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"The wet nurse is back," writes Tralee Pearce in Breast friends .

"Like co-sleeping and baby-wearing, cross-nursing is gaining ground among adherents of attachment parenting, a child-rearing style that treats the parent-child bond as sacrosanct. With medical evidence pointing overwhelmingly to the health benefits of breast milk, wet-nursing has also found a niche among women who, for medical reasons, can't nurse."

Dr. Jack Newman, who specializes in helping mothers succeed with breastfeeding, has answered questions on everything from cross-nursing to the debate over breast milk versus formula to more general queries on breastfeeding.

Answers to select questions can be found at the bottom of this page.

Dr. Jack Newman has worked as a physician in Central America, New Zealand and South Africa. He founded the first hospital-based breastfeeding clinic in Canada in 1984.

He was a staff pediatrician at the Hospital for Sick Children emergency department from 1983 to 1992. Once the breastfeeding clinic started functioning, he eventually worked full time helping mothers and babies succeed with breastfeeding. He now works out of one clinic based at the Canadian College of Naturopathic Medicine.

Dr. Newman has several publications on breastfeeding, and in 2000 published, along with Teresa Pitman, a help guide for professionals and mothers on breastfeeding, called Dr. Jack Newman's Guide to Breastfeeding. In 2005, he and others brought out a DVD for breastfeeding called Dr. Jack Newman's Visual Guide to Breastfeeding.

Editor's Note: The usual guidelines that apply to live discussions will also apply to this Q&A. globeandmail.com editors will read and allow or reject each question/comment. Comments/questions may be edited for length or clarity. We will not publish questions/comments that include personal attacks on participants in these discussions, that make false or unsubstantiated allegations, that purport to quote people or reports where the purported quote or fact cannot be easily verified, or questions/comments that include vulgar language or libellous statements. Preference will be given to readers who submit questions/comments using their full name and home town, rather than a pseudonym.

Bonnie Lass, Canada: I am currently expecting my first child and my husband and I are discussing breastfeeding. For me it has always been a no-brainer. I was always planning to breastfeed my kids. But he isn't sure it's right for us. He's concerned about wanting to participate in feeding and about the convenience factor. Many of our friends who use formula insist that while breast milk is superior, there's not that big a difference really. My question is, how much more beneficial is breastfeeding than formula feeding really? Is it THAT big a difference or is it just slightly better?

Jack Newman: The father will have plenty of opportunities to feed the baby once the baby is on solids. And there is so much the father could do for you and the baby besides feed the baby. This will become obvious once you have the baby.

And convenience factor? What's the convenience factor in artificial feeding?

This is about the baby, and doing the best for the baby and the mother. The most convenient thing would have been not to have a baby in the first place.

Then nothing interferes with your life. But the “inconvenience” of having a baby is offset by the pleasure the baby gives you.

Is the father aware of the risks of artificial feeding? Is the father aware that there are risks in not breastfeeding for you? You decrease your risk of breast cancer, for example, by breastfeeding, and the longer the better.

I think the father should rethink all this.

Trina Vallbacka, Canada: My 13 month old son is on a nursing strike, not sure why, maybe teething. How do I get him back on the breast? He will drink from a sippy cup. He arches and turns away even before he sees the breast.

Jack Newman: There is a chapter in my book (Dr. Jack Newman's Guide to Breastfeeding) on breast refusal and in that chapter is a section on nursing strikes. Follow the approach in that chapter on how to deal with a nursing strike. That is, take the baby into bed at night, with the baby in a diaper only and you undressed from the waist up. During the day, carry the baby around with you in a sling, with the breast available. Do not try to force the baby to take the breast. This is futile. Do not try a bottle.

Nursing strikes can act, though, in the same way as when a mother has a decrease in her milk supply. See the video clips at www.drjacknewman.com to see if the baby is actually drinking when (and if) he takes the breast. See Slow Weight Gain After the First Few Months for reasons your milk supply might be down. Fix whatever you can fix (for example, go off the birth control pill, make sure you are not pregnant, feed both breasts, etc).

Use the Protocol to Increase Breastmilk Intake by the Baby, on the website. See the video clips at the websites below to help you use the Protocol.

Domperidone could be helpful in this situation. If this is a nursing strike, domperidone won't cause more problems for you. If it is a decrease in the milk supply, it will help. Contact your physician to see if s/he will prescribe it for you.

