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Q&A: Breastfeeding Myths, Facts, Legends, Benefits and Lies

It is a startling that in the 1970s, less than 25% of mothers attempted to breastfeed their newborn babies. By 2011 it has been estimated that this rate trebled with about 75 % of babies getting some breast milk from their mothers. The tide has turned, and mothers who don't breastfeed their babies are frowned upon even if there are sound reasons why it has not worked. Doctors have been advised that mothers should be warned of the health risks to babies that are not breast fed

There is ongoing, and at times controversial, debate about the pros and cons of breastfeeding. Controversy surrounds issues such as breastfeeding in public and the right age for weaning the baby. Its time for an update on the latest research findings to separate myth from fact, legends and lies from the truth, and scientific findings versus claims and counter claims. This article aims to review the evidence and debating points about breastfeeding and to debunk some of the myths using the latest advice.

Is Breastfeeding Natural?

The answer is obviously 'Yes', in the biological sense, but is not true culturally. In times past many mothers in high society, or mothers who had the money and privilege, hired other women to breastfeed their babies. Very few of these women actually breast-fed their own babies.

The other aspect relating to whether breastfeeding is natural or not, is whether breast milk is wholesome and supplies exactly what the baby needs. Yet again this would seem to be obvious, but it depends on what food the mothers eat, and the health of the mother. Breast milk can be tainted by what's in the food eaten, and environmental contaminants, including what's in the air, water and other parts of the environment. Breast milk may be tainted by lead, insecticides as well as drugs, alcohol and various prescription medicines taken by the mother. In this sense breast milk may be unnatural or contaminated.

Is Formula as Healthy as Breast Milk?

This claim was often made throughout the early part of the 20th century. Some nutritionist have even gone so far as saying that formula made from soy, cow’s milk or whey, supplemented with vitamins, oils and minerals is more nutritious than human breast milk. Many formula based milks have been very carefully prepared to provide exactly what the baby needs in terms of nutrients. In some cases the levels of vitamins for example exceed those of breast milk. However it is the small subtle things in breast milk that stand out as being different.

A recent major review study has shown (see the table below) that that breast milk, with its balance of fats, proteins, vitamins, carbohydrates and many trace substances and nutrients, provides a range of significant health benefits, that greatly reduces the risks of various ailments such as asthma, ear infections, diabetes, gastrointestinal ailments, obesity, allergies and sudden infant death syndrome. This study has proposed that the decision of the mother to breast feed actually a health issue rather than a lifestyle decision, because of increased risks of health problems for the baby that is not breast-fed.

A major study on the breast-feeding and the benefits of Human Milk concluded that:

Research and practice has reinforced the conclusion that breastfeeding and the use of human milk confer unique nutritional and non-nutritional benefits to the infant and the mother and, in turn, optimize infant, child, and adult health as well as child growth and development.

Recently, published evidence-based studies have confirmed and quantified the risks of not breastfeeding. Thus, infant feeding should not be considered as a lifestyle choice but rather as a basic health issue.

As such, the paediatrician's role in advocating and supporting proper breastfeeding practices is essential and vital for the achievement of this preferred public health goal.

Risk Reduction Conferred by Breast-Feeding

Optimal Weaning Age 

Is 12-months the Optimal Age for Weaning?

The recommendation of the American Academy of Pediatrics is for breastfeeding to continue for a minimum period of 12 months, and for as long as both mother and baby want to continue it. The World Health Organization recommends a minimum time of 2 years and beyond. So there is no real evidence to support the one-year duration and there is no optimal age for weaning as it depends on the individual mother and baby. While it is true that most the benefits of breastfeeding are conferred during the first 3-4 months of life, there is strong support for a longer period despite the fact that some babies and mothers lose interest after 6-9 months for various reasons. Many mothers stop breastfeeding when their babies grow teeth and begin to talk and walk, and because of cultural pressures on mothers. However there is good support for 12 months as the minimum period to provide benefits to the babies.

Potential to Save Lives

It has been calculated that more than 900 infant lives per year may be saved in the United States if 90% of mothers exclusively breast-fed for 6 months. In the 42 developing countries in which 90% of the world's childhood deaths occur, exclusive breastfeeding for 6 months and weaning after 1 year is the most effective intervention, with the potential of preventing more than 1 million infant deaths per year, equal to preventing 13% of the world's childhood mortality.

