Most women don’t produce enough milk.

The vast majority of women do produce just the right amount of milk for their babies, no supplementing required. However, it is a common fear among moms that their babies are not getting enough milk. Out of a desire to ensure the very best for our babies, we try to control and manage even natural processes that function best when not micromanaged. If your pediatrician is concerned about your baby’s slow weight gain, ensure that your doctor is referencing the World Heath Organization’s (WHO) Breastfeeding Infant’s Growth Chart (not the Centers for Disease Control and Prevention’s (CDC), which is based on formula-fed infants).^{5, 30} You can spend more time skin-to-skin, drink plenty of water, and offer the breast frequently to encourage feeding. You can also meet with a quality lactation consultant at a breastfeeding support group or in a private consultation. There are many avenues you can pursue for stimulating more production. But the best thing you can do is relax and trust in your body.

If you can’t produce enough or any breastmilk for your baby, formula is your only option.

There are some amazing mamas out there who donate their excess breastmilk. You can go through a milk bank or join a direct milk sharing organization.⁹ A milk bank processes and screens their milk. This process kills some of the living components of the breastmilk, and milk banks tend to be pricey. With direct milk sharing, you are using milk that that mother is feeding her own baby (can’t get much better of an endorsement than that) and you can flash boil the received donated milk in a process that would kill even HIV.

You know the milk you buy from the grocery store is a cow’s breastmilk, right? It comes from a dirty, stinky farm animal and is tailor-made for baby cows. My breastmilk is tailor-made for baby humans. Were I overproducing with a stockpile in the freezer, I would happily donate that extra breastmilk to an under- or non-producing mom or dad. We transplant organs, we transfuse blood, we share milk.

Cross nursing can also be a good resource among close friends. Need to leave your baby with a mama friend for a few hours? She could nurse your baby alongside her own and vice versa.

Pumping will show me how much milk I am producing.

Pumping is not an accurate indicator of how much breastmilk your baby is receiving. Pumps are not babies and your brilliant breasts know the difference. Instead, weigh your baby before a feeding, then after (you can stand on your scale and subtract your baby’s weight from your own) and you will get a more accurate picture.

Larger breasts produce more milk.

More breast tissue (fat) does not equal a greater volume of milk glands.⁶ A woman with larger breasts can have a low supply and a woman with smaller breasts can have an over supply. If you do have a smaller milk storage capacity, your baby will likely just feed more frequently. My very humble breasts “rocked the Casbah,”¹⁰ exclusively breastfeeding three babies on cue for a combined ten years and counting. Have I mentioned that my first and third babies were 20 pounds at 3 months old?

Breastfeeding is more work.

Breastfeeding is the lazy mom’s best friend! My formula-feeding friend might have to wake up at 2 a.m., walk to the kitchen, take out a bottle and sterilized artificial nipple, get the formula, mix formula with water, heat it, feed the baby, put the baby back to sleep, go back to the kitchen and wash the dishes. I roll over and he opens his mouth. Done! I can make milk and feed my baby while I am sleeping. No bottles to wash, no artificial nipples to sterilize, no formula to buy (a hefty expense). I open my shirt and snap down my bra—lazy mom’s dream come true.

It is easier to bottle-feed in public.

Think about all the gear required to bottle-feed out in the world that you must carry with you at all times: bottle, artificial nipple, cap, formula container with formula, purified water, and a means to heat that formula once mixed. Again, the breastfeeding process consists simply of opening the shirt and bra you are already wearing. Read the Nursing in Public chapter of the Sage Breastfeeding book for more on this topic.

You can’t leave the house if you breastfeed.

This is terrible advice. I love my house, but no matter how lovely, I still wouldn’t want to be imprisoned in it. You absolutely can and should leave the house. Breastfeeding is extremely society friendly. It keeps babies content and happy while being extremely convenient. Lunch is always ready at Mama’s Milk Diner. Again, read the Nursing in Public chapter of the Sage Breastfeeding book for more on this topic.

You can never leave a breastfeeding child.

While the supply and demand system of breastfeeding does function optimally when mother and baby are together, you are free to separate as much or as little as with a formula-fed baby. Pump some milk into a bottle with a simple hand pump. You have just as much or as little freedom of independence as any new mother.

