2. It is normal for breastfeeding to hurt. Not true! Though some tenderness during the first few days is relatively common, this should be a temporary situation which lasts only a few days and should never be so bad that the mother dreads nursing. Any pain that is more than mild is abnormal and is almost always due to the baby latching on poorly. Any nipple pain that is not getting better by day 3 or 4 or lasts beyond 5 or 6 days should not be ignored. A new onset of pain when things have been going well for a while may be due to a yeast infection of the nipples. Limiting feeding time does not prevent soreness. (See handout #3 Sore Nipples).

3. There is no (not enough) milk during the first 3 or 4 days after birth. Not true! It often seems like that because the baby is not latched on properly and therefore is unable to get the milk. Once the mother's milk is abundant, a baby can latch on poorly and still may get plenty of milk. However, during the first few days, the baby who is latched on poorly cannot get milk. This accounts for "but he's been on the breast for 2 hours and is still hungry when I take him off". By not latching on well, the baby is unable to get the mother's first milk, called colostrum. Anyone who suggests you pump your milk to know how much colostrum there is, does not understand breastfeeding, and should be politely ignored.

4. A baby should be on the breast 20 (10, 15, 7.6) minutes on each side. Not true! However, a distinction needs to be made between "being on the breast" and "breastfeeding". If a baby is actually drinking for most of 15-20 minutes on the first side, he may not want to take the second side at all. If he drinks only a minute on the first side, and then nibbles or sleeps, and does the same on the other, no amount of time will be enough. The baby will breastfeed better and longer if he is latched on properly. He can also be helped to breastfeed longer if the mother compresses the breast to keep the flow of milk going, once he no longer swallows on his own (Handout #15 Breast Compression). Thus it is obvious that the rule of thumb that "the baby gets 90% of the milk in the breast in the first 10 minutes" is equally hopelessly wrong.

5. A breastfeeding baby needs extra water in hot weather. Not true! Breast milk contains all the water a baby needs.

6. Breastfeeding babies need extra vitamin D. Not true! Except in extraordinary circumstances (for example, if the mother herself was vitamin D deficient during the pregnancy). The baby stores vitamin D during the pregnancy, and a little outside exposure, on a regular basis, gives the baby all the vitamin D he needs.

7. A mother should wash her nipples each time before feeding the baby. Not true! Formula feeding requires careful attention to cleanliness because formula not only does not protect the baby against infection, but also is actually a good breeding ground for bacteria and can also be easily contaminated. On the other hand, breastmilk protects the baby against infection. Washing nipples before each feeding makes breastfeeding unnecessarily complicated and washes away protective oils from the nipple.

8. Pumping is a good way of knowing how much milk the mother has. Not true! How much milk can be pumped depends on many factors, including the mother's stress level. The baby who nurses well can get much more milk than his mother can pump. Pumping only tells you have much you can pump.

9. Breastmilk does not contain enough iron for the baby's needs. Not true! Breastmilk contains just enough iron for the baby's needs. If the baby is full term he will get enough iron from breastmilk to last him at least the first 6 months. Formulas contain too much iron, but this quantity may be necessary to ensure the baby absorbs enough to prevent iron deficiency. The iron in formula is poorly absorbed, and most of it, the baby poops out. Generally, there is no need to add other foods to breastmilk before about 6 months of age.

10. It is easier to bottle feed than to breastfeed. Not true! Or, this should not be true. However, breastfeeding is made difficult because women often do not receive the help they should to get started properly. A poor start can indeed make breastfeeding difficult. But a poor start can also be overcome. Breastfeeding is often more difficult at first, due to a poor start, but usually becomes easier later.

11. Breastfeeding ties the mother down. Not true! But it depends how you look at it. A baby can be nursed anywhere, anytime, and thus breastfeeding is liberating for the mother. No need to drag around bottles or formula. No need to worry about where to warm up the milk. No need to worry about sterility. No need to worry about how your baby is, because he is with you.

12. There is no way to know how much breastmilk the baby is getting. Not true! There is no easy way to measure how much the baby is getting, but this does not mean that you cannot know if the baby is getting enough. The best way to know is that the baby actually drinks at the breast for several minutes at each feeding (open—pause—close type of suck). Other ways also help show that the baby is getting plenty (Handout #4 Is my Baby getting enough milk?).

13. Modern formulas are almost the same as breastmilk. Not true! The same claim was made in 1900 and before. Modern formulas are only superficially similar to breastmilk. Every correction of a deficiency in formulas is advertised as an advance. Fundamentally they are inexact copies based on outdated and incomplete knowledge of what breastmilk is. Formulas contain no antibodies, no living cells, no enzymes, no hormones. They contain much more aluminum, manganese, cadmium and iron than breastmilk. They contain significantly more protein than breastmilk. The proteins and fats are fundamentally different from those in breastmilk. Formulas do not vary from the beginning of the feed to the end of the feed, or from day 1 to day 7 to day 30, or from woman to woman, or from baby to baby... Your breastmilk is made as required to suit your baby. Formulas are made to suit every baby, and thus no baby. Formulas succeed only at making babies grow well, usually, but there is more to breastfeeding than getting the baby to grow quickly.

14. If the mother has an infection she should stop breastfeeding. Not true! With very, very few exceptions, the baby will be protected by the mother's continuing to breastfeed. By the time the mother has fever (or cough, vomiting, diarrhea, rash, etc) she has already given the baby the infection, since she has been infectious for several days before she even knew she was sick. The baby's best protection against getting the infection is for the mother to continue breastfeeding. If the baby does get sick, he will be less sick if the mother continues breastfeeding. Besides, maybe it was the baby who gave the infection to the mother, but the baby did not show signs of illness because he was breastfeeding. Also, breast infections, including breast abscess, though painful, are not reasons to stop breastfeeding. Indeed, the infection is likely to settle more quickly if the mother continues breastfeeding on the affected side. (Handout #9 You can still breastfeed).

15. If the baby has diarrhea or vomiting, the mother should stop breastfeeding. Not true! The best medicine for a baby's gut infection is breastfeeding. Stop other foods for a short time, but continue breastfeeding. Breastmilk is the only fluid your baby requires when he has diarrhea and/or vomiting, except under exceptional circumstances. The push to use "oral rehydrating solutions" is mainly a push by the formula (and oral rehydrating solutions)manufacturers to make even more money. The baby is comforted by the breastfeeding, and the mother is comforted by the baby's breastfeeding. (Handout #9 You can still breastfeed).

16. If the mother is taking medicine she should not breastfeed. Not true! There are very very few medicines that a mother cannot take safely while breastfeeding. A very small amount of most medicines appears in the milk, but usually in such small quantities that there is no concern. If a medicine is truly of concern, there are usually equally effective, alternative medicines which are safe. The loss of benefit of breastfeeding for both the mother and the baby must be taken into account when weighing if breastfeeding should be continued (Handout #9 You can still breastfeed).

Handout #11. Some Breastfeeding Myths. Revised January 1998

Written by Jack Newman, MD, FRCPC

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