Answering your questions about breastfeeding

A recent U.S. government ad campaign using scare tactics to tout the benefits of breastfeeding has led to more questions than answers and has inspired some fiery debate. Dr. Joan Meek, a pediatrician and author of the American Academy of Pediatrics' new mother's guide to breastfeeding, answers your questions and explains the benefits of breastfeeding.

What are the most common questions about breastfeeding?

Is breastfeeding going to hurt? It should not hurt if the baby is latched on properly and positioned well at the breast.

Am I going to be able to do it? Yes, most women can breastfeed. Before your baby is born, get advice and tips from books and from your pediatrician. Once the baby is born, a hospital nurse or lactation specialist can help with proper latching-on techniques. For more information, see Quick tips for the new mom, below.

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How do I know the baby is getting enough milk? You'll know the baby is getting enough milk by checking the diapers. Breastfed babies have lots of stools; often they stool every time they eat because breast milk has a natural laxative effect. Also, your pediatrician will check the baby's weight at each visit to make sure the baby is gaining enough weight.

How long should a mother breastfeed?
The American Academy of Pediatrics recommends exclusive breastfeeding for about 6 months (that means no water, juice, formula or solids are needed). After that, continued breastfeeding through at least the child's first birthday, with the addition of solids. The mother and baby should decide when to wean. What I try to teach mothers is that any breastfeeding is better than none at all, and that the longer the baby is breastfed, the greater the benefits will be. And breastfeeding does not have to be exclusive. Some mothers may choose a combination of breastfeeding and infant formula.

Babies are designed to be able to tolerate breast milk better than formula. The bacteria that grow in the baby's intestine are different if the baby is breastfed, and this makes the baby less likely to contract severe diarrhea. Infant formula is an acceptable alternative to breastfeeding, but should not be viewed as an equal choice to mother's breast milk. Babies can be happy, healthy, and formula fed, but they probably will have more infections and may be more prone to chronic diseases as they get older.

What advice do you have for a mother who breastfeeds her first child, but thinks she won't have time to breastfeed the second?
Breastfeeding is actually cheaper and more convenient than mixing formula. Breast milk is always available, always at the right temperature, always ready to feed, and even comes in an attractive package. Nighttime feedings are especially more convenient — no stumbling through the house to mix or heat formula. Traveling with a breastfed baby is a lot easier, too. No cans, bottles and cleaning supplies to worry about.

What are you likely to see down the road when it comes to differences between a breastfed child and one who is not?
Some studies point to reduced risk of diabetes, obesity, certain childhood cancers, and even asthma and allergies when you compare groups of breastfed babies with groups who were not. The longer a baby is breastfed, the better the health outcome.

Questions from viewers
A mother with a five-month-old son writes:
Q: I was wondering if it is okay for me to try to lose the weight I gained during pregnancy now or do I need to wait until I stop nursing? I have heard that it can affect milk production if you lose a lot of weight. Is this true?
A: We don't recommend women significantly reduce calories during breastfeeding. It's more helpful to increase exercise. Most women will actually lose weight in spite of what they're eating. Many feel they can practically eat anything they want, which is unlike any other time in life! Enjoy it!

Banan from Michigan writes:
Q: How many calories does breastfeeding actually burn? I've heard so many different numbers, ranging from 100 calories a day to 500 calories. Does it matter how many times you breastfeed in one day?
A: It's really how much total breast milk the baby takes in over the period of the day. The average mom will make about 24 to 28 ounces of breast milk a day. It takes about 500 calories to make that much milk. Some of those calories come from fat stored during the pregnancy or previously, and some come from the mother's daily nutrition.

Laurie from Connecticut, who was able to breastfeed her son only for the first three weeks, then switched to a combination of breast milk and formula, writes:
Q: When is enough enough with a woman's attempts to nurse her child? I don't dispute all the research that shows the enormous benefits of breastfeeding, but I do also feel that it comes more naturally to some. In those early weeks of motherhood, when fatigue and baby blues are very real things, trying to breastfeed can start to do more harm than good.
A: If it gets to the point that the mother is experiencing severe stress or fatigue trying to breastfeed, she may want to rethink her options. Some mothers may decide to do a combination of breastfeeding and formula feeding, while others may decide to formula feed their babies. It is critical to try to get breastfeeding off to a good start. Often mothers get fatigued from trying to take care of other children or household responsibilities, plus breastfeed the baby. Having someone else around to help with meals, laundry, dishes, and other children will allow the mother to concentrate on breastfeeding. When the baby breastfeeds, hormones are released from the mother's brain that not only cause milk production, but also contribute to an intense bond with the baby, and a sense of well-being. Pain, fatigue, and stress can actually interfere with those hormones, slowing milk production.

Liz from Texas writes:
Q: I've been told that it's the sucking motion, not the breast milk, that reduces the likelihood of ear infections. Is that true?
A: Probably more likely a combination of the two. Suckling at the breast is different than sucking on a bottle. Protection from ear infections also results from the infection-fighting components of the breast milk itself. Research shows that as few as four months of breastfeeding helps a baby to have fewer infections for approximately the first year of life.

