The Top Five Misconceptions About Breastfeeding

By Teresa Stackhouse, MSW, RN, BSN, IBCLC

As an RN working in postpartum and special care nursery, and as a Lactation Consultant working in the NICU and outpatient settings, I’ve encountered several recurring misconceptions about breastfeeding. These misconceptions get handed down and passed around from well-intentioned girlfriends, aunties, and neighbors.These people have your best interests at heart, but their own lack of knowledge and experience can give you a defeatist attitude toward breastfeeding before you even start. Most of these myths and misconceptions focus on how difficult and insufficient breastfeeding is.

Make no mistake, breastfeeding can be challenging, especially in the first few weeks. Here’s the good news…if you can hang on it gets easier. There are even some conveniences to breastfeeding. Consider this, you won’t be washing bottles, sterilizing nipples, spending money on formula, and you’ll never have to leave the house and turn around because you forgot to bring a bottle. There is no mixing, portioning, or heating in the middle of the night. Your breast milk is always ready, the right temperature and the right amount. Read the following misconceptions with an open mind and reconsider some of the false impressions that you’re holding onto about breastfeeding.

It has to hurt.

I can’t lie to you. There might be some discomfort in the beginning weeks. Sore nipples and painful engorgement have conspired to derail even those mothers who are very determined to breastfeed. I often tell new mothers that I can’t take all the discomfort away, but I can minimize it. The best way to minimize your chances of getting sore nipples is to obtain good positioning and latch. Start by getting your baby up to the height of your nipples. This may require one or two pillows on your lap. If you’re using a boppy or other breastfeeding positioning pillow, you may need to add a flat, folded blanket on top for additional height and to prevent the infant from rolling into the crevice. Don’t lean over baby to breastfeed. It’s painful and will definitely result in sore, cracked nipples. Baby should be on his/her side, belly to belly with mama. Baby’s nose should be in the middle of mama’s nipple. This insures good tongue placement on the nipple. A lot of nipple trauma is a result of poor positioning which causes baby’s tongue to pinch the end of mama’s nipple. A good hold can minimize nipple trauma as well. Three of the best holds for newborns are crosscradle, football, and laidback breastfeeding. The cradle position that everyone sees in pictures and associates with breastfeeding is really more appropriate for older infants with more head control than newborns have. 

Make sure that baby has a wide open mouth full of breast tissue and flanged lips. You should see more of the dark part of the areola above the baby’s upper lip than below. Believe it or not a little lip that is rolled under can cause a lot of trouble. Inexperienced mothers often don’t know that the lip is rolled under or how to correct the lip positioning. So this brings me to my number one way to prevent sore, painful nipples…Ask for help. Your hospital may have a lactation consultant (LC), a healthcare professional with training, certification, and experience in assisting breastfeeding mother. In order to achieve a good start with breastfeeding ask the LC to be there for your first feeding. If your hospital doesn’t employ an LC ask your labor or postpartum nurse for assistance. If you are registered for assistance through Women Infants and Children (WIC) ask your peer breastfeeding counselor to assist you after delivery. Another alternative is to ask a friend who has successfully breastfed to come and help you latch your baby for the first feed. In addition, there are lots of good websites with videos that demonstrate how to achieve a good latch. Two of my favorites are kellymom.com and http://www.breastfeedinginc.ca/. It only takes one bad latch to traumatize the nipple. Breastfeeding shouldn’t be painful. I’m not saying that you won’t feel anything, after all, someone is tugging on your nipple. What you feel shouldn’t be painful. Your latch should never hurt more than a two out of ten on a numbered pain scale. If it does, you need to break the seal and start over with a new latch.

Colostrum isn’t enough to satisfy a baby’s hunger.

Colostrum is nature’s perfect first food. It is rich in protein, carbohydrates, calories, and mama’s own immunities. It is nectar thick which prevents choking and aspiration. Colostrum gives your baby 2-4 days of practice with a rich, thick liquid before transitioning to the thinner, larger volume of mature milk. Yes, it’s true, colostrum is not a large volume, but it’s also true that it does not need to be a large volume to be sufficient. At day one your newborn’s stomach capacity is only 5-7mLs…that’s only one to one and a half teaspoons. Colostrum is a great example of the less is more philosophy. Drops of you colostrum are a sufficient feeding for your newborn. Over the course of the next 3-5 days, in order to accommodate the larger volume of mature milk, your little one’s stomach is slowly stretched and increases capacity. At this point your newborn has transitioned from suck as a reflex to suck as a learned skill. Your baby can now manage your mature milk flow and his/her stomach has achieved a larger capacity to keep it down.

Unless there is a medical reason to do so, you do not need to “supplement” your infant with formula.

Introducing a bottle too early can disrupt the breastfeeding relationship. It is so much easier to get milk from a bottle. It is much more difficult, at least initially, to transfer colostrum from the breast. Newborns are smart, smarter than we give them credit for. They can develop a preference for the “easier” way to feed. An infant that has received a lot of supplemental bottles is often fussy, crying, and arching at the breast. It can be difficult to get him/her to latch.