A breastfeeding mother can never consume alcohol.

The greatest risk posed to an infant with an intoxicated mother is being dropped or suffocated due to Mom’s loss of motor coordination. Alcohol content in breastmilk mirrors alcohol in blood. This means that as your liver processes the alcohol, your milk gets sober too.⁷¹

I have to quit breastfeeding to take a medication (my doctor told me so).

I strongly encourage you to check every medication you are prescribed in Dr. Hale’s book Medications and Mother’s Milk, with the Infant Risk Hotline, or on the LactMed app.^{73, 74, 75} It’s a simple matter of looking up the medication prescribed and checking the safety rating. If only I could get these resources into the hands of every physician so they would stop telling nursing women to prematurely and unnecessarily wean to take medication that is actually safe while breastfeeding.

Breastmilk and formula are comparable.

Not even close. Breastmilk is full of antibodies, hormones, anti-viruses, anti-allergies, anti-parasites, growth factors, and enzymes completely absent from formula. Formula-fed babies are at greater risk for ear infections, respiratory infections, meningitis, diarrhea/constipation, pneumonia, Sudden Infant Death Syndrome (SIDS), and of developing obesity, diabetes, asthma, allergies, cancer and a lower IQ.^{11, 12} And newly researched benefits of breastmilk are discovered every day. Formula companies try to duplicate the ingredients but they just can’t even come close. Looking at a complete list of known ingredients, the formula column pales in comparison.¹³

It’s a good idea to keep that free formula sample—just in case.

“Research shows that the main factor in continued breastfeeding is whether a woman exclusively breastfeeds at the hospital or not . . . ‘Formula samples received from a medical facility signals to the mom that formula feeding is medically endorsed’ . . . 16.4% of American mothers exclusively breastfeed for at least six months.”⁶⁵

Throw it away. The numbers are clear: If a family is given and accepts a free formula sample, Mom is less likely to successfully breastfeed. You will likely turn to the formula instead of breastfeeding support during any challenges along your breastfeeding journey.

If you choose to breastfeed, you need to supplement with formula and vitamins for your baby to receive all the proper nutrients.

Unless your baby has been identified as having a specific problem for which a specific supplement has been recommended, breastmilk is all your baby needs. If a specific recommendation is made, I urge you to thoroughly research outcomes and make informed choices for your baby.⁸

Breastfeeding comes completely naturally.

Some aspects of breastfeeding knowledge fall into the innate column. For example, newborn infants will use their stepping reflex to make their way up Mommy’s body toward the bull’s-eye created by the enlarged areola and darkened nipple and start sucking as the nipple triggers their rooting reflex. Some aspects of breastfeeding are learned, like positioning and optimal latch. I once read a fitting metaphor comparing breastfeeding to riding a bike. You live your life having never seen anyone ride a bike (or while they rode they were covered from the neck down by a blanket) or receiving any instruction, and on the day your baby is born you are given a bike and pushed down a hill. If we do not grow up with breastfeeding role models around us (read the Nursing in Public chapter of the Sage Breastfeeding book for more about the importance of breastfeeding in public for normalizing breastfeeding) nor receive any formal education on the process, the chances for successfully reaching our breastfeeding goals are low. And that’s not even taking into account the forces of an unsupportive society and targeted formula marketing. Breastfeeding is natural and once you get your riding legs, it feels natural.

You are a failure as a mother if you cannot or do not breastfeed.

Babies are supposed to be born the way Mother Nature intended: through the birth canal. Sometimes physical conditions arise in which a vaginal birth is physically not a safe option. Thankfully, under those circumstances, we have surgical technology and skilled doctors available to us to perform c-sections. The same can be said of breastfeeding. Babies are supposed to be fed at the breast with breastmilk as Mother Nature designed. Many mothers who formula-feed do so as a result of a lack of support and dedication. Sometimes, on rare occasions, conditions arise in which breastfeeding is not an option, even with all the supportive forces in the world. Thankfully, under those circumstances, we have donated breastmilk and/or formula to feed our babies. Gratitude and pride is what I feel toward women who are able to take what they have been dealt and utilize the resources at their disposal to make the best choices for their babies with peace and confidence. To be clear: you are not a failure.

