Breastfeeding Advice & Tips From A Doctor
Meet Dr. Snow.
Where are you from?
Louisville, Kentucky, but living outside of St. Louis, Mo.
Children?
A son. He just turned one.
How would you describe breastfeeding to a new mom?
The most wonderful hard thing you'll do after having your baby. I work an average of 60-80 hours a week, and many times I leave before my baby wakes up and come home right as he is getting ready for bed or after he is asleep. Breastfeeding helps me feel connected to him, like I am still a part of his day even if I'm not there physically. He still wakes up at night to nurse, and even though I am so tired and oh-my-god-why-won't-he-sleep-longer, I love that moment where we are the only ones awake in the quiet house, and I get to smell his sweet sleepy baby smell, and know that I am the only person in the world who he needs at this time. It can be challenging but it is so so worth it.
What are some of the biggest misconceptions about breastfeeding? Why do you think women believe these?
There are a lot of misconceptions about breastfeeding.
First off there seems to be this idea that formula is better, as a doctor I deal with that one a lot. Formula will definitely provide a baby what that baby needs to grow, but biologically speaking breastmilk is superior food for human infants. I believe a lot of it goes back to the 1950s when physicians told moms that formula was better than breastmilk (my Grandma was told this), and that line has persisted in some way or another to today. Plus we are inundated with aggressive and misleading formula advertising. I'm happy formula exists because now babies who don't get breastmilk for whatever reason won't literally die, but it also won't make your baby sleep longer, cure their colic, make them smarter, or whatever else it's promising to do. I also see a lot of formula advertising suggesting that breastfeeding needs to supplement. As long as a baby is growing appropriately, meeting their milestones in a reasonable manner, and having appropriate wet and dirty diapers, then they are getting enough breastmilk with no need to supplement.
Much of modern baby advice is based on formula-fed babies. For example, feeding the baby every 3-4 hours; for a breastfed baby, those are maximum, not minimum intervals. Breastfed babies should be fed whenever they are hungry because breastmilk is digested faster than formula, which in the beginning can be anywhere from every hour to every 4 hours. Lack of a schedule can be very frustrating for new moms (myself included), but for the first 4 weeks a baby's only schedule are cycles of eating and sleeping. Another example, many growth charts are based on how formula fed babies grow, which is different than breastfed babies, who can seem to 'fall off' the growth chart around 6 months. Be sure your pediatrician is using WHO growth charts. Another example is the notion that babies 'should' be sleeping through the night by 12 weeks or some arbitrary date. It would be awesome if all babies did this, but night waking is actually protective against SIDS. Some doctors will tell moms to give formula at night to help their babies sleep longer, or tell moms to stop night nursing. I have to disagree with this simplistic advice- it's a whole huge discussion in and of itself, but I believe that baby sleep is a spectrum of normal from sleeping 12 hours to waking every 2 and much of it is determined by temperament and things like baby's sleep environment. Anecdotally, there are breastfed babies that sleep through the night by 12 weeks, just like there are formula fed babies who wake up overnight.
Another misconception is that breastfeeding is all or none. A lot of women cannot provide exclusively breastmilk for their babies, and it's ok. Fed is definitely best. I have read that 2oz of breastmilk a day can provide immunologic benefit to babies. Breastfeeding shouldn't be torture, but if a mom can do it in any capacity then I try to encourage her to keep it up.
Finally, as a doctor, I will be the first to admit that we often get terrible training with breastfeeding. I think I had one slide during med school that essentially said, "Breastmilk is really good for babies". A lot of primary care advice can unintentionally undermine breastfeeding. Probably my biggest pet peeve is when moms are told to pump and dump all willy nilly. For example, moms having surgery are told to pump and dump after anesthesia anywhere from 24 hours post-op to 5 days post-op. This is outdated advice, and the evidence shows that as soon as mom is awake enough to safely hold her baby then she can safely nurse or pump. Same for contrast dyes for CT or MRI- both are safe to breastfeed after receiving. Unless a doctor takes a personal interest in breastfeeding then they will not be given much education about it. It's totally ok to double check with a lactation consultant or on a site like kellymom.com if a doctor gives advice that seems suspect.
Why should a mom choose breastfeeding?
