What I Wish I Had Known About Breastfeeding
Mothers need more support and less judgement about their feeding choices
This week is World Breastfeeding Week, which is a yearly event with the goal of spreading awareness about breastfeeding. This week you will see many social media accounts and news media outlets highlighting the benefits of breastfeeding. However, I am going to take a different approach. Instead, I want to talk about how incredibly hard and complicated breastfeeding can be, so that anyone who is struggling or has struggled feels less alone. I also want to give you some concrete tips on breastfeeding and pumping, since research finds that most women do not quit breastfeeding or wean early due to a lack of pressure or awareness that “breast is best,” but rather due to a lack of support.
Here is me as a naive and clueless first-time mother in August 2015
Why is breastfeeding so hard?
Research finds the following as the most common reasons that mothers stop breastfeeding:
Lactation issues (“trouble with infant sucking or latching on,” “sore, cracked, or bleeding nipples,” “breastfeeding too painful,” “breasts overfull or engorged,” “breasts infected or abscessed”)
Nutritional concerns (“I didn’t have enough milk,” “breastmilk alone did not satisfy my baby,” “I had trouble getting milk flow to start,” “I was concerned about infant weight gain,” “a health professional was concerned about infant weight gain”)
Medical problems (“I was sick or had to take medicine,” “baby was sick and could not breastfeed”)
Difficulty with pumping (“pumping milk no longer seemed worth the effort that it required”)
TRANSLATION: Research does not find that mothers quit early because they do not understand the benefits of breastfeeding OR because no one told them that “breast is best.” Rather, these results suggest that, most mothers quit due to circumstances outside of their control. So, if we expect more mothers to breastfeed exclusively for at least 12 months, they need more support to make it happen! We also need to understand that some mothers may not make this choice for a variety of reasons which are none of our business! If you are ever tempted to ask a new mother why she is no longer breastfeeding, remember that some mothers choose to stop breastfeeding due to a history of sexual abuse that makes breastfeeding triggering and some mothers choose to stop breastfeeding due to the need to take important, potentially lifesaving psychiatric medication. Many women may not want to discuss their personal medical and psychiatric history with every stranger on the street who feels entitled to ask them about breastfeeding.
So which is more supported by the research: “Breast is Best” or “Fed is Best”?
So the “breast is breast” versus “fed is best” debate… which side is most supported by research? I would argue that it really depends on the individual situation. Research finds many benefits of breastfeeding but research also demonstrates that a mother’s mental health impacts infant growth and child development across all domains. This research suggests that mothers should not continue to breastfeed at the cost of their own mental health.
How about “supporting mothers in their feeding goals is best”? If a mother desperately wants to exclusively breastfeed for 6 months but is struggling to get her baby to latch, she should not simply be told “fed is best” but provided with support to reach that goal. If a mother wants to formula feed from day one due to concerns about her own mental health or well-being, she should be supported in that goal and not simply told “breast in best.” Each individual family should determine their unique feeding goals for their children and should be supported in this goal rather than being shamed or pressured in any way.
Ten Research-Backed Breastfeeding Tips That I Wish I Had Known:
If possible, find a lactation consultant that you like and trust while you are pregnant and schedule a visit with them both before you give birth and in the first week of life regardless of how you feel breastfeeding is going. Research finds that seeing a lactation consultant both before and after you give birth results in an increased chance for breastfeeding success. Even if you don’t see any problems, you may still want to work with a lactation consultant to make sure that breastfeeding is as comfortable as possible for both you and the baby since you will be breastfeeding a lot in the first year. Many lactation consultants now provide virtual services (for example, the lactation consultant I saw with my daughter does—click here for her website!). If you live in the United States, your health insurance should cover the cost of a lactation consultant. Unfortunately, even given virtual lactation services and health insurance coverage, lactation consultants are a privilege and not every mother has access to them.
It can take up to five days for your milk to “come in” and this time may be very stressful. Your baby may be “cluster feeding” (aka feeding constantly) and it is very common to worry that your baby is not getting enough. However, in the first few days of life, infants are only meant to get a very small amount of colostrum (only about 1 to 2 ounces). In addition, the constant cluster feeding in these first few days is important for stimulating your breasts to produce milk. Research finds that frequent feeding in the first few days is linked to increased milk production, as well as a lower risk for jaundice. So let your baby feed as often as possible in these first few days and don’t see the frequent feeding as a sign your baby is “hungry” but as a normal way that babies stimulate milk production! If you would like to encourage the process, hand expressing drops of colostrum into your baby’s mouth and a lot of skin-to-skin contact may help your milk to come in more quickly.
The only evidence-based way to increase your milk supply involves emptying your breast as often as possible through feeding your baby frequently and on demand and/or through pumping between feedings. Put simply, the more often your breast is completely drained, the more milk you will make. When your breast is empty it signals to your body to make more milk. Most of the time your baby will empty the breast fully when your milk supply is low but if it doesn’t seem to be working, it can be helpful to contact a lactation consultant to find out why and use a pump to fully empty your breasts in the meantime. A supplement called moringa oleifera may also help to improve your milk supply, according to more recent research.
There is no research that oatmeal, beer, lactation cookies, or even drinking more fluids will increase your supply. There is some research showing that fenugreek may improve milk production but this is generally low-quality evidence and more research is needed on this topic.