If your milk doesn’t come in right away, you won’t produce any.

I had a friend who, after the premature birth of her baby, was told by the hospital’s lactation consultant that if days after her traumatic surgical birth she wasn’t producing milk, it would never come in, and she needed to let it go. Insert my dropped jaw here. Thankfully, she was educated and experienced enough with breastfeeding (and had me yell texting with her husband) to stick with it, and over a year later, she is still enjoying a perfect breastfeeding relationship with her baby.

Your body makes your baby’s first milk, colostrum, while you are pregnant. It usually takes three to four days for your milk to surge in volume, but it can take up to a week.⁷ All of those attachment-promoting behaviors involved in kangaroo care (keeping Baby skin-to-skin on your chest) can help to bring your milk strongly and quickly.

Baby has acid reflux if they cry, spit up, and don’t sleep through the night.

Your baby is a human infant if they cry, spit up, and don’t sleep through the night. This is an issue that has begun to weigh heavily on my mind, as there is suddenly a huge spike in the number of babies in my Sage Baby classes that are on acid reflux medications. Babies are being diagnosed with acid reflux and put on serious medication (an off-label use) that has significant side effects (for example, food allergies) when parents present their infants to the pediatrician with symptoms of crying, spitting up, and not sleeping enough (all of which are normal symptoms of infancy, in varying degrees), looking for their baby to be fixed. Studies are showing that while the PPI’s (proton-pump inhibitors) are reducing (healthy) acid content in the stomach, they are having no effect on the presenting symptoms. As one doctor puts it, “We are medicalizing normality.” This is not to say that there are no legitimate cases of GERD (Gastroesophageal Reflux Disease), but it is vastly over diagnosed and over medicated.³⁵

There is nothing you can do to help a baby with a troubled tummy.

Learn how to properly massage that belly in an infant massage class like Sage Baby!⁴⁴ I like to tell parents that any compassionate touch is good touch, and if Baby is happy and you are happy, then you are doing it right. The only exception to this is over the belly because you have to move in the directions of digestion to really move things through and pick up the efficiency of the digestive system. Once you learn the proper strokes (think clockwise and down), you can move through a week of constipation in one fell swoop, and you can work out a gassy tummy with nothing more than your loving touch. It’s an incredible and powerful thing.

The other suggestion I have for a little troubled tummy is to wear your baby chest-to-chest. Babywearing in this position keeps your baby upright (keeps things moving down), applies comforting pressure to your baby’s abdomen, and provides rhythmic movement (works out obstructions), all while in your loving embrace and providing you the convenience of mobility and free hands.

Could your baby have sensitivity to a food in your diet? “If a breastfed baby is sensitive to a particular food, then he may be fussy after feedings, cry inconsolably for long periods, or sleep little and wake suddenly with obvious discomfort. There may be a family history of allergies. Other signs of a food allergy may include: rash, hives, eczema, sore bottom, dry skin; wheezing or asthma; congestion or cold-like symptoms; red, itchy eyes; ear infections; irritability, fussiness, colic; intestinal upsets, vomiting, constipation and/or diarrhea, or green stools with mucus or blood.”⁴⁷ Food allergies in a breastfed baby are not a death sentence for breastfeeding. If you suspect a particular food as the culprit, for example dairy, which is the most common food allergy for the breastfed baby, completely eliminate it from your diet for two weeks. If your baby’s symptoms go away, then stay dairy free. If they persist, eliminate the next suspect for two weeks.

You must work to ensure a proper foremilk/hindmilk balance.

Foremilk is the milk that is sitting at the forefront of your breasts and is consumed by your baby at the start of breastfeeding, which is typically higher in sugar and water content. Hindmilk is the milk further back in the breast, which is typically higher in fat and protein content (looks creamier). Nurslings thrive on a mixture of both and there is absolutely nothing that the typical mother needs to do to ensure an ideal mix. No, you do not need to do anything to ensure a proper foremilk/hindmilk balance.

