when the need for a lactation aid arises in an older baby, when a mother needs to supplement twins, when the need for a lactation aid will be long term, or whenever difficulty arises using the improvised lactation aid. Though the manufactured lactation aid is not inexpensive, the cost is about equal to 2 weeks of the usual milk based formula."--from Using a Lactation Aid, Dr. Jack Newman 

--Reprinted from Jack Newman, MD, FRCPC, "Handout #1," [c]1998. He graduated from the University of Toronto medical school as a pediatrician in 1970. He started the first hospital-based breastfeeding clinic in Canada in 1984 at Toronto's Hospital for Sick Children. He has been a consultant with UNICEF for the Baby Friendly Hospital Initiative in Africa, and has published articles about breastfeeding in Scientific American and several medical journals. Dr. Newman has practiced as a physician in Canada, New Zealand, and South Africa.