Busting breastfeeding m’larky

Did you know that women should apply essential oils to their nipples so that their nurslings can better digest breast milk? Of course you didn’t, because breastmilk is the most easily digested food available; it’s why breastfed babies nurse often.

During one of my prenatal yoga sessions, a very well-intentioned mother and instructor advertised the benefits of essential oils applied to nursing mothers’ nipples to aid in babies’ digestion. I watched first time moms absorb her instruction, wondering how many of them would immediately seek out her suggested concoction after class.

_MG_6225 croppedI got to wondering about breastfeeding myths and how they inhibit mothers from successfully and uncomplicatedly nursing their babies.

Why do myths arise? What causes them to persist? What are some of the most common breastfeeding myths? How can we debunk myths to better serve moms and babies?

I turned to the visionary Linda Smith, MPH, FACCE, IBCLC, FILCA, founder of Bright Future Lactation Resource Centre Ltd, for answers.

Why do breastfeeding myths arise?

It’s a combination of things: Many health professionals hardly know how breasts and lactation work, Smith says.

Breasts are one of the least studied parts in the human body.

Because humans are heuristic creatures, we seek answers to the unknown even if we must speculate.

Formula companies also have a lot to do with myth creation and while their marketing campaigns might be clever, they are predatory and wrong.

“There is an influence of the formula companies telling mothers that they don’t know how to make enough milk,” Smith explains.

Likewise, formula companies influence health care professionals. In “Free” Booklets Aren’t Free!, Smith asks health care workers to purchase educational material from sources without conflict of interest.

When formula marketing became widespread by the mid 1900s, breastfeeding rates dropped to an all time low. Formula feeding and mother baby separation became the norm.

The knowledge we had about babies back in the 1940s and 1950s was severely inaccurate, Smith tells me. She recalls a LLL colleague of hers who told her that many health care professionals didn’t even think babies could see until several weeks after birth.

“A lot of what we know now about newborns’ neurophysiology has been learned in last ten to 15 years,” Smith says. “We are trying to undo 50 plus years of misinformation.”

What perpetuates breastfeeding myths?

Many of the same ideas that create myths, perpetuate them; namely lack of knowledge and the financial interest of formula companies.

Smith adds that we have developed a society that has weird perceptions about breasts. We use breasts to sell a car but women aren’t permitted to feed their babies, for example.

And although we have laws in place to protect the breastfeeding mother, unlike when Smith nursed her children,  mothers are still harassed for feeding their babies.

Simple language can perpetuate myths.

In her article Watch Your Language, Diane Wiessinger, MS, IBCLC advises lactation professionals to consider the impact of language on the normalization of breastfeeding.

She writes: “All of us within the profession want breastfeeding to be our biological reference point. We want it to be the cultural norm; we want human milk to be made available to all human babies, regardless of other circumstances. A vital first step toward achieving those goals is within immediate reach of every one of us. All we have to do is…watch our language.”

In Smith’s attempt to debunk breastfeeding myths, she also reminds us of the power of language.

She cites a common myth, “Milk is made faster during letdown” and offers this clarification, “Empty breasts try to refill. Milk flows faster during letdown.”

Further she reminds us that the phrase “milk supply” implies an unchanging quantity.

“Milk is production,” she clarifies. “Yet we talk about supply as if it’s static like the number of eyes or arms you have. It’s like saying I don’t have enough tears.”

Maternal food quality and/ or quantity, fluid intake and general emotional state (unless it affects her willingness to bring baby to breast) do not influence milk production.

So what does matter? Frequent and thorough milk removal from breast. In other words,

The milk in your breast

Wasn’t put there to stay

More milk isn’t made

Till you give some away,

Smith quotes her daughter Hannah.

What are some common breastfeeding myths?

I’m willing to bet you’ve heard the myth, “Some babies are just lazy.” This is perhaps the most disheartening myth circulating, because it blames the child instead of acknowledging what adults are doing to make feeding difficult.

Smith puts it perfectly. “Lazy implies wilful opposition. Babies don’t willing starve.”

So what might be going on in the baby who seems lazy?

  • Baby has been injured during a traumatic birth experience. Perhaps he or she has a headache from instruments used during birth.

  • Baby is premature and has not fully developed the capability to feed at the breast.

  • Baby is ill.

  • Baby is drugged from labor procedures.

Similarly in our go, go, go world we often expect babies to finish a feeding in ten minutes flat.

In Eating is Not a Race, Smith writes, “Adults who guzzle their food this fast are considered to have an eating disorder.”