If you are engorged with an over supply and your baby has explosive, foamy green poop along with gas, bloating, abdominal distention, or reflux, then you could have a foremilk/hindmilk imbalance. For most, this means your baby is getting mostly foremilk and is full before getting to that hindmilk. Thankfully, the treatment is harmless and easily tried to see if it alleviates your baby’s gastrointestinal discomfort. The first strategy is to breastfeed your baby on the same side for every feeding in one day and pump the other side. Then switch the next day (block nursing). The second strategy is to simply pump n’ dump for a few minutes before breastfeeding your baby. Try this for several days and see if it makes a difference. If it does, then continue until you balance out (and you will eventually achieve balance). If not, then it is probably not a case of a foremilk/hindmilk imbalance and you may want to consider eliminations from your diet to check for potential allergies.⁴³

An improper latch means you must quit breastfeeding.

If you are struggling with an ineffective and painful latch, I urge you to seek the help of a lactation consultant (IBCLC (International Board Certified Lactation Consultant)). One note on lactation consultants: some are amazing and some are not. If the first does not provide the support you need, get some recommendations and try another. It is worth it. You can also find significant help at a breastfeeding support group. Many are even no or low cost.

One common cause of latch problems is a tongue or lip tie (which can be diagnosed by an IBCLC). A tongue tie exists when the frenum is attached too far toward the tip of the tongue. This causes limited mobility of the tongue, which is a main player in the act of breastfeeding (as the latch is actually created with the tongue, not the lower lip). A lip tie exists when tissue connects the upper lip far down the gum line where the upper teeth will eventually emerge. A lip tie prevents the upper lip from opening wide enough to maintain a good latch. In both cases, a pediatric dentist or ear, nose, and throat doctor can release the tie by cutting or with a laser.⁴⁶

Sleep training does not affect breastfeeding.

Night waking from hunger is not a behavioral issue; it is a physical need. You cannot teach your baby to have a bigger stomach. At one month of age, your baby’s stomach is still only the size of an egg.³⁶ This means that they cannot store enough milk to last all through the night. So if you’re sleep training, you are forcing your baby to sit in a torturous state of hunger for a prolonged period of time, which can have significant consequences for overall health from lack of nutrition, such as Failure to Thrive (FTT). You are also damaging the foundation of trust (communication yields response) that is essential to the cooperative breastfeeding relationship (demand yields supply). In addition to the negative effects on Baby’s end of the breastfeeding relationship, there is a significant pitfall for you as the milk producer: Breastmilk production is highest at night, so skipping the night nursing will significantly reduce your overall milk production.

You cannot breastfeed if you have had breast augmentation.

Yes, you can breastfeed if you have had breast implants or a breast reduction. A lot of the specifics depend on your particular situation, so do some homework to see how you can overcome your specific challenges.⁴⁵

Dad won’t be able to bond with the baby if you breastfeed.

There are so many ways in which Daddy can bond with his baby: kangaroo care, babywearing, infant massage, singing and dancing with Baby, responding sensitively and consistently to Baby’s cues, bathing with Baby, etc. To say that a daddy cannot have a strong bond with his breastfed baby is completely false. My husband has never fed our little West and enjoys an extremely close bond with him—as his daddy. He is not Mommy; he is Daddy. He does not make milk or have boob pillows on his chest. Daddy likes to run and jump, his voice has the low hum of a deep drum, and we love to stick our tongues out at each other.

Lactating is a biological function of a woman’s breasts. This is not a sexist denial of men. Breastfeeding is one of a myriad of ways to bond with a baby, to which Daddy has full access.

Breastfeeding is easy. Breastfeeding is hard.

You should not underestimate the dedication and support required to successfully breastfeed, nor should you be intimidated by a perceived high level of difficulty. Educate yourself and have some supportive resources in place. Pair this with trust in yourself—a belief that you can and will breastfeed just fine—and a commitment to follow through—you will breastfeed your baby despite any challenges that do arise.

My first baby breastfed like a champ from minutes after birth. I was challenged by painful, engorged breasts and cracked, bleeding nipples for the first couple weeks (along with after pains that accompanied letdown). Those free formula samples looked enticing. I threw them away, researched some remedies, talked with my sister (who breastfed her four kids), and after a couple weeks, my body had adjusted. I have since enjoyed a decade of effortless and rewarding breastfeeding.

If you get mastitis, you have to stop breastfeeding and take antibiotics.

