Is Breastfeeding Safe?
Why Wouldn't It Be?
Any part of the body can fail to work well. Human reproduction, in particular, contains many complex processes that can go wrong at any point. Consider the fact that about 10–20% of pregnancies end in miscarriage. In nature, about 1% of mothers and 10% of babies routinely die in childbirth. Throughout human history, about 27% of all infants died during the first year of life. Even now, about 10% of babies are born prematurely and rely on modern medicine to live.
How has the human race survived if our breasts don't work perfectly almost all the time?
Although our reproductive systems aren’t perfect, they work well enough to keep the human species alive. Milk production is a natural part of reproduction, but it is not always perfect. Nature also doesn't need to provide the absolute best for your baby—it just needs enough people to survive long enough to reproduce.
What does this have to do with safety?
Newborns are very vulnerable to not getting enough calories and fluids. From the moment the umbilical cord is cut, their bodies are responsible for providing their own energy to live. One of the ways they do that is by showing hunger cues or crying to be fed. If a newborn does not get enough milk from breastfeeding, they use their own stored sugars and fats to provide energy.
Why wouldn't a baby get enough milk from breastfeeding?
Colostrum, the valuable first milk babies get after being born, is primarily about supporting their immune systems, not providing calories and fluids. It has calories and nutrition, but it is usually produced in small amounts, and hospitals don't yet have a way of measuring how much newborns are getting before the milk comes in.
Some babies have enough fuel stored in their bodies to tolerate this typically brief period of underfeeding. Others don’t, and their blood sugar can drop—sometimes to dangerous levels.
Babies that are born early or small may not have enough calories stored, because they:
- missed the last growth weeks of pregnancy, or
- did not get enough nutrients from the placenta
Some babies have higher calorie needs; this is common with:
- larger babies
- babies of diabetic mothers
- babies who have gotten cold or had trouble breathing
- babies who went through long or difficult labors
Crying also burns calories.
Skin to skin contact is helpful for keeping babies warm and comfortable so they don't burn excess calories—but the only thing that provides calories is milk.
Mothers are often told that it's rare not to have enough milk, and they should not worry about it. They learn in their prenatal classes that as long as they get breastfeeding off to a good start after childbirth, and have support for any problems they encounter, they will make exactly what their babies need.
The reality is that mothers often find out the truth when they are at their most vulnerable—newly delivered and 100% responsible for their precious baby's life—that low milk supply and delayed onset of full milk production are not in fact rare; they are common and can afflict any mother through no fault of her own.
How many mothers have low or delayed milk supply?
Since the publication of Prevention of Breastfeeding Tragedies in 2001, lactation experts thought about 5% of women had true low milk supply. (How this was interpreted as “rare,” when 5% means 1 in 20, is somewhat baffling.) Since many more than 5% of mothers report problems producing enough milk, experts assumed that these mothers were just anxious or uneducated about breastfeeding—or that they were using it as a socially acceptable excuse for not wanting to breastfeed. (Really.)
Delayed milk production
Sometimes a mother's milk supply is simply delayed and will increase to fully support her baby's needs. In this study, 44% of first-time mothers had delayed onset of full milk production—but 98.3% had their milk come in by the end of the first week. The Infant Feeding Practices Survey II reported that of 3,019 mothers, 15% of mothers who have had more than one birth and 31% of first-time mothers experienced their milk coming in on Day 4 or later.
You may hear that milk coming in between 3 and 5 days after birth is normal. It is certainly common, but researchers define "late" as >72 hours. This is because by about day 3, babies have burned through all their energy stores (if they had them) and require more food and fluids (milk), or they will start digesting their own bodies to stay alive (called autophagy).
Here is a list of factors that can increase the risk of delays in your milk coming in:
There is also evidence for these additional risk factors:
- complicated or long labor
- large blood loss
- need for blood transfusion
- delayed first breastfeeding
- infrequent or ineffective breastfeeding in the first few days
- nipple pain
- mother–baby separation
Remember that "risk factor" does not mean your milk will definitely be delayed; it means there is a greater likelihood, so be sure to get early help from a lactation consultant if your milk is not starting to come in by Day 3.
