It’s not easy being a new mom (or a mom in general) these days. We have information flying around everywhere and from everyone. Friends, family, and even strangers feel inclined to throw you their opinions and advice which often comes across as criticism. In reality, every mom just wants to do her best.
Breastfeeding definitely fits into this category of advice-giving. But how about we just go back to the basics: the simplicity of observing your infant, knowing what to watch for and understanding basic principles of breastfeeding. You can’t ask your infant “Did you have enough to eat? Are you getting heartburn? Bloating and upset stomach? Are you full?” Instead, new parents rely on observations, cry sounds, and body movement for information.
The following controversies are topics I find most discussed or researched among new moms. It can be heartbreaking for a new mom who has her heart set on breastfeeding to then find it frustrating and sometimes impossible. One of the best resources for troubleshooting techniques can be found through the Newman Breastfeeding Clinic and Institute (NBCI), but here’s a run-down of topics and information that can be helpful to get you started:
Controversy #1: I have low milk supply and can’t breastfeed.
Assuming you have low milk supply is extremely common. It can be hard to “measure” how much breastmilk baby is getting. Maybe baby gets really fussy at feedings, or still lets out those hunger cries. Maybe you’ve tried pumping and you don’t seem to be producing very much. Or maybe baby isn’t putting on enough weight and you think he/she isn’t getting enough milk. These are all reasons to believe your milk supply is low. However, the issue might not be with your milk at all. It could be the feeding practices themselves.
First and foremost is the importance of a good latch. If baby can’t latch on, they’re not going to be able to feed. As a general rule, keep the nipple pointed towards the roof of baby’s mouth as you bring baby’s body into/towards your body. Baby’s nose should be slightly tilted up and their chin coming into the breast so that the nose never touches the breast. Another troubleshooting tip would be to have baby evaluated for a tongue tie. If there is too much connective tissue tethering the tongue down, they may not be able to get a good latch.
Second, be able to recognize if baby is actually drinking. This is actually controversy number two
Controversy #2: Baby’s mouth movements and sucking means they are drinking.
As you watch your baby, you see their mouth move, they seem content pacified on your nipple, but are they actually drinking? Watching baby’s mouth and jaw movement is essential. Sucking does not equal drinking. Baby takes gulps of milk when the mouth and jaw open and you see a pause in the movement before little sucking movements start again. Observe and look for this pattern: 1) Mouth opens wide, 2) Pause in movement, 3) Small close-mouth sucking. Then it should repeat. Each time baby’s mouth pauses wide, they are getting milk. I highly suggest watching the NBCI’s videos that are posted online to visualize this movement.
Another reason for “slow” or “low” milk supply could be that mom is dehydrated. Make sure you’re drinking plenty of water each day! You can also try nursing teas, Blessed Thistle or Fenugreek supplementation, all of which can potentially be helpful. If you’re still unsure whether baby is getting enough milk, I recommend seeing a lactation consultant rather than going straight to a bottle. By switching between breast and bottle, baby can get confused and may be hesitant to go back to the breast afterwards. There’s no “formula-shaming” here, but for mom’s who have their hearts set on breastfeeding, alternating breast and bottle can work against you. Also, babies will often still take more milk from a bottle, even if they are full from the breast – leading to our next topic: Gastroesophageal reflux (spitting up).
Controversy #3: My baby has GERD (Gastroesophageal Reflux Disease).
GERD is very commonly diagnosed in babies, especially those that spit up frequently, cry during or after feedings, and who have difficulty with feedings. Unfortunately, this is often a misdiagnosis, and thus often mistreated. In a recent lecture by Dr. Jack Newman MD, one of the leading experts in breastfeeding, Dr. Newman discussed how exclusively breast-fed babies do not get GERD, perhaps which is due to the composition and pH of breastmilk.
