By BMSG Editorial Committee

Editor’s Note: This article is meant to help mothers recognise errant or misconceived breastfeeding advice that they may receive from individuals who claim to be breastfeeding professionals. Ultimately, we hope this article empowers mothers to discern between well-meaning and problematic advice.

What is a Lactation Consultant?

If you are a breastfeeding mother, chances are, you might have been asked to contact a lactation consultant or LC for short. This is usually the case when a breastfeeding mother is facing challenges that go beyond what a peer counsellor or lactation nurse is able to help with.

In such situations, mothers are strongly encouraged to seek help from a certified lactation consultant. Currently, International Board Certified Lactation Consultants (IBCLCs) are the only breastfeeding professionals who can provide mothers with assistance to more serious breastfeeding issues such as oral restrictions and latching difficulties. IBCLC is also the highest qualification standards for lactation certification globally.

Unfortunately, the term “Lactation Consultants” are not exactly protected. Anyone can call themselves a “lactation consultant” but to become an IBCLC, one would have completed the requirements to be eligible to sit for and passed a rigorous exam, prove continuing education every year and accumulated relevant number of hours before they can legally use the term.

Recognise the Alarm Bells

So if you are meeting someone who claims she is a lactation consultant or a lactation specialist, paying attention to this list of errant comments may help you to decide if the advice you are receiving from the individual is sound:

1. “Your milk is too thin and of poor quality.”

   Breastmilk is made up of many components and unlike commercialised milk or milk powders, breastmilk will separate into many layers when settled. At the start of a feed after a letdown, milk that is expressed from the breast may take a watery texture. It may be natural for anyone who is uninformed to conclude that this is a sign of poor milk quality. But once we understand that milk is made up of part water and part fat, both of which are important as these help to quench a baby’s thirst AND keep them full all in one feed, the appearance of a mother’s milk rarely is any cause for concern. This is akin to the appetiser-main course-dessert analogy where breastmilk fulfils all the necessary nutritional needs for babies.

   If you were to place a bottle of expressed breastmilk and let it stand for a while, you will notice that the breastmilk will separate into layers. The fattier layers will climb to the top (characterised by a layer of fat or oils) and the watery layers will sink to the bottom.

2. “Your baby is too lazy to latch.”

   It must be heart-breaking to know that your baby has been labelled “lazy” at such a young age! Such advice can never be further from the truth. The fact is that a percentage of babies may face some difficulties or challenges to latch, either due to an oral obstruction (tongue ties, lip ties, missing palate etc.) or due to interventions that affect baby’s ability to latch (e.g. using a bottle before breastfeeding is well-established, using a nipple shield or a pacifier very early on in baby’s life, or mum having taken epidural in labour).

   A baby is never lazy! But they can be taught to latch and if they have oral conditions that prevents them from latching well, their situation can be improved with medical interventions. After all, especially for a newborn, breastfeeding requires practice. Some babies may have very small mouths that may need them to put in considerable effort to latch on mummies’ breasts.

3. “You need to pump to see how much milk you are making.”

   Pumping to check your supply is inaccurate as a pump is never able to extract as much milk as a baby can latch. The best way to check your supply is to monitor your baby’s wet and dirty diapers, weight gain as well as level of activity. Pumping too early can also trigger an onset of problems such as oversupply in the early days, which can inevitably lead to complications such as blocked ducts and mastitis.

4. “You must introduce bottles at 3 weeks to prevent bottle rejection.”

   This is not true. Early introduction of bottles (anytime before 4 to 6 weeks) can interfere with a baby’s ability to latch at the breast. Parents should wait before introducing bottles because babies may develop a preference for the fast flow of the bottle. They may also experience nipple confusion where they are unable to latch at the breast or become too impatient to wait for a letdown at the breast. While it is true that breastfed babies can reject the bottle, there are other ways to provide expressed breastmilk (EBM) to babies when the time comes such as when mothers return to work. Alternatives such as cup, spoon, syringe and straw feedings have worked with many babies. Babies can also receive EBM through age-appropriate sippy cups.

5. “Pump after latching to prevent blocked ducts.”

   There is no need to pump after each time you latch your baby. If your baby has emptied your breast during the session, you can continue to offer your baby the other breast at the next feeding session. Pumping unnecessarily after each latch can signal to your body to make more milk than what your baby is actually receiving. This can lead to complications such as oversupply and subsequently blocked ducts and mastitis. If you still feel that your breast is not fully empty after a feed, use breast compressions during the feed to activate the milk flow once you sense it has slowed down. This can be seen when baby falls asleep at the breast. Baby will automatically unlatch or fall into a deep sleep once he or she has received enough milk. Some mothers also hand express the excess milk and store them for later use. As long as your baby is feeding efficiently, there is no need to pump after every latch.

6. “Feed baby on both sides for 15 minutes each.”

   The time that baby takes to feed from the breasts is not important. Latch on demand and allow baby to drink from the breast for as long as he or she wants. Limiting time at the breast (or unlatching too quickly) may prevent baby from getting a full feed from the breast, which may consequently mean preventing baby from getting the fattier part of the milk which is present towards the end of a feed (i.e. an emptier breast). An empty breast also stimulates the brain to urge the body to produce more milk, hence helping to maintain your supply.

Knowledge is Power

With all that has been said, at the end of the day, it would be helpful for mothers to seek evidence-based information and to talk to as individuals as possible before making important decisions for your breastfeeding journey. It can be overwhelming and also demoralising to receive comments that may be far from accurate but knowing how to sieve out errant information and to seek opinions from different sources will greatly help you to decide what is best for yourself and your baby.

A lot of times, advice can be well-meaning. It can also be problematic if it is actually misinformation or does not help you to make a well-informed decision. It is therefore highly important that parents understand the techniques behind breastfeeding and do some fact-checking before arriving at a decision. A wrong move can greatly impact what happens subsequently.

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