Gary D, Canada: Has there been any research done on the effect of breastfeeding on preventing breast cancer in mothers who nursed their babies?

Jack Newman: Yes, lots. In fact, it is now the best documented benefit of breastfeeding, with the best research behind it. One study in Iceland showed a decreased risk of about 50 per cent for women who breastfed over a year compared to women who breastfed less than five weeks. What is interesting about this study is that the women were enrolled in the study before any had developed breast cancer and included virtually the whole population of Iceland.

Carolyn Davison, Canada: I am currently breastfeeding my nearly eight- month-old son and planning to return to work June 1. What suggestions do you have regarding breastfeeding: Pump? Formula? Bottle? Sippy cup? Combination?

Jack Newman: No need for formula and no need for bottles. The “need” for formula to a year is marketing, very successful marketing. A sippy cup is a bottle, essentially. Give an open cup. Or mix fluids with his solids. In any case, he eats solids when you are not there, and he breastfeeds when you are. See What to feed the baby when the mother works outside the home at the website www.drjacknewman.com.

Dawn Calvinisti, Canada: Of course, breast is best but some moms formula feed. I've heard you say that after six months of age even cow's milk is better than formula. Why change a child from formula before one year of age? What is it in formula specifically that is such an issue that even cow's milk is a better substitute?

Jack Newman: I didn't ever say that cow's milk is better than formula after 6 months.

What I do say is that if the baby is eating solids in adequate amounts and eats a variety of solids, including iron containing solids such as meat, cow's milk is fine after six months or so. Formula is more expensive and unnecessary. Why pay for something you don't need?

Kelly Drennan, Toronto: What is your position on drinking and breastfeeding? MotherRisk has a chart on their site which states on average that women should wait two hours before the alcohol leaves their bloodstream before nursing, and that the pump and dump method does not work.

Jack Newman: I think that MotherRisk's position is neo-puritanical. The amount of alcohol in the milk is very small after a drink or two, much less than you would find in de-alcoholized beer. In most provinces, you are considered too drunk to drive if you have 0.08 per cent alcohol in your blood. If you have that amount in your blood, you have that amount in your milk. That's nothing. I don't understand MotherRisk's position. They are willing to tell mothers they can take all sorts of other drugs while breastfeeding (quite rightly) and are squeamish about alcohol.

Chuck Farmer, Mississauga: Dr. Newman, My wife is now extended nursing our little girl (2 1/2 years old), but sometimes we get stares and snide comments from friends and family. Could you summarize some of the benefits of extended nursing for mother and child? Also, are there supplements that my wife should take (calcium?) to protect herself while nursing?

Jack Newman: Your wife doesn't have to protect herself while breastfeeding. If her diet is adequate, she shouldn't need any sort of supplements.

As for breastfeeding a toddler, it is the best time for nursing for many mothers and babies. Toddlers love it. Mothers also usually love it. It's a great pleasure for both mother and child. Breastfeeding is so much more than breast milk, and that's why it's so special. In our messed up society where breasts are seen only as sexual, nursing mothers often get stares and silly remarks. Your wife and you should be proud to be in this situation, and those who stare should only avert their eyes if they are offended. It's their problem, not yours.

And yes, breast milk after a year contains antibodies and dozens of other immune factors that protect the baby against infection, growth factors that help develop his immune system, his brain and his gut as well as other systems, still contains the long chained polyunsaturated fatty acids that help develop his brain (and the formula companies make such a fuss about), still contains appropriate proteins. If it's good for a baby, why isn't it good for a toddler?

Lori R, Kitchener: First, Dr. Newman, thank you for all your work, and more personally, answering the few late night emails in moments of desperation, when I thought breastfeeding would never work. You truly have helped a generation of Ontario women give their babies the best start possible. My question is, now that so many women are starting breastfeeding, how can we change the stigma of breastfeeding older babies and toddlers? As soon as my daughter turned six months, the weaning talk began. In the end, with my husband's strong support, we breastfed for well over 18 months. I hope to make it to two years with the next!

Jack Newman: See my answer to Chuck above.

Breastfeed toddlers, and breastfeed them in public. Damn the stares.

Remind anyone who dares to question your wisdom in nursing a toddler, that both Health Canada and the Canadian Paediatric Society recommend women breastfeed to two years and beyond. So does UNICEF.

