Breastfeeding comes with no shortage of rules, from pumping and dumping after a drink to massaging a clogged duct. But according to Dr. Katrina B. Mitchell, much of that familiar advice isn’t actually supported by what we now know about breast anatomy and physiology.
A breast surgeon, international board-certified lactation consultant, and perinatal mental health provider, Mitchell brings a rare combination of expertise to breastfeeding care. She is also the founder of Physician Guide to Breastfeeding, a widely used evidence-based resource for parents and healthcare professionals. Her new book, Go With the Flow, out today, takes on some of breastfeeding’s most persistent misinformation. We asked her to break down eight myths new moms can stop believing.
+ You can’t drink alcohol while breastfeeding.
New research shows that even binge drinking is unlikely to result in any significant blood level of alcohol in an infant. This is because the baby consumes a fraction of the volume of alcohol that mom does (for example, 1 ounce, not the entire beer) and then has to metabolize that through his stomach, gut, liver, and into his bloodstream, after the mom’s stomach, gut, liver, and bloodstream have already done the same. The main issue is being too drunk to hold your baby and nurse. But if you’re on a getaway without baby and planning to pump and dump, save that precious milk instead.
+ You also can’t drink caffeine while breastfeeding.
This myth is particularly painful for exhausted new moms craving a badly-needed pick up. Unless you’re pounding countless uber-high-caffeine energy drinks a day, caffeine (even on the high side of coffee consumption) is safe. While there is some very minor transfer into breastmilk, like alcohol, the amount isn’t clinically significant.
+ Use heat to treat mastitis or a “clog” of milk in your breast.
It’s impossible to get a discrete “clog” of milk in the ducts of your breast. Milk is stored in milk-making cells, not ducts. You have billions of microscopic ducts in an interlacing, cobweb-like design, not a few straws that form cysts that need to be melted, or squeezed out or popped. When you get swelling and redness in your breast, it’s from a lot of blood flow in the area – not a stuck “clog” of milk. Like you would for a sprained ankle or after surgery, ice continuously to reduce the swelling and pain.
+ You need APNO for your nipples.
APNO (all-purpose nipple ointment) is an expensive, compounded product that contains an antibacterial, antifungal, and steroid component. But the nipple is one of the last places on the body where a fungal or bacterial infection wants to occur. Steroids can be dangerous if used for long periods of time. Women deserve better. No man would tolerate an APPO—all-purpose penis ointment—and we should not consider APNO acceptable for our bodies either.
+ Bras cause mastitis.
Bras do NOT cause mastitis. It’s like saying that a tight belt causes an intestinal obstruction. The bra myth too often results in moms’ experiencing unnecessary neck pain, back pain, aching breasts, redness, and swelling. Likewise, you do not develop mastitis because your posture was wrong, you were wearing a seat belt, you slept on your side at night, or you used a carrier for your baby.
+ Massage helps “unclog” a “plug” of breastmilk.
The idea of massaging a lactating breast is probably the most dangerous concept in lactation, and one that persists in all corners of the internet. Massage leads to the worst breastfeeding complications: mastitis and even abscess if you’ve massaged those delicate cells and blood vessels into a literal breast soup. All you need is ice and to treat your breasts gently like you would any other spot in your body that is irritated.
+ Milk stasis causes mastitis.
The milk stasis myth causes people to pump frantically, heat, and massage, which often ends in mastitis, galactoceles, and abscesses. Women have been taught that breastmilk forms a cesspool of infection if they don’t regularly “empty” their breasts. But remember that we do not need to eat on a schedule to prevent a gallbladder or stomach infection. We don’t experience an intestinal obstruction from fasting. Our bodies are designed to accommodate variability in feeding patterns, and we up and downregulate blood flow and secretions in response to fluctuating stimuli. Trust your body, not the lactation industry.
+ A “yeast infection” is the cause of your nipple’s pain, itching, redness, or rash.
Yeast grows problematically in very specific parts of the body (generally the vagina and esophagus), NOT in your breast or on your nipple. Excruciating, toe-curling, razor-blade-like or shooting, shocking pain? That’s nerve pain that can be treated by certain types of medication (NOT anti-fungals). An itchy, flaky red rash is most likely dermatitis (eczema) that resolves nicely with stopping exposure to a specific allergen (for example, lanolin nipple balm) and a short-term prescription steroid cream.
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