Early breastfeeding support may need a reset

Clinical takeaway: When counseling families during the first 72 hours after birth, clinicians can reassure mothers that normal colostrum volumes are usually sufficient, recognize that routine pacifier restriction is not supported by current randomized evidence, and reserve early electric breast pump use for specific clinical indications.

The first few days after birth are critical for establishing breastfeeding, yet many common maternity ward practices are based more on tradition than evidence. A new narrative review argues that several routine interventions intended to promote breastfeeding may instead undermine maternal confidence and breastfeeding success.

The authors reviewed evidence from randomized trials, systematic reviews, meta-analyses, and observational studies examining three common practices during the first 48 to 72 hours postpartum: concerns that colostrum is insufficient, routine pacifier restrictions, and early introduction of electric breast pumps.

The review found that normal colostrum production is physiologically matched to a healthy newborn's stomach capacity and nutritional needs. Perceived insufficient milk supply—one of the leading reasons for early formula supplementation—more often reflects unrealistic expectations than true lactation failure. While formula supplementation remains appropriate for clear medical indications, unnecessary supplementation may reduce breast stimulation and contribute to lower milk production.

Randomized trials also did not support routine restrictions on pacifier use in healthy, breastfeeding term infants. Likewise, evidence did not support routine introduction of electric breast pumps during the first days after birth. When milk expression is needed because of poor latch or temporary mother-infant separation, hand expression generally produced better early breastfeeding outcomes than routine pumping.

Rather than changing breastfeeding goals, the review recommends aligning early postpartum care with current evidence by providing realistic counseling about normal colostrum volumes, offering early lactation support, using hand expression as the preferred initial approach when milk expression is needed, and individualizing decisions about formula supplementation and pacifier use.

"My hope is that this review gives clinicians the confidence to reassure mothers, rather than reach for formula, a pacifier ban or a pump by default, and that postnatal care is shaped by the evidence and by listening to parents," said lead author Maria Di Chiara, MD, a neonatologist at Sapienza University of Rome.

Source: Di Chiara M, et al. (2026 Aug 1) J Matern Fetal Neonatal Med. Colostrum is enough, the pacifier is not the enemy, and the pump can wait: a narrative review of common misconceptions affecting early breastfeeding in healthy term neonates