Mona M, Canada: I chose to have a breast reduction in my early 20s. I was well aware that one risk would be the possibility that I might not be able to breastfeed any future children. Having been raised as a breastfed baby, I would most definitely want to breastfeed any child that I may have in the future. If I do not live in BC to take advantage of the Milk Bank there, what options are available to me should it turn out that I cannot breast feed?

Jack Newman: If you were told you might not be able to breastfeed, you were misinformed.

Surgeons don't seem to know much about the glands they operate on. Of course you can breastfeed. That's not the question. The question is can you produce enough milk for the baby.

Most mothers who have had this surgery do not produce enough milk. Some do, and we have even had a woman recently who breastfed twins exclusively in spite of breast reduction. Too often nurses in hospital will assume the mother won't produce enough simply because she has had a breast reduction.

But these new mothers seem to produce enough colostrum, even though many will not produce enough milk. So supplementation is not usually indicated in the first few days.

Our approach for women who have had breast reduction is to try to help them have realistic expectations without, obviously, ruling out the possibility that they will produce enough. We try to help them understand that breastfeeding is more than breast milk. Thus, if supplementation is necessary, it should be done with a lactation aid at the breast, because then the mother is breastfeeding, even if it means the baby is being supplemented. If they wish, we suggest that they start fenugreek and blessed thistle from the day of the baby's birth, as well as domperidone, 30 mg three times a day. Though domperidone does not usually work well in the first few weeks, it does sometimes, and I think it is worth a try. We encourage the mothers to follow the Protocol to increase breastmilk intake by the baby (see the website www.drjacknewman.com) and use the video clips at this website to help them use the Protocol.

Marusia H, Whitehorse: Dear Dr. Newman, I am expecting twins and am alternately confused and curious about how I should breastfeed. Some books recommend getting twins onto the same feeding schedule, whereas other suggest feeding on demand so that the babies know and understand that their individual needs are being met. Any suggestions about which is the better course of action? Also, is it realistic to think that I will be able to breastfeed two babies enough to meet all of their nutritional needs or are they likely to need top ups with formula as well? With two babies am I likely to run out of milk? Thanks in advance for your guidance!

Jack Newman: There is no reason you shouldn't be able to breastfeed twins. Most women can produce lots of milk and with good help and good advice, they should be able to manage.

We usually recommend that the mother learn to breastfeed one baby at a time, so that the babies get a good latch and drink well at the breast.

Once this is achieved, and it can be done very quickly, within a few days with good help, then we show the mother how to feed the babies together. This saves lots of time, which a mother of twins does not have in abundance, and increases the milk supply. Please get good help for breastfeeding because good help is not always easy to find at the last minute. See our website www.drjacknewman.com and find the Protocol to increase breastmilk intake by the baby and use the video clips to help you use the Protocol. I realize the information is geared to one baby, but the principles are the same for two.

#3 on the way!!!, Fredericton: I am expecting my third child in a couple of months and plan on breastfeeding again, as I did previously. My only issue is that my milk seems to dry up after a few weeks, despite what I do (pumping, increasing my fluid intake, etc.) Is there anything I can do that will enable me to breastfeed longer than 3 or 4 weeks?

Jack Newman: Again milk “dries” up because we give mothers poor advice. Also you can check our website www.drjacknewman.com and find the Protocol to increase breastmilk intake by the baby. Use the video clips to help you use the Protocol. If you start off with a good supply, following this Protocol will keep up the milk supply.

Celeste Brown, Richmond Hill: I am currently nursing my second child who is four months old. I find that I have less milk this time (I have heard this may be true for many women). I also find that at the end of day (exhausted mom), my milk is significantly reduced. I would appreciate your “realistic” advice to increase my late day supply (knowing that I have two children under the age of three year who keep me busy day and night).

Jack Newman: See Slow Weight Gain After the First Few Months (at the website www.drjacknewman.com) for reasons your milk supply might be down. Fix whatever you can fix (for example, go off the birth control pill, make sure you are not pregnant, feed both breasts, etc). Use the Protocol to Increase Breastmilk Intake by the Baby, attached. See the video clips at the websites below to help you use the Protocol. This may be enough for most situations.

You can also increase your milk supply using domperidone. See the information on domperidoneat the website www.drjacknewman.com.

Do not supplement with a bottle if you are tempted to do so. If you feel you must give the baby more, give solids. See the information sheet on solids at the website.

