[Best of Birthful] What to Expect When Bodyfeeding Your Newborn

[Best of Birthful] What to Expect When Bodyfeeding Your Newborn

Adriana Lozada:

Hey, Mighty One. With nearly 300 Birthful episodes in over five years, it may be hard to know where to begin listening to the show. To make it easier, we’ve put together the Best of Birthful series, which showcases some of our favorite or most relevant episodes. This is one of those. If you enjoy what you hear, make sure you subscribe. It’s free, and that way you won’t miss a thing. Enjoy. 

Today, I’m so happy to have Canadian pediatrician and renowned breastfeeding expert, Dr. Jack Newman on the show. His website is filled with the most amazing resources and free breastfeeding videos, where you can check out, say, the difference between a baby that is eating well at the breast, and another one that is more of a nibbler and isn’t getting that much, or what a really good latch looks like. It is a fantastic resource: ibconline.ca. All right, let’s get to it. Jack, welcome to the show. 

Dr. Jack Newman:

Thank you very much. It’s good to be here. 

Lozada: It’s so good to have you here. So, I figured we’d talk about breastfeeding today. Breastfeeding newborns. But I’d like to backtrack a bit and start when moms are still pregnant, like what are ways for pregnant moms to prepare for breastfeeding to have a successful breastfeeding relationship? 

Newman: Well, Adriana, I think it’s very, very important that mothers get good information about how to get started with breastfeeding, because those first few days after the baby is born are extremely important, and unfortunately most hospitals in North America, in fact around the world, do not really support breastfeeding in the way that it should be done. Too much emphasis is based on weights of the babies, that sort of thing, and too many of the people that work with mothers in the first few days really don’t know very much about breastfeeding, so it’s up to the mother, I’m afraid, to get the information that they need to help them understand how breastfeeding works, that breastfeeding is not bottle feeding through a different sort of bottle that is attached to your chest, but is something completely different. 

And so, but the idea that breastfeeding is, well, just bottle feeding in a different way has got to go out the window, and the mothers need to get this information. And unfortunately, the people, including the nurses and the lactation consultants all too often I’m afraid, and even the pediatricians and neonatologists really don’t understand breastfeeding, and they often, too often, lead the mothers the wrong way. 

Lozada: And I hear that a lot as a doula from my doula clients when I see them postpartum, how one nurse, and that they did see the lactation consultant, and everybody gave them a different information and a different suggestion. 

Newman: Well, if everybody’s giving different information, then somebody has to be wrong, and it doesn’t mean that somebody is right. 

Lozada: Yeah. No, that’s what I mean. It leads to a lot of confusion. 

Newman: Absolutely. 

Lozada: So, you mentioned that the breastfeeding relationship at the beginning, with the people that support moms, are not supporting them… That support is not given, proper support is not given. How should it be supported? What does good support look like? 

Newman: Well, I think that the first thing is that if the mother is concerned about anything, somebody should be there to help her, and I think that somebody should be there to watch the baby at the breast. Somebody who knows what to watch for should be there to watch the baby at the breast. Because even if things seem to be going okay, they aren’t always, and the mother just needs to know, “Here’s how I know my baby’s getting milk.” And if the mother knows how to know a baby’s getting milk, so much is overcome. We have video clips on our website that show even a 10-hour old baby breastfeeding and getting milk from the breast, and how to know that. 

And unfortunately, in hospitals, too many mothers are just being told, “Well, your baby’s lost X% of birth weight, so we have to give the baby formula.” Which is not the way to do it. One needs to be watched. If a mother has any sort of problem, if a mother has sore nipples, somebody should be there helping her with the way the baby is latching on, because breastfeeding should not hurt. 

So, a mother needs help, and she needs help right away, and the red light is, “I’m sore. The baby is spending hours on the breast. The baby is always crying every time I take the baby off the breast.” And if that happens even within a few hours after birth, that should be looked into by somebody who knows what  they’re doing. One of the most important things that needs to be done in the immediate postpartum period, immediately after the baby is born, that baby should be dried and put onto the mother’s abdomen, skin to skin, and the baby should be allowed to crawl up to the breast and latch on all by itself. And if that happens, and it won’t always happen. That’s true. Because so many mothers get medications during the labor and birth and so on. 

But if that baby crawls up to the breast and latches on all by himself, chances are that there will be no problems with the breastfeeding from then on, and this is something that is miraculous, to watch a baby crawl up to the breast and latch on all by himself. This is something that no mother should be prevented from seeing, because it’s amazing. 

