A review of 78 international studies is challenging some of the most persistent beliefs about breastfeeding during the first days after birth, arguing that routine assumptions about colostrum, pacifiers and electric breast pumps may unintentionally make breastfeeding more difficult for healthy, full-term newborns. The analysis, led by researchers at Sapienza University of Rome, concludes that several common maternity-ward practices are based less on strong evidence than on expectations about how much milk a newborn “should” receive immediately after delivery. The findings are published in The Journal of Maternal-Fetal & Neonatal Medicine as World Breastfeeding Week highlights the importance of protecting and supporting breastfeeding worldwide.
The review focuses on the first 48 to 72 hours postpartum, a period when breastfeeding is still being established and parents are often highly vulnerable to conflicting advice. During this stage, the breasts produce colostrum, a thick, concentrated fluid that precedes mature milk. Although colostrum is produced in relatively small quantities, the researchers explain that its composition and volume are biologically adapted to the newborn’s early needs. It contains proteins, immune factors, growth-promoting compounds and other bioactive components that help support intestinal development and early immune protection. Its small volume also corresponds with the limited capacity of a newborn stomach during the first days of life.
According to the review, the belief that colostrum is insufficient remains one of the most common reasons for introducing formula early. Parents may interpret frequent feeding, crying or small expressed volumes as evidence that the baby is not receiving enough milk. Yet these behaviors can be normal features of early neonatal adaptation. Newborns commonly feed frequently as they stimulate the breast and help trigger the hormonal transition toward increased milk production. The researchers argue that when normal physiology is mistaken for inadequate supply, formula supplementation may be introduced before a genuine medical need has been established.
This can create a self-reinforcing biological cycle. Supplementary formula may reduce the time a newborn spends sucking at the breast, decreasing stimulation of the nipple and areola. That stimulation normally promotes the release of prolactin, which supports milk synthesis, and oxytocin, which drives milk ejection. If breast stimulation is reduced, milk production may increase more slowly, potentially confirming the original concern that the mother does not have enough milk. The authors emphasize that medically indicated supplementation can be essential, particularly when a baby shows signs of inadequate intake or illness, but they call for structured protocols so that supplementation is not used automatically in otherwise healthy infants.
The second misconception examined by the review concerns pacifiers, also known as dummies. Many hospitals continue to restrict them because of concerns that artificial sucking could cause “nipple confusion” or reduce the frequency of breastfeeding. However, evidence from randomized controlled trials involving healthy, full-term infants did not show that pacifier use shortened breastfeeding duration or reduced the likelihood of exclusive breastfeeding. The authors note that pacifiers can serve different purposes, including soothing, supporting non-nutritive sucking and, in some circumstances, reducing the risk of sudden infant death when used during sleep. Their conclusion is not that pacifiers are necessary for every newborn, but that blanket hospital bans are not supported by the available evidence.
The review also questions the routine early use of electric breast pumps. Pumps are valuable clinical tools, especially when a newborn cannot latch effectively, when a parent and baby are temporarily separated, or when milk must be expressed for a premature or medically fragile infant. In the first days after an uncomplicated birth, however, the authors found little evidence that routinely prescribing an electric pump improves breastfeeding outcomes. For some parents, the volume collected by a pump can become a misleading measure of milk production, particularly before mature milk has fully come in. A small amount in a bottle may be interpreted as proof of failure even though a healthy newborn may transfer milk more effectively at the breast than a pump can.
The researchers instead identify hand expression as the preferred first-line method when milk needs to be removed during the early postpartum period. Hand expression can collect colostrum efficiently because the thick fluid may be difficult to remove with some pumps, and it allows parents to learn how their breasts feel and respond. It can also provide stimulation without turning every feeding into a quantified test. The review does not reject electric pumps, but argues that they should be introduced for a clear clinical reason rather than as a routine response to anxiety, normal early feeding patterns or the desire to build a milk supply before it is medically necessary.
The analysis draws on randomized trials, systematic reviews, meta-analyses and observational cohort studies from countries including the United States, Italy, Germany, Australia, India and Mexico. Its authors say the findings point to an evidence–practice gap: well-intentioned clinical routines may persist even when newer research has weakened the assumptions behind them. They recommend that prenatal education explain the normal volumes of colostrum, the changing capacity of the newborn stomach and expected early weight loss. They also call for timely access to trained lactation professionals, ideally within the first 48 hours, so that latch problems, ineffective milk transfer and genuine feeding difficulties can be assessed before they escalate.
The findings arrive as global breastfeeding rates remain below the World Health Organization’s target of exclusive breastfeeding for the first six months. Fewer than half of infants worldwide are exclusively breastfed for that duration, while rates are particularly low in many high-income countries. The researchers stress that their conclusions do not challenge the goal of exclusive breastfeeding or suggest that medical supplementation should be avoided when it is needed. Instead, they argue that better support begins with distinguishing normal newborn physiology from pathology. Reassurance, skilled assessment and individualized counselling, they say, may be more effective than default formula supplementation, compulsory pacifier restrictions or automatic pump use during the crucial first days after birth.
Subject of Research: People
Article Title: 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
News Publication Date: 1-Aug-2026
Web References: https://doi.org/10.1080/14767058.2026.2671562; World Breastfeeding Week
References: The Journal of Maternal-Fetal & Neonatal Medicine, DOI: 10.1080/14767058.2026.2671562
Keywords: breastfeeding, colostrum, newborn nutrition, pacifiers, breast pumps, lactation, neonatal care, postpartum care, formula supplementation, maternal health
Tags: breastfeeding initiation guidelinesBreastfeeding practicescolostrum benefitsearly neonatal immune supportelectric breast pump effectsevidence-based breastfeeding recommendationsimpact of pacifiers on breastfeedinginfluence of hospital practices on breastfeeding ratesmaternity ward routinesneonatal gut developmentpostpartum breastfeeding challengesWorld Breastfeeding Week