She says that if you ask a group of adults how long it takes them to consume food when they aren’t being rushed, they report anywhere between ten to 30 minutes. This eating window is virtually equal for a healthy adult and healthy baby.

In order to put an infant’s experience into perspective, let us remember that they are humans too!

The same advice goes for the bedsharing controversy. Adults do not typically sleep alone, so why should babies?

Smith explains that babies are trying to double their weight in just a few months, so an infant under six months typically eats between one and three times throughout the night (countless if you’re my daughter). When the dyad is separated, mothers miss out on important feeding signals and that causes concern like improper weight gain and stunted development.

So what’s the beef with bedsharing? Smith cites three common concerns:

  1. Mother might squish baby. This is true if she’s drunk, on a couch or other factors are present. The Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame provides an abundant list of articles on the evolutionary perspectives of bedsharing and safety guidelines.

  2. Couples will never have sex again. Fortunately, most couples figure out how to be romantic outside of the bedroom, Linda says. Fancy that.

  3. If you let baby sleep with you now, he or she will never sleep alone. Linda compares this argument to, “If you don’t get them to walk at two weeks, they never will.”

On top of nine months gestation in the womb, human babies require about another nine months “external gestation” to reach the same level of maturity as other primates. At birth, the human neonate’s brain is only at about 25 percent of its adult capacity, Smith explains. Plenty of skin to skin contact and breastmilk allows for optimum brain growth and bedsharing can offer an opportunity to practice both of these. (Smith’s Best Start Conference presentation The Co-Sleeping Contoversy offers more information.)

“You’ve got under a year to get it right,” Smith says of baby’s fundamental development. “You can’t go back and do it when the child is five.”

The most ridiculous breastfeeding myth of all time is scheduled feedings, Smith argues.

Where did the four hour feeding schedule come from? Smith says it was created in response to a typical eight hour hospital shift.

“It makes no sense in normal physiology,” she says.

Why debunk breastfeeding myths?

“Because according to the CDC at least 60 percent of moms who intend to breastfeed are not meeting their own goals. Mothers who want to are not able to succeed,” Smith offers a simple answer.

How can we challenge breastfeeding myths?

Smith has created an image that illustrates three core concepts of debunking breastfeeding myths. It encompasses practices that health professionals use and very appropriately resembles the breast.

At the center core, evidence based practice.

“The health care provider should be using evidence based practice when it exists,” Smith explains.

The middle ring encompasses common use and theory driven practice. These practices have some physiological basis and seem to generally make sense. Practices in the middle ring may move into the center core when and if research affirms its validity. Likewise, they might also be exiled to the outer ring.

Smith uses the example of episiotomy. Common practice once dictated the use of heat lamps to heal wounds. Fortunately this is no longer accepted as research has proven that heat decreases the likelihood of healing. Instead, cold assists the healing process. These findings can also be applied to the injured breast.

Lastly, new ideas, experimental and anecdotal evidence, trial and error, observation and case reports make up the outer ring. Sometimes health care professionals must resort to practices in the outer ring simply because there are no evidence based or physiological commonsensical answers.

“The message to all of us is when there is good research, use it,” Smith says. “When not, then use common sense.”

Teach the rule, not the exception.

Let’s look at the myth, “Just one bottle of formula won’t hurt” for instance.

In a Debunking Myths presentation, Smith shares some (of many) issues related to introducing just one bottle of formula:

  • Every brand of formula has triggered anaphylaxis

  • Formula permanently changes gut flora and pH

  • It adds iron which feeds pathogens

  • It introduces pathogens via fluid and feeding device

“Occasionally there is a need for [formula],” Smith agrees. Alison Stuebe shares an example of a mother more concerned about her milk production than tending to her crying baby in OB/GYN sheds lights on creating breastfeeding culture.

But Smith says, “There are exceptions to everything. It doesn’t mean we teach it as a rule.”

Many myths are deeply rooted in culture, so how can the health care professionals go about debunking breastfeeding myths in a culturally sensitive fashion?

Smith says, give people the facts.

“Biology doesn’t change their culture,” she adds.

Our formula feeding culture and culture of isolating mothers and babies aren’t backed by biology, for example.

In this light, Smith advises lactation professionals to question everything.

“And listen to mothers,” she adds. Mothers are always right, even the 14 year-old mother she says.

“I’ve been doing this work for 38 years and mothers have always been right.”

Smith is thankful for the researchers and authors who are putting evidence based knowledge into everyone’s hands.

“We’re on a wave of success that is just terrific right now,” Smith says. “There are a lot of good things happening.”

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