10 Breastfeeding Myths That Need to Die
Raise your hand if someone has given you breastfeeding advice (solicited or not) at some point in your life. Yep. Go ahead - let's all collectively raise our hands. We've all been there. Whether it's Aunt Sally, Susie Sunshine down the street, or even your mother, it comes from a place with nothing but good intentions. However, many of the "rules" and suggestions about breastfeeding are at worst myths and at best, outdated. The study of human lactation is ongoing and ever evolving.
Moreover, we have only begun to scratch the surface in what we know about human milk! As lactation professionals, we recertify every three years and have to continue our education to stay up to date and advise moms using the most current evidence-based information. Even still, there are a handful of recurrent breastfeeding myths that I see all over social media and, well, they need to die.
1. Breastfeeding is natural.
This point in and of itself is not untrue. However, there are some things to consider with this natural process. True that breastfeeding is the natural way to feed an infant. And true, that baby instinctively knows what to do at the breast directly following birth, BUT there is a caveat.
The first hour after birth (AKA the Magical Hour) is critical to the "natural" process of breastfeeding. Meaning that if a baby is put skin to skin (on mom's bare chest between her breasts) immediately following birth, and left undisturbed, they will instinctively crawl (yes crawl!) up to and latch on - all by themselves. However, how often do we see postpartum events unfold just so? Often there have been interventions, medications, or hospital policy that inhibit this whole "natural" process from going down. So what happens when we miss the Magical Hour window for baby to do what baby naturally knows what to do? We have to help the process along, and unfortunately, the longer that we take to get an infant to the breast and latch postpartum the more of a learning curve they will need. All is not lost, but the process turns from an intuitive one to an educational one. And for most women, this is the experience, which is why you will hear me discuss breastfeeding as a learned behavior more often than not.
2. You need to prepare your nipples.
You guys, I was about six months along in my first pregnancy when my mom matter of factly informed me that I needed to start preparing my nipples. Wait; what?! As horrified as I was, what did I know? She nursed three babies so, I took the advice, and for a week straight I took a dry washcloth to my nipples and scrubbed them. I cringe recalling it now. I remember looking down at my jacked up nipples - sore and red and thinking this can't be right.
Friends, whatever you do, do not do anything to your nipples to prepare for breastfeeding. Just don't. Number one, and this might shock you, but your breasts and nipples are made for the sole purpose of feeding an infant (I know!). That means they are just fine the way they are to do so, without anything extra. Furthermore, "roughing up" (the actual term used by my mom - sorry mom!) your nips will strip them of their natural lubricant and dry them out, which is a recipe for cracked nipples once your baby arrives. If you want to do anything to prepare your nipples while your pregnant and postpartum we recommend discontinuing the use of soap on them while showering. They have a natural antibacterial process on their own, and the soap can be drying. And remember, friends, don't let friends rough up their nipples (yes, that's a thing we say now).
3. Breastfeeding will make your breasts sag.
Let's all say it together: Breastfeeding does not make your breasts sag. But don't take it from me. In 2007 the American Society of Plastic Surgeons presented research confirming that breastfeeding, "even for a long period of time," does not make breasts lose shape. So what does give way to breast sagginess? I'll tell you. How fat you are, how many pregnancies you've had, how big your breasts are, and whether you smoke.
4. You have to wait for your milk to come in.
Your body starts producing milk as early as the third trimester of your pregnancy. It's called colostrum, otherwise known as liquid gold. The beauty of human milk is that it is always changing to meet your baby's needs. When a baby is first born, the milk is thick and gold colored, nutrient dense and full of protective antibodies. It is considered milk, and it is precise enough for the small stomach of a newborn. Over the next few days, the milk will transition in composition and color, gradually, until it is the recognizable milky color and consistency we all associate with as your "milk coming in." However, a more accurate way to describe this process is to say your milk has "transitioned." During this time, so long as the latch is optimal and diaper output, and weight, indicate milk transfer, it is not necessary to supplement the colostrum with artificial milk.
5. You need to eat more food & water to make milk.
Similar to point number one, the structure of our modern western society has changed the way we approach the actual caloric needs of a breastfeeding mother. When researchers first worked out the theory that a woman needed 500 additional calories per day to maintain lactation, they weren't doing so with our modern world of abundance in mind. The extra calories they suggested roughly equaled an extra serving of typical everyday food, for example, a serving of rice, vegetables, a peanut butter sandwich, or a small bowl of nuts. Again, there is a catch. If you are a woman living in North America, Europe, or Australasia in 2019 chances are you do not need any additional calories because most of us (myself included) eat more than we need to. Remember that our bodies are designed to keep fat stores for the sole purpose of fueling lactation. It's why we as women, naturally have more fat than men.
That said, you will feel hungrier when breastfeeding (especially in the early weeks). Part of this is because you are expending more energy and the other part may be due to poor sleeping habits which we know alter our appetite-regulating hormones. As a general rule of thumb, you want to eat to hunger and drink to thirst just as you usually would. Again, women breastfeed their babies the world over, in conditions that would shock us. Women in prison camps, Jewish ghettos of the Holocaust, and in third world poverty have all successfully maintained lactation throughout history. The body is designed to provide milk for a suckling baby, and will do so under most circumstances without any extra help - this is especially true for the conditions we encounter here in the United States.
Fun Fact: The reason you feel thirsty during the let-down reflex during breastfeeding is due the the release of oxytocin (the hormone that moves milk).