Breastfeeding Myths Revealed - Fact or Fiction, Plausible or Not

If you have small breasts, will you struggle to produce enough milk?

False: Size does not really matter that much. The milk generating breast tissue you require to nurse a baby expands during pregnancy regardless of breast size. So irrespective of whether you have A or D cup, your breasts will be capable of providing your baby with enough milk. However, irrespective of breast size some women find they need to supplement the milk they can produce.

You can't breastfeed if you have had breast-augmentation or breast-reduction surgery.

False: (but depends) Modern implants are usually placed near the armpit or under the breast muscle or tissue and so do not generally interfere with breastfeeding.

You should only eat bland foods while breastfeeding.

False: (but depends) By the time foods eaten are digested, processed and used to make breast milk, there are generally few residues that could affect your baby. However several foods can cross into breast milk and can cause upsets in babies - namely soy, peanuts, dairy products, fish and shellfish.

You need to nurse every two hours - no more, no less.

False: The eating patterns of babies vary a great deal, but many newborn babies do seem to fall into a two-hours routine. However this routine is not required or necessary - it depends on the baby and the mother.

If you use bottles of pumped milk, the baby will get used to the bottle and refuse the breast.

False (generally): Most babies switch between bottle and breast without any problems. But it is suggested that mothers wait until after about 6 weeks for the baby to master breastfeeding before pumping and using bottles,. It is also suggested that only one bottle be used per day.

You should you not breastfeed if you have a blocked duct or breast infection.

False: The exact opposite is true, as the best way to treat a partially blocked duct is to nurse the baby as often as you can, to overcome the problem. The best way to help clear a blockage is to apply heat in the form of a heating pad or wet towel before nursing.

A breastfed baby will not sleep right through the night until solids are eaten

False (but depends) : Babies start to sleep right through the night when they are ready. However breastfed babies do need to be fed more often than formula-fed babies in the first few months because breast milk is digested more rapidly than formula. This can make it harder for a baby to sleep all night.

Once the mother goes back to work, the baby will have to be weaned

False: Mothers who are committed to breast-feeding, and pumping, can support the baby on breast milk for as long as they wish. Pumping three times a day when the mother is at work maintains a regular routine.

Breastfeeding your child for more than one year makes weaning difficult.

False: There is no evidence for this, and it is clearly a myth. It depends both on the baby and the mother as individuals.

Sore nipples are inevitable when breastfeeding

False: When many women have episodes of sore nipples it is usually caused by improper latching - with better techniques sore nipples are entirely preventable.

Pumping is a good way of determining how much milk is available

False: The amount of milk that can be pumped depends on many things and not all the milk can be pumped. It partially depends on the mother's level of stress. It has been shown that a breastfeeding baby well can get much more milk than the mother can pump. So pumping only indicates how much milk can be pumped - not what is available.

Breastfeeding babies need extra vitamin D

False: Everyone needs vitamin D. However each baby is born with adequate vitamin D in the liver, and gets some via breast milk and makes its own by exposure to sunlight. Supplements are rarely required.

A breastfeeding baby needs extra water in hot weather

False: Breast milk contains all the water a baby needs.

Most women do not produce enough milk

False: It has been shown that virtually all women can produce more than enough milk. Problems arise not because of supply problems, but because of delivery - the baby does not get the milk that the mother has available, mostly due to poor latching onto the breast.

It is normal for breastfeeding to hurt

False: Most mothers feel some tenderness during the first few days, this is temporary and ongoing soreness is rare.

There is never enough milk during the first three or four days after birth

False: Provided the baby is latched on properly there is generally enough milk.

A mother should wash her nipples each time before feeding the baby

False: Breast milk protects the baby against infection and washing nipples adds complexity and may wash away protective oils from the nipple. Normal cleanliness is adequate.

Breast milk does not have enough iron to sustain the baby's needs

False: If the baby is full term he/she will get enough iron from breast milk to sustain what they need for at least the first six months, after which many babies start to eat solids.

It is much simpler to bottle feed than to breastfeed

False (but depends): This should not be the case, but many women do not get the support and help they need to get started and keep breastfeeding. Many pressures build up as the baby gets older.

Breastfeeding ties the mother down

False (but depends): This really depends on how the mother weighs up the various issues. There is nothing simpler than breastfeeding - which can be dome anywhere and any time, and avoids all the hassles of formula milk in bottles. But it is the pressure of society which can be a problem.

