1. Many mums can’t make enough milk to satisfy their hungry/larger baby.

Research indicates less than 4% of mums are physically unable to produce enough breastmilk, this includes mums who have had breast surgery and/or mastectomy or who may be taking severe drugs such as cancer medicines which would pose a risk for the breastfeeding baby.

This figure is also thought to be on the high side because the amount of accurate advice/support received by the 4% cannot be ascertained. So if the % of mums physically unable to breastfeed is so low then why are so many mums seemingly not able to nurse their babies? In reality with even a basic understanding of how breastfeeding works, how milk supply is managed, what breastmilk contains and what is simply normal breastfed baby behaviour, the majority of mums would succeed.

The signal breasts need to make more milk is baby feeding. This feeding triggers the release of milk making hormone prolactin, very simply the more baby feeds, the more hormone is released = more milk. Mums can make enough to feed several babies as in the case of multiples so when mum allows baby frequent or unrestricted access to the breast this allows baby to establish a good supply of milk and/or increase the supply to meet his growing needs. Some mums take this frequent feeding (often combined with fussiness) as a cue baby is not getting enough to eat when in reality both when establishing milk supply and around the time of growth spurts, this is completely normal behaviour to control the supply of milk.

What interferes with this natural process is schedule feeding, pacifiers and seperation of mother and baby via moses baskets etc and restriction of skin to skin.

If we look at “bigger babies” - whether 15lb at 3 weeks or 3 months, mums who breastfeed exclusively until 6 months, breastfeed bigger babies! It’s therefore nonsensical to claim just because a baby is larger earlier, the mum can’t meet their needs.

Lastly if we compare breastmilk and formula:

Mature Breastmilk
(Average)
Energy 75 kcal/100 mL
Fat 4.2 g/100 mL

SMA white (for hungry babies)
Energy 67 kcals/100 mL
Fat 3.6 g/100mL

Therefore shouldn’t the breastmilk with more fat and calories satisfy the hungry baby more?

Breastfeeding means no alcohol.

Ethanol - the chemical name for alcohol - is approved by the American Academy of Pediatricians for use during lactation.

Hale (Dr Thoms Hale in Medications and Mothers Milk, international research based textbook) found that a mother needs to have a blood level of 300 mg alcohol per decilitre of blood before her infant shows significant side effects (mainly sedation).

The legal drink driving limit in the UK is 80mg of alcohol per 100ml of blood.

100ml is a decilitre so this means you would have to have consumed between 3 and 4 times the legal limit for driving before the alcohol you were drinking had significant effects on your baby….and actually feeding at the time you were affected, too.

Alcohol reaches the breastmilk shortly after it reaches the bloodstream - so fairly quickly, but in dilute quantities. Hale says ‘the absolute amount transferred into milk is low’. It is estimated less than 2% of the alcohol consumed by the mother reaches her milk.

You can be sure your breastmilk is clear of alcohol when your bloodstream is clear of it, and the usual guide for this is that the body processes alcohol at a rate of one and a half to two hours per unit. Alcohol peaks in milk approximately 1/2-1 hour after drinking although of course this varies considerably from person to person (see below)

Hale does not imply it’s a good idea to drink whilst breastfeeding….he suggests waiting 2-3 hours after drinking, although I think perhaps it is difficult to pin down an exact time as this will vary in each situation.

Factors that should be taken into consideration include; the amount of alcohol consumed ie smaller amounts will leave the blood stream much more quicky plus the weight and age of the baby (this information is directed at healthy fullterm babies) A newborn has a very immature liver, so minute amounts of alcohol would be more of a burden. Up until around 3 months of age, infants detoxify alcohol at around half the rate of an adult. An older baby or toddler can metabolize the alcohol more quickly.

Of course how quickly each mum metabolises alcohol will also vary slightly depending upon how much food was eaten in the same time period, mums body weight and percentage of body fat, etc..so this could explain the more conservative time frame presented by Hale.

There is no need to pump & dump milk after drinking alcohol, other than for your own comfort, pumping & dumping does not speed the elimination of alcohol from the milk.