Low milk production
Current research has revealed that a much greater number of mothers (estimates range from one in eight to one in seven, or about 12–15%) produce a partial milk supply, no matter how much breastfeeding education and support governments, hospitals, pediatricians, lactation consultants, and random bystanders throw at them.
A 2020 summary of current research stated that "Occasionally, a woman does not experience lactogenesis II [milk coming in] and only produces small volumes of milk (prevalence 5%–8%)."
Five to eight percent. "Occasionally."
The same article also stated that "occasionally" (again?) "strategies described here to improve milk production and transfer are not effective, and long term supplementation with either donor milk or infant formula is medically necessary."
Their conclusion? "Most mothers can produce adequate colostrum and mature milk, and most newborns are able to breastfeed exclusively." #technicallythetruth
But when people hear over and over:
- "most mothers can breastfeed, with rare exceptions"
- "true low supply is rare"
- "most of the time your body makes exactly what your baby needs"
along with gems like
- "breastfeeding is the best gift you can give your baby"
The most important things I want people to know (besides how to keep their babies safe) is that low supply is not the mother's fault, and her worth as a mother is not measured in ounces.
Why have I never heard of this?
I know! It seems kind of important, right?
Mothers talk about it, but like in many other areas of women's health, they are often not believed about what they are seeing with their own eyes—their babies’ hunger, and little or no colostrum coming out. There is a word for that—gaslighting. People will also suggest that low supply is the mother's fault, because she supplemented with formula or used bottles. Well, what was she supposed to do if she didn't have enough milk? (Readers, if you find yourself mentally listing all the things you think she should have done, kindly click here.)
Researchers talk about "perceived insufficient milk supply," a polite yet patronizing way of saying it's all in our heads. This can (understandably) cause mothers to lose trust in the healthcare system for ignoring their concerns, or worse, blame themselves for "failing" their babies. Assuming mothers are wrong about their own bodies and babies can result in deep confusion and distress, and worse, serious threats to their babies' health.
To really be confident and relaxed while breastfeeding, it is important to know if it is resulting in enough milk intake, and what to do if it isn't—not on Day 3, when your baby has lost too much weight—but in the first hours of life. Waiting and seeing is not usually a strategy that parents or babies are comfortable with. (In fact, neither are health care providers—that is why hospitals do daily weight checks, jaundice testing, diaper tracking, logging of minutes on each breast, and sometimes multiple heel sticks to measure baby's blood sugar. Unfortunately diaper tracking and logging of minutes at breast are crude and unreliable measures of milk intake in the first few days.)
If there truly are risks to breastfeeding, maybe I should just formula feed. I don't want to harm my baby!
It is always your choice how to feed your baby, and that choice should be supported and respected. However, human milk does have benefits, and I would still recommend breastfeeding to any family. I made this website to promote safe breastfeeding, because I want parents to be able to do it confidently and enjoyably, no matter how much milk they ultimately make, or whether want to breastfeed exclusively or partially.
As mentioned above, colostrum, while relatively low in amount, calories, and carbohydrates, contains substances that support a baby's newly developing immune system, such as secretory IgA, lactoferrin, and leukocytes, as well as enzymes and beneficial bacteria that help the baby's digestive system develop. Over the first two weeks, as your milk shifts from colostrum to mature milk, you'll see a change from a golden color (from beta-carotene, the same component that colors orange fruits and vegetables!) to a thinner whitish liquid mixed with creamy drops.
Mature milk also contains many ingredients that help prevent infections, such as antibodies that line the upper respiratory and gastrointestinal tracts. (Antibodies also come through the placenta directly into the baby’s bloodstream, which is why doctors recommend mothers be vaccinated while pregnant, and why exclusively formula fed babies also thrive.) There are also other nutritional and bioactive factors in human milk, such as sugars called oligosaccharides, hormones, enzymes, and others, not all of which are understood yet.
Your milk is valuable in any quantity you can or wish to provide. For mothers and babies who enjoy breastfeeding (which may take a good 6 weeks), it's not even all about the milk; it's about the closeness too. Building an entire human, and then nourishing them with your body, feels pretty darn amazing, whether you make one ounce a day or 30.
