Who transfers the milk?
The video below is of a baby born at 35 weeks gestation (see a larger and longer version of the video), now 5 weeks old. The mother is breastfeeding and supplementing with a bottle. The video shows that the widely held notion that breastfeeding “tires out the baby” is false. Babies respond to milk flow. In this video, when the milk flow slowed, the baby started to fall asleep and the video starts with the baby essentially asleep and not sucking. When the flow is increased by supplementation with a lactation aid at the breast, the baby wakes up, opens his eyes and sucks vigorously. The video illustrates two related realities:
1. That young babies respond to milk flow and tend to fall asleep when the flow slows (Watch older babies may pull away from the breast when the flow slows) and
2. Babies don’t “transfer” milk, mothers transfer milk. The baby, of course, does his part, which is to stimulate the breast so that the milk flows from the breast to the baby. This is why a good latch helps the baby get more milk. When the baby latches on poorly, the breast is not stimulated well, and milk does not flow well from the breast. But the baby doesn’t “suck the milk out of the breast”.
This baby was not receiving milk well from the breast. To increase the amount of milk he receives, the mother was shown how to latch the baby on with an asymmetric latch. An improved latch and breast compressions resulted in the baby receiving significant amounts of milk.
The above becomes obvious, I think, when we imagine a baby waking up from a sleep and perhaps starting to cry. Many mothers would have a milk ejection reflex (letdown reflex) and the front of their blouse would become wet. So who transfers milk? Obviously, it’s the mother. It is necessary to emphasize that the baby does his part, letting the mother know he’s hungry, but it’s the mother who transfers the milk.
What are some of the implications?
1. Breastfeeding is not tiring for the baby. Babies respond to milk flow. If the flow of milk is slow, the baby tends to fall asleep as in the video. Increase the flow and the “tired” baby suddenly is wide awake.
2. Babies (whether full term, babies with cardiac problems, premature babies) do not use up more energy breastfeeding than they do bottle feeding. It is almost universal thinking at many cardiology units and intensive care units in pediatric hospitals that mothers are told that they cannot breastfeed their babies because the baby will tire out from the breastfeeding and we need to conserve his energy.
3. It is not easier for the baby to feed from a bottle than from the breast. Too often pediatricians, pediatric cardiologists, tell mothers not to breastfeed because it takes too much work for the baby to breastfeed and it’s better to bottle feed.
4. Babies don’t need “strong” muscles in their cheeks to breastfeed. This is said to be one of the reasons that “near term” babies have difficulties breastfeeding. It is not true that “near term” necessarily have difficulties breastfeeding.
5. Babies are not “lazy”. They respond to milk flow. And it follows that normal babies do not have “weak sucks”, unless they are affected by medication or other cause of depression of the nervous system. If the flow of milk from the breast is steady and rapid, the baby will suck just right if he is latched on well.
6. We teach a technique we call “breast compression” to increase the transfer of milk from the mother to the baby. It works very well much of the time. The technique helps the mother transfer more milk to the baby.
7. And why would breast compression help? Because the baby isn’t doing his part as well as he could. And the reason? The baby’s not as well latched on as well as he could be. And why is the baby not latched on as well as he could be?
b. Use of artificial nipples such as bottles and nipple shields and
c. The baby has a tongue tie. Recently we saw a baby of 3 days of age with a very tight tongue tie. Before the release of his tongue tie, the baby was getting almost no milk from the breast. After the release of the tongue tie, the increase in the amount of milk the baby received from the breast was dramatic. For this reason, tongue ties should be released early, before the mother’s milk supply reduces. How I wish we had filmed this baby.
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Copyright: Jack Newman, MD, FRCPC, 2017