The La Leche League’s BREASTFEEDING ANSWER BOOK (pp. 509-510) says,
“Occasional or light drinking of alcoholic beverages has not been found to be harmful to the breastfeeding baby. Moderate-to-heavy regular alcohol consumption by the breastfeeding mother may interfere with the let-down, or milk-ejection reflex, inhibit milk intake, affect infant motor development, slow weight gain, and cause other side effects in the baby.

It is important for dad to give baby a bottle to feel involved and to bond with baby/allow others to feed the baby.

It is true that breastfeeding is an intimate bond between mother and baby, oxytocin, a hormone is released, which promotes bonding and is relaxing to both mother and baby. Some parents are concerned that if dad doesn’t become involved with feedng, it may on some level prevent bonding. Bottle feeding however, does not confer these same benefits. There are many other ways however, a dad can embrace his new role and effectively bond; without compromising breastfeeding and therefore the longterm health of the baby.

Dads can take an active role in bath time. A 14 year study by Dr Howard Steele, of the University of Central London, revealed vabies who miss out on regular baths by their father are three times more likely to experience behavioural problems. The study, thought to be the first of its kind, found 30% of boys and girls who were not bathed regularly by their father were prone to “significant friendship problems” when they grew up. This compares with 3% who were bathed three to four times a week who went on to suffer problems.

Dr Steele says:
QUOTE
one reason for the long-term effects of bathing is hormones called oxytocins, which are released into the body when touch and warm temperatures are combined.

Dads, or father figures, have a particularly powerful influence on their child’s social competence development and so they need to know how important things like bath time are for their baby.”

“The function of the father is to introduce the child to the social world beyond the mother, through assuming some of the early caregiving duties and increasingly via playful and joyful stimulation of the child’s interest.

“Bath time is an obvious place for this stimulation in dad’s busy life.”
END QUOTE

Dads can also enjoy lots of skin to skin contact with baby, provide a relaxing massage post bath or carry baby in a sling as bonding methods both father and baby will enjoy.

A Bottle Of Formula Before Bed Helps Baby Sleep Longer
There is no evidence supporting this theory and in fact, can make sleep worse for some babies -as they struggle to digest a foreign substance.

One study did illustrate breastfed babies were more rousable between three and six months of age (ie formula fed babies sleep deeper), a study that could prove quite significant as research also indicates longer stretches of deep sleep are associated with sudden infant death syndrome (SIDS) and babies who sleep longer/deeper may be more vulnerable to SIDS (see in particular the research of James McKenna, PhD) This may go some way to explaining why the risk of SIDS is increased if a baby receives formula, although there are also other plausible theories.

Many parents may also not be aware of other risks of introducing formula to their babys diet, in the hope of improving sleep. Exclusively breastfeeding your baby creates a protecting layer in babies gut that prevents substances entering babies blood stream directly, passively providing immunity during the time of reduced immune function. This is often referred to as “virgin gut”.

These antibodies ignore useful bacteria normally found in the gut and ward off disease without causing inflammation. ONE bottle of formula causes a change in the gut flora of a breastfed baby and studies seem to suggest that the problems associated with formula feeding are what we call “dose related.” That means the more formula a baby gets the more likely they are to have the associated problems. Many parents are unaware that destroying this protective lining reduces many of the benefits associated with exclusively breastfeeding.

If formula is given within the first 7 days it is possible the full potential of the gut will never be reached, otherwise if breast milk were again given exclusively, it would take 2-4 weeks for the intestinal environment to return again to a state favoring the grampositive flora. (Brown & Bosworth, 1922; Gerstley, Howell, Nagel, 1932)

(read more at http://www.drjaygordon.com/breastfeeding/supplement.htm )

Nightfeeds are also one of the most effective ways of increasing milk supply as milk making hormones peak in the early hours. Combined with the fact any supplementation will cause a natural reduction in milk supply, formula at night can often cause more problems than are at first apparent.

References:

Cunningham, A. Jelliffe, B. , Jelliffe, E, “Breastfeeding and Health in the 1980’s: a global epidemiologic review.” Journal of Pediatrics 118: 659-6, 1991

McKenna, et al, “Infant-Parent Co-Sleeping in an Evolutionary Perspective: Implications for understanding Infant Sleep Development and the Sudden Infant Death Syndrome” Sleep, Vol 16, No 3 1993.