When breastfeeding is not working so well for a mother or baby, or both, some mothers make the decision to reduce or stop breastfeeding, because it is the right decision for their family. Infant formula (aka science milk) is made to resemble human milk nutritionally and is an excellent option for families that need or choose it. Some mothers find that their bond with their babies improves from bottle feeding; breastfeeding struggles can be so stressful that feedings become dreaded instead of enjoyed.
Whether you choose to get help and persist with breastfeeding to see if it improves (and it usually does), or whether you are feel that formula feeding or exclusive pumping is the best decision for you and your baby, you deserve to be supported and respected. Caring for a baby is hard.
You are also important!
Mothers often put their own needs last. Fathers do too. Your baby will thrive when you both keep yourselves healthy and well rested. How does this relate to safe breastfeeding? New mothers often become so exhausted that they may fall asleep holding their baby in a hospital bed or chair.
It is ok to send your baby to the nursery for a few hours so you can sleep! Rooming in 24 hours a day has not been shown to make a difference in the establishment of breastfeeding. (Hospitals appreciate the opportunity to cut costs on nursery services though.) In fact, it stands to reason that mothers may be more likely to give up breastfeeding if lack of sleep makes it feel unsustainable. Most cultures throughout history in fact, have enforced a rest period of 40 days for new mothers to recuperate from childbirth and establish breastfeeding.
If your hospital does not have a nursery and you don't feel safe being the sole caregiver for your baby due to exhaustion, pain, or narcotic medications, please let your nurse know!
Is this a formula website?
It is not possible to prove a negative. Try to prove that you're not being funded by unicorns. But I will tell you why, despite my support of the product itself, I have nothing but loathing for the companies that supply the majority of infant formulas: Abbott Labs, Nestlé, Danone, and Mead Johnson (Perrigo, the manufacturer of generic formulas, has not committed any violations that I'm aware of). Forty-four years after Nestlé was first boycotted for killing babies in Africa, formula companies are still hurting and killing babies in developing countries.
Even in the US, formula companies exploit families by making unfounded claims that their formulas are "closest to breastmilk," when store-brand formulas are equally nutritious and cost about $1000 less per year. This is leading to many poor families buying brands they can't afford and sometimes watering it down or rationing it to make it last. The only reason hospitals and WIC use name brands is because they can get them cheaply from the companies, who benefit from parents thinking their brand is "hospital-approved."
Please buy generic if you need it (babies usually do fine switching), and stop putting money into the hands of companies who care more about their shareholders than they do about your baby. The savings could start a nice college fund or better yet, pay someone to do your housework while you recover and enjoy your baby!
Still, this is a lot to take in...
I hear you. If all this is true, why haven't you heard about any of it?
Basically, it's because confidence is important in breastfeeding, and no one wants to scare mothers away from doing it. There is a huge worldwide effort to increase breastfeeding rates, because it is healthy and reduces the risk of infections in infancy, as well as having health benefits for mothers.
Those are great reasons to gloss over (or outright omit) information that parents need for their babies' safety, right?
If you want to breastfeed, I am confident you and your baby can do it, no matter how much milk you make, and I believe you have the right to know everything, not just the sunshine and roses parts. Healthcare providers know, and you deserve to know too, so you can protect your baby. Parents are educated on choking, SIDS, and carseat use, not to scare them, but to empower them; you also deserve to be empowered with safe breastfeeding education. Knowing you can meet your baby's needs—no matter what—is the best way to be confident as a parent.
If you are scared by some of what you read, you have every right to be
Parenthood is scary. But breastfeeding is very special for most mothers and babies, and I wholeheartedly believe everyone who wants to should start out doing it; most problems that come up can be solved in one way or another with support—true support, not just support for you to exclusively breastfeed unless there is an immediate medical problem. We need to be preventing medical problems, rather than treating them after they have already happened—like we do in every other area of medicine when possible.
The likelihood is that you will be able to breastfeed your baby, but if biology doesn't fully cooperate with your breastfeeding plan (and it's important to be flexible), know that there are many ways to promote health and happiness for your baby and family. Feeding is important, but love is everything.
So, how do I breastfeed safely?