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Myths
about breastfeeding are rampant in our culture. Sadly, a lot of women don't even
try to nurse their babies, or give up almost immediately due to feelings of
incompetence, lack of education and/or in many cases poor or misinformed advice
from their doctors. Unbelievably, medical schools barely touch on the subject of
breastfeeding, so many doctors know very little about it and in fact, some end
up perpetuating many of the myths that keep women from breastfeeding their
babies. Here is a list containing 26 of the most common myths.
1. Many women do not produce
enough milk.
Not
true! The vast majority of women produce more than enough milk.
Indeed, an overabundance of milk is common. Most babies that gain too
slowly, or lose weight, do so not because the mother does not have enough
milk, but because the baby does not get the milk that the mother has. The
usual reason that the baby does not get the milk that is available is that he is
poorly latched onto the breast. This is why it is so important that the mother
be shown, on the first day, how to latch a baby on properly, by someone
who knows what they are doing.
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2. It is
normal for breastfeeding to hurt.
Not
true! Though some tenderness during the first few days is relatively common,
this should be a temporary situation which lasts only a few days and should
never be so bad that the mother dreads nursing. Any pain that is more than mild
is abnormal and is almost always due to the baby latching on poorly. Any nipple
pain that is not getting better by day 3 or 4 or lasts beyond 5 or 6 days should
not be ignored. A new onset of pain when things have been going well for a while
may be due to a yeast infection of the nipples. Limiting feeding time does not
prevent soreness.
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3. There
is no (not enough) milk during the first 3 or 4 days after birth.
Not
true! It often seems like that because the baby is not latched on properly
and therefore is unable to get the milk. Once the mother's milk is abundant, a
baby can latch on poorly and still may get plenty of milk. However, during the
first few days, the baby who is latched on poorly cannot get milk. This accounts
for "but he's been on the breast for 2 hours and is still hungry when I take him
off". By not latching on well, the baby is unable to get the mother's first
milk, called colostrum. Anyone who suggests you pump your milk to know how much
colostrum there is, does not understand breastfeeding, and should be politely
ignored.
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4. A
baby should be on the breast 20 (10, 15, 7.6) minutes on each side.
Not
true! However, a distinction needs to be made between "being on the breast"
and "breastfeeding". If a baby is actually drinking for most of
15-20 minutes on the first side, he may not want to take the second side at all.
If he drinks only a minute on the first side, and then nibbles or sleeps, and
does the same on the other, no amount of time will be enough. The baby will
breastfeed better and longer if he is latched on properly. He can also be
helped to breastfeed longer if the mother compresses the breast to keep the flow
of milk going, once he no longer swallows on his own. Thus it is obvious that
the rule of thumb that "the baby gets 90% of the milk in the breast in the first
10 minutes" is equally hopelessly wrong.
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5. A
breastfeeding baby needs extra water in hot weather.
Not
true! Breastmilk contains all the water a baby needs.
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6.
Breastfeeding babies need extra vitamin D.
Not
true! Except in extraordinary circumstances (for example, if the mother
herself was vitamin D deficient during the pregnancy). The baby stores vitamin D
during the pregnancy, and a little outside exposure, on a regular basis, gives
the baby all the vitamin D he needs.
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7. A
mother should wash her nipples each times before feeding the baby.
Not
true! Formula feeding requires careful attention to cleanliness because
formula not only does not protect the baby against infection, but also is
actually a good breeding ground for bacteria and can also be easily
contaminated. On the other hand, breastmilk protects the baby against infection.
Washing nipples before each feeding makes breastfeeding unnecessarily
complicated and washes away protective oils from the nipple.
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8.
Pumping is a good way of knowing how much milk the mother has.
Not
true! How much milk can be pumped depends on many factors, including the
mother's stress level. The baby who nurses well can get much more milk
than his mother can pump. Pumping only tells you have much you can pump.
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9.
Breastmilk does not contain enough iron for the baby's needs.
Not
true! Breastmilk contains just enough iron for the baby's needs. If the baby
is full term he will get enough iron from breastmilk to last him at least the
first 6 months. Formulas contain too much iron, but this quantity may be
necessary to ensure the baby absorbs enough to prevent iron deficiency.
The iron in formula is poorly absorbed, and most of it, the baby poops
out. Generally, there is no need to add other foods to breastmilk before about 6
months of age.
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10. It
is easier to bottle feed than to breastfeed.
Not
true! Or, this should not be true. However, breastfeeding is made
difficult because women often do not receive the help they should to get started
properly. A poor start can indeed make breastfeeding difficult. But a poor start
can also be overcome. Breastfeeding is often more difficult at first, due to a
poor start, but usually becomes easier later.