Lozada: So, yes. That… It’s sometimes so hard to do, because people want to intervene, and want to rub, and want to touch, and want to adjust, and want to move that poor baby. 

Newman: Exactly. And it’s not necessary most of the time. I mean, we are still mammals, meaning that we’re related to moose, and seals, and elephants, and you know, in the wild, if a baby mammal doesn’t latch on all by himself, well, they’ve gotta do it, don’t they? If they don’t do it, then they will die. And so, it’s something that we have inherited. Just because we’re at the top of the evolutionary scale doesn’t mean that we are no longer mammals, and our babies should be able to do that. 

Lozada: So, Jack, you mentioned you have videos on how to know if a baby’s getting enough milk. Can you describe that a little bit? How can a mom know? I know this is radio, or this is audio, and we can’t show people how, but can you describe that a little bit? 

Newman: Well, okay. I mean, it’s actually once you’ve seen it, then it’s obvious, and that’s why we put on our videos on our website, the first video actually shows a one-month-old baby who is drinking very well, and that’s the name of that video is Drinking Very Well, or Very Good Drinking, or something like that. And it shows that as the baby opens its mouth to the maximum, there is a pause, and then the baby closes. So, one suck is open, pause, close. And you can see that in the baby’s chin. And once the mother knows that, she can figure out what it looks like when the baby is say only five hours old, and sure, the reason it’s not so obvious in a five-hour-old baby is because there’s a lot less milk in the first few days, and that’s the way it’s supposed to be, by the way, and this is a perfect example of how we use bottle feeding as our model of normal. 

We say, “Well, you know, the baby would take half an ounce of formula if we gave it to him, and that means there’s not enough milk.” No, no, no, no. We are overfeeding babies in the first few days, because we think that they need it, but they don’t. What they need is to be at the breast and bring in that milk. And anyway, at five hours the pause is much shorter, but if you look carefully for it, if you know what to look for, you can see it. And if a baby is doing that, then the baby is getting milk. And if the baby is doing it well, then the baby will be fine at the breast with getting only those small amounts of colostrum that the baby needs. 

Lozada: Because their stomach is also so tiny at that point. 

Newman: Well, we don’t know exactly why nature made it so that there’s very little milk in the first few days, but that’s fine. I mean, let’s trust nature. Let’s trust our bodies. And you know, not go the way of, “Oh, we can do it better because we’re smarter.” 

Lozada: Oh, absolutely. 

Newman: We’re smarter than nature. 

Lozada: Yeah. No, no. We meddle with it way too much. So, okay, say a mom is having pain, is having some sore nipples, the baby’s wanting to eat all the time and is fussy and crying. What can be going on or what should moms be on the lookout for or try to do to change that? 

Newman: Okay. Well, the first thing is that the baby is probably not getting a good latch, and there are many reasons for babies not getting good latches. I mean, one is just simply the technique. You know, I mean what happened in the old days? Mothers don’t have to latch on babies the way we teach it, and by the way, we teach it differently than most other lactation consultants, most other people, and I think our approach works better much of the time. I wouldn’t say all the time, but I would say much of the time. And you can see that technique on our website again. 

But the thing is that if the baby has a tongue tie, for example, and there are lots of babies that have tongue ties, then the babies will cause the mother pain and the babies won’t get milk well from the breast. Once the milk comes in and the milk is abundant, then it’s just the baby doesn’t have to have a good latch, although the mother may still have sore nipples. But lots of mothers have breastfed babies with latches that I call suboptimal, and they still do okay, because most mothers, if everything goes the way it should, most mothers, the vast majority of mothers will produce all the milk the baby needs. 

Most of the causes of not enough milk are not due to the fact that the mother is not able to produce enough milk, but due to the fact that we mess her up, give her bad advice, teach her stuff that she shouldn’t really listen to. So, for example, nipple shield. I mean, I hate nipple shields. I know that people think that it saved their breastfeeding in some situations, but to tell you the truth, there’s nothing that a nipple shield does that good technique and good help won’t do. And that’s why I feel that the nipple shields should actually be banned. I think they’re a dangerous product because many babies end up failing to thrive because the babies who are on a nipple shield don’t latch on properly, they don’t get milk well, and they end up with the mother not getting enough milk. 

Lozada: It affects the relationship. 

Newman: I think I went off on another tangent there. 

Lozada: But I gotta tell you, I love your tangents, because you give us so much information in them and bring up these things, because nipple shield, yeah, so that’s something I see often and it’s like the go-to solution almost. It’s like an easy go-to fix. Here, have a nipple shield and this will work. And then moms have to have this thing that’s in the middle of their relationship that they have to figure out how to deal with it and get rid of it, and it’s another obstacle. 