Research finds that babywearing/skin-to-skin contact is linked to being more likely to exclusively breastfeed and breastfeeding for a longer time. Specifically, babywearing may make you twice likely to be breastfeeding your baby at 5 months and skin-to-skin contact may make you twice as likely to be breast-feeding your baby at 3 months. Skin-to-skin immediately after birth may increase the success of the first breastfeeding session. Skin-to-skin contact can even increase your confidence in your ability to breastfeed and your ability to be an effective parent (something we all need in the early weeks!). See here for a skin-to-skin carrier so you can do skin-to-skin while out and about with your baby or when you need your hands free to do something else.
Research finds that most women who think they have low milk supply actually don’t! As long as your baby is growing and having a sufficient number of dirty diapers and your pediatrician is not concerned, there is no reason to worry. Research also finds that the more confident you feel, the more likely you are to be successful at breastfeeding.
It is extremely common to have painful or damaged nipples (up to 90% of women experience this). Interestingly, a summary of the research found no evidence evidence that common treatments for painful and cracked nipples, such as lanolin and all-purpose nipple ointment, improved pain in mothers with this experience. This research also found that women who applied expressed breastmilk to their nipples reported lower levels of pain than women who applied lanolin to their nipples after 4 to 5 days. However, women did not report that this effect was maintained after 6 to 7 days of treatment. The authors concluded that expressed breastmilk or applying nothing at all might be most effective in reducing nipple pain. Importantly, the authors also found that most women reported that nipple pain declined after 7 to 10 days regardless of treatment, so regardless of what you do the pain is likely to improve! In addition, finding the right position and deepening your baby’s latch may be best way to prevent nipple problems and help your baby to get more milk.
Every baby and breastfeeding mother is very, very different so don’t compare your experience to others! It is completely normal for mothers to produce anywhere from 15 to 41 ounces per day and your infant can grow and develop normally whether you are at the high or low end of this range. It is also completely normal for infants to feed from anywhere from eight times a day to what seems like 24/7. You likely have no control over how often your infant feeds since it is determined by the storage capacity of the breast, the infant's stomach capacity, and the infant's stomach emptying time. Also, breastfeeding sessions can take 12 to 67 minutes for most infants. Breastfeeding that is more efficient tends to be shorter. These ranges are even more extreme if your child is premature, has tongue tie, or anything else that makes breastfeeding less efficient.
It doesn’t hurt to ask your pediatrician and lactation consultant about the possibility of a tongue tie (called ankyloglossia) if your child seems to be inefficient in breastfeeding of if breastfeeding is painful. Research finds that releasing a tongue tie (called a frenotomy) may improve feeding and result in less pain for mothers with few side effects. My second baby had a minor tongue tie and I chose to have a frenotomy. The procedure was incredibly quick and he only cried for a second. After the procedure, he was much more efficient at breastfeeding and I experienced less pain.
Some pumping tips:
Massage the breasts while pumping since this technique may result in enhanced milk production
Store breastmilk in glass containers if possible to preserve the qualities of milk (I used glass mason jars with my third baby and found it so much easier than those flimsy plastic bags!)
Use refrigerated rather than freezer milk whenever possible since refrigerated milk shows less degradation of immune properties and reduction of vitamin content (although still has sufficient levels of both)
Make sure you are using the right size flange as this may make pumping more efficient
Schedule a visit with a lactation consultant so they can help you to optimize your pumping and find the right flange size
If you are in the United States, companies like Aeroflow will help you to determine what you which breast pumps are provided for free through your health insurance and will coordinate with your insurance company to get the pump delivered directly to you (I used Aeroflow to get three free breast pumps for each of my three kids as well as new pump parts).
More Resources
For more evidence-based information on breastfeeding, please check out the following websites:
Academy of Breastfeeding Medicine
Newsletter Review
As I mentioned in a previous newsletter, all Parenting Translator newsletters are “peer reviewed,” meaning they are reviewed by an expert to make sure they are as accurate and as helpful for you as possible. This newsletter was reviewed by the incredible Valerie Goodman, RN, BSN, IBCLC. Valerie has been a lactation consultant for over 15 years and is a founding member of the Breastfeeding Medicine Program at the University of Virginia. Thank you Valerie for reviewing this newsletter and providing such valuable input!
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Welcome to the Parenting Translator newsletter! I am Dr. Cara Goodwin, a licensed psychologist with a PhD in child psychology and mother to three children (currently an almost-2-year-old, 4-year-old, and 6-year-old). I specialize in taking all of the research that is out there related to parenting and child development and turning it into information that is accurate, relevant, and useful for parents! I recently turned these efforts into a non-profit organization since I believe that all parents deserve access to unbiased and free information. This means that I am only here to help YOU as a parent so please send along any feedback, topic suggestions, or questions that you have! You can also find me on Instagram @parentingtranslator, on TikTok @parentingtranslator, and my website (www.parentingtranslator.com).
DISCLAIMER: The information and advice in this newsletter is for educational purposes only and is not intended or implied to be a substitute for professional medical, mental health, legal, or other professions. Call your medical, mental health professional, or 911 for all emergencies. Dr. Cara Goodwin is not liable for any advice or information provided in this newsletter.
I wish I had this info when I started 9 years ago. I was also unprepared for how hard it would be at first and shed many tears. If not for a patient LC who talked me off the cliff and helped me manage my over supply, I would have quit. There isn’t enough support for moms post partum on any level.
This piece is great. Learning to breastfeed is the hardest thing I've ever done. My housekeeper saw me early on and said, "it'll take about three month for you to 'get it.'" Geez that sounded like a million years away in that moment. She was right! Three months of getting A LITTLE better each and every time the baby fed. SO much stress, crying, etc. With subsequent children, though, it was like riding a bike.