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11.
Breastfeeding ties the mother down.
Not true! But it depends how you look at it. A baby can be nursed anywhere, anytime, and
thus breastfeeding is liberating for the mother. No need to drag around
bottles or formula. No need to worry about where to warm up the milk. No need to
worry about sterility. No need to worry about how your baby is, because he is
with you.
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12.
There is no way to know how much breastmilk the baby is getting.
Not
true! There is no easy way to measure how much the baby is getting,
but this does not mean that you cannot know if the baby is getting enough. The
best way to know is that the baby actually drinks at the breast for several
minutes at each feeding (open—pause—close type of suck). Other ways also
help show that the baby is getting plenty.
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13.
Modern formulas are almost the same as breastmilk.
Not
true! The same claim was made in 1900 and before. Modern formulas are only
superficially similar to breastmilk. Every correction of a deficiency in
formulas is advertised as an advance. Fundamentally they are inexact copies
based on outdated and incomplete knowledge of what breastmilk is.
Formulas contain no antibodies, no living cells, no enzymes, no hormones. They
contain much more aluminum, manganese, cadmium and iron than breastmilk. They
contain significantly more protein than breastmilk. The proteins and fats are
fundamentally different from those in breastmilk. Formulas do not vary from the
beginning of the feed to the end of the feed, or from day 1 to day 7 to day 30,
or from woman to woman, or from baby to baby... Your breastmilk is made as
required to suit your baby. Formulas are made to suit every baby, and
thus no baby. Formulas succeed only at making babies grow well, usually,
but there is more to breastfeeding than getting the baby to grow quickly.
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14. If
the mother has an infection she should stop breastfeeding.
Not
true! With very, very few exceptions, the baby will be protected by the
mother's continuing to breastfeed. By the time the mother has fever (or cough,
vomiting, diarrhea, rash, etc) she has already given the baby the infection,
since she has been infectious for several days before she even knew she was
sick. The baby's best protection against getting the infection is for the mother
to continue breastfeeding. If the baby does get sick, he will be less sick if
the mother continues breastfeeding. Besides, maybe it was the baby who gave the
infection to the mother, but the baby did not show signs of illness because he
was breastfeeding. Also, breast infections, including breast abscess,
though painful, are not reasons to stop breastfeeding. Indeed, the infection is
likely to settle more quickly if the mother continues breastfeeding on the
affected side.
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15. If
the baby has diarrhea or vomiting, the mother should stop breastfeeding.
Not
true! The best medicine for a baby's gut infection is breastfeeding. Stop
other foods for a short time, but continue breastfeeding. Breastmilk is the
only fluid your baby requires when he has diarrhea and/or vomiting, except
under exceptional circumstances. The push to use "oral rehydrating solutions" is
mainly a push by the formula (and oral rehydrating solutions) manufacturers to
make even more money. The baby is comforted by the breastfeeding, and the mother
is comforted by the baby's breastfeeding.
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16. If
the mother is taking medicine she should not breastfeed.
Not
true! There are very very few medicines that a mother cannot take safely
while breastfeeding. A very small amount of most medicines appears in the milk,
but usually in such small quantities that there is no concern. If a medicine is
truly of concern, there are usually equally effective, alternative medicines
which are safe. The loss of benefit of breastfeeding for both the mother and the
baby must be taken into account when weighing if breastfeeding should be
continued.
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17. A
breastfeeding mother has to be obsessive about what she eats.
Not
true! A breastfeeding mother should try to eat a balanced diet, but neither
needs to eat any special foods nor avoid certain foods. A breastfeeding mother
does not need to drink milk in order to make milk. A breastfeeding mother does
not need to avoid spicy foods, garlic, cabbage or alcohol. A breastfeeding
mother should eat a normal healthful diet. Although there are situations when
something the mother eats may affect the baby, this is unusual. Most
commonly, "colic", "gassiness" and crying can be improved by changing
breastfeeding techniques, rather than changing the mother's diet.
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18. A
breastfeeding mother has to eat more in order to make enough milk.
Not
true! Women on even very low calorie diets usually make enough milk, at
least until the mother's calorie intake becomes critically low for a
prolonged period of time. Generally, the baby will get what he needs. Some women
worry that if they eat poorly for a few days this also will affect their milk.
