Here are some FAQ's about breastfeeding whose answers may surprise you. Some would have surprised me ten years ago - and quite a few of them will surprise your mom and her friends who were breastfeeding pioneers when you were born. Their courage and perseverance made it possible for us to gain all this knowledge that makes their advice, born out of their reading, out-of-date today!

OLD WISDOM: Sore nipples are a normal part of the early days of breastfeeding.

NEW WISDOM: Sore nipples mean that you need help with positioning, or that the baby/mom anatomical match is a challenge in some way.

Professional books in the 1980's suggested that nipples needed use to toughen up. It was likened to the keratin layers that our feet develop when we walk barefoot! It's not a good analogy. Nipples are erectile tissue. They are formed with expandable tissue. When a baby gets a good latch, there is no friction on the nipple, and nursing is comfortable and efficient.

The #1 cause of sore nipples is a bad latch. Most often it has to do with the way we are holding our babies to nurse. Babies need to open wide as if they are going to eat a grinder with extra filling - not sipping soda through a straw. Babies will intuitively tilt their heads back to help get that big mouthful. With our old wisdom on latch, babies who did this instinctive arch were often said to be "fighting the breast". Most likely though they were fighting to breathe and swallow! Soreness caused by this kind of bad latch is most often found at the tip of the nipple.

Sometimes even with excellent positioning from mom, there will be soreness - a feeling of pinch, not pull. The baby's needs may be the cause of this pinching.

* The baby may have had a difficult birth, born with a cone head and a palate that is more arched than usual. (It will get better!)

* A difficult birth can lead to facial bruising. Using a position that avoids touching the tender spots may be useful (eg an under-the-arm approach for a baby whose mouth area is bruised).

* The baby may be born with a short tongue. Tongues usually catch up with mouths by six weeks.

* Tongue-ties often run in families. Some tongue-tied babies do great once the milk starts flowing, but often need to be switched from side to side to help keep them on-the-flow.

* The baby may be neurologically disorganized. Babies who have a hard time settling down may need to be swaddled before nursing, or be firmly held close to you. Bringing them together into a compact bundle helps get them centered. These little ones also appreciate eating sooner, not later!

OLD WISDOM: Breastfeed on both sides at each feeding. That way your baby will get enough milk.

NEW WISDOM: Finish the first side first.

We've known for centuries that breastfeeding is a Supply & Demand game. We thought we knew how it worked: the more your baby asks for, the more you will make. Imagine our surprise when researchers discovered that breastfeeding is regulated by how much is left in the breast.

Mother's milk contains a small whey protein called Feedback Inhibitor of Lactation (FIL). FIL seems to slow milk synthesis when the breast is full. So when the breast is full of milk (and more FIL is present), milk production slows. Milk production speeds up when the breast is emptier (and less FIL is present).

You've probably read in your breastfeeding books that prolactin and oxytocin also have a big role in making milk. Research is being done on the prolactin receptor site theory of milk production. By the way, if you'd like more information about ongoing research in this area, check out www.kellymom.com. Kelly Bonyata is one marvelous webmother!

Good positioning can be a challenge during the first weeks of feeding. (It's hard to keep your eyes open!) Work at getting the baby onto the first side with an excellent wide gape and a good latch. Then let that baby nurse on that side for as long as s/he would like. When the baby falls off the breast, give him or her a burp, and if you're still in the mood to nurse (as in, it's 2 PM not 2 AM!) change the diaper and then offer dessert on the second side.

Breastfeeding in this way triggers feeds with lots of essential fatty acids, and the babies tend to be very satisfied. That leads to happy moms as well as happy babies.

OLD WISDOM: Feed your baby every 1-1/2 - 2 hours. After all, breastfed babies want to eat 10-12 times a day.

NEW WISDOM: Nurse your baby when s/he is beginning to root. Babies will cluster feed sometimes, and go longer other times. It's still usually 10-12 times a day.

I'm a natural day person, as are many of the nurses I work with on days. We all eat breakfast before leaving the house, and we're happy to have something to nibble on during report at 7 AM. Most of us are eating a snack around 930, and we all want early lunch! That means we've eaten four times before noon. Most of us aren't really interested in supper.

Watch your baby. Many newborns love to eat between 11 PM and 4 AM. They often sleep well from about 5 AM - 9 AM. As time goes on, many babies switch to non-stop nibbling just before and after supper time. They may be hungry - but they also may just need to get themselves centered, and nursing in your arms works just fine, thank you!

Do you have questions about breastfeeding? We are blessed in this area to have lots of women who love to help.

Dawn Kersula MA, RN, IBCLC, LCCE, FACCE
And doula facilitator for our New Moms Network at Brattleboro Memorial Hospital in Brattleboro, VT