what do you REALLY want to know about breastfeeding?

[LizaJ]

I had an absolute nightmare breastfeeding for the first 8 weeks and got really fed up with the fact that my experience was so different from the one portrayed in a lot of the 'official' information from the NHS etc. Being a nerdy scientist by trade (and therefore having free access to medical journals), I started to look into what the actual, clinical research says about breastfeeding, and was amazed by some of the inaccuracies that are out there.

I have been sharing the info in a blog, but so far I've only really written about the things that have affected me. I was wondering what breastfeeding topics other ladies would like to know 'The Truth' about..?

Jacksmamma, you ask, "why are we not told the truth about breastfeeding, which is that it hurts until, like any other exercise, your body gets used to it?"

You should not be told this, because it isn't true.

Breastfeeding pain is common, but it is not normal. Your nipples do not need to toughen up, and your breasts and nipples are made for breastfeeding

Please don't perptuate this myth that painful nipples are inevitable. They are not.

How brilliant you had a realistic portrayal of bf from a professional SalBySea - so much better than being patronized and then thinking you must be doing it wrong.

Bf can be protective against depression BUT this is only when it's going well - when mothers have difficulties it makes them more vulnerable. Not sure about colic. It does seem to be the case that bf babies don't sleep as 'well' (although this may be protective against SIDS). Will write about these things properly.

I need to look into changes to milk over the long term, but I did find out recently that even if you carry on producing milk your boobs eventually got back to their pre-pregnancy size! I'd love to hear more from the nutritional 'expert', Jacksmama.

Milk storage is next on my list. Will be adding all the other suggestions too (and prioritizing the raspberry one...)

LisaJ: have another look at the PND and breastfeeding studies. You say: "Bf can be protective against depression BUT this is only when it's going well - when mothers have difficulties it makes them more vulnerable."

I don't think the studies show this very clearly, in fact - it's a very hazy area of research. I've done some research into the literature and found it very difficult to get a consistent picture.

For milk changing as time goes on, there's a good Pediatrics study here - search on
DOI 10.1542 peds.2005-0313

tiktok - while painful nipples may not be inevitable, I do think that quite a lot of women have this experience. I did and most of my friends who bf did (although I admit, that's only a small sample).
I bf 9 babies and every time it was painful during the first couple of weeks. So it was true for me and others that I know. And while I don't think nipples have to "toughen up" I do think that for some they have to de-sensitise.

tiktok EVERY woman on both the post natal wards I was on had pain, as has every one of my antenatal friends, so for us it certainly is the norm. If most woman experience it then doesn't that make it 'normal'? And what is wrong with saying so? what on earth could be wrong with preparing woman for this?

I would also like to know if 'nipple confusion' actually exists! My LO has had a dummy since week 2 which comforts him a lot when he's colicey but when he is hungry he has no interest in it and demands the type that milk comes out of, he is definately not confused! We want to introduce a bottle of EBM but have been told to wait till 6 weeks "to avoid nipple confusion" - I have never met anyone who's baby has become confused but know a few who tried to introduce bottles at and after 6 weeks and found it to be too late for their LOs to accept where as friends who introduced one earlier had no probs. So is there evidence for waiting till 6 weeks to introduce dummies and bottles if you are BFing?

yes lisaJ it was brilliant and I feel very lucky to have had it

I honestly think I would have given up by now if I hadn't been reassured and warned in advance that the pain and difficulty is quite normal but can often be eased with time and lots of Bfing support

Great blog - this is JUST the info new bf'ing mothers need! Specially interested in the 'laid back' position article as I just discovered in bed last night that dd seems to have a better latch like that but it flies in the face of all the instructions you're given by mws/hvs/books etc.

Tiktok, thanks for replying to my post yesterday about losing my confidence because dd won't demand food, feel much better today after looking through a few threads and dicovering you talking about fore/hindmilk miconceptions and finding same info in LizaJ's blog. It's a revelation! All the 'professionals' tell you that you need to be sure you don't give too much foremilk and make sure you empty your breast and so on (but I can always squeeze some out so when is it empty?...)

BTW I am reliably informed by dp that my nipples definitely toughened up when feeding ds for 13mo - sorry if TMI!

Thanks for the pointer to the extended lactation paper tiktok. Definitely need to look into the PND thing in more detail - I guess this is a very complex issue, but also an important one to talk about (esp given that several people have now mentioned it).

