Author Name:
Dr Jack Newman MD, FRCPC

Biography:
Dr. Jack Newman is a Toronto pediatrician who has practiced medicine since 1970. In 1984 he established the first hospital-based breastfeeding clinic in Canada, at Toronto's Hospital for Sick Children. He now holds breastfeeding clinics in several hospitals in the Toronto area. Jack is a consultant with UNICEF's Baby Friendly Hospital Initiative and is a popular speaker at breastfeeding conferences across North America and beyond. He is the father of three children, all breastfed.

Article:
Breastfeeding Myths
1. Nursing mothers cannot breastfeed if they have had X-rays. Not true! Regular X-rays such as a chest X-ray or dental X-rays do not affect the milk or the baby and the mother may nurse without concern. Mammograms are harder to read when the mother is lactating, but can be done and the mother should not stop breastfeeding just to get this done. Furthermore, there are other ways of investigating a breast lump. Newer imaging methods such as CT scan and MRI scans are of no concern, even if contrast is used. And special X-rays using contrast media? As long as no radioactive isotope is used there is no concern and the mother should not stop even for one feed. Herein are included studies such as intravenous pyelogram, lymphangiogram, venogram, arteriogram, myelogram etc. What about studies using radioactive nucleotides (bone scans, lung scans, etc.)? The baby will get a little radioactive nucleotide. However, as we often do these very same tests on children, even small babies, and the potential loss of benefits if the mother stops breastfeeding are considerable, the mother should, in my opinion, continue breastfeeding. If you feel you must stop for a period of time, express milk in advance so that the baby can be fed your milk and not formula. After 2 half lives, 75% of the compound will be out of your body. This is surely waiting long enough (the half life of technetium, which is used in most radioactive scans is only 6 hours, so that 12 hours after the injection, 75% of it will be out of your body). The exception is the thyroid scan using I131. This test must be avoided in breastfeeding mothers. There are many ways of evaluating the thyroid, and only very occasionally does a thyroid scan truly have to be done. If the scan must be done, doing it with I123 requires the mother to stop nursing for 12 to 24 hours only depending on the dose. Check first before taking the radioactive iodine—the test can wait until you know for sure. In many cases where the scan must be done, it can be put off for several months. Incidentally, lung scans with radioactive contrast no longer is the best test to rule out a lung clot. CT scan is now the preferred test to prove or disprove the diagnosis. [See also handout #9a You should continue breastfeeding-1)

2. Breastfeeding mothers' milk can "dry up" just like that. Not true! Or if this can occur, it must be a rare occurrence. Aside from day to day and morning to evening variations, milk production does not change suddenly. There are changes which occur which may make it seem as if milk production is suddenly much less:
• An increase in the needs of the baby, the so-called growth spurt. If this is the reason for the seemingly insufficient milk, a few days of more frequent nursing will bring things back to normal. Try compressing the breast with your hand to help the baby get milk (Handout #15, Breast Compression).
• A change in the baby's behaviour. At about 5-6 weeks of age, more or less, babies who would fall asleep at the breast when the flow of milk slowed down, tend to start pulling at the breast or crying when the milk flow slows. The milk has not dried up, but the baby has changed. Try using breast compression to help the baby get more milk. See the website www.thebirthden.com/Newman.html for videos on how to latch a baby on, how to know the baby is getting milk, how to use compression.
• The mother's breasts do not seem full or are soft. It is normal after a few weeks for the mother no longer to have engorgement, or even fullness of the breasts. As long as the baby is drinking at the breast, do not be concerned (see handout 4 Is my baby getting enough milk).
• The baby breastfeeds less well. This is often due to the baby being given bottles or pacifiers and thus learning an inappropriate way of breastfeeding.

The birth control pill may decrease your milk supply. Think about stopping the pill or changing to a progesterone only pill. Or use other methods. Other drugs that can decrease milk supply are pseudoephedrine (Sudafed), some antihistamines, and perhaps diuretics.

If the baby truly seems not to be getting enough, get help, but do not introduce a bottle that may only make things worse. If absolutely necessary, the baby can be supplemented, using a lactation aid that will not interfere with breastfeeding. However, lots can be done before giving supplements. Get help. Try compressing the breast with your hand to help the baby get milk (Handout #15, Breast Compression).

3. Physicians know a lot about breastfeeding. Not true! Obviously, there are exceptions. However, very few physicians trained in North America or Western Europe learned anything at all about breastfeeding in medical school. Even fewer learned about the practical aspects of helping mothers start breastfeeding and helping them maintain breastfeeding. After medical school, most of the information physicians get regarding infant feeding comes from formula company representatives or advertisements.

4. Pediatricians, at least, know a lot about breastfeeding. Not true! Obviously, there are exceptions. However, in their post medical school training (residency), most pediatricians learned nothing formally about breastfeeding, and what they picked up in passing was often wrong. To many trainees in pediatrics, breastfeeding is seen as an "obstacle to the good medical care" of hospitalized babies.