Leah Martin, Quebec: I am currently 31 weeks pregnant. I was wondering if there is anything I can do now that will help me be successful at breastfeeding. My mother keeps telling me to buy formula and bottles just in case I have trouble but I am afraid that if I have formula around I might give in and give up on breastfeeding. In my city we stay 2 days in the hospital after vaginal birth. I figure if I am having difficulties in the hospital that I can get formula on my way home but I am concerned about nipple confusion and breast rejection by the baby. Should I be focusing on other things or doing any planning differently?

Jack Newman: Yes, definitely you should be focusing on other things. Don't assume you are going to have difficulties. What you need to assume is that most mothers should be able to breastfeed just fine. If they have good help and advice. Unfortunately these are not always forthcoming. Get good information. See our website www.drjacknewman.com. Watch the video clips.

Anne Borrelly, Toronto: Dr. Newman we met about eight years ago and you were awesome in helping me with my first son. Now my second son wont stop - he will be 3 this summer and still nurses 2 or 3 times a day and especially at night. How can I wean him so we can get a full night sleep? Is this unusual? My family constantly makes comments about his nursing habits - and it is starting to hurt.

Jack Newman: Don't worry, he won't breastfeed forever, guaranteed. Why start fighting to stop the night feedings when he will stop soon enough. You are doing the best for him, and for yourself. It may not seem like it now but you will see. Trying to force the issue may make him even more determined to continue. I am sure he's an extremely charming young man. Check out my book, Dr. Jack Newman's Guide to Breastfeeding, the chapters on Breastfeeding a Toddler, and Sleep.

SW, Ottawa: I'm wondering why so many women I know (typically in their 30s) have trouble with breastfeeding (“the latch” etc.). Is it because we're having children when we're older? Or is it just physiologically more complicated than it would seem? If so, did infants die of malnourishment before there were so many other options and interventions, or did they just take a week or to get the hang of it and then catch up later, without anyone worrying about it?

Jack Newman: To be brutally honest, the problem has more to do with mothers not getting good help in the first few days in hospital. Indeed, in many hospitals, the mothers' breastfeeding is undermined. The nursing staff (not all of course) and the physicians (not all of course) are underskilled at helping mothers breastfeed. Indeed, many do not understand breastfeeding and how it works. So the mothers get all sorts of nonsensical information, such as: feed the baby every three hours; feed the baby 20 minutes on each side; 10 per cent weight loss means the baby needs to be supplemented.

All these issues and many more are completely beside the point. The issue is that mothers need help to get the baby to latch on well, and they aren't. The emphasis is on timing. A baby who feeds well will want to feed again when he's ready. A baby who feeds so poorly that he won't wake up on his own in the first week is not going to do better getting nothing 8 times a day instead of 5 times a day. All the feedings still add up to zero. So the idea is, get the baby feeding well.

A common problem is babies who refuse the breast. A lot of this is due to birthing practices, unnecessary epidurals and other medication, mothers labouring in unnatural positions (on their backs), too many caesarean sections. Separation of the mother and baby after the birth is also much too common. Mothers and babies should be skin to skin for at least an hour after the birth. In most hospitals, the mother and baby are lucky to get 5 minutes of skin to skin contact.

Sore nipples are also common, due to a poor latch. However, in many hospitals, mothers are being told to take the baby off the breast and relatch the baby if it hurts. And again, and again. This is insane. If the baby is pulled off the breast to “get a better latch” 5 times, this usually results in 5 times more pain, 5 times more damage and a frustrated mother and baby.

Having said that, there were always mothers who did not produce enough milk. In tribal cultures perhaps babies were nursed by several mothers so the issue did not come up.

John David Penner, Ajax: Two questions: 1) Is there a variance in the nutritional value or “genetic” composition of breast milk among different mothers (other than the normal differences due to the age of the suckling infant)? 2) How significant is a mother's diet in affecting the quality of her breast milk? If a woman has a poor diet or is entirely malnourished, as found in areas experiencing famine) does the mother produce breast milk that lacks certain properties?

Jack Newman: Studies show that women who are malnourished produce about the same milk as a woman who is well nourished, but there is a tendency to produce less, though usually enough milk.

Virtually all the ingredients of breast milk vary from day to day, from morning to evening, from the beginning of the feed to the end of the feed, from woman to woman, from 3 days after birth to 3 weeks after birth to 3 months after birth to 30 months after birth.

