Guest post by Kristen Tea
In the past 4 years since becoming a mother and an enthusiastic breastfeeding supporter, I have learned that myths about breastfeeding and formula are running rampant. I am left frustrated and concerned that our formula culture has won, that our mothering instincts have been trampled by the corporations that would prefer a dollar over a healthy child.
Most significantly, I have seen many, many mothers state that their breast milk never came in, or that it dried up after a couple months. I know that some women genuinely do not produce milk due to Insufficient Glandular Tissue, and I do not mean at all to belittle their struggles or suggest that if they would have tried this or that, it would have worked.
Related: What I Really Wish I'd Known About Breastfeeding Before I Had Kids
But it is a very rare medical condition, and when the conversation goes something like this: "I never made any milk! I squeezed my boob an hour after my baby was born and nothing came out so I started formula!" I know that is most likely NOT a case of IGT, but rather misinformation about how the process of breastfeeding works. The misinformation and myths are effective "booby-traps" that can derail a successful breastfeeding relationship, and our society currently does very little to support and educate new moms.
[Edited to add important information]
It is important, however, to note the difference between Insufficient Glanduar Tissue or mammary hypoplasia and simply having low supply or difficulties latching. Some of the signs of latch and positioning issues or low supply, or issues that may be causing problems with breastfeeding include:
- Poor latch- a baby's lips should splay out when they are nursing. If a baby's lips are tucked under, then they may not be nursing as well as they should be. This can result in uncomfortable or even painful nursing sessions and your baby having difficulty getting milk efficiently out of the breast.
- Lip or tongue tie- Lip and tongue ties can cause a baby to have a poor latch or insufficient sucking reflex, making it difficult to nurse. It can also cause painful nursing sessions. Many mothers who switch to bottles because of a lip or tongue tie think that nursing was the issue because the baby is able to get milk out of a bottle. However, this is often because milk from a bottle is easier to get out, even with a poor latch, than a breast.
- Waiting too long to breastfeed- If your baby is in the NICU or, because of COVID-19 you are separated for days or weeks at a time, you may wait so long to breastfeed that your supply drops. Your body thinks that there is no baby around to feed so it starts lessening the amount of milk being made.
- Staying on a schedule- If you nurse on a schedule, instead of on demand, you may find that your supply starts to drop or feel like your baby isn't getting enough milk during feedings. Your milk changes as your baby grows, so nursing on demand allows your body to recognize that your baby is eating more as they get bigger.
- Supplementing breastfeeding- If your doctor recommends supplementing with formula, this can drastically cause a dip in supply in your breastmilk. Supplementing means your baby relies on the formula instead of spending the time working on getting milk from the breast. However, it is important to recognize when your baby does need help and you do need to supplement with formula. If your baby is dropping weight rapidly, you may want to considering supplementing with formula or donor's milk.
- Certain medications- Some medications can cause your milk supply to decrease expotentially. Look up possible side effects for any medication or herbal supplements you may be taking to see if they are causing a decrease in your breastmilk supply.
- Premature birth- Babies who are born prematurely may not have the reflexes to nurse like a full-term newborn. Coincidentally, waiting to breastfeed until your baby is of gestational age can also decrease your supply or make it nearly impossible to breast feed.
- Maternal obesity, pregnancy-induced high blood pressure, and poorly controlled insulin-dependent diabetes also can cause low milk supply.
When reflecting on the beginning of my nursing relationship, it is easy to see how breastfeeding can seem challenging and how it can be ruined if the conditions aren't right. I had a fairly typical hospital birth which included no breastfeeding support, a nurse who tried to convince me that she needed to take my new baby to the nursery in order for my milk to come in, and of course I was sent home with a "breastfeeding support kit," complete with free formula samples. The fact that formula samples are sent home from hospitals with new moms is despicable, especially when we look at the reality that our lack of breastfeeding in the U.S. costs nearly 1,000 lives and billions of dollars every year, and artificial infant feeding is linked to a plethora of health issues.
It is also important to consider every baby's natural "virgin gut"- the perfect balance of gut bacteria that is crucial to a life of good health. Breast milk maintains the ideal gut flora, and introducing foreign substances like formula, milk, solids when introduced too early, and even water can cause an imbalance in the body which can manifest into many different illnesses, from allergies to acid reflux to Crohn's disease. That in conjunction with new evidence that healthy gut bacteria has "a significant impact on brain development and subsequent adult behavior" tells us that starting and maintaining a solid breastfeeding relationship can be imperative for good health.
