September 8, 2022
By Sowmya Jasti, MS4, Drexel University College of Medicine

As an MS4, I thought I was ready to excel in my Women’s Health in the Community: Breastfeeding Elective at St. Christopher’s Center for the Urban Child. It turns out that I had to learn even faster than I usually do. As the trained lactation consultants went through common breastfeeding myths with me that afternoon, I realized that I had believed every single one of them. At another hospital, one without lactation consultants, a doctor might even be counseling their patients wrong. In order for us to counsel our patients correctly, we must first debunk those misconceptions that we hold for ourselves. Here are the biggest ones that have fundamentally changed how I will practice medicine.

Breast Milk Is the Best Milk

At first glance, the phrase “Breast milk is the best milk!” seems like the perfect rhyme to improve breastfeeding rates in America. This public health crisis is perhaps the best-known fact about breastfeeding. There are countless contributors to the low rate of breastfeeding — lobbying by formula companies, inadequate workplace protections for new parents, societal misconceptions, and structural racism. Every chance to talk to a new parent seems like the perfect opportunity to get them breastfeeding (exclusively would be ideal!) for a full two years. We know about the IgG that is passed down through breastmilk, and it’s cheaper and better for the environment. At first glance, why would anyone not breastfeed?

But the very first time you meet someone who knows all the information on the handouts you provided, sets alarms for every two hours day and night, has three other children and no help at home, and still wants to breastfeed exclusively despite slow weight gain, you may start to soften on your stance. As a person who has never breastfed a child, much less for the AAP recommendation of one year¹ , I cannot imagine the toll. Always remember that your first priority is a healthy parent and a healthy baby — if formula is the way to achieve that, then formula it is.

Stimulating Milk Production

Mother’s Milk Tea tastes like licorice, which is already off-putting to plenty of people. On top of that, in order for the active ingredient, fenugreek², to actually build up to high enough levels, the tea has to be drunk upwards of five to six times per day. Another common herb, moringa³, has the same low pharmacokinetics. Both are evidence-backed to result in modest increases in milk production.

However, the best way to stimulate milk production is actually milk removal. Breast tissue knows to make milk only when milk is removed, otherwise feedback mechanisms become inhibitory. The two major hormones involved are prolactin and oxytocin — the former is stimulated by nipple stimulation and the latter by milk ejection. In addition, the earlier suckling starts, the more milk the breasts will make for the rest of the breastfeeding period. In fact, partners who want to chest-feed (the more gender-neutral term for breastfeeding) can stimulate milk production without hormones or herbs, just by pumping even when nothing comes out—though this process may take upwards of six months to reach high volumes.

The OB Postpartum Visit

People who have just given birth usually visit their obstetrician to see how everything is healing at around three to six weeks. While most OBs I know would love to see them earlier, it is usually not possible. Even by three weeks, milk production is almost impossible to jump start if the patient has been doing nothing up until that point. So, this is another reminder that pediatricians and family doctors, while already superstars with postpartum depression screeners and birth history-taking, are the main teams that can convince parents to breastfeed in a truly achievable time frame.

Pain While Breastfeeding

I do not have personal experience with breastfeeding, so I have little room to preach on this issue, but breastfeeding is not supposed to hurt⁴! The most common reason that it does hurt is that the baby is not latching deeply enough. This can be fixed with a few different holding techniques, or a device called a nipple shield.

If the nipple is chapped or even bleeding, the baby can still feed! Some things that can help with healing: Hand express some breastmilk and then rub it in. It is good for the baby, and it is good for the parent. Let air dry, and do not use anything occlusive like Vaseline. Patients can use nipple ointment, which is mostly olive oil so the baby can latch and there aren’t any chemicals being ingested. If patients do not want to pay for the ointment, olive oil or coconut oil work just as well⁵.

Cultural Appreciation

Breastfeeding is a ritual that dates back to the beginning of humanity, and is something we share with every mammal. Therefore, it is unsurprising that every culture has their own unique take. While a few clash with our scientific database of knowledge, babies have been surviving with these practices for this whole time, and for the majority of the time it has been without formula available. Listen with open ears and hearts as your patient gushes to you about the ancient practices passed down by mothers and grandmothers, and for the most part, rest assured that the baby is going to be healthy. Tradition and science can coexist.

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Sources/Resources:

• 1. Eidelman, A. I., Schanler, R. J., Johnston, M., Landers, S., Noble, L., Szucs, K., & Viehmann, L. (2012). Breastfeeding and the Use of Human Milk. Pediatrics, 129(3), e827–e841. https://doi.org/10.1542/peds.2011-3552
• 2. Bumrungpert, A., Somboonpanyakul, P., Pavadhgul, P., & Thaninthranon, S. (2018). Effects of Fenugreek, Ginger, and Turmeric Supplementation on Human Milk Volume and Nutrient Content in Breastfeeding Mothers: A Randomized Double-Blind Controlled Trial. Breastfeeding Medicine, 13(10), 645–650. https://doi.org/10.1089/bfm.2018.0159
• 3. Fungtammasan, S., & Phupong, V. (2021). The effect of Moringa oleifera capsule in increasing breastmilk volume in early postpartum patients: A double-blind, randomized controlled trial. PLOS ONE, 16(4), e0248950. https://doi.org/10.1371/journal.pone.0248950
• 4. Brimdyr, K., Blair, A., Cadwell, K., & Turner, -Maffei C. (2013). The relationship between positioning, the breastfeeding dynamic, the latching process and pain in breastfeeding mothers with sore nipples. Breastfeeding Review, 11(2), 5–10. https://doi.org/10.3316/informit.441347225025880
• 5. Page, T., Lockwood, C., & Guest, K. (2003). Management of nipple pain and/or trauma associated with breast-feeding. JBI Reports, 1(4), 127–147. https://doi.org/10.1046/j.1479-697x.2003.00004