There is no way of knowing how much breast milk the baby is getting and whether its enough.

False: While there is no easy way to measure how much the baby is getting from breastfeed, unlike a bottle where you can see how much is consumed. However it is relatively easy to know if the baby is getting enough, which is what really matters.

When a baby is getting adequate mouthfuls of milk there will be an obvious pause at the point of the chin after opening the mouth wide, before closing it again. So that one successful suck is (open mouth wide to pause to close mouth again for each suck). The pause that is visible represents a mouthful of milk. The longer the pause, the more milk the baby got with the suck.

Modern formulas are almost the same as breastmilk.

False: Modern formulas are only superficially similar to breastmilk and do not contain many of the crucial micro-nutrients. Formulas contain no antibodies, no enzymes, no living cells, no hormones, etc.

A breastfeeding mother has to consume much more fluids.

False: Mothers should drink according to what their thirst tells them. Thirst is a much undervalued sense, which many studies have shown to be very reliable, even when running marathons. Some mothers feel they need to drink more, but others drink the usual amount.

When the mother develops an infection breastfeeding should stop

False: With very few exceptions, the opposite is true as continuing breastfeeding will actually help protect and support the baby. By the time the mother starts to show the symptoms such as has fever, vomiting, diarrhea, cough, rash, etc. she has probably already passed the infection onto the baby.

If the baby has diarrhea, an upset stomach or vomiting, breastfeeding should stop.

False: The best medicine the baby can get for an intestinal infection is breastfeeding. By all means stop other foods briefly to try to work out the cause, but continue breastfeeding. Breastmilk satisfies all the fluid needs of the baby even when having bouts of vomiting, except under rare circumstances. Both the baby and mother are comforted by the breastfeeding.

If the mother is taking prescription medicine she should not breastfeed her baby.

False: There are very few medicines that a mother takes that cannot be continued while breastfeeding (ask your doctor to clarify this). Some medicines can appear in the milk, but generally in extremely small amounts.

A breastfeeding mother need to eat more calories in order to make sufficient milk.

False: Even women on very low calorie diets make enough milk for their babies. While it is claimed that breastfeeding mothers need to eat an extra 500 calories a day, this is not true and it is much less than that, and most mothers simply eat normally with a balanced diet dictated by appetite.

A mother who smokes should not to breastfeed.

False: Breastfeeding provides many health benefits to both mother and baby. It is preferable for mothers not to smoke but it is better the mother smoke and continue breastfeeding than smoke and feed the baby with formula.

A mother should not drink alcohol while breastfeeding.

False: Low to moderate alcohol consumption is not a problem because as with medicines very little alcohol passes through to the milk.

A mother whose nipples bleed should not breastfeed.

False: Blood is not important, however the pain and cause of the problem the mother is having need to be identified and addressed. Breastfeeding can continue while the problem is being sorted out.

Breastfeeding babies require other types of milk after about six months or age

False: Breastmilk provides everything the baby needs and no other milks are required. Many babies older than six months start on solid foods and so no transition to bottled milk and formulas is required. Most babies older than six months will not accept formula, if they have never tried it because of the taste.

Women with inverted or flat nipples cannot breastfeed.

False: Babies breastfeed on the breasts not on the nipples. Some nipple shapes may make it easier for a baby to latch on to a breast, but the nipples do not have to stick out. All shape and sizes work.

A woman who becomes pregnant must stop breastfeeding.

False: Breastfeeding can continue if the mother and child want it.

Babies will stay on the breast for long periods of time because they like to suck.

False: Babies do need and like to suck, but will generally only stay breastfeeding while they are hungry. Ensuring that the baby is latched onto the breast in the optimal way allows the baby to breastfeed more effectively, and this may reduce the feeding time.

Babies need to learn how to take a bottle, before they may reject it

False: There is no reason for a baby to learn how to use a bottle unless they need to for some reason. A baby can start learning how to drink from a cup from a very early age.

A mother whose breasts are not full and bulging has little milk in the breast.

False: Breasts do not have to feel full to yield lots of milk. Generally breasts will feel less full as the mother's body adjusts to her baby's milk demands.

A mother should not breastfeed after exercise.

False: There is no reason for this and it is simply a myth that is contradicted by the everyday experience of many mothers.