A lot of new mothers, and experienced nurses for that matter, confuse normal infant behavior with hunger. It is normal for infants to cluster there feedings close together, especially on the second night of life, and later at home, usually in the evenings. This is nature’s perfect design to provide mother with good stimulation that tells her body to produce mature milk or more milk. This fussy, cluster feeding behavior does not mean that your infant is starving. Your infant is doing exactly what he/she should do in order to stimulate your body to produce mature milk. Ride it out. Sleep as much as you can in anticipation of the second night of life. Take naps with your infant during the day to help you get through the fussy evening feeds.

The first few days after delivery focus on the number and quality of feedings and output. These are the clues that tell you your baby is getting enough. Your baby should be eating at least 8-12 times in 24 hours. These should be good quality feedings with lots of audible swallows. Wet and dirty diaper goals are easy to remember. In the first 24 hours we want one void and one stool. Day two we like to see two voids and two stools. Day three…you guessed it three voids and three stools. Day five is an important output day. By day five your infant should no longer have dark, tarry, meconimum stool. Your five day old infant should transition to yellow, seedy stool. Your mature milk supply should be established and your infant should have six to eight wet diapers and three to four good size stools in 24 hours. This is the minimum output that we want to see from this point on. Your infant can have a lot more wet and dirty diapers, but we don’t want him/her to have less.

I’ll have to stop breastfeeding when I go back to work.

Good news, thanks to the Affordable Care Act most commercial insurances and state Medicaid programs pay or reimburse for good quality electric breast pumps. This removes a major stumbling block for many mothers who would like to extend the breastfeeding relationship.

Introduce a bottle to your infant between weeks three and four. A window of opportunity opens at this time that allows you to go back and forth between the bottle and breast. Introduce a bottle earlier and you have trouble convincing your baby to latch at the breast. Introduce a bottle later than this and the baby is less likely to accept the bottle. Continue to offer at least one pumped bottle daily (a good job for daddy, auntie, grandma, or older sibling) to prepare your baby for your eventual separation during work hours.

Talk with your employer before you return to work tell him/her about your need to pump when at work. Many states have enacted laws that protect you and insure that you have adequate breaks and privacy for pumping.

When you return to work you will need to pump as frequently as baby would eat. Usually, this is about every three hours. Going longer than four hours without emptying breasts will result in a diminished milk supply. Pump until there are no more drops of milk and go an additional minute or two.

I’m going to stop breastfeeding when my baby gets teeth.

Some babies are early teethers and get their first incisors at four months others are seven, eight, or even nine months before getting their first pearly white. Your baby’s teething schedule should not determine the duration of your breastfeeding relationship. You will not feel your infant’s teeth when you breastfeed. If your fear is that baby will bite please know that many babies never bite. If your infant does bite there are several techniques that you can be used to stop this behavior. Contact your local LC, peer breastfeeding counselor, or friend who breastfeeds who can help you learn these techniques so that you can continue to breastfeed your infant.

Breastfeeding a baby past one year is gross.

Many toddlers continue to use a pacifier or have a bedtime bottle past one year of age. This continued “dependence” on an artificial nipple is perfectly acceptable in our culture. However, many people have an erroneous belief that breastfeeding a toddler causes an unnatural dependence between the toddler and the mother. Nothing could be further from the truth. Breastfeeding a toddler is usually limited to mornings after waking, evenings before bed, or comfort nursing for pain or sickness. Breastfeeding toddlers are just as curious and active as non-breastfeeding toddlers. Extending the breastfeeding relationship provides your toddler with a safe “base” that he/she can use to regroup and seek comfort before exploring his/her environment.

In addition, the immune properties of breast milk do not just disappear at one year of age. Your toddler continues to receive immune properties and protection from illness from your breast milk well into the toddler years. The American Academy of Pediatrics recommends exclusive breastfeeding to six months, then breastfeeding and complimentary foods to at least one year, and longer as mutually desired. Think about developmental goals in your own life. Were you ready for marriage because you graduated from college? Were you ready for children because you were married? A date on a calendar or a developmental milestone doesn’t necessarily mean immediate, complete, and utter abandonment of the previous stage. I often tell the mothers that I work with that they will know when they are done breastfeeding. This doesn’t always coincide with the first birthday. When it comes to your breastfeeding relationship with your baby approaching toddler status, keep an open mind, watch for signs that baby is ready to move on, respect his/her timetable and your own. Try adopting a day-by-day approach. After all, breastfeeding past the first birthday doesn’t mean that you’ve signed up for another calendar year.

Whether you’re a breastfeeding mother struggling with some of the challenges that come along in the first few weeks, you’ve made it six weeks and you need information on returning to work, or you want to learn distraction skills for your biting/teething eight month old, there is help. Some of the best help available comes from peer support. Check out www.llli.org to find a local chapter of La Leche League or www.breastfeedingusa.org for a local support group. Help is only a call or click away. Don’t struggle alone and don’t let old mindsets and myths limit your breastfeeding relationship.