On the painful/sensitive nipples issue, this is anecdotal, but I may have a small insight from a tandem feeding perspective. I have found during both pregnancies that my nipples have become more sensitive and at times feeding toddler ds was very uncomfortable in the nipple region during pregnancy. I was gutted when after dd arrived, this sensation persisted -as I had expected it to go. It was a bit sore, very sensitive and generally unpleasant, but not the cracked soreness, IYKWIM? I had no nipple trauma. It vanished overnight when dd was 5-6 days old. Both children were well attached when they fed, but the 'soreness' seemed independent of that. I had a v straightforward completely unmedicated delivery with dd, so my interpretation was that what I noticed was probably physiologically normal and I guessed related to the hormonal changes occuring in the early days after birth. The change did not co-incide with my milk 'coming in', something that happened within about 30hrs of birth. The morning it vanished was AMAZING, as I latched ds on and suddenly remembered what feeding him had been like pre-pregnancy .

I seriously doubt there's any research on this, but it does make me wonder if some sensitivity/soreness in the very early days could be unrelated to nipple trauma.

Sorry to hear that Allegrogirl. Was the problem worse at the start, or did it continue for a long time?

Good to hear the laid-back latch is working for you christie00. I wish I'd known about this earlier!

Sore nipples are very, very common...this does not mean they are inevitable, or normal.

Of course women should be prepared for things like this - not by telling them 'this will happen and your nipples have to desensitise and there is nothing you can do about it but grit your teeth and wait' ...which is what some people are saying here.

I had dreadful sore nipples - really bad ones, with each of three babies, despite having qualified as a bfc between infant one and two!

Better postbirth practices, more opportunities for babies to self-attach, better guidance and support and information about what to do with a sleepy baby inc one recovering from birth and pain relief, skilled help in assisting mothers with positioning and attachment, and sore nipples would be far less common.

christie, glad things are going better and that good information helped.

No one should talk about breasts 'emptying' - when bf is going well, they do not empty. It would make no biological sense if the baby could drain them to the last drop - nature is starting to make the replacement milk even as the milk is being removed and studies have shown most babies remove only about 70 per cent of the capacity.

SalbySea - nipple confusion is controversial. Bottles do interfere with bf, but it is less to do with the mode of delivery than the fact that bottles reduce the time at the breast (IMO) Anyone giving dogmatic dates and times with regard to bf - like 'not before 6 weeks ' - is showing how little they know about bf...though a rough rule of thumb is that bf is less likely to be messed up with the odd bottle after a few weeks, compared to the beginning, and if someone really wants some sort of date on a calendar to ring then 6 weeks is ok...but I do hate to pin mothers down when there is no real evidence for it. There is no good evidence that intro'ing bottles before a certain date means the baby will take a bottle happily, either,and that he will stick to that ability. Plenty of babies will refuse after some weeks or even months - just read mumsnet and this is a common issue. It can almost always be overcome, and in any case, you can always use a cup.

The pressure to give bottles to a bf baby can be hard to resist. It's not essential - if you really, really have to get the milk into the baby, then you can do it by other means than a bottle anyway.

OK, since you asked....

What does it mean when your milk goes practically across the street? but then your baby won't latch on?

Do I wake up my baby to feed, or is it better for them to sleep, as I had always been told the mantra, 'never wake up a sleeping baby...'

Oh, and why am I getting night sweats? Is this a post partum thing, or is it a b/fing thing? Keep in mind that b/fing moms won't distinguish between the post partum and b/fing as it all gets muddled together.

Why is baby feeding in small intervals? Is this better than feeding for longer stretches?

How do I know if he/she is getting enough and what do I do if he/she isn't?

Tiktok -I agree that sore nipples are not inevitable. I know mothers who have fed babies without experiencing this. I also agree with all of the measures you suggest for minimising it, and am sure vast numbers of women with sore nipples could have significantly improved experieces if these were universally implemented.

However, I just do not think we know whether or not some sensitivity/soreness (not really sure how best to describe it!) in the very early days despite all these things being in place is common enough to count as 'normal' or not. For some women, even with well attached babies and no nipple trauma and no shaping of the nipples after feeds etc etc etc this seems to happen for a few days regardless of anything else. I am not advocating telling pregnant women that they will need to grit their teeth and bear it if feeding is painful. There usually is something that can be done to improve matters, fortunately , and any pain or discomfort is certainly something that should be a trigger for seeking additional skilled help.

Agree, Grendle - initial sensitivity does seem to be hormonal in nature and some women will interpret the new sensation of the baby sucking as strange and be sensitive to that too.

I do make a distinction between this and trauma, and pain which does not improve with time.

Great blog!

Ok, tiktok, let me rephrase. Because I am the last person who'd want to perpetuate unhelpful myths about anything to do with pregnancy, birth or breast-feeding.

I would like to know why women are not usually told that in the beginning, a lot of women (though by no means all) find breastfeeding uncomfortable, and some find it painful for a few days. After all, nursing a baby is what many women (but not necessarily all) look forward to as a peaceful happy bonding experience, in addition to feeding their babies. It seems unfair that woman are often told in excruciating detail how painful labour can be (but of course it isn't for everyone, which is lovely), because that can be frightening which is unhelpful. But we are frequently not prepared to have discomfort in the early days of breastfeeding, whatever the cause may be - poor latch, oversensitive nipples, whatever.

