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Considering Breast-Feeding? This Guide Can Help

San Francisco lactation counselor Caroline Kerhervé — with kids of her clients — during a weekly session of a new mothers' group she coached in May.
Courtesy of Caroline Kerherve
San Francisco lactation counselor Caroline Kerhervé — with kids of her clients — during a weekly session of a new mothers' group she coached in May.

There's a big push in the U.S. from pediatricians to have mothers of newborns breast-feed exclusively for at least six months.

And many new moms want to. But only about 60 percent who start off breast-feeding keep it up for six months or more, according to the Centers for Disease Control and Prevention.

Shots interviewed nearly a dozen lactation consultants, pediatricians and researchers who had tips for women on how to reach their breast-feeding goals. Here's a quick guide to their advice.

1. Expect problems at first

Many people think of breast-feeding as automatic and expect it to be easy, says Caroline Kerhervé, a leading lactation educator and counselor in San Francisco.

"We often think moms and babies will know exactly what to do, and they won't even have to think about it," she says. "Sometimes that happens, but it's not the most common outcome."

Even in traditional societies that don't use formula or bottles, women often struggle to breast-feed, it turns out.

Take for example, Himba moms in the desert of northern Namibia. As we reported Monday on our sister blog Goats and Soda, essentially all Himba mothers breast-feed their babies. But about two-thirds of these women have problems at the beginning, one researcher found. They have trouble getting their baby to latch. They have breast pain and worry they aren't making enough milk. And many, like many women in the U.S., need help and guidance to make breast-feeding work.

So, it doesn't mean you're failing as a mom if you have trouble, Kerhervé says. It means you're normal.

"Most moms need to learn how to position the baby and get the baby to latch onto the nipple," Kerhervé, tells Shots. "This takes — for most moms and babies — about two weeks to get comfortable."

2. Line up a lactation coach, even before the baby comes

Since problems are likely, Kerhervé says, be ready.

Arrange to have somebody who's experienced with breast-feeding present at the baby's birth — or right after the birth — to coach you, Kerhervé, suggests.

This coach can be a friend or a relative, or a professional lactation consultant, like Kerhervé.

"Many women don't know we exist," she says. "They are looking on the Internet, on YouTube about how babies should latch and what to do. But moms really need hands-on guidance."

Many health insurers will cover consultations from lactation consultants, she says. To find one near you, check the International Lactation Consultant Association's website.

And line up that support ahead of time, if you can; life gets even more stressful after a new baby arrives.

"Many families are hiring me for prenatal assessments," Kerhervé says. "I can do a breast exam and anticipate any problems that might arise. Then we can prepare for them — before the mom is overwhelmed."

Because, here's the tricky thing about breast-feeding: Little problems early on can affect the milk supply later. And if the baby isn't latching correctly, Kerhervé says, the infant can damage the nipple.

3. Create your own support network for breast-feeding

"In the U.S., there's a tendency for mothers to feel really isolated and confused about what they're supposed to do after birth," says Aunchalee Palmquist, an anthropologist at Elon University, and a certified lactation consultant.

But being isolated with a newborn is the opposite of how humans evolved, she says.

"Throughout evolutionary history, humans have relied so much on others to share the load of caring for our babies," Palmquist says. "It's one of things that make us human."

Traditionally, new moms — all over the world — have been taught how to breast-feed. They had their moms or aunts or close friends there to help.

Himba moms in Namibia, for instance, usually go to live with their own mothers for a few months after the birth. The baby's grandmother gives the mom 24/7 guidance on how to breast-feed.

And in the Beng culture of West Africa, new mothers are taught by a network of women.

"During the first few weeks, a newly delivered woman — especially a first-time mother ... has a constant stream of visitors, particularly women," writes Alma Gottlieb, an anthropologist at the University of Illinois. "Through them, a new mother is quickly socialized into accepting an almost continual round of breast-feeding suggestions dispensed by more experienced women."

New mothers can replicate that sort of network, Palmquist says.

"Before the birth, I would suggest spending some time with mothers who know about breast-feeding or who are breast-feeding themselves" she says. "Check out a La Leche League meeting or other breast-feeding groups in your community."

Make a list of women you can contact when problems arise. Invite them over to help out a few days after the birth. Even just a few words of encouragement can make a huge difference.

And when you're looking for a pediatrician, check to make sure that doctor is knowledgeable about breast-feeding, Palmquist advises.

"It's important to find a lot of resources ahead of time," she says, before you're sleep-deprived and hardly even have time to shower and eat.

4. Don't sweat a little supplementation with formula

Pregnant women often hear a lot from friends, family and even doctors about the importance of "exclusively" breast-feeding. That's what the American Academy of Pediatrics recommends for the first six months.

But here's a little secret many doctors don't mention: Women all over the world have traditionally supplemented their young babies' meals — and have done so for hundreds of years.

The AAP recommends supplementing only with baby-approved formula. In particular, honey can cause botulism in infants, for example, so do confer with your pediatrician about what's best for your baby.

Still, in other parts of the world the practice of supplementing breast-feeding has been common, anthropologists note.

"Cross-cultural feeding patterns also show that no matter the method or style of feeding, mothers use some sort of supplemental food," Cornell anthropologist Meredith Small wrote in her still popular 1999 guidebook Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent.

"Quecha mothers in Peru ... give the baby tea and broth soon after birth," according to Small. "In India, mothers use a combination of clarified butter and honey to replace colostrum ... The Amele of Papua New Guinea use soup, juice and a mash of bananas and papaya as occasional baby food."

And Himba women supplement with goats' milk if they don't make enough breast milk, anthropologists have found.

Bottom line: Supplementing with formula in no way means you've failed, Kerhervé says.

"I want women to celebrate what their bodies can do," she says. "Maybe they breast-feed 40 percent of the time, or 20 percent. It's all helpful to the baby. Even just a little bit of breast milk."

Copyright 2021 NPR. To see more, visit https://www.npr.org.

Corrected: June 26, 2017 at 11:00 PM CDT
An earlier version of this story neglected to mention that because honey can contain botulism spores, the American Academy of Pediatrics recommends that honey not be given to children who are under 12 months of age.
Michaeleen Doucleff, PhD, is a correspondent for NPR's Science Desk. For nearly a decade, she has been reporting for the radio and the web for NPR's global health outlet, Goats and Soda. Doucleff focuses on disease outbreaks, cross-cultural parenting, and women and children's health.