Debunking Breastfeeding Myths for New Mothers
Maya Bunik, MD, MPH, FABM, FAAP
July 26, 2017
We live in an era of our smartphones being our life lines. YouTube is our source for learning new skills such as knitting or how to get kinks out of bent window blinds. We've grown to rely on this sort of information gathering.
New parents often look to online sources to help get the hang of another new skill: breastfeeding. Arriving home with their newborns, sometimes with conflicting information about breastfeeding from different sources, they search the internet to get consensus, support and solace in knowing they are not alone in the new parent journey.
As medical providers, we need to provide time and expertise to debunk new mother myths being accessed daily online by this sometimes vulnerable and isolated population of women—misinformation that may affect whether they start and continue breastfeeding their infants.
This is the recurring story of vaccine preventable diseases.
- See more at: https://www.aap.org/en-us/aap-voices/Pages/We-Can%27t-Let-Our-Guard-Down-Against-Vaccine-Preventable-Diseases.aspx#sthash.196pj2e8.dpuf
the mid-1980’s, the vaccine for HIB was released and thirty years later
we no longer see this disease. Because of the effectiveness of this
vaccine my younger partners only know of HIB meningitis through
textbooks (and some of my anecdotes).
This is the recurring story of vaccine preventable diseases.
- See more at:
worried about their infants losing weight in the first few days are
most likely to feel derailed in the immediate postpartum weeks of
on evidence suggesting a host of health benefits, the American Academy
of Pediatrics supports breastfeeding as a public health imperative and
recommends babies be exclusively breastfed for about 6 months. Many of
the academy's recommendations are outlined in the recently released
policy statement, "The Breastfeeding-Friendly Pediatric Office Practice."
Currently, though, just 22.3 percent of U.S. infants are breastfed
exclusively at the age of 6 months. Getting accurate information about
breastfeeding information for new parents could play an important role
in helping reach this goal.
A recent Google search using ‘breastfeeding problems”
yielded no less than 20.7 million results.
I tell mothers that 50 percent of what we recommend with breastfeeding is
evidence-based and well-studied, and the other 50 percent is clinician
experience or ‘expert opinion’ which is why they get conflicting opinions, both
in the hospital and online.
often assume babies cry because they're hungry, and feedings often do
quiet down babies, because it's difficult to cry, suck and swallow at
the same time."
As a general pediatrician with breastfeeding expertise and training, I hear a lot of questions from parents about things that can interfere with the establishment of breastfeeding in the first 3-4 weeks. The main issues that come up in my consultative faculty practice include:
- How Much is Enough? Mothers worried about their infants losing weight in the first few days are most likely to feel derailed in the immediate postpartum weeks of breastfeeding. Research confirms that up to a 10 percent weight loss from extra body fluids after birth is normal in full-term infants. Especially when new, breastfeeding mothers begin pumping and worry if they're not filling bottles every time, they often begin supplementing with formula early on and start a hard-to-break cycle . Babies start out nursing as little as 1 ounce each feeding, studies show, and sometimes as little as 4 ounces even as they reach their first birthday. When choosing bottle sizes, I recommend parents opt out of the 8 ounce sizes and stick with 4 ounces. Most adults would be satisfied with 4 ounces of whole milk, and 8 ounces would be overfilling at one sitting.
- "Power" Pumping. Pumping on and off for 10 minutes for a 2-hour period to increase milk is advised on many mommy blogs. This is based on anecdotal evidence, and the only gains may come in the mother's stress levels. For example, parents focused on every ounce produced over a short period, especially in the late afternoon when prolactin levels are lowest, may panic if they're not filling up bottles right away. I tell mothers to use the first morning pumping session, when prolactin is at its peak, as a 'thermometer" of their milk supply
- Herbal Supplements. I ask mothers about any herbs or supplements they take as a separate question from medications during clinic visits. Many mothers tell me they drink teas or eat cookies made with ingredients believed to boost milk supply. Evidence about the effectiveness of lactation supplements such as fenugreek and other herbs is mixed, with one study concluding that nursing mothers may experience some increased breast fullness but no real change in milk supply. My main concern is when mothers rely on these substances, known as galactogues, rather than doing the minimum of 6 pumping sessions every 24 hours recommended to maintain a healthy milk supply or talking with their doctor about concerns.
- Fussy babies. New parents quickly learn that babies can be hard to read. Does that fussing mean, "I'm still hungry," or "My feet are cold"? Many wish they came with a cartoon bubble to tell what is going on. Parents often assume babies cry because they're hungry, and feedings often do quiet down babies, because it's difficult to cry, suck and swallow at the same time. However, many times babies are overfed, which leads to spit up and more crying, as lactation researcher Jane Heinig, PhD, first described when training mothers enrolled in the Women, Infants and Children federal nutrition program on feeding cues. I advise parents to try swaddling fussy infants rather than feeding them extra. Many parents express concern about restricting the baby's motor development, but I assure them that wrapping babies in a snug blanket and placing them on their back to sleep is safe and unlikely to have lasting effects when used for short periods.
- Tongue or lip tie. Photos all over the internet show babies with especially short bands of tissue connecting the tongue to the mouth floor or lip to the gums, with anecdotes about how the condition interferes with latching and sucking during breastfeeding. About 30 to 40 percent of my clinic patients already had clipping procedures performed in the community to release the tissue by the time I see them. Families pay out of pocket for these and other procedures, such as targeted massage intended to increase muscle mobility around the baby's tongue, jaw and neck. There is limited evidence on clipping's effectiveness, however, and risks of not doing the procedure may include pain for the mother and inadequate milk transfer for the baby. The procedure also may delay families in seeking evidence-based evaluations.
- Late premature gestation. Babies who are born prematurely, between 36-39 weeks gestational age, make all the above even more confusing because they are just not ready to be good feeders, do not latch well, are sleepy at the breast and may have other medical issues. These babies, especially, may need a little extra time to get good at breastfeeding, especially if they have tight oral musculature or are small mouthed. Giving parents support for pumping during this time is key. I tell them to do something fun when pumping, rather than stare down at the drops. Listen to a podcast or audiobook or binge watch a show. But, I always add, just don't search on your phone!
I have a great clinical breastfeeding team, which includes a lactation specialist and psychologist (described in the Trifecta Approach to Breastfeeding) and we have a strong reputation for our clinical assessments. But I think the best service we provide is debunking the many myths that surround breastfeeding.
The views expressed in this article are those of the authors, and not necessarily those of the American Academy of Pediatrics.
Maya Bunik, MD, MPH, FABM, FAAP, is an executive committee member of the American Academy of Pediatrics' Section on Breastfeeding and a Professor of Pediatrics at the University of Colorado. She is also author of the American Academy of Pediatrics' Breastfeeding Telephone Protocols and Advice.