Related: 10 Things You Might Not Know About Breastfeeding
Fortunately, I was informed about several of the issues surrounding breastfeeding and formula, so although I hit a few bumps along the road, as a new single mom with little support, I was able to persevere and nurse my son for over three years. I am thankful that I had read about the dangers of formula and the benefits of breastfeeding before I gave birth, because I believe knowing the facts can empower women to push through some of the barriers and beat the booby traps. There are things I wish I had known; my best advice follows:
- Don't plan on "trying" to breastfeed- plan to breastfeed. When we think of breastfeeding as a difficult thing to "try" at, instead of as the biologically normal, healthy way to nourish a child, we are already setting up mental barriers. Unless you are one of the rare women to have a diagnosed inability to produce breast milk, you can breastfeed. Similar to birth, if we believe that our bodies function well and can do what they are designed to do, we are less likely to reach for other options.
- You will have colostrum. This is one of the main reasons that I realized lack of education was really a burden on women who want to nurse. When I've asked around, I've found that many women do not know what colostrum is, nor do they know they will solely have this substance until their milk comes in. Colostrum is a thick yellowish/brownish substance that comes out of the breast in tiny amounts and gives your baby everything she needs in the first days of her life. Some women experience their milk coming in on the first or second days; some women have nothing but colostrum for 5-7 days or more. Have no fear! Your newborn's stomach is tiny and only needs a small amount of colostrum to be full. The more you nurse, the more you will produce. Once more for the people in the back! The more you nurse, the more you will produce!
- Don't attempt a schedule! Forcing a baby onto a schedule is sometimes known as "Babywise," but it is so unwise that it can be disasterous. Any pediatrician that suggests otherwise needs to update his or her education. Babies need to be fed on their cue and anything else can lead to Failure to Thrive. It is important to notice your baby's cues before they get to the crying stage, which is a late cue. It is hard to nurse a child that is screaming, so look for signs like rooting, sucking on hands, alertness, snuggling to the breast, etc. I basically kept my boobs out the whole time for the first couple of months because my son wanted to nurse all the time. It is good to know that this is what babies do and it is normal!
- Forget the formula! Refuse the "support kit" full of formula if you give birth in a hospital. Also be sure to tell every nurse and doctor you see that you are breastfeeding and not to introduce any bottles in the event that you are unable to be present. And of course ignore any advice that your baby needs to be away from you for your milk to come in. The best way to stimulate your milk is by nursing. Let everyone who may give you a baby-shower gift know that you have no intention of using formula but would appreciate breastfeeding supplies like Mother's Milk tea (do not use if oversupply seems to be an issue), nipple butter in case you struggle with latch, or hot rice socks to help ease the tension when your milk first arrives.
- Ditch the bottles! Although our maternity-leave rates in the U.S. are deplorable, most employed women get at least 6 weeks off from work, and during that time bottles should be avoided. Breastfeeding is a demand-supply situation; your baby has to nurse pretty much constantly in the beginning to establish a good supply. Introducing a bottle in the beginning, even of pumped milk, takes time away from the breast, which signals to the body that less mik needs to be made. Nipple confusion can also be an issue; this can happen because the act of nursing is very different than drinking from a bottle, with nursing being a little more challenging, involving more work. The bottle nipple allows for much quicker eating (which may be why formula is linked to obesity), and the baby may gain a preference for the bottle, making him reject the breast.
- Never mind the pacifiers! Children who are breastfed on demand have little need for a pacifier because the act of nursing is a pacifier in itself. The amount of times my son has recovered from a fall or a fright by nursing is numberless. Although some children who have already established a good nursing relationship may like a pacifier for extra comfort, they really are needed much less than is insisted by our culture. Pacifiers should also be avoided because, again, they can interfere with establishing a solid milk supply in those early days. A new baby needs to be at the breast nursing as much as possible, so no substitutes are needed. I suspect it is the overuse of these substitutes that causes some women to "dry up."