I hope I phrased that better, because I think it would be useful to have that information. I've heard from several patients that they really found breastfeeding painful at the start and had had no idea that it could be, and thought they were doing something wrong and nearly quit! I think if we were prepared to look at it as an unfamiliar activity to which our bodies have to get used to, we might be more accepting of initial discomfort.

As far as perpetuating the myth that nipples have to toughen up goes, maybe I should have said "nipples have to desensitize" or similar - but if I'm perpetuating the myth, so are the baby books where I got it from, in which I read that you're supposed to "toughen up your nipples in the last trimester by rubbing them with a terry cloth towel". If that's not true, or even utter crap, it shouldn't be in print. But I can tell you, and so can girlfriends whom I've asked, that there's a heck of a lot less sensation in them 15 months on than there was when DS was born. Previously I'd have screamed the house down if an adventurous toddler had shoved his hand down my cleavage and pulled my nipple like saltwater taffy. These days, that merits an "ouch, let go".

"and there is nothing you can do about it but grit your teeth and wait'"

That's all that worked for me tbh.
With my first baby, the community more or less said that sometimes you just have to bear with it and it will get better. I found this reassuring as I thought I was doing something wrong. For subsequent babies, I knew that it would go in time because of my previous experience. Although I must admit to being surprised that it hurt 2nd time as I thought it hurt first time because I was inexperienced. With my 9th I nearly gave up as there was still pain at almost 6 weeks. In the main it took around 2w to settle with the others.
To varying degrees, I had cracking/bleeding with each baby.
I don't see how I could have avoided any of this. It's not as though I didn't know what I was doing. As has been said, it's a common occurrence so how can it not be normal?

I totally agree jacksmama - this is something I actually feel quite strongly about. I really, really fretted in the first few weeks because I thought and had been repeatedly told: 'if it hurts, I'm doing it wrong'. I sought out all the advice, etc. etc. to get help on the latch (which everyone said looked fine) and got very stressed worrying about it. Then I finally met a lovely nurse who told me it was normal for it to hurt for the first week or two, especially when lo latches on. Far from discouraging me, I found this very reassuring, as I could then literally 'grit my teeth' and get through it - after a couple of weeks it was fine. I'm sure there are other women out there like me who'd prefer to be prepared for some pain (PAIN, not discomfort) and to be prepared to have to just get on with it for a few weeks than to waste loads of energy worrying about what is actually very, very common (therefore, pretty normal?) experience.

It goes without saying that advice should always be sought in case it is a latch / angle / thrush issue, but the fact is lots of women find bf very painful for the first 2 weeks or so - then the pain passes. They're not doing it wrong and it will get better.

Phew. Got that off my chest.

ps. please ignore my stupid name - am feeling pretty average today!

that should have been community midwife in my last post.

Wonderful woman who did tell me that it did hurt for some women but it would pass if I persevered. She was right.

I have breastfed three children for 5 years, and I can report that yes, breastfeeding did hurt for the first two weeks with all three. I agree that telling women it shouldn't hurt unless they are doing it wrong is potentially very demoralising and not at all helpful.

Have only read through quickly, but wanted to say that thrush does exist. Please do prove it! Although my GP was fascinated to find that the searing glass-breaking-in-my-chest-pain went away with fluconazole.
I wish there was more out there about tandem feeding/feeding through pregnancy. Same GP was horrified to hear that I am still feeding while pg as she told me it would without a doubt cause me to miscarry.

I and really hate it when you get jumped for saying that can hurt in a perfectly normal way on the grounds that it might put people off. I think that if people are likely to be put off by being told that it might hurt a little at first but that it's normal, then they may not be all that sold on breastfeeding in the first place. And that surely it is better to properly support the women who have decided to breastfeed and are making a go of it than those whose resolve may not be as strong anyway.

Thank you so much for this excellent blog!! Wish I'd known about it a few weeks ago. The information on mastitis is very interesting - instinctively I used a breastpump to drain mine when affected, but I was not advised to do this, and perhaps should have been.

I had mastitis twice, each time it was severe enough that I seemed to have no option but to take antibiotics. The antibiotics caused agonising thrush. The first time this went undiagnosed for several weeks, meaning I had several weeks of breastfeeding being hell and my cracked nipple did not heal. My baby had thrush as well and was transformed once this was treated.

I was not advised that antibiotics might lead to thrush and that I should take measures to reduce the risk. My GP was openly skeptical that breast thrush could exist. There seems to be very little decent information about it, with some online info suggesting drastic measures to attempt eradication. From hearing descriptions from friends who gave up bf, I wonder if thrush is more common than currently thought. I would love to know "The Truth" about it....

X post turtle!! There needs to be more clinical research on thrush! And diagnosis guidelines...