Breastfeeding

How long and how frequently should babies be breastfed? Can the mother breastfeed while she’s smoking? working? when she has mastitis? while she’s taking medication? Is lack of milk a common problem? How can sore nipples be soothed? What’s the best protection against cracks?
Twelve questions and answers offering some practical tips on breastfeeding.

12 KEY IDEAS IN THE
“BASICS OF BREASTFEEDING” REPORT 

 

Mothers should not have to follow rules about how often or how long they breastfeed

The number and length of feeds varies considerably from one infant to another and, for a given infant, even from day to day, depending on the child’s nutritional needs and physical proximity. Moreover, breastfeeding influences milk production: the more milk an infant takes, the more the mother will produce. These two factors explain why mothers should not have rules about how often or how long they breastfeed. During the first few weeks of breastfeeding, most children want to be fed often, as much as 8 to 12 times a day. That should not be interpreted as a problem; in particular, it does not indicate a lack of milk.

Tip

Breastfeed the infant whenever he or she wants to be fed, as often and for as long as the infant wants (see point 3), without setting any minimum time between feedings or a maximum length for any one feeding.

A lack of milk, in the sense of a mother being physiologically unable to produce milk, is unusual

Only a minority of women do not truly produce enough milk to breastfeed their babies. For the vast majority, any “lack” of milk can be explained by something other than a physiological deficiency. It may be a subjective impression, because the child is crying or wanting to be fed in a way that is unusual. Such “peak days” are normal. In addition, the production of milk may decline if breasts are not being fully emptied, e.g., if feedings are too short or spaced too far apart.  Any problem of that nature does not indicate a true lack of milk and can be easily resolved.

Tip

To ensure they don’t “lack” milk, mothers should breastfeed without restriction, day and night, even when the infant demands to be fed virtually all the time.

To know whether infants want to be nursed, just observe them closely when they awaken, without waiting for them to cry

When infants wake up, there are several subtle indications that they want to be fed: they will bring their hands to their mouth, open their mouth, suck on their tongue and, if they’re being held by their mother, they will turn toward her breast. Tears are a late signal of hunger. Don’t wait for tears before offering your breast: if you wait, the child may not latch on to the breast properly and will have less effective suction.

Tip

For effective breastfeeding, offer your breast as soon as the child wakes up, opens his or her mouth and moves his or her tongue.

Cracked nipples are not caused by breastfeeding too much or for too long, but when infants are improperly positioned on the breast

Cracks are due to abnormal friction between the nipple and the baby’s mouth when the baby is not correctly positioned on the breast. Ensuring the infant is properly positioned for nursing offers the best prevention and the most effective treatment.

Tip

The four golden rules for ensuring an infant is in the proper latching position: the baby’s face is facing the breast; the baby’s ear, shoulder and hip are aligned on the same axis; the mouth is wide open; and the nose is free and clear.

The best way to prevent or soothe breast tension and pain is to breastfeed whenever the infant wants it

Breast tension and pain while nursing are rarely caused by excessive milk production, but rather by inadequate breast drainage. To fight this problem, it’s important to empty the breasts completely on a regular basis, so as to prevent any accumulation of milk. For that purpose, babies must be able to breastfeed effectively to their heart’s content. Restricting water intake, bandaging the breasts or wearing a tight bra are not recommended: those measures are ineffective and can even aggravate the problem.

Tip

Don’t place limits on the length or frequency of your breastfeeding! Check to be sure your baby is nursing effectively, with a slow and regular suction rhythm and occasional swallowing.

The use of supplemental bottles during the first few weeks can disrupt proper breastfeeding

When women doubt their ability to feed their infant adequately with their own milk, they’re tempted to use bottles to supplement their breastfeeding.  Except in special cases, this practice is not recommended, since it reduces the infant’s need for breast milk, can lead to lower milk production and increases the risk of premature weaning.

Tip

Do not give breastfeeding newborns any food or drink other than breast milk, unless medically indicated. In babies carried to term who are in good health and feed effectively on demand, there is no risk of dehydration or delayed growth.

Mastitis does not prevent you from continuing to breastfeed

Mastitis is an inflammation of the breasts brought on by anything that prevents proper breast drainage, such as breastfeeding that is ineffective or too brief or feeding intervals that are too far apart. Treating mastitis requires that you restore proper breast drainage. For that reason, breastfeeding can and indeed should be continued. If breastfeeding is interrupted, there is a risk that a breast abscess could develop.

Tip

Breastfeed the child as often and for as long as he or she wants, and offer both the healthy and unhealthy breast. This poses no risk to a healthy infant.

It’s possible to breastfeed after returning to work

There are several ways to continue breastfeeding after you have returned to work: you can nurse the infant in the morning and evening on days that you work and whenever the infant wants to be fed on your days off, and you can collect and store milk to give to the infant between feedings; in addition, you can partially breastfeed if the child is old enough. Moreover, the French Labor Code includes measures that make it easier to continue breastfeeding (shorter work days, flex-time work hours, breaks during work hours, access to a room where mothers can express milk).

Tip

Continue to breastfeed until you go back to work. Once you’re back on the job, breastfeed your infant whenever you’re with the child and he or she wants to be fed.

Breastfeeding women can eat whatever they want

Breastfeeding mothers are under no obligation to eat some foods and avoid others. Nor is there any reason to eat more in order to meet the infant’s nutritional needs, or to force yourself to drink large volumes of liquids in order to produce more milk. On the other hand, drinking alcohol while breastfeeding is not recommended. If abstinence is impossible, mothers should limit themselves to one or two drinks on occasion and avoid breastfeeding afterwards.

Tip

Maintain a normal, varied and balanced diet, and drink whenever you’re thirsty.

A large number of medications can be taken by breastfeeding women without endangering their child

In most cases, only a very small amount of a medication passes into breast milk, and breastfeeding infants receive no more than one percent of the dose taken by their mother. As a result, when mothers are ill, it is very often possible to find a drug that is compatible with continued breastfeeding. The Vidal reference work is not an adequate source of information for finding an appropriate drug, since it advises against or contraindicates breastfeeding for most products, to avoid any medical/legal risk.

Tip

To learn more, here are two reliable sources of information:
- “2016 Medications and Mothers’ Milk - 16th Edition,”
- the LactMed database from the US National Institutes of Health.

Women who smoke may breastfeed their child

It’s better for breastfeeding women not to smoke, but if they’re unable to stop, they should still continue to breastfeed. Children who are breastfed by mothers who smoke actually have a lower risk of illness than those who are fed with formula. In addition, nicotine replacements for stopping smoking are permitted for breastfeeding women. The nicotine they contain passes into the mother’s milk, but in much smaller quantities than the nicotine contained in cigarettes. To reduce nicotine concentration in the blood even further, oral forms of nicotine replacement are preferable to a patch.

Tip

Do not smoke in the presence of an infant. Smoke immediately after breastfeeding and wait at least two hours before breastfeeding again.

When breastfeeding mothers receive support from trained healthcare professionals and support groups, they are more likely to breastfeed their infant for a longer period

Several studies have shown that it’s essential for mothers to continue receiving support once they go home from the maternity clinic if they are to continue breastfeeding for as long as possible. This support will make it easier for mothers to breastfeed, help prevent any problems and increase each mother’s confidence.

Tip

Encourage mothers to meet right away with a healthcare professional who is trained in monitoring breastfeeding, such as a midwife, pediatric nurse, physician or lactation consultant, or to contact a local support group, after the baby is born.