McKenna, J. & Mosko, S. “Evolution and infant sleep: an experimental study of infant-parent co-sleeping and its implications for SIDS” ,Acta Paediatr, 1993, 389, 31-36.

Walker, M. “A fresh look at the risks of artificial feeding infant feeding”. Journal of Human Lactation Vol 9. 97-107, 1993.

A Breastfed Baby Needs Flouride Supplementation

According to the Institute of Medicine (I0M, 1997, page 292), “The fluoride concentration in human milk ranges from 0.007 to 0.011 mg/liter (Ekstrand et al., 1984; Esala et al. 1982; Spak et al., 1982).” In other words the level of the fluoride ion in mothers’ milk is approximately 0.01 ppm, which is 100 times lower than that added to the public water supply where water fluoridation is practiced. This means that a baby, which is bottle fed with milk formula made up with fluoridated tap water will be getting 100 times more fluoride than nature had intended.

As far as the practice of water fluoridation is concerned we should be concerned about this on two fronts. First of all this very low natural level of fluoride in mothers’ milk is telling us that fluoride is not necessary for healthy teeth, healthy bones or healthy anything else. Mothers’ milk has been designed by nature over a huge period of time to present to the baby the ideal mixture of nutrients for early growth.

As apologists for fluoridation are swift to point out the fluoride ion is readily available in nature -indeed it is the 13th most abundant element in the earth’s crust, so it is not through any lack of availability which causes it to be so low in mothers’ milk. Indeed, life evolved from the sea which has an average concentration of fluoride ion of about 1.3 ppm. This low level further underlines the fact that no evidence has been presented to persuade the scientific community that fluoride is a nutrient. In particular, no disease has ever been shown to be caused by lack of fluoride.

Dr. Vyvyan Howard, an infant and fetal pathologist from the University of Liverpool in the UK puts the situation this way:

“Nature appears to have evolved a mechanism of minimizing the exposure of infants to fluoride. Human breast milk only contains between 5 and 10 parts per billion of fluoride, while adult blood contains between 59 and 640 parts per billion. However chloride, a closely associated halogen ion that is essential for life, is present in breast milk at 360,000 parts per billion. There must be an evolutionary selection pressure operating for this selective exclusion of an otherwise highly diffusible anion.”

The second reason for concern is the notion that fluoride is so low in mothers’ milk because nature was aware of fluoride’s extremely high biological activity and therefore had good reasons for keeping it away from the baby’s developing tissues. We now know that fluoride can inhibit many enzymes; can interfere with the normal fucntioning of several metal ions like calcium and magnesium, and in the presence of a trace amount of aluminum can switch on G-proteins, thereby interfering with he messaging system of many important messengers such as water soluble hormones, growth factors and neurotransmitters.

A mother who smokes is better not to breastfeed

It is often stated that should a mother smoke it is better that she does not breastfeed.

According to Dr Jack Newman:
QUOTE
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.
END QUOTE

According to LLLI’s THE BREASTFEEDING ANSWER BOOK, if the mother smokes fewer than twenty cigarettes a day, the risks to her baby from the nicotine in her milk are small. When a breastfeeding mother smokes more than twenty to thirty cigarettes a day, the risks increase. Heavy smoking can reduce a mother’s milk supply and on rare occasions has caused symptoms in the breastfeeding baby such as nausea, vomiting, abdominal cramps, and diarrhea. (Vorherr 1974).

Bottle-fed infants have a much higher incidence of respiratory illnesses than breastfed infants. A bottle-fed baby whose mother or other household members smoke would therefore be at even higher risk of these problems. Dr. Jack Newman states:

QUOTE
“The risks of not breastfeeding are greater to the baby than the risks of breastfeeding and smoking. The decision is up to the mother and I would encourage her to breastfeed.”
END QUOTE

Mothers who would like to stop smoking may wonder about the safety of smoking cessation aids which replace nicotine. When used as directed, these products pose no more problems for the breastfeeding infant than maternal smoking does.

