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Breastfeeding: myths and misconceptions.

We've had a lot of feedback on the article entitled 'Lactation-related infections' in the last issue of Community Practitioner, with many readers concerned about the evidence base of the advice given within the piece. Carmen Pagor clears up some of the myths and misconceptions.

Myth: 'If the breasts are not producing sufficient milk to satisfy the newborn, there should be no hesitation in offering some additional bottle feeding. Babies do not get 'confused' and will happily take to bottle and breast - that is, to whatever satisfies their appetite. By 48 hours, most breasts will be producing sufficient milk and supplementary bottle feeding can be stopped or used intermittently as needed'.

On day one the newborn has a stomach capacity of 6ml, increasing to 12ml on day two (Wilson-Clay and Hoover, 2013; La Leche League, 2013). The drops of colostrum a mother feeds her newborn are physiologically normal and meet the needs of the healthy infant. A newborn's swallow is approximately 0.6ml; an effective feed on day one being around eight to 10 swallows (Lawrence, 2011). The onset of copious milk production typically happens around day three.

Unnecessary early supplementation with formula has been shown to significantly reduce the duration of breastfeeding (Ekstrom, 2003). Supplementation without medical indication is undermining for the mother and can damage her confidence in her body and the process of lactation. Day three and days 10-14 have been shown to be pivitol or 'crisis' points in cessation of breastfeeding (UNICEF, 2012), demonstrating how vital evidence-based practice and sensitive input is in the early days. The UNICEF Ten Steps of the Baby Friendly Hospital Initiative suggests giving newborns time to learn to breastfeed without interference or unnecessary interventions, especially bottles (UNICEF, 1998).

The notion that a mother can just stop bottles is unrealistic when her confidence may have been shattered by being told she was not able to satisfy her baby's hunger from birth. The action of drinking from a bottle is completely different to breastfeeding, which can alter the suck pattern for a newborn making them reluctant to return to the breast (La Leche League 2013, 2014). Interfering with the breastfeeding dyad by supplementing with artificial baby milk can lead to engorgement; this milk stasis can lead to blocked milk ducts and potentially mastitis. Aside from the risk of these breastfeeding complications, supplementation can have a negative impact on the milk supply. Once the placenta has been delivered, lactation depends on a supply and demand system. The more supplementation, the less time spent stimulating milk supply, therefore the less milk is made (Hoover and Wilson-Clay, 2013).

For the baby, disruption of exclusive breastfeeding alters gut flora, increases risk of cow's milk protein allergy, insulin-dependent diabetes and the risk of infection (Riordan and Wambach, 2010). The human immune system is immature at birth. Breastfeeding is a dynamic process that allows the mother to effectively share her well-developed immune system with her baby. Breastmilk is a living food, which cannot be replicated by any artificial baby milk. The secretory immunoglobulins (SIgA) in colostrum coat the gut offering protection from pathogens. Exposure to foreign proteins interrupts this process and damages the permeable gut (Hoover & Wilson-Clay, 2013).

In the case of low income families a mother's milk has been shown to have up to three times the levels of SIgA's than a higher income mother. It is as though breastfeeding can also assist in protecting against the harmful impacts of poverty (Best Beginnings, 2015; Riordan & Wambach, 2010).

Myth: In cases of early breast infections ... 'For women who want to continue to breastfeed but don't want to feed from the affected side, the short-term solution is to express and discard from the affected side.' In the management of breast abscesses. 'The majority of women will be advised to stop breastfeeding'; Lactation may need to be suppressed to enable healing to take place, 'the majority of women will be advised to stop breastfeeding to minimise ongoing complications'

It is rarely necessary to avoid feeding from the affected side in the case of mastitis.

Current research supports the continuation of breastfeeding where possible, offering affected side first to ensure milk flow (Riordan and Wambach, 2010; Hoover & Wilson-Clay, 2013; Morhbacher and Stock, 2003). If the mother is too uncomfortable to feed from the affected side support with expressing should be offered to protect supply and avoid inflammation and infection from worsening. The milk is safe to be fed to the baby (Hoover and Wilson-Clay, 2013; Riordan and Wambach, 2010). It may be necessary to discard milk in the case of a breast abscess if the breast is still draining pus and the baby is unwell or premature. This is due to the high number of pathogens (AAR 2012). Leaking milk in a wound may be beneficial due to the immune factors, anti-inflammatory properties and human growth factors (Hoover and Wilson-Clay, 2013). Therefore milk suppression should not be advised without careful consideration.

Becoming a mother is a monumental life event that can bring an increased vulnerability. It is the role of the healthcare professional to share evidence-based information and sensitive input to encourage the mother to have faith in her body and ability to nourish her baby. Without interference, the mother is physiologically programmed to care for and feed her baby (Best Beginnings, 2015). The release of oxytocin during breastfeeding promotes early attachment behaviours as well as facilitating the milk let down reflex. Oxytocin is impacted negatively by stress, thus demonstrating importance of sensitive input at this stage.

References

American Academy Pediatrics (AAP) Comimittee on infectious diseases. (2012) Red book.: Report of the committee on infectious diseases (29th edition). Elk Grove Village

Best Beginnings: 1001 Critical Days, Breastfeeding Supplement (2015)

Ekstrom A, Widstrom AM & Nissen E (2003) Duration of breastfeeding in Swedish primiparas and multiparas women. Journal of Human Lactation 2003:19(2): 172-178

Lawrence RA, Lawrence RM. (2011) Breastfeeding: A guide for the medical profession (7th edition) Elsevier Mosby.

La Leche League (2014) Nipple confusion? Information sheet. La Leche League: Great Britain.

La Leche League (2013) Breastfeeding basics Information sheet. La Leche League: Great Britain.

Mohrbacher N, Stock J (2003)| The breastfeeding answer book. Third Edition. La Leche League: Illinois.

Riordan J, Wambach K (2010) Breastfeeding and human lactation. 4th edition. Jones and Bartlett: USA.

Wilson-Clay B, Hoover K (2013) The breastfeeding atlas. 5th edition. Lact News Press: USA.

UNICEF (1998) Evidence for the ten steps to successful breastfeeding Division of child health and development.

World Health Organization: Geneva.

UNICEF (2012) Guide to Baby Friendly Initiative Standards. UNICEF: London.

CARMEN PAGOR

(Bsc Hons) IBCLC

International Board Certified Lactation

Consultant

Health Visitor

Lewisham and Greenwich NHS Trust
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Title Annotation:CLINICAL FEATURE
Author:Pagor, Carmen
Publication:Community Practitioner
Geographic Code:4EUUK
Date:Jul 1, 2015
Words:1103
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