5. Formula company literature and formula samples do not influence how long a mother breastfeeds.
Really? So why do the formula companies work so hard to make sure that new mothers are given these samples, their company's samples? Are these samples and the literature given out to encourage breastfeeding? Do formula companies take on the cost of the samples and booklets so that mothers will be encouraged to breastfeed longer? The companies often argue that, if the mother does give formula, they want the mother to use their brand. But in competing with each other, the formula companies also compete with breastfeeding. Did you believe that argument when the cigarette companies used it?

6. Breastmilk given with formula may cause problems for the baby. Not true! Most breastfeeding mothers do not need to use formula and when problems arise that seem to require artificial milk, often the problems can be resolved without resorting to formula. However, when the baby may require formula, there is no reason that breastmilk and formula cannot be given together.

7. Babies who are breastfed on demand are likely to be "colicky". Not true! "Colicky" breastfed babies often gain weight very quickly and sometimes are feeding frequently. However, many are colicky not because they are feeding frequently, but because they do not take the high fat milk as well as they should. Typically, the baby drinks very well for the first few minutes, then nibbles or sleeps. When the baby is offered the other side, he will drink well again for a short while and then nibble or sleep. The baby will fill up with relatively low fat milk and thus feed frequently. The taking in of mostly low fat milk may also result in gas, crying and explosive watery bowel movements. The mother can urge the baby to breastfeed longer on the first side, and thus get more high fat milk, by compressing the breast once the baby sucks but does not drink. (Handouts #3 Colic in the breastfed baby and #15 Breast Compression). See videos at www.thebirthden.com/Newman.html

8. Mothers who receive immunizations (tetanus, rubella, hepatitis B, hepatitis A, etc.) should stop breastfeeding for 24 hours (3 days, 2 weeks). Not true! Why should they? There is no risk for the baby, and he may even benefit. The rare exception is the baby who has an immune deficiency. In that case the mother should not receive an immunization with a weakened live virus (e.g. oral, but not injectable polio, or measles, mumps, rubella) even if the baby is being fed artificially.

9. There is no such thing as nipple confusion. Not true! The baby is not confused, though, the baby knows exactly what he wants. A baby who is getting slow flow from the breast and then gets rapid flow from a bottle, will figure that one out pretty quickly. A baby who has had only the breast for 3 or 4 months is unlikely to take the bottle. Some babies prefer the right or left breast to the other. Bottle fed babies often prefer one artificial nipple to another. So there is such a thing as preferring one nipple to another. The only question is how quickly it can occur. Given the right set of circumstances, the preference can occur after one or two bottles. The baby having difficulties latching on may never have had an artificial nipple, but the introduction of an artificial nipple rarely improves the situation, and often makes it much worse. Note that many who say there is no such thing as nipple confusion also advise the mother to start a bottle early so that the baby will not refuse it.


More Breastfeeding Myths

1. A breastfeeding mother has to be obsessive about what she eats. Not true! A breastfeeding mother should try to eat a balanced diet, but neither needs to eat any special foods nor avoid certain foods. A breastfeeding mother does not need to drink milk in order to make milk. A breastfeeding mother does not need to avoid spicy foods, garlic, cabbage or alcohol. A breastfeeding mother should eat a normal healthful diet. Although there are situations when something the mother eats may affect the baby, this is unusual. Most commonly, "colic", "gassiness" and crying can be improved by changing breastfeeding techniques, rather than changing the mother's diet. (Handout #2 Colic in the breastfed baby).

2. A breastfeeding mother has to eat more in order to make enough milk. Not true! Women on even very low calorie diets usually make enough milk, at least until the mother's calorie intake becomes critically low for a prolonged period of time. Generally, the baby will get what he needs. Some women worry that if they eat poorly for a few days this also will affect their milk. There is no need for concern. Such variations will not affect milk supply or quality. It is commonly said that women need to eat 500 extra calories a day in order to breastfeed. This is not true. Some women do eat more when they breastfeed, but others do not, and some even eat less, without any harm done to the mother or baby or the milk supply. The mother should eat a balanced diet dictated by her appetite. Rules about eating just make breastfeeding unnecessarily complicated.

3. A breastfeeding mother has to drink lots of fluids. Not true! The mother should drink according to her thirst. Some mothers feel they are thirsty all the time, but many others do not drink more than usual. The mother's body knows if she needs more fluids, and tells her by making her feel thirsty. Do not believe that you have to drink at least a certain number of glasses a day. Rules about drinking just make breastfeeding unnecessarily complicated.

4. A mother who smokes is better not to breastfeed. Not true! 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.

5. A mother should not drink alcohol while breastfeeding. Not true! Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for nursing mothers.