“Mastitis is an infection of the breast tissue that results in breast pain, swelling, warmth and redness of the breast. If you have mastitis, you might also experience fever and chills.”⁴² The absolute best thing you can do for mastitis is breastfeed, breastfeed, breastfeed! Think of a river flowing out through your ducts, clearing your breast of the mastitis. Also, stay completely topless to avoid any binding and increase ventilation around the breast and nipple. Hot showers and massaging the breast are also helpful. Husbands are usually pretty big fans of this treatment course: “My wife needs to stay topless, take steamy showers, and have someone massage her breasts? I volunteer.” Eating garlic, taking vitamin C, and drinking tons of water while getting lots of rest with baby is the best medicine. If some time passes and your state is not improving, then you can seek a prescription for antibiotics from a doctor.

If you wish to become pregnant, you must cease breastfeeding.

It is true that one of the fantastic benefits of full-term breastfeeding is that it can act as a natural birth control. But if fertility is your goal, you can encourage ovulation by breastfeeding less—far from weaning completely. You can also breastfeed while pregnant, and even tandem nurse. You can read more about the relationship between breastfeeding and pregnancy in the Full-Term Breastfeeding chapter of the Sage Breastfeeding book.

You should not be a human pacifier.

Let’s really think about this for a minute. The pacifier being referred to is an imitation nipple. So you’re advising not to be a real, fake . . . you? How is the absurdity of this lost on some people? The spirit of this warning is that you should only allow your baby to breastfeed for strictly physical, nutritionally based reasons. You cannot isolate the moment-to-moment motivations for breastfeeding! Babies breastfeed for all of the benefits in a completely interconnected way. Deny your baby the breast because you perceive they are receiving primarily comfort and you deny your baby milk and a significant portion of the overall benefits to breastfeeding. It’s that simple.

Night nursing causes cavities.

Cavities, or dental caries, are caused by a bacterium called strep mutans, which produces acid that causes decay. Breastmilk contains lactoferrin, which actually kills strep mutans. Based on all available research, Pediatric Dentistry stated that, “It is concluded that human breast milk is not cariogenic,”⁶³ and the American Dental Association proclaimed that there is “ . . . no association between breastfeeding and early childhood caries.”⁶⁴

Bottle rot is a condition of childhood tooth decay where a formula- (or cow’s milk-) fed child sleeps with a bottle in their mouth. The formula (or cow’s milk) pours from the artificial nipple and pools in the mouth, resting on the teeth all night long. The mechanics of breastfeeding differ in that a child must be actively sucking to pull the breastmilk into his mouth (no milk passively dripping all night long) and the nipple is placed well behind the teeth. The strep mutans bacterium can be introduced into the mouth through artificial nipples and bottles, and the dietary components of the formula, cow’s milk, or other foods in the child’s diet (sugar) all contribute to the formation of cavities while simultaneously lacking the lactoferrin, milk protein (which protects enamel), and antibacterial components of breastmilk.

Breastfeeding is psychosexually damaging, especially beyond a certain age.

As was discussed in the Nursing in Public chapter of the Sage Breastfeeding book, breastfeeding for a few years is the norm for a homo sapien. Both mother and child are evolutionarily designed to thrive under that condition and within that breastfeeding relationship. There is no research that exists showing any negative effect from breastfeeding beyond any milestone or age. Laws and official recommendations reflect this (supporting a woman’s right to breastfeed her child for as long as is mutually desired by both parties). Uninformed opinions, judgments, and gossip may not, but thankfully, I don’t base my parenting decisions on those things.

Breastfeeding past a year is more for the mother than the baby.

Once you can ask for it, you’re too old for it.

Once they have teeth, Baby needs to be cut off.

Breastfeeding is not fantastically healthy the day your baby is 11 months and 29 days old and then disgustingly unhealthy the day your baby is 12 months old. Verbal ability and presence of teeth are irrelevant. Some kids don’t talk until they are a couple years old. Some babies are born with teeth. Ignore the little quips and do what feels right for your child knowing that science supports the luck of a baby who enjoys an extended breastfeeding relationship. Read the Full-Term Breastfeeding chapter for more on this topic.

All references can be found in the Sage Breastfeeding book.