- Plan on co-sleeping. Sleep-sharing of all kinds has many benefits, and one of them is assisting a normal breastfeeding relationship. If you are not comfortable with your baby in your bed, keep her in a safe sleeping space next to your bed, like a co-sleeper or a crib. Co-sleeping has gotten a bad reputation because of incredibly unfortunate deaths- but all of the reported deaths have been because of unsafe co-sleeping (smoking, feeding formula, drinking alcohol or using other drugs are examples of unsafe co-sleeping). It is important to know the difference, but sleep-sharing is as old as time & has been done safely for generations. Crib-deaths are more common than co-sleeping deaths, but if you feel more comfortable with a crib, at least recognize that the idea of a seperate nursery for your baby to sleep in is probably an unrealistic goal. Either way, newborns are not supposed to sleep more than a few hours at a time because they need to have their bodies regulated and be fed. The best, safest way to do this is by keeping your baby near & nursing him often, even through the night. There are many options for gentle night-weaning and transitioning from co-sleeping, but it shouldn't be rushed. They are only babies once. P.S. Avoid any form of sleep-training 100%.
- Pumping is NOT an accurate way to tell how much milk you make, or how much milk your child gets. Every time I hear a mother say she didn't make any milk, I wonder how she came to this conclusion. Some women have gone through incredible trials with pumping, herbs, and pharmaceuticals before being properly diagnosed with inability to lactate, but the most common scenario I have heard is instead of just nursing, moms are pumping to see how much they are making, then getting discouraged when it is only a few drops. Not only is this an inaccurate way to tell, it can actually hinder the breastfeeding relationship. The most important thing is to keep your baby near and nurse, nurse, nurse. If you need to build up a stash of milk to return to work or for any other reason, try pumping on one breast while nursing on the other, or pumping in between each nursing session, instead of being tempted to supplement with bottled milk or formula. But unless your child is clearly malnourished, there should be no concern about "how much" your baby is getting. Breastfeeding is a biological process that is designed to work; have faith in that!
- Expect your baby to feel like a floppy bag of jello that doesn't know how to nurse. Nursing at first can be quite awkward; I remember being surprised at how flimsy my new baby seemed, and how little he seemed to know about breastfeeding. He latched like he was tired from staying up for days, with the muscle strength of a feather. It took a week or two to feel confident, then a couple more weeks to feel really confident, but in this case, practice does make perfect.
- If you have to return to work, commit to pumping. This one just makes me angry because while plenty of countries have 1-3 year maternity leaves, paid, and some include paternity leave as well, the U.S. (and other countries, mostly developing) fails miserably at helping its women workers meet the 2-year mark recommended by health organizations. We deserve better maternity leaves, but in the meantime, many companies are required by law to provide adequate nursing/pumping breaks. If you can find a personal nanny for your baby, or if your partner or family members can assist, you may be able to nurse every few hours while at work. If you cannot nurse at work, pumping is an option. I have a few friends who have been pumping exclusively for their babies for over a year. It can be done.
- Nurse in public. I have known more than one mama whose nursing relationship ended because they turned to bottles instead of nursing in public. In cultures that embrace nursing women instead of shaming them, we find breastfeeding rates beyond what the health organizations of the world recommend. Lactophobic cultures around the world need to learn that nursing is normal and that we have a legal right to do it as our child needs. I have also known women who cited their fear of nursing in public as their main reason for choosing formula, which means that our cultural attitude toward breastfeeding is directly affecting the health & quality of life of children, which is unacceptable. Put on your brave face and nurse in public!
- Consider changing your diet. If you notice that your new baby seems extra fussy, instead of reaching for the formula, which will usually make things much worse, try eliminating foods from your diet. Some babies are very sensitive to foods like dairy, soy, nuts, caffeine, and sugar in breast milk. Many mothers have reported improvement after following an elimination diet.
- Don't assume a crying baby means he's not getting enough. I remember this fear very clearly when I first had my son. He had a fussy period starting at 7pm almost every night for the first couple of weeks and I often wondered if he was "getting enough." This is also a sentiment I have heard many times when nursing is derailed- "I tried but my baby wasn't getting enough." Babies do cry and sometimes it is impossible to figure out why. They don't need you to panic and run for the formula; they need to be held close, worn in a comfortable wrap/sling/carrier, and nursed. It is easy to want to try something new if your baby is fussing and you don't know why, but in the long run it is much safer to just continue to nurse and forget about supplementing altogether.
