A few days ago, I posted some true-false questions about breastfeeding. Here are some more. Test your knowledge-- or learn about this important human function, if you've never studied it.
1. Mothers start to lactate (produce milk in the breasts) as a result of changes in hormones following childbirth. True or false?
Only partly true. Although it is easier for women to begin to lactate when they have recently given birth, the major cause of lactation is the stimulation experienced when the baby sucks. Quite a few years ago, I did a study with Ruth Russ, a nurse, of the timing of the beginning of lactation. We found that a major factor was the mother's experience with the baby's sucking. The timing of the first experience-- the first time the baby was put to the breast-- was strongly related to the timing of the beginning of lactation. The sooner after birth the baby was allowed to suck, the sooner the mother's milk "came in". For most mothers whose babies were put to the breast within the hour after birth, milk appeared by the end of the second day after the birth. For mothers whose babies did not nurse until 24 hours after birth, the appearance of milk was delayed until as long as 7 days after the birth.
Of course, to evaluate this research evidence, we need to think why some mothers and babies had one experience, and others had a different one. Some babies with delayed nursing might have been sick or had a rough birth experience, and if they sucked weakly they might not have stimulated the mothers' nipples effectively. That would mean that that other factors caused both the timing of the first nursing and the timing of the milk "coming in", rather than the first timing being the cause of the second. Ruth Russ and I weren't in a position to collect all that information, so we can't say for sure why the results turned out the way they did. However, it did appear that factors other than a simple hormone change were at work here, because the hormone change was the same for everyone, but the timing of lactation varied.
2. Milk is milk is milk; whenever a baby gets fluid from its mother's breast, it gets the same substance. True or false?
False; there is a lot of variation in the fluid secreted by the breast. When the newborn baby is first put to the breast, no true milk is yet being produced. Instead, the baby sucks colostrum, a sticky, transparent yellowish fluid that contains a large and useful dose of antibodies to protect against certain kinds of infection. There is only a small amount of colostrum, but it is extremely helpful in protecting against stomach and intestinal infections and preventing the diarrhea that can rapidly dehydrate and even kill a young infant.
After at least a day or two, true milk begins to be secreted. Human milk is a faintly bluish white in color (not all milks of all species are white) and is more opaque than the colostrum was. But even the true milk varies in color and density, with the milk obtained early in a feeding session (foremilk) thin and translucent, and the hindmilk, produced later when the baby has sucked longer, thicker and more opaque.
3. Because it's easier to suck from a bottle than from the breast, it should be simple to wean a baby from the breast to a bottle at any time. True or false?
This is false after the baby is 4-6 weeks old. In the early weeks, babies are willing and able to suck on almost anything, but they gradually develop specialized, efficient ways of sucking at the breast. These don't work well with the bottle, and the baby shows strong objections to food in the wrong "container", even if the bottle contains its own mother's milk. If babies have no experience sucking a bottle in their early lives, it may be extremely difficult to move them away from breastfeeding until they are old enough to use a cup.
Babies are creatures of habit and don't easily give up, even if they are starved. An acquaintance of mine had to nurse lying down for the first weeks because of a back injury-- when she recovered, the baby had decided that lying down was the only way, and that was that for the next 10 months!
4. A woman cannot breastfeed a baby unless she has been pregnant and given birth recently. True or false?
Surprisingly, this is false-- although no one would claim that is a simple matter to start lactation without pregnancy hormones to help. Different species of mammals are different in this respect. Cows must have given birth to "freshen" and produce milk, but goats, like humans, are "virgin milkers" and will eventually respond to infant sucking by producing milk ---"eventually" being the operative word. Humans can do "adoptive nursing" by techniques that allow the mother enough breast stimulation to begin lactation, but keep the baby fed in the meantime.
An important point here is that a mother who has weaned her baby from the breast and had her milk dry up can re-establish the milk supply by letting the baby suck again-a process called "relactation".
