Q & A with Dr Jack Newman

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1. I have heard that if a mother is taking medication she must interrupt breastfeeding.

A: This is almost never true. The question itself implies that breastmilk and formula are basically the same and therefore even a little bit of drug in the milk is risky. But chemically breastmilk and formula are very different: the list of ingredients in breastmilk that are missing from formulas would fill several pages of a book.

The real question then, is which is safer for the baby: breastfeeding with a tiny amount of drug in the milk – and it is almost always tiny – or formula? The risks of formula are well-documented and real, for mother as well as baby. A mother who breastfeeds decreases her risk of breast and ovarian cancers, for example, and the longer she breastfeeds, the lower the risk.

Medications almost never require a mother to stop breastfeeding, though there are rare exceptions (such as chemotherapy drugs). As an example, I cannot think of a single antibiotic that requires a mother to stop breastfeeding, not one.

2. I am surprised by how often I am hearing my friends say that they are not producing enough milk for their babies.  How did babies survive in the old days?

A: Happily, the vast majority of mothers are able to produce more milk than the baby needs. Unfortunately, too often milk production is undermined by interventions during labour and birth, separation of the mother and baby after the birth, early introduction of bottles, poor advice on breastfeeding and so on.

Sometimes decisions about whether a mother is making enough milk are based on weighing the baby. However, weighing a baby on two different scales and making a decision from the result can lead to misinterpretation.  Scales are not perfect and some are not properly calibrated.  Observing the baby drinking at the breast is a better way to determine if the baby is getting enough milk. See the videos here. This video clip shows a baby drinking well at 10 hours after birth.

A small number of mothers really cannot produce all the milk their babies need. Breast compression can be used to increase the flow of milk to the baby. If the baby is still hungry, the mother can supplement the baby with a feeding tube (lactation aid) at the breast. That way the baby is still at the breast and still breastfeeding while being supplemented. We also often use medication (domperidone) to increase milk supply.
3. I am 20 weeks pregnant and I have several friends who breastfed and had considerable nipple pain. This scares me as I am not good with pain. Is there anything I can do to prevent sore nipples?

A: Pain is a not a necessary part of breastfeeding, not even in the first few days after birth when mothers are told that the nipples have to “get used” to breastfeeding or that the nipples must “toughen up.” I cannot believe we still talk about toughening up nipples; after all these years!

During the first few days after birth, some mothers will describe a mild discomfort as the baby suckles. It shouldn’t be more than that, and it shouldn’t be bad enough that the mother dreads feedings. If the mother has significant pain something is wrong. Generally, this means the baby’s latch is not as it should be.

Sometimes mothers are told that if it hurts, they should take the baby off the breast and latch him on again. They may end up doing this over and over, causing more pain and a frustrated baby. Don’t do it! A good breastfeeding helper will be able to improve the latch without this painful process. Some help is available from our website www.breastfeedinginc.ca, especially from the videos.

Bottom line? Nipple pain is preventable; if you do get sore nipples, treat them as soon as possible. Taking the baby off the breast to “help the nipples heal” is a last resort only. There are other possible causes for nipple pain as well, including a tongue-tied baby or an infection of the skin on the nipple, so do look for expert help to resolve the problem if adjusting the latch doesn’t do it.

 4. I am going back to work soon. Does this mean I have to wean? If not, how can I keep breastfeeding going when I’m away from my baby all day?

A: Returning to work doesn’t need to mean the end of breastfeeding. Your strategy for maintaining the breastfeeding relationship will depend on how old your baby is and your working situation. If you have a young baby (under six months old or so), you will most likely want to express your milk during the day. Your milk can be kept at room temperature for up to eight hours, or in a fridge for up to eight days. If you need to freeze it, you will lose some of the antibodies and immune factors but it is still better for your baby than formula (which never had any of those immune factors to start with). You can keep it in the freezer over a fridge for about three months and in a chest freezer for a year.

With an older baby (over a year), you may not need to express your milk at all: your baby can eat solid foods and drink water or milk during the time you are apart and you can nurse when you are together.

Remember that any breastfeeding is better than none, and your baby will appreciate the chance to reconnect with you by nursing as much as the milk.

5. My baby is six months old, and people are already asking me when I’m going to stop breastfeeding. My doctor told me there are no health benefits after a year so I should wean by then. How long should you breastfeed?

A: You can breastfeed as long as you and your baby want. There’s no time limit, and there’s no point in time when your milk stops being an excellent source of nutrients, antibodies and immune factors. The World Health Organization and the Canadian Pediatric Society both recommend exclusive breastfeeding for six months, with solid foods gradually added after that and breastfeeding continuing for two years and beyond if you like.







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