- Nurse, nurse, nurse. This really is the best way to begin and keep a good nursing relationship. We have been so fooled by our modern society into thinking that we need bottles, formula, pacifiers, gadgets, battery-powered infant play-mats, deluxe bouncers, etc. etc. etc. when for the most part we need a breast and maybe a sling to get some stuff done. It's wise to avoid the temptation of letting other people feed your new baby, even though family members or even partners may feel that they are missing out. The most important thing is creating an excellent breastfeeding rapport, and there are many other ways for babies to bond. Visitors and family members can wear the baby in a sling while mom showers; dads/partners can practice skin-to-skin contact while baby-wearing for a beautiful bond.
- Attend a La Leche League meeting. La Leche League is a support system for breastfeeding women, and they have meetings all over the world. You can probably find one near you, or at least contact a leader for guidance. They are excellent with trouble-shooting and each group can be expected to have a wealth of knowledge on breastfeeding issues. They can observe your latch in the beginning to help prevent any discomfort, and you may find there is a whole host of other benefits to knowing the women of LLL.
- If you've had a challenging birth, do not give up hope! When a new mom has a cesarean birth or other traumatic birth (physically and emotionally), it may take her milk longer to come in. Add to that the fact that surgical birth can include the mother being unable to nurse for the first couple hours of her new baby's life, during which formula can be introduced by well-meaning nurses. (Side note: if your baby is not in distress after a cesarean, you can request that (s)he be brought to you immediately for nursing.) When a baby ends up in the NICU it can also be very trying to the breastfeeding relationship. The best resource I have for this type of situation is here. Read it; save it; you or someone you know may need it later.
- Adoption! If you are planning on adopting a child, know that it is possible to provide breast milk through induced lactation. I have limited knowledge in this area, but I have read a few induced-lactation stories and I am always in awe of the mothers that put in such hard work to make sure their new baby gets breast milk. Here is another story. In some adoption situations, the new parents can request breast milk from the birth mother, which I think is such a lovely gift for a birth mom to give. Donor milk is another option! I know some women immediately balk at this idea, but upon inspection, human milk is much more normal to give a baby than milk from another species' nipples, especially when it is dried, all the nutrients are removed, and synthetic vitamins are added to the bovine secretions. Human Milk 4 Human Babies is a remarkable organization that finds local milk donors for women in need. It is completely grass-roots, totally Do-It-Yourself, and free! Wet-nursing and milk-sharing is not new; it is how babies survived before formula was invented if their mother died, had to find work, or was unable to lactate. It is safe because you can meet your donor, meet her family, watch her nurse her own children, see how she eats and lives. You can also ask for testing to be done to ensure she is healthy, but many of the moms I know who have received donor milk have created a very special bond with the mother who is donating. It is a beautiful thing and needs to take the place of formula in our country.
- Educate yourself. Learning about the importance of breastfeeding is very inspiring and it is what kept me going when I was first experiencing nipple pain. There is a lot of literature available about breastfeeding, from the politics of it to advice for success. I highly advise learning about latch technique as well. I believe one of the top complaints from new breastfeeding moms is pain or discomfort, which is usually a sign that a good latch has not been achieved. Even though I had read about good latch, I think I could have avoided a lot of pain if I had watched a few latch videos; seeing it in the real world makes more sense than reading a description, at least to me.
- If you are having problems, ask for help. Breastfeeding is NOT always a challenge. I had a bit of pain that disappeared after we got comfortable; some women have no issues at all. The breastfeeding rates in my country show me that my experience with nursing is not what most women get. Somehow, even though the World Health Organization recommends at least two years of breastfeeding, the breastfeeding rates in my country fall dismally short, and the health of our nation shows it. It's not just the U.S.; there is a serious lack of breastfeeding throughout the world. In each case that is not a specific medical issue, something goes wrong that leads the mother to choose formula, or she chooses formula from the start. Whatever problems we come across, we can hope to find answers for through La Leche League, local breastfeeding support groups, and the vast amount of resources to be found online and at your local library. Find breastfeeding moms in your area, ask breastfeeding moms in your family, or find a good lactation consultant at your local hospital or birth center. Commit yourself to breastfeeding, for the health of your child, and be aware of the option of donor milk if a true need does arise!