An infant’s stomach has a capacity of approximately 15-30mL which increases rapidly during the first few weeks1. Paired with a weak lower esophageal sphincter, infants commonly experience gastroesophageal reflux (GER) from the stomach, whereby food will back up from the stomach, leading to baby spitting up.
It’s important to note that this is different than GERD, which is caused from stomach acid refluxing up the esophagus creating irritation and the pain we associate with heartburn. Treatment for GERD, even in infants, includes administering a drug to help decrease stomach acid. Ranitidine (a histamine H2-receptor antagonist) or a proton-pump inhibitor are both regularly prescribed for this.
Other pharmaceutical treatments have been shown to improve pressure of the LES, such as domperidone and metoclopramide, but come with some serious adverse effects2. Metoclopramide can induce lethargy, irritability and gynecomastia in 11-34% of infants ages 1 month to 2 years old; and the most common side effect of domperidone is colic2.
GERD can also be a misdiagnosis for cow’s milk protein allergy (CMPA), which presents similarly as vomiting and regurgitation2. Often the two will be treated together, whereby the infant and mother will both be required to eliminate cow dairy from the diet.
What’s important to take away is that GER is not GERD. GER is a physiologically normal reaction in many babies which over time will subside as the esophageal muscles become more toned, as baby stays upright more often. H2-receptor antagonists and proton-pump inhibitors should be reserved for cases of esophageal erosion due to acid. Breastmilk, with a pH of about 7.2 would generally “neutralize” any dramatic increase in stomach acidity. Overall improvement in symptoms should be seen by 4-6 months of age and GER should resolve by 12-15 months. Of course it’s always important to have a proper assessment done to rule out any underlying and more serious issues including structural and congenital abnormalities.
Controversy #4: My baby falls asleep at the breast, so they must be finished feeding… or they’re lazy.
Babies often fall asleep at the breast due to slowing of milk flow. Comfortable and pacified with a nipple in their mouth, babies can become bored (so-to-speak) and fall asleep if milk flow slows. This doesn’t necessarily mean they are full or are finished eating, but they might need to be reminded that milk is there – it’s just not flowing as fast as when they initially latched on. Breast compressions can help with milk ejection. This will increase the pressure in the breast and stimulate a “letdown” of milk.
It’s important to use breast compressions only if baby is sucking but not drinking. If they stop sucking all together, release the pressure. If baby still isn’t drinking, try switching to the other breast where flow will be faster again to start.
It’s easy to get caught up in everything we read in mommy forums and blogs, and with everyone around us giving their advice and personal opinions. There’s a big difference between offering words of support and offering a condescending opinion. Information sharing is wonderful, but before you let breastfeeding frustrations get you down, seek the support you need, whether from a good friend, a lactation consultant or a community breastfeeding group.
Additional resources:
www.nbci.ca (which is now known as the International Breastfeeding Centre)
Dr. Sarah King is a licensed Naturopathic Doctor, graduating from the Canadian College of Naturopathic Medicine in 2014. Prior to completing her medical studies, she attended Nipissing University where she received her Honors Bachelor of Science in Biology. Sarah has a passion for women’s health and is a birth doula in Durham and Toronto Region. She treats a wide variety of health conditions including menstrual disorders and hormone balancing, fertility, prenatal care, digestive concerns, skincare and mental health/anxiety. Outside the office Sarah is an avid runner with a love of the GTA’s best forest trails. She also continues to improve her yoga practice and teaches breath work as part of stress management counselling to her patients.
References:
- Fraser, Diane, Margaret A. Cooper, and Margaret F. Myles. Myles Textbook for Midwives. Edinburgh: Churchill Livingstone, 2003. Print.
- Ferreira, Cristina Targa, Elisa De Carvalho, Vera Lucia Sdepanian, and Mauro Batista De Morais. “Gastroesophageal Reflux Disease: Exaggerations, Evidence and Clinical Practice.” Jornal De Pediatria 90.2 (2014): 105-18. Web.