Newman: It is another obstacle and the problem with it is because it decreases the milk that the baby gets, it makes it even harder to get the baby off that nipple shield. And as I say, there’s no reason that I have ever run across where a nipple shield is the best answer. If we can get in there and help the mother with the latching on of the baby, if we can help the mother deal with sore nipples, whatever the cause, then we can get rid of those nipple shields. And even some of the biggest advocates of nipple shields will say that nipple shields, for example, are not the answer for sore nipples. 

Lozada:   you’ve mentioned a couple times the birth weight, so can we talk a little bit about this obsession with birth weight? What is actually normal and what should be expected? Because there is, and again, an obsession with your baby’s lost two ounces, you’ve gained two ounces, you lost it again. That just gives moms lots of guilt and worry. 

Newman: Well, exactly. I think the problem is that basing, especially if we’re talking about the first few days, basing the adequacy of breastfeeding on the baby’s weight loss is completely, completely useless, and wrong, and causes mothers problems. The vast majority of women, we have to admit, in North America, deliver babies in hospital. And the vast majority of those mothers also receive lots of IV fluids during the labor and birth. And what that means is that the babies are… The mothers are born, or sorry, are giving birth, and they end up being overhydrated, right? The mothers often have big, swollen ankles, big, swollen fingers, and they also have extra fluid on board because of all that fluid, and the baby also got a lot of fluid, so he’s born extra heavy. And when he’s born, he pees out that extra fluid, and of course then he loses weight. 

And so, basing the adequacy of breastfeeding strictly on the baby’s weight loss is already a hazardous thing to do, because those babies are losing weight simply because they’re peeing. And there are other issues, as well. And one of those issues is that the baby is born usually in a delivery room, where there’s one scale, and then they go to postpartum, where there’s another scale, and the problem there is that when you weigh babies on two different scales, it’s not accurate. You cannot compare two different scales. So that, for example, we have over our scale in our breastfeeding clinic, we have a photo of a baby who was weighed on one scale and weighed on another scale within a minute, and there’s 12 ounces difference between those two scales. And we have to remember that the scale is not the word of God. It’s made by men and women and it’s not always accurate, and it often hasn’t been calibrated properly or hasn’t recently been calibrated. 

But on top of that, on top of that, we have the problem of the mother being overhydrated. So, not only are her ankles often swollen and her fingers often swollen, but so are her nipples and areolas, and so the baby has difficulty latching on. So, there may actually be a problem. It’s not just a problem of the scale, or the fact that the mother’s gotten so much fluid, and therefore the baby pees it off. I mean, there is also the problem that the baby might not be latching on well, and so the mother gets sore nipples, or the baby refuses to latch on, or the baby latches on in such a way that not only does the mother have sore nipples, but the baby’s not getting the colostrum. And so, we really, really have to do something, and I think the answer is that we need to avoid too many interventions during labor and birth. 

I mean, I’m not saying that every mother should be able to birth her baby without any interventions, or pain relief, or whatever, but many mothers could do it if they had the support, and the fewer the interventions, the more likely the baby is to get started with breastfeeding really, really well. 

Lozada: So, I’m curious. Because a lot of moms are getting all this extra fluid and babies are having… So, you have that situation. Extra fluid and babies are having difficult latching on because of swelling in the breasts, in the areola. What is a mom to do? 

Newman: Well, the first thing is to… If she does not feel, if she’s gotten the information, she knows when a baby is well latched on and when the baby is actually getting milk from the breast, and she feels that’s not happening, she should be able to get help from the staff on the postpartum ward. And that’s where our whole system fails, because even if a mother is aware of what’s going on, a mother often doesn’t get the help that she needs. And I think that what really needs to be done is the mothers have to put in the extra effort, and unfortunately the extra money, and say, “Look, I want to birth with a doula.” That’s a plug for you, but I agree with you. And also, with somebody who really knows about breastfeeding, and that does not come from hospital staff. 

Even lactation consultants in hospitals sometimes are sort of stymied by the policies that the pediatricians, who know nothing about breastfeeding, and other staff, who often don’t know much about breastfeeding, they put these policies in place, and the lactation consultant, even if she really knows what she’s doing, which I have to say is not a lot of the time. But even if she knows what she’s doing, she’s stymied by these policies that say, “Oh, the baby lost 10% of his birth weight. We have to supplement.” And so, she goes out on a limb to help that mother, because she can, because now she’s gotta give the baby formula. And that’s according to the policy. 