Sara Cooke, Vancouver: Hello Dr. Newman. Your book was a fantastic resource for me while I learned to breastfeed my first child. I was surprised (and saddened) to read the number of women who exclusively breastfeed until 6 months (18 per cent) - or even 4 months (35 per cent) - was so low, considering close to 90 per cent start out trying to breastfeed. I know from experience that it can be a struggle - but why do you think so few women persevere when we all know by now that ‘breast is best'? What sort of community supports do we need to have in place to increase the number of mothers and babies benefiting from a breastfeeding relationship?

Jack Newman: Many women are not getting the support they need to continue. When troubles arise, and they frequently do due to poor support, they don't get the help from the health system and their families often to continue. Most doctors have received no training in breastfeeding at all, and their knowledge of how to help and their skills are virtually zero. Any honest physician, with few exceptions, will tell you s/he received no training in practical breastfeeding at all. So the answer to any problem? Formula.

Most other health professionals do have a bit more knowledge, but not much more.

Marketing of formula plays a big part here, too. Marketing to the health system, “The answer to colic — formula x,” and so on, and physicians, not knowing what to do, go for it. Marketing also has convinced mothers that formula is just as good as breastfeeding. We think we are not influenced but we are.

Adrienne Percy, Canada: I was devastated when I couldn't nurse my first child. I tried everything from engaging the expertise of a lactation expert to calling la leche for support. My second baby is due in a month. I strongly believe that a big part of the failure in the first go round was a nurse that basically told me to force my son to breast even if he was pushing away. Do you think that ‘aversion' is a valid theory? And what is your chance of being able to ‘successfully' breast feed your second child if you had problems doing it the first time? What are the key factors that lead to success?

Jack Newman: Forcing babies to the breast is a good way of making sure that they refuse the breast. Of course babies forced to the breast will develop an aversion. The nurse forcing the baby to the breast is an example of exactly what I've been saying in these answers. The whole system is geared to making mothers fail at breastfeeding, with health professionals, as a rule, there are of course exceptions, not having the knowledge or skills to prevent problems before they arise or fix them once they have.

If you got the help you got, the chances are good. Most mothers should succeed. You don't give enough information for me to judge, but in any case I would hesitate to answer without actually seeing you. You should get good help before the baby is born.

Carolyn Davison, Halifax: I pumped 4 to 6 ounces/day for a week when my son was 6 months old to give to my sister's son who was two weeks old. They live in another province. She can only nurse from one breast due to reconstructive surgery and her supply wasn't enough for him to gain back his birth weight. Is my milk OK to give to a newborn? Safe? Nutritious? Better than her topping up with formula?

My nephew spit up my milk a little but so does my son. I didn't put her son to my breast because we thought he might have thrush. We will be together for a week or so this summer. Could I nurse her son occasionally if needed?

Jack Newman: Of course your milk is good for a newborn. I am always surprised by this question. See the question and answer above about how milk varies, but it's still superior to formula, which is not at all like the milk a baby is supposed to get at birth. Yes, put the baby to the breast if you and she agree.

The milk is safe, but there is a small risk of passing on viruses such as HIV, CMV, hepatitis. So I don't routinely recommend cross nursing. Still, your milk is good.

Lynda Morris, Toronto: I started breastfeeding and experienced problems by the 3rd week. I had a plugged duct and then an infection. I began pumping to relieve the engorgement and began using bottles. Very soon afterwards my baby got used to the bottles. My baby is now 10 weeks old and I really want to relactate. I'm nervous about it but really want to try and don't know what the best method is to go about doing it...need advice...

Jack Newman: Lynda, It is possible to relactate. It would be good to get some good hands on help. Perhaps you should come to our clinic. You can make an appointment by emailing breastfeeding@ccnm.edu.

There are people who say there is no such thing as nipple confusion. What would you say to them, given your story?

Rasha Mourtada, Globe Life web editor: Thank you, Dr. Newman, for being so generous with your time and addressing all of these questions. I know you've helped a lot of moms. To our readers, we're sorry we couldn't get to all of your questions. Dr. Newman, are there any last thoughts you'd like to leave us with?

Jack Newman: Yes, I would like to say that it's worth going through the difficulties that you might encounter to continue breastfeeding. Very few mothers regret struggling through. I wish very much that mothers got more reasonable help in the hospital and after, but unfortunately, they don't. The should, if they have the means, birth with a good midwife and perhaps see a lactation consultant as soon as difficulties arise. The mothers need to be educated, but they are so vulnerable immediately after the birth that they need an advocate who will stand up for them and the baby.