6. A mother who bleeds from her nipples should not breastfeed. Not true! Though blood makes the baby spit up more, and the blood may even show up in his bowel movements, this is not a reason to stop breastfeeding the baby. Nipples that are painful and bleeding are not worse than nipples that are painful and not bleeding. It is the pain the mother is having that is the problem. This nipple pain can often be helped considerably. Get help. (Handout #3 Sore Nipples and #3b Treatments for Sore Nipples and Sore Breasts). Sometimes mothers have bleeding from the nipples that is obviously coming from inside the breast and is not usually associated with pain. This often occurs in the first few days after birth and settles within a few days. The mother should not stop breastfeeding for this. If bleeding does not stop soon, the source of the problem needs to be investigated, but the mother should keep breastfeeding.

7. A woman who has had breast augmentation surgery cannot breastfeed. Not true! Most do very well. There is no evidence that breastfeeding with silicone implants is harmful to the baby. Occasionally this operation is done through the areola. These women do have often have problems with milk supply, as does any woman who has an incision around the areolar line.

8. A woman who has had breast reduction surgery cannot breastfeed. Not true! Breast reduction surgery does decrease the mother's capacity to produce milk, but since many mothers produce more than enough milk, some mothers who have had breast reduction surgery sometimes can breastfeed exclusively. In such a situation, the establishment of breastfeeding should be done with special care to the principles mentioned in the handout #1 Breastfeeding—Starting Out Right. However, if the mother seems not to produce enough, she can still breastfeed, supplementing with a lactation aid (so that artificial nipples do not interfere with breastfeeding).

9. Premature babies need to learn to take bottles before they can start breastfeeding. Not true! 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.

10. Babies with cleft lip and/or palate cannot breastfeed. Not true! Some do very well. Babies with a cleft lip only usually manage fine. But many babies with cleft palate do indeed find it impossible to latch on. There is no doubt, however, that if breastfeeding is not even tried, for sure the baby won’t breastfeed. The baby's ability to breastfeed does not always seem to depend on the severity of the cleft. Breastfeeding should be started, as much as possible, using the principles of proper establishment of breastfeeding. (Handout #1 Breastfeeding—Starting Out Right). If bottles are given, they will undermine the baby's ability to breastfeed. If the baby needs to be fed, but is not latching on, a cup can and should be used in preference to a bottle. Finger feeding occasionally is successful in babies with cleft lip/palate, but not usually.

11. Women with small breasts produce less milk than those with large breasts. Nonsense!

12. Breastfeeding does not provide any protection against becoming pregnant. Not true! It is not a foolproof method, but no method is. In fact, breastfeeding is not a bad method of child spacing, and gives reliable protection especially during the first 6 months after birth. It almost as good as the pill if the baby is under 6 months of age, if breastfeeding is exclusive, and if the mother has not yet had a normal menstrual period after giving birth. After the first six months, the protection is less, but still present, and on average, women breastfeeding into the second year of life will have a baby every 2 to 3 years even without any artificial method of contraception.

13. Breastfeeding women cannot take the birth control pill. Not true! The question is not exposure to female hormones, to which the baby is exposed anyway through breastfeeding. The baby gets only a tiny bit more from the pill. However, some women who take the pill, even the progestin only pill, find that their milk supply decreases. Estrogen containing pills are more likely to decrease the milk supply. Because so many women produce more than enough, this often does not matter, but sometimes it does even in the presence of an abundant supply, and the baby becomes fussy and is not satisfied by nursing. Babies respond to rate of flow of milk, not what's "in the breast", so that even a very good milk supply may seem to cause the baby who is used to faster flow to be fussy. Stopping the pill often brings things back to normal. If possible, women who are breastfeeding should avoid the pill, or at least wait until the baby is taking other foods (usually around 6 months of age). Even if the baby is older, the milk supply may decrease significantly. If the pill must be used, it is preferable to use the progestin only pill (without œstrogen).

14. Breastfeeding babies need other types of milk after 6 months. Not true! Breastmilk gives the baby everything there is in other milks and more. Babies older than 6 months should be started on solids mainly so that they learn how to eat and so that they begin to get another source of iron, which by 7-9 months, is not supplied in sufficient quantities from breastmilk alone. Thus cow's milk or formula will not be necessary as long as the baby is breastfeeding. However, if the mother wishes to give milk after 6 months, there is no reason that the baby cannot get cow's milk, as long as the baby is still breastfeeding a few times a day, and is also getting a wide variety of solid foods in more than minimal amounts. Most babies older than 6 months who have never had formula will not accept it, because of the taste.

Questions? (416) 813-5757 (option 3) or drjacknewman@sympatico.ca or my book Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA)

Handout #12 More breastfeeding myths. Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005
This handout may be copied and distributed without further permission,
on the condition that it is not used in any context in which the WHO code on the marketing of breastmilk substitutes

Handout #14. More and more breastfeeding myths. Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005

This handout may be copied and distributed without further permission,
on the condition that it is not used in any context in which the WHO code on the marketing of breastmilk substitutes is violated