So, if I were a woman who felt that she had to deliver a baby in hospital, I would hire a doula, and I would hire a lactation consultant who really knows what they’re doing. The question, of course, is how do you know they know what they’re doing. That’s a very, very difficult problem to know. 

Lozada: What would you… When do you, or I guess not specific to weight, but what makes you alarmed? What, not just 10% weight loss, but what makes you think, “Hey, no, we do actually have a real big problem here that needs to be addressed.” 

Newman: Well, again, I watch the baby at the breast. I help the mother with the latching on. And sometimes the hands on. I don’t sort of do it at the end of the table or the bed, and I do that, and if the baby still is not drinking well, if the mother’s still having pain, then we have to go to the next step, which is maybe we do have to supplement the baby. But we do not supplement the babies with bottles, or cups, or finger feedings unless the baby does not latch on. If the baby is latching on and the baby really in my opinion needs to be supplemented, then we will do it, and we will do it with a tube at the breast with what I call a lactation aid. It’s done at the breast and it allows the baby to stay at the breast, to continue breastfeeding and get milk from the breast, but at the same time, the baby gets supplemented. And in the first few days, most babies, the vast majority of babies do not need formula supplementation. What they need is just a little bit of extra fluid, and that extra fluid can be just plain glucose water. 

I know, I know, people say that that can’t be done, but I’m telling you it can be done. And it’s been done since… You know, it’s been done for years, before about 20 years ago when everybody said, “Oh, it’s gotta be formula in the first few days.” No, it doesn’t. 5% glucose water contains nothing that isn’t in breastmilk, whereas formula contains all sorts of stuff that’s not in breastmilk, and breastmilk of course contains lots of stuff that’s not in formula. 

Lozada: So, the tubes, they’re just… Can you describe them a little bit? 

Newman: Well, we have a video on our website, too, that shows what’s called Inserting Lactation Aid. And the tube is… You don’t see the container that contains, in this case it does contain formula, because the baby is… I can’t remember. I think is about four or five weeks old. But it does contain formula, unfortunately. The mother’s been using it for most of the time the baby was born. And so, we have a container. It has a supplement. In some cases, it’s the sugar water if the baby is under three or four days of age. It’s formula if the mother doesn’t have any expressed milk, or it’s her expressed milk, and in some cases it’s donated breast milk from a human, milk for human babies. 

So, we have the container, and from the container there’s a tube that is a long, flexible tube that enters into the baby’s mouth while the baby is on the breast. And I would recommend that people go to our website and see that one. It’s called Inserting Lactation Aid. Because it also shows how to avoid bottles, finger feeding, spoon feeding, cup feeding. Any feeding off the breast is not as good as breastfeeding and supplementing at the breast. 

Lozada: So, basically to summarize, if a mom is having any kind of pain and the baby is not latching well, then no matter what kind of advice that mom has gotten, the idea is that she continue looking for better advice. 

Newman: Absolutely, and the sooner, the better. I mean, what is so discouraging for us when we are at the clinic is that we see so many mothers who are coming in for the first time to see us six weeks after the baby is born, or even longer than that. I mean, I believe very strongly. I mean, a lot of these mothers get a lot better. The pain goes away, we manage to fix the insufficient milk supply and all the rest of the stuff that they’re coming in for. But boy, it would have been so much easier if we had seen them when the baby was five or six days old instead of six weeks, or eight weeks, or ten weeks old. 

Lozada: Because then the problem has snowballed from maybe a bad latch to bad latch with milk supply problems and transfer problems, would you say? 

Newman: Exactly. 

Lozada: Yeah. So, moms need to get there and quick, and know that their intuition… It shouldn’t hurt, and if it’s hurting, then keep at it. Keep working instead of just, “Oh, the doctor just said I need to supplement.” 

Newman: Yeah. Just tough it out. Yeah. Just tough it out. I mean, and I have to say that if pediatricians are honest, they will admit that they learned absolutely nothing about breastfeeding in their entire training. Most pediatricians wouldn’t know a good latch if they fell over it. They wouldn’t know if a baby’s getting milk. And they often don’t even want to know, and many pediatricians and family doctors, I’m talking about everybody. Obstetricians, as well, get most of their infant feeding information from formula companies. 

Lozada: And that’s what makes it the normal. 