6. Pumping and Dumping Removes Alcohol
The good news is that you can safely breastfeed while continuing to have some semblance of adult life, thanks in part to your breast pump (or hand expression). However, it may not be for the reasons you think. Many women believe that we pump and dump to actively remove the alcohol from your milk. In actuality, we want to pump and dump when we've been drinking to maintain our milk supply. The alcohol level in your milk will always be that of your blood alcohol level. The only way for the alcohol to leave your milk is for it to metabolize over time the same way it leaves your bloodstream. During this time your baby will need to be supplemented with previously expressed milk, and you will need to continue removing milk from your breasts to maintain supply and prevent infection. The art of the pump and dump, or drinking while nursing, is a whole different post - so check back for that.
7. You have to avoid certain foods.
There are no fast and hard rules for foods you have to avoid. Again, women breastfeed the world over on a variety of different diets and in general we advise women to continue their standard diets. However, just like some people have food sensitivities babies can, too. Dairy from Cows milk is known to be an irritant for many babies (and adults), so if you suspect gas or diarrhea due to your diet, I recommend eliminating dairy first. As for fried foods, beans, broccoli, etc. There is no reliable evidence to correlate these types of food to upset stomach via breastfeeding. Typically when we experience gas, it's as a result of the digestive process, and that would not transfer to a baby via milk. However, certain herbs, supplements, and oils can be dangerous for an infant and transferred via milk so exercise caution in these areas.
8. Lanolin is your friend.
Current research tells us that lanolin users have the highest rate of infection (44% more than non-lanolin users). Often women will use lanolin to soothe pain from nipple trauma or soreness, but it's not generally recognized as the best option anymore. At the very best it's used as a band-aid, and at the worst can lead to more problems (in the case of infection). We need to be asking what is causing the pain or injury to the nipple. More often than not nipple pain and the damage is caused by a poor latch. And when it comes to healing damaged nipples, breastmilk is your (free) friend. Express and let a little breastmilk dry onto the nipple post feeding and watch the healing happen - typically in 48-72 hours.
Check out this post about how to redirect a challenging feeding to correct a painful latch.
9. Supplementing with formula will not affect supply.
What I am about to say is an unpopular fact. Take a deep breath and promise me you won't make this personal. Whether or not you choose to supplement with artificial milk is your choice. It's my job to make sure you have all the facts to make that decision as knowing as possible. The truth is, anything that your infant ingests from 0-6 months that is not breastmilk will decrease your supply. This is especially true in the first week to two weeks. Your milk makers work on a supply and demand system. This means that the more often milk is removed from your breasts, the more milk your body will make.
It also works in reverse. The less milk removed, the less made. Lather, rinse, repeat. So if you have a partner offering bottles (of expressed milk or formula) at night, your body will get the signal that it needs to produce less milk. The same is true for water or bottle supplements throughout the day. It will also decrease the baby's appetite, and they may spend less time at the breast during the next feeding if they've had 2 oz of water as a snack. And again, the less empty the breast becomes, the less milk will be made next time.
10. You can increase your supply using foods/supplements.
Piggybacking off of unpopular topic number 9, we have unpopular fact number 10. While there is a ton of anecdotal evidence saying things like oatmeal, certain herbs, teas, and tinctures can increase milk supply, the reliable peer-reviewed studies are lacking in evidence for this. Furthermore, similar to the lanolin use, low milk supply can indicate a host of other issues so; first, we need to try to address the root of the problem. Poor fitting pump parts, inadequate latch, and milk transfer, for example, can lead to low milk supply. If we can address these issues at the root cause, we can avoid having to experiment with other means to induce lactation. Many of the herbs suggested for use can also have adverse side effects for the baby. For example, fenugreek is linked to digestive issues, fussiness, and can inhibit the absorption of certain minerals and vitamins. There are prescription medications available for women who lack adequate mammary tissue, but even those can be costly for many women, and as with most prescription drugs carry side effects for mom.
What we know to be an evidence-based method for increasing milk supply is to increase the removal and milk via nursing or pumping, falling back on the supply and demand system of the body. If you want to make lactation cookies and drink teas, by all means, I will not discourage you. I too, drank mother's milk tea as a full time working and pumping mom, and it helped me feel as though I had more control over my milk supply; however, my supply never rebounded the way it did on the weekend. It was like clockwork. By Friday my supply would be decreasing due to full-time pumping and work schedules. Cue freak out. Then I would be with my baby all weekend, nursing on demand and frequently at the breast (in addition to pumping morning and evening), and by Monday morning my abundant milk volume would have me feeling like a goddess of the milky way. Each week the cycle would repeat. I kept drinking the teas, but it was the increased milk removal during the weekend that ultimately revived my supply week in and week out.
Breastfeeding continues to be surrounded by controversy, emotion, and misinformation in our modern world. Then combine the hot button issue with the internet and the ability for anyone with an opinion to have a platform to mass share said opinion and what you have is a recipe for disaster when it comes to finding sound science-backed information (on any topic!). In one way, I love that we have so many pro breastfeeding voices. From well-meaning mothers to practitioners who work with women in their childbearing years, it's a blessing that breastfeeding continues to be a topic of conversation. However, we have a responsibility to our sisters worldwide to ensure that we are sharing evidence-based information.
Because the sad reality is, while we in industrialized countries like the US have access to clean water, electricity, and liveable wages that make it safer for us to choose formula when incorrect information leads to early cessation of breastfeeding, that is not the reality for the rest of the world. An infant born into a third world country is 25 times more likely to die of diarrhea when formula fed because the luxuries that make it a viable option (reliable and clean water, electricity, sanitation, monthly wages) don't exist. So regardless of your personal stance on breastfeeding, for these mothers and their babies, it's imperative that we do our part to protect breastfeeding and that begins with making sure we share up to date information.