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Wrong Advice

When mothers are having breastfeeding challenges, there is a lot of advice out there. Some good, some confusing, some conflicting, and some just downright wrong. While every scenario is different, here are the Top Eleven pieces of advice that, if followed, may sabotage your breastfeeding experience:

  1. “Nipple and/or breast pain are normal until your nipples toughen up. Just deal with it, and eventually it will go away”.
    • While nipple and breast pain is common it is not normal. And yes, it may go away, but it is not because your baby’s latch is improving. Sometimes the damage from nipple trauma heals and calluses, but your baby still cannot latch on deeply. Pain past the first few days, especially pain that lingers for weeks, is NEVER normal and always means your baby is not latched onto your breast deeply enough. If you cannot improve the latch with positioning, your baby may have an anatomic reason that is preventing him/her from GAPING widely enough to achieve a deep, pain free latch. Luckily, this is CORRECTIBLE with an easy office procedure.
  2. Even though you are cringing in pain while your baby nurses, someone tells you the latch “looks great” from the outside.
    • What happens inside your baby’s mouth during nursing is invisible to the outside observer. It is something YOU feel. If your baby is latched on correctly it will feel good. If the latch is too shallow, it will hurt or be uncomfortable. Even though your baby may be making all the right movements, if you have pain, those movements are not positioned where they are supposed to be.
  3. “As long as your baby is gaining weight, everything is fine.”
    • Often, the only measure of breastfeeding success is whether or not your baby is gaining weight, with no consideration given to what it takes to get there. If you are nursing constantly with a fussy baby and lots of colic, your baby may gain weight, but things are not working correctly. If you start out with a big supply and your baby gains weight at first, but then your supply dwindles over the next weeks and months and your baby doesn’t gain weight, this may be because your breasts are not being emptied efficiently so they make less and less milk.
  4. “Your baby has a small mouth.”
    •  Your baby was not born with a small mouth. In order to breastfeed, babies must first GAPE very widely, which results in the baby almost dislocating the jaw, to fit around your breast. The GAPE is a REFLEX. However, very often (nearly 25% of the time), babies are born with a RESTRICTED GAPE because of the shape and position of their head and neck anatomy. If a baby does not have a wide enough gape to fit around his mother’s breast, he will not develop the ability to gape. His gape will not grow or stretch. The baby can do it at birth, or not. The good news is that gape restriction can be released in the office. If you want to nurse as long as possible, the sooner the procedure is done, the better.
  5. “Every woman makes enough milk to breastfeed her baby.”
    • There are a certain percentage of women, 10-15%, who cannot make adequate milk. Common causes for inherent low supply are hypoplastic breasts, obesity, diabetes, and breast surgery or cancer. They may still be able to breastfeed, but they must be prepared to supplement as well. There are also women who make so much milk it almost doesn’t matter what happens in nursing (see Oversupply). For the remainder of women, milk supply is directly correlated to demand and efficient, timely emptying (See Supply). If your baby can’t efficiently transfer your milk out, you may have a lot left in there. Not even the best pump can pull out as much milk as an appropriately latched baby. But if you don’t catch the problem in time, you may miss the window and end up with a little milk.
  6. “Your nipples/breasts are the reason your baby is struggling to breastfeed. They are too (fill in the blank).”
    • Believe it or not, the mother is RARELY the cause for failed or difficult breastfeeding. The sad truth is that society, other mothers and even health care practitioners often blame you because they can’t explain why you followed all of their advice and failed anyway. You can insert almost any adjective in the sentence above, and it has been said. While your breast and/or nipple may not easily fit into your baby’s mouth, if your baby has an appropriately wide gape, any breast can fit into her mouth. It is about the FIT between you and your baby.Some breast shapes are easier for babies to latch onto, but today, women prefer to nurse their own babies and not hand them over to a friend, relative, or wet nurse, as they did in the past.
  7. “If your baby isn’t gaining weight from nursing alone, keep feeding her for as long as she wants, even if it is for hours.” And the correlates: “Cluster feeding just means your baby is having a growth spurt.” and “Nursing on demand is the best way to feed your baby.”
    • If your baby is not gaining weight and wants to nurse all the time, it is either because she is not transferring milk effectively or your supply is low. Either way, your baby is working way too hard for food. Also, continuously nursing will actually reduce your supply. Your breasts have to be emptied in a very specific way to maintain their supply (see Supply). Even women with oversupply will eventually make less milk if they try to nurse this way.
  8. “Bottles and pacifiers create nipple confusion.”
    • Bottles and pacifiers are not inherently bad. In fact, there is a study that shows babies have a greater likelihood of breastfeeding if they are given pacifiers. Babies want to breastfeed. But more than breastfeeding, babies want to eat. And if they are struggling to nurse, they will learn that the breast means hunger if a mother continues to offer the breast when it is obviously not working. If babies are offered the breast and cannot transfer milk efficiently then given a bottle full of easily extracted milk, they will learn that the bottle means satiety. So it actually isn’t nipple confusion, it is behavioral conditioning.
  9. “If you have pain from nursing, nipple shields are the answer. Nipple shields fix breastfeeding problems.”
    • Nipple shields are a mixed blessing. While nipple shields create a layer of protection between your baby’s mouth and your breast and even give your baby something to hold onto, like a bottle nipple, they mask the real problem. The problem is usually due to a poor fit between your breast and your baby’s gape. If your baby cannot latch on and you need a nipple shield, it means she probably has a restricted gape and cannot fit around your breast.  Also, using a shield inhibits contact between your breasts and your baby’s mouth, so the touch receptors on your breasts are not be stimulated. Touch receptors stimulate release of two important hormones that increase and set your milk supply and push the milk out of the breast, making it more easily extracted by your baby’s mouth.
  10. “If your baby falls asleep on the breast it is because he is lazy.”
    • Babies have three inherent survival drives when they are born: eating, evacuating, and sleeping. If they are working too hard to eat, their brain secretes a hormone called cholecystokinin, which makes them sleep to conserve energy. They will then wake up soon afterwards to try again until the same hormone is secreted from their gut, which means they are full. If your baby is expending too much energy nursing, one defense mechanism is to fall asleep at the breast. Another is to cry and fuss at the breast.
  11. “If your baby spits up and has a lot of gas and colic it is because he has reflux and medication is the most helpful way to treat the symptoms.
    • Babies’ guts are not developed when they are born. Their intestinal flora is populated by birth method (vaginal provides more protective flora than C section) and what they ingest. However, they do not overproduce stomach acid. They do, nearly 30% of the time, react to the milk protein in cow’s milk formula. They also react to excess estrogen and allergens in soy formula. And if they have a restricted gape and shallow latch, they swallow a lot of air when they nurse. If your baby has a high palate she will swallow a lot of air even with a bottle. Medication should be the last resort for babies with gas and colic. Releasing gape restriction should be the first line of treatment.