There is no need for concern. Such variations will not affect milk supply or
quality. It is commonly said that women need to eat 500 extra calories a day in
order to breastfeed. This is not true. Some women do eat more when they
breastfeed, but others do not, and some even eat less, without any harm done to
the mother or baby or the milk supply. The mother should eat a balanced diet
dictated by her appetite. Rules about eating just make breastfeeding
unnecessarily complicated.
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19. A
mother who smokes is better not to breastfeed.
Not
true! A mother who cannot stop smoking should breastfeed. Breastfeeding has
been shown to decrease the negative effects of cigarette smoke on the baby's
lungs, for example. Breastfeeding confers great health benefits on both mother
and baby. It would be better if the mother not smoke, but if she cannot stop or
cut down, then it is better she smoke and breastfeed than smoke and formula
feed.
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20. A
mother should not drink alcohol while breastfeeding.
Not
true! Reasonable alcohol intake should not be discouraged at all. As is the
case with most drugs, very little alcohol comes out in the milk. The mother can
take some alcohol and continue breastfeeding as she normally does. Prohibiting
alcohol is another way we make life unnecessarily restrictive for nursing
mothers.
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21. A
woman who has had breast augmentation surgery cannot breastfeed.
Not
true! Most do very well. There is no evidence that breastfeeding with
silicone implants is harmful to the baby. Occasionally this operation is done
through the areola. These women do have problems with milk supply, as does any
woman who has an incision around the areola line.
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22. A
woman who has had breast reduction surgery cannot breastfeed.
Not
true! Breast reduction surgery does decrease the mother's capacity to
produce milk, but since many mothers produce more than enough milk, mothers who
have had breast reduction surgery sometimes manage very well to breastfeed
exclusively. In such a situation, the establishment of breastfeeding should be
done with special care to the principles mentioned in the topic #2
Breastfeeding: Starting Out Right. However, if the mother seems not
to produce enough, she can still breastfeed, supplementing with a lactation aid
(so that artificial nipples do not interfere with breastfeeding).
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23.
Babies with cleft lip and/or palate cannot breastfeed.
Not
true! Some do very well. Babies with a cleft lip only usually manage fine.
But many babies with cleft palate do indeed find it impossible to latch on.
There is no doubt, however, that if breastfeeding is not tried, it will not
work. The baby's ability to breastfeed does not always seem to depend on the
severity of the cleft. Breastfeeding should be started, as much as possible,
using the principles of proper establishment of breastfeeding. (topic #2
Breastfeeding: Starting Out Right). If bottles are given, they will
undermine the baby's ability to breastfeed. If the baby needs to be fed, but is
not latching on, a cup can and should be used in preference to a bottle. Finger
feeding occasionally is successful in babies with cleft lip/palate, but not
usually.
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24.
Women with small breasts produce less milk than those with large breasts.
Absolute Nonsense!
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25.
Breastfeeding does not provide any protection against becoming pregnant.
Not
true! It is not a foolproof method, but no method is. In fact breastfeeding
is not a bad method of child spacing, and gives reliable protection especially
during the first 6 months after birth. It almost as good as the pill if
the baby is under 6 months of age, if breastfeeding is exclusive, and
if the mother has not yet had a normal menstrual period after giving birth.
After the first six months, the protection is less, but still present, and on
average, women breastfeeding into the second year of life will have a baby every
2 to 3 years even without any artificial method of contraception.
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26.
Breastfeeding women cannot take birth control pills.
Not
true! The question is not exposure to female hormones, to which the baby is
exposed anyway through breastfeeding. The baby gets only a tiny bit more from
the pill. However, some women who take the pill, even the mini-pill, find that
their milk supply decreases. Estrogen in the pill may decrease the milk supply.
Because so many women produce more than enough, this often does not matter, but
sometimes it does and the baby becomes fussy and is not satisfied by nursing.
Babies respond to rate of flow of milk, not what's "in the breast", so that even
a very good milk supply may seem to cause the baby who is used to faster flow to
be fussy. Stopping the pill often brings things back to normal. If possible,
women who are breastfeeding should avoid the pill, or at least wait until the
baby is taking other foods (usually 4-6 months of age). Even if the baby is
older, the milk supply may decrease significantly. If the pill must be used, it
is preferable to use the progestin only pill (without estrogen).
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Written by Jack Newman, MD, FRCPC - Revised January
1998.
Jack
Newman 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 and, more recently, established
similar clinics at Toronto's Doctors Hospital and St. Michael's Hospital. He has
been a consultant with UNICEF for the Baby Friendly Hospital Initiative in
Africa, and has published articles on the subject of breastfeeding in Scientific
American and several medical journals. Dr Newman has practiced as a physician in
Canada, New Zealand, South Africa and in Central and South America.
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