breastfeeding

Just a couple of ideas about breastfeeding that might be important for you; they may challenge some preconceptions - so be it.

The first is the myth of diet. "Everybody knows spicy and gassy foods can upset the baby!" Let's examine that concept.

First, if you think spicy foods give babies problems, consider this: Most of the world is dirt poor and can afford neither Internet access or formula. So those women nurse their babies. They also typically invent some pretty spicy cuisines because their basic staples are generally bland (think of Mexican cooking, Cajun cooking, Szechuan, Tai...). How come their babies are not bothered by spicy foods?

Think about so called gassy foods - those which are fermented in the colon to produce excessive amounts of gas - for example beans, cabbage. Now, granted, this does happen. But do you really believe that gas bubbles travel through the mother's bloodstream to be secreted in the breast milk? "Gee, honey, your milk looks awfully foamy tonight..." "Yes, dear, I think it was that cabbage I ate..." No, gas in the baby is swallowed air that didn't get burped up. Period.

Feeding interval myths also abound. Now survey after survey in the published scientific literature has shown these things about breastfeeding patterns in American women: they feed more often than the bottle feeders do; their babies do not sleep as well as the bottle feeders (more night wakings, more bedtime problems, more sleep problems in general); and there is a rate of cessation of breastfeeding (throwing in the towel and going to the bottle) which most concerned public health professionals find to be too high given the known health benefits of breastfeeding.

And yet there exists an incredible state of denial concerning what causes these unhappy results. I have puzzled over these things for years and will share with you what I think actually goes on.

Concerning nursing frequency and interval, I made an interesting discovery years ago with one of my mothers who was nursing her fourth or fifth child. She remarked that he nursed every four hours, slept through the night at two months, and was her happiest child so far. Obviously an "easy" baby. But as I reflected on the reasons for his easiness, it struck me that the baby had the same mom and dad genetically. The one thing that was most different about him was where he was in the birth order, and more specifically, that his mother was a lot more experienced now.

I reflected on the fact that we usually like to have our bellies full after a meal, and that then we often like to take a big long nap (think of Thanksgiving day). It seemed that the happiest babies were those that fell into the eat - nap - play - eat - nap - play rythmn.

I started counselling my new mothers to try to gently coax the baby out to his or her maximum feeding interval (though not until the milk was really in well for the breastfeeders). I did not tell them to put the baby on a rigid schedule, but to try to get the baby to tank up and rack out - to feed him at the end rather than at the beginning of his normal wakeful time between sleep phases.

Bam! Babies in my practice became known as the good sleepers. I now tell my prenatal class that their babies should sleep through the night (10 - 11 hours straight) by eight to ten weeks. And lo and behold, they do. Their mothers are very happy with the situation, too.

Breastfeeding is not a religion. It is a means to an end, a healthy and happy baby. That is the goal, a healthy and happy child, not for mother to be able to brag at the La Leche meeting. Anyone who loses sight of the true goal of breastfeeding and slips into the religious advocacy mode will suffer inevitable consequences.

I once had a (male) partner who is a rabid breastfeeding advocate (and incidentally a wonderful person and a fine pediatrician, lest you misunderstand). He insisted that the mothers nurse, to the point of giving them lectures on the delivery room table. No joke. Well, he counselled his mothers with what I call the Vietnam War approach to nursing problems (if 5,000 troops don't work, send 50,000, if that doesn't work, send 500,000 - more and more of the same - many people espouse the maxim that "basically all problems with nursing are cured by more nursing").

I would see his mothers sometimes while covering for him and they would be in tears. Their babies were obviously hungry and not gaining weight properly. They had been told to nurse more, so they were nursing for hours and hours a day, the baby crying fretfully in between - with little or no sleep, these mom's were physically and emotionally at the breaking point. When I told them to give the baby a bottle of formula so they both could rest a bit there was invariably a sigh of relief followed by "Oh, please don't tell Dr. X!"

It is indeed true that in general, the more you stimulate the breast by nursing the more milk a healthy, rested, stress-free mother will produce. That is why when milk supply is in question, the general counsel to increase nursing frequency and increase nursing time to increase milk production is right. There is however a natural limit to how much milk any mother can produce in 24 hours which cannot be exceeded.

Read that last paragraph again.That means that if the baby is hungry and crying all the time, and mother is stressed out because of the baby's crying, her milk supply will decrease. If she tries even harder to nurse more often and longer, the fatigue and frustration can decrease her milk even more. And this will make her baby even more hungry and fretful. Which will make her milk supply drop even more, if she lasts that long.

When a woman breastfeeds, everything will work great as long as there is a good match between supply and demand. Ordinarily there is. When there isn't, rigid, authoritarian prescriptions for remedy are doomed to failure. Then, a bottle at the very end of the day to supply that little boost to the calorie supply may be just the thing to salvage breastfeeding and all its benefits for both mother and baby.

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