Rebecca from Wisconsinsays that her first two children latched on, but she did not produce enough milk.
Q: As we think about having a third child, I don't think I could do it again. Is it normal to not have the capability to produce enough milk, or is there something else I could have done to increase my milk?
A: About 1 percent to 2 percent of the population cannot make enough milk to meet their babies' needs. Other moms fail to produce a good milk supply because they don't get the right help after delivery. The baby's ability to latch properly is critical. Poor latch can cause pain and make the mother's nipples sore. Low thyroid, hormone levels or diabetes in the mother can also cause low milk supply. There are a variety of factors to consider. Sometimes you can figure out why there is a problem, and sometimes you might not. Every pregnancy and every baby are different. Sometimes it is easy with the first pregnancy, but more difficult the next time around. It's a complex process, and just because it is natural does not mean it is always easy. Feeding some colostrum in the first week would be better than the baby getting no breast milk at all. The baby can learn to latch better when the breasts are nice and soft after delivery. Babies who feed well right after delivery seem to do better than those who have a delay in the first feeding. After the first few days, the breasts may become much more firm, and it can be a little more challenging for the baby to latch on.

Kory from Hawaii, a mother of a 10-month-old daughter, writes:
Q: I was adamant about breastfeeding from the beginning and don't regret my decision. However, now that I would like to stop breastfeeding by her first birthday, I worry about the transition. Will she be able to let go of the emotional needs nursing gives her? What are the options for mothers who want to avoid the “crying it out” strategy for weaning?
A: Gradual weaning is easier for both mom and baby, instead of going cold turkey. Gradual weaning over a few months is ideal, if mom has the luxury of time. It probably works best to take out a feeding a week. Weaning quickly can be difficult for both. Slow and gradual is the way to go.

Kimberly from Oregon writes:
Q: I am currently nursing my four-and-a-half-month-old daughter. Sometimes during evening feedings she sucks me dry but still seems hungry. Should I be concerned when she wants to continue to eat but there is nothing left? Does this mean that I need to start supplementing with formula?
A: If the child is growing appropriately, it's not an indication for formula. Mother's supply is more plentiful in the morning. Frequent feeding in the evening, or cluster feeding, is pretty common, especially when mom is trying to fix dinner and the older kids are demanding attention. Frequent nursing will stimulate increased supply. It doesn't necessarily mean you need to supplement. Fortunately, the baby never completely empties all of the milk from the breast, so even if the baby is feeding often, she is still getting milk. Also, babies have periodic growth spurts. The breastfed baby will feed more vigorously and the mother's supply will be boosted.

Quick tips for the new mom
Be prepared ahead of time
Attend breastfeeding classes, read books, or rent videos/DVDs. Talk to your breastfeeding friends. If you have never actually seen a baby breastfeed, go to a La Leche League Meeting. If you have had breast surgery or have nipples that point inward instead of outward, consider seeing a lactation consultant before delivery. Choose an obstetrician and a pediatrician that are supportive of breastfeeding and will help you through any problems you encounter. Interview your prospective pediatrician or ask your friends which pediatricians support breastfeeding. Make sure your partner is educated about breastfeeding and will support your decision. Deliver at a hospital that supports breastfeeding and will provide you help after delivery.

Recognize it takes commitment
While breastfeeding is a natural process, it does not always come naturally. For some mothers and babies it takes awhile to become comfortable with the process. The first few weeks of breastfeeding require time and patience. It is normal for mothers to feel like they are spending most of the day and night breastfeeding. Once the milk supply is well established and the mom and baby have learned to breastfeed, it gets a lot easier and becomes a much more convenient way to feed the baby.

Ask for help and ask early
Get help in the hospital before you leave. If you are having problems with pain or are unsure if the baby is latched on properly, ask for help. Make sure the baby is latching on with a wide open mouth, which helps him to drink more milk while he is feeding. Ask your doctor or lactation specialist for help. Your pediatrician should see your baby within 2 to 3 days after hospital discharge to check their weight, their breastfeeding, and to look for signs of jaundice (yellow color of the skin). If mother is having any problems with breastfeeding, this needs immediate attention to establish and maintain a good milk supply.

Any breast milk is better than none
Breastfeeding is the gold standard for infant feeding. Formula feeding is an acceptable alternative, but it is not equivalent to breastfeeding in terms of health or optimal growth and development. The American Academy of Pediatrics recommends exclusive breastfeeding for about 6 months, continued breastfeeding with the introduction of solids for at least the baby's first year of life, and as long thereafter as the mother and baby desire to continue. This is the ideal, but may not work for every mother and baby. Providing colostrum to the baby in the first days after delivery is important to boost the baby's immune system. Delaying introduction of cow milk protein may help to prevent allergies. Breastfeeding for even 4 months helps to prevent ear infections for up to a year. Longer duration of breastfeeding provides the best developmental outcomes and protection from obesity or other chronic diseases. A combination of breast milk and infant formula may end up being the best choice for some families. Any breast milk the baby gets is better than none at all, and the longer the baby breastfeeds, the greater the potential benefits.