I'll start with benefits to mom, which are often not discussed. Immediately after birth, starting to breastfeed releases hormones that help her uterus shrink back down, which can reduce pain and bleeding. Then, breastfeeding burns an average of 500 calories a day, that is more than what pregnancy burns! Many- not all- breastfeeding moms lose weight quicker and with less effort than non-breastfeeding moms. The more months a woman breastfeeds the more she will reduce the risk of breast, uterine, and ovarian cancer. It also is beneficial emotionally as the hormones released when breastfeeding can combat postpartum depression. I am still fighting postpartum depression, but I firmly believe that breastfeeding was one of the few things that kept me from going to some really dark places. Finally, it saves money. The cost of forumla-feeding for the first year range in $1,200-1,700; meanwhile breastfeeding costs $0, you never have to go to the store because you've run out, and if you nurse then there are no bottles to make at 2am and no pump parts or bottles to wash.
The benefits to baby are also numerous. Immediately after birth, colostrum is nutrient and immune cell rich. It's pretty much their first vaccination against the external world. The immunologic benefits continue and breastfed babies tend to get fewer ear infections, upper respiratory infections, and diarrhea. It also reduces the risk of allergies, asthma, diabetes, and obesity. There is research into how breastmilk positively influences the bacteria that live in our intestines and how those bacteria later influence our health as adults. Breastfeeding is protective against SIDS. WHO estimates published in The Lancet state that if almost everyone globally breastfed then 800,000 lives would be saved every year, with most of those being babies under 6 months of age.
Why do you think breastfeeding is still seen as taboo?
The culture of sexualization around breasts can be a huge barrier for people. I have definitely heard dads in the labor room say in regards to their partner's breasts, "Those things belong to me." Actually, sir, they belong to your partner, and breasts can sustain a baby as well as provide you whatever sexual satisfaction you get from them. Having a supportive partner is one of the number one factors contributing to if a mom continues breastfeeding that is otherwise going well- a partner who will encourage a breastfeeding mom when things are rough and help make her life easier will contribute to success. This is also the reason many women feel embarrassed or are outright shamed for nursing in public. Legally, a woman has the right to feed her baby wherever she wants and however she wants. I hate being told to pump or nurse in the bathroom, because that is not where I eat my lunch so that is an unacceptable place to feed my baby. So many women feel pressure to hide when they are nursing, which only adds to it not being seen as 'normal'. I've nursed without a cover in front of my father and brother and grandpa, and luckily for me they have never made me feel uncomfortable. When someone asked my husband if he felt weird about me whipping my boob out in a restaurant to nurse during dinner, he said, "So? They're just boobs. Everyone has seen a boob. Besides, it's more important that she feed him." It was one of the proudest moments for me (again, going back to that supportive partner thing!).
Another 'taboo' thing I have encountered is that breastfeeding requires too much sitting. especially in the beginning when it takes 30 minutes for the baby to nurse. I was so frustrated, feeling tied to the couch! I felt like I needed to be up 'doing things', because there were dishes in the sink and laundry waiting to be folded. People would come over to see the baby and I'd be so embarrassed that my house was a wreck. You know what? It literally doesn't matter. I now tell patients who are planning on breastfeeding that their one and only job for the next 4-6 weeks is to feed the baby. The house does not matter. It is ok to eat 5 granola bars a day. It is ok to binge watch Netflix. It is ok to not put on makeup or a bra. Her job is not entertaining, her job is breastfeeding and recovering from childbirth. Babies get faster at nursing and soon she won't be sitting so much.
Similarly, for moms who work, some people can be nasty about pump breaks. I've certainly heard it, "Why is she getting a break?" During my pump breaks I am writing notes, checking lab values, calling consults, studying, and eating.If people are given 20 minutes to smoke every 3-4 hours, then I shouldn't be given grief for taking 20 minutes to make food for my baby. Legally, employers have to give adequate time and space to pump. Know your rights!
One piece of advice for a mom considering to breastfeed?
Help. You need help. I tell my patients that breastfeeding is a natural thing that sometimes doesn't come naturally. Educate yourself and your primary support person while you are pregnant by going to a breastfeeding class- they are free and everywhere. Find out resources ahead of time. Get lactation involved as soon as you arrive at the place where you will be giving birth so that they can see you shortly after delivery, especially if you are having a scheduled c-section and not laboring. Then find a support group, or even another friend who has breastfed successfully, because you need someone to text or post to who gets what you are going through. My breastfeeding relationship was saved by a Facebook group of other physicians who are breastfeeding. You are going to get so much pressure to stop and I just would encourage you to keep going.
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