According to the 1999 edition of “Medications And Mother’s Milk” by Thomas W. Hale, R.Ph., Ph.D., the blood level of nicotine in most smokers (20 cigarettes per day) approaches 44 nanogram per milliliter (ng/mL) whereas levels in patch users average 17 ng/mL, depending on the dose in the patch.

Dr. Hale writes,
QUOTE
“Therefore nicotine levels in milk can be expected to be less in patch users than those found in smokers, assuming the patch is used correctly and the mother abstains from smoking. Individuals who both smoke and use the patch would have extremely high blood nicotine levels and could endanger the nursing infant. Patches should be removed at bedtime to reduce exposure of the infant and reduce side effects such as nightmares.”
END QUOTE

Premature babies need to learn to take bottles before they can start breastfeeding.

Premature babies are less stressed by breastfeeding than by bottle feeding. A baby as small as 1200 grams and even smaller can start at the breast as soon as he is stable, though he may not latch on for several weeks. Still, he is learning and he is being held which is important for his wellbeing and his mother’s. Actually, weight or gestational age do not matter as much as the baby’s readiness to suck, as determined by his making sucking movements. There is no more reason to give bottles to premature babies than to full term babies. When supplementation is truly required there are ways to supplement without using artificial nipples - Jack Newman

Bottles require less sucking finesse and less effort. However, studies comparing premature infants during bottle-feedings and during breastfeedings have shown that breastfeeding is actually less stressful. Babies’ breathing and heart rate are more stable during feedings at the breast. Babies have more control over the milk flow and can establish a more regular rhythm of sucking, swallowing, and pausing. Feeding at the breast also requires less energy. - Dr Sears

When can a premature baby begin to breastfeed?

Breastfeeding can gradually be introduced from 32-33 weeks providing a baby is stable and relatively well. Before this stage, expressed breastmilk can be given to via a gavage tube, cup, syringe, dropper or via finger feeding. Baby’s interest in breastfeeding should be encouraged by kangaroo care.

Kangaroo care means placing your baby upright, dressed only in a nappy, between your breasts on your bare chest. You may also hear this referred to as skin-to-skin care.

Benefits of Kangaroo Care:

Increases milk supply

Promotes essential neuro-development

Stabilises blood sugar levels

Stabilises temperature

Earlier feeding at the breast

More successful breastfeeding

Earlier discharge from the hospital

Stablises heart rate, oxygen sats and blood pressure

Increases bonding

Better tolerance for noise and stress

Conserves baby’s energy

Encourages non-nutritive sucking

Read more at www.kangaroomothercare.com

During kangaroo care baby will often start to move toward the breast and find the nipple. They may lick or suck the nipple which demonstrates the beginning of breastfeeding behaviour. “Non-nutritive”* sucking is rapid and irregular sucking which encourages milk to flow.

In addition to sucking on the breast, babies may have non-nutritive sucking on objects such as the feeding tube, a finger, or their fist.

This sucking helps the baby to:

Awaken

Get ready to feed

Learn how to suck, swallow, and breathe at the same time

Calm down

Gain weight by helping in digestion

Breastfeeding may well be vital to preserving the mother/baby contact. If a baby is taking bottles mothers may be encouraged to rest and allow staff to take care of the baby, perhaps even in a different ward in the case of premature babies:

Even short-term separation from mother leads to elevated cortisol in infants, indicating stress.(1,2) In fact, after one full day of separation, infant rats already show altered brain organization of chemical receptors. (3) A similar rat study revealed that one day without mother actually doubled the number of normal brain cell deaths. (4)

References:

1. M.L. Laudenslager et al., “Total cortisol, free cortisol, and growth hormone associated with brief social separation experiences in young macaques,” Dev Psychobiol 28, no. 4 (May 1995): 199-211.

2. P. Rosenfeld et al., “Maternal regulation of the adrenocortical response in preweanling rats,” Physiol Behav 50, no. 4 (Oct 1991): 661-71.

3. H.J. van Oers et al., “Maternal deprivation effect on the infant’s neural stress markers is reversed by tactile stimulation and feeding but not by suppressing corticosterone,” J Neurosci 18, no. 23 (Dec 1, 1998): 10171–9.

4. M.A. Smith of Dupont Merck Research Labs as reported by JohnTravis of Science News 152 (Nov 8, 1997): 298