Newman: That’s what makes it the normal and that’s what makes it so wrong, because feeding a baby formula in a bottle is nothing like breastfeeding, and I don’t care how many people are gonna write in and say, “Dr. Newman is anti-bottle.” Yes, I am actually anti-bottle, and unfortunately, and I should put this to anybody who is listening, is that what’s the one thing that will make breastfeeding work better in the United States is that women get decent maternity leave. It’s appalling. You’re probably amongst the worst in the whole world with regard to maternity leave, and the people that are most against extending the maternity leave are those politicians who never stop talking about family values. It’s appalling. 

Your northern neighbor, that’s Canada, mothers have one year maternity leave. And if that’s the case, they never need to use formula. They never… Well, I mean unless they’re having difficulties with breastfeeding, but if they’re breastfeeding fine, they never have to use a bottle. They never have to use formula. They just… They never have to pump, for goodness sakes, because a one-year-old baby will breastfeed when mother’s there and eat solids when the mother’s not there, and drink from an open cup. It’s just a whole different situation. And we’re not even the best in the world. There are countries where mothers get three years maternity leave and stipulations such as a breastfeeding mother in the first three years of life, even if she returns to work before three years, is not allowed to do night shifts, for example. 

Lozada: Yeah. We agree that our maternity leave is appalling, and on top of that, it’s unpaid leave. 

Newman: That’s right. That’s right. 

Lozada: One last thing before we go that I wanted to, because I see this being another just as obsessive as the focus on the weight leading to formula feeding, the issue of jaundice. If the baby develops jaundice, that makes him or her a little more sleepy and has a hard time… What is your best recommendations for moms who have a baby that has jaundice? 

Newman: Everything I just said. The thing is if a baby gets higher than average bilirubin levels, that’s what causes the jaundice is the bilirubin, in the first few days, it’s usually because the baby’s not breastfeeding well. So, the baby doesn’t need… And we sort of get this idea that formula is the answer to everything. So, the baby gets formula, the jaundice decreases, right? But  that’s not because there’s something magical about formula. It’s because the baby wasn’t breastfeeding well enough, and so the first thing to do is not give the baby formula. The best first thing to do is to get that baby breastfeeding well. 

In fact, there is at least one study that came from Italy that showed that breastfeeding babies actually have lower bilirubins in the first three days after birth than formula-fed babies, and that’s because breastmilk is a laxative and makes the baby poop more, and the bilirubin that ends up normally in the gut is pooped out instead of being reabsorbed into the baby. So, if a baby is breastfeeding well, then it doesn’t matter if the bilirubin is whatever unless it’s caused by something like a breakdown of red cells. That’s a whole different story. But if it’s… The vast majority of babies who have a little bit of jaundice after birth, it’s because they’re not breastfeeding as well as they could be. 

The long-term issue of a baby who’s breastfeeding exclusively and say at a month has a bilirubin of… I don’t know, 10, or 11, whatever. Say even higher. 15. If that baby is breastfeeding exclusively, and gaining weight well, and there’s no… and drinking well from the breast, and there’s no obvious reason why this baby should have a higher, that sort of bilirubin, then it’s normal. It’s normal for exclusively breastfed babies to be jaundiced. Not just for a few weeks, but actually for three or four months. We have to make sure there’s no liver disease. We have to make sure that the baby’s not hemolyzing, that is breaking down red cells, but it’s normal to be jaundiced, and we know now that bilirubin is an antioxidant. 

Everybody is hot on antioxidants and so again, this is an example of we use the formula-fed baby as our model of normal, and formula-fed babies are rarely jaundiced at a month, say, but breastfed babies are not infrequently jaundiced at a month. So, who’s the normal baby? The normal baby’s the one that’s drinking what normal babies are supposed to be drinking, and that is breast milk. 

Lozada: Thank you, Jack, so much, for being on the show today. This has been great. 

Newman: Thank you Adriana. 

Lozada: You’ve been listening to a Best of Birthful episode and there are many more where this came from. Look for episodes with the words Best of Birthful in the title to continue your deep dive to inform your intuition. You can find the in-depth show notes for this episode at Birthful.com. You can also connect with us directly on Instagram. We’re @BirthfulPodcast. 

Birthful was created by me, Adriana Lozada, and is a production of Lantigua Williams & Co. The show’s senior producer is Paulina Velasco. Virginia Lora is the managing producer. Cedric Wilson is our lead producer. Thank you for listening to and sharing Birthful. Be sure to subscribe on Apple Podcasts, Amazon Music, Spotify, and everywhere you listen. Listen every week for more ways to inform your intuition.   

CITATION: 

Lozada, Adriana, host. “[Best of Birthful] What to Expect When Bodyfeeding Your Newborn.” Birthful, Lantigua Williams & Co. August 31, 2022. Birthful.com.