Tuesday, June 14, 2011

Misinformation's Role in Breastfeeding

A friend of mine is a doula as well.  She had a client deliver a baby in an uncomplicated, unmedicated full term birth last week.   There were no complications, the baby latched on within the first hour of birth, and was nursing every 2-3 hours in the first days after birth.

Everything was going about as perfect as it could be.

Until she went to the doctor when the baby was three days old. 

The baby, who weighed about 7  pounds at birth, had lost a few ounces.  Mom's milk wasn't in yet. 

The pediatrician recommended formula supplementation due to the concerns about the baby's weight.   The baby, who again, was full term and was not experiencing any problems with blood sugar or jaundice.

This is an example of a place where the medical system is failing families.

Did you know that most medical schools provide very little, if any education at all, about lactation?  How exactly are the physicians supposed to teach patients about nursing if they've had little education in it themselves?

Most pediatricians and obstetricians are given huge supplies of free formula to distribute to their patients as "gifts".  What's the harm in taking a sample, right?  The harm, I would argue, is tremendous. 

The truth is that healthy, term infants almost never need supplementation.

Babies are supposed to drink only the colostrum the mother produces for the first few days.  This early milk is incredibly nutrient rich, and serves as a laxative to help the baby purge the meconium from their system to help avoid jaundice.

It is those first few days, with only the colostrum, and the increasing hunger of the baby, that causes the mother's milk supply to come in adequately.  Giving a bottle here or there will interfere with the supply being established correctly.

Feeding a newborn a bottle will teach them that food comes immediately.  In my experience, this will interfere with nursing perhaps more than anything else.   It is because in nursing, the baby has to latch and suck long enough to trigger the let down reflex.  The milk does not start flowing immediately.  Giving the baby a bottle, which works immediately, interferes with the baby's natural feeding process.

Thousands, if not millions, of well -intentioned first time moms have reluctantly supplemented after being told their babies were losing weight in those first few days.  Trouble is....THIS IS NORMAL.  Healthy, term babies can easily tolerate losing up to 5-10% of their body weight in those days.  It isn't a cause for alarm, especially before the mother's milk comes in.  Unfortunately, this is where doctors begin to show concern and mothers start to doubt their body's ability to nourish the baby without artificial assistance. 

Once that doubt sets in, it's a recipe for disaster.  Loss of confidence in nursing undermines the overall confidence in parenting.  Moms can start to feel like they are failing their baby.  They give a bottle, then the baby gets frustrated quickly at the breast.  They eventually give up.  And for what reason?  The loss of a few ounces that the baby is designed to lose anyway? 

The better guideline is that a newborn should be nursed on demand, but not less frequently than every 3 hours, timed by the start time of the feeding.  They should not lose more than 10% of their body weight, and should return to their birth weight by two weeks.  If those goals are not reached, it still does not automatically mean that formula is the solution. 

Often, the best way to reassure a new mother that the baby is eating well is to weigh them before and immediately after a feeding.  Many breastfeeding support groups have scales available for this purpose.  This reassure mothers that they are indeed producing an adequate supply. 

Another big misconception is that pacifiers will create nipple confusion.  I do not believe this to be true for the simple reason that pacifiers do not feed the baby.  A baby will learn quickly that milk does not come from a pacifier, and will use it for sucking needs that exist outside the need to eat.  I encourage new mothers to wait until nursing is established and the milk supply fully in before giving a pacifier.  Beyond that, if the baby has a high suck need, by all means, use a pacifier. 

Bottle feeding can be a great way for the father and other family members to bond with the baby.  Again, as with pacifiers, once nursing is well established, it can be added to the routine without major incident.  Wait until the milk supply is fully established, then give a bottle every other day or so at one feeding.  For the first few months, the mother should pump during every bottle feeding.

When bottle feeding, it is important that breast milk not be combined in the same container as formula.

I could write books about this subject, but I will stop here for now.  I will address pumping, milk insufficiency and formula feeding in later posts.  If you have any specific questions, please feel free to ask!

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