A Guide to Breastfeeding 1

A Guide to Breastfeeding
1
Lactation
Offices:
Voice Mail: 513-585-0597
To schedule a
breastfeeding
class call:
513-585-HUGS
If your questions concern medical
advice or you have an emergency,
please contact your physician or
nurse midwife.
Acknowledgments
Table of Contents
We wish to acknowledge the following for providing support and
information in developing this booklet.
Congratulations.......................................................................................... 1
Benefits........................................................................................................ 1
A Message to the Baby’s Father............................................................... 1
Breastmilk Basics: Anatomy..................................................................... 2
Before Your Baby is Born............................................................................ 4
Nipple Exam
In the Hospital........................................................................................... 5
Exercises
BREASTFED - the ABC’s
Positioning
Latch-on
Cesarean Birth
Signs Baby is Getting Enough Milk
Sleepy Babies
If Baby is not Breastfeeding Well After 2-3 days
Breastfeeding at Home........................................................................... 14
The Early Weeks
Adjusting to Breastfeeding: Overcoming Common Concerns............ 15
Family Adjustments
Baby Blues
Sore Nipples
Engorgement
Plugged Ducts
Mastitis
Thrush/Candida
Nutrition while Breastfeeding................................................................ 20
Special Situations and Other Concerns................................................ 22
Building and Maintaining a Milk Supply
Fussy Baby
Jaundice
Leaking
Feeding Schedules and Sleep Patterns
Medications and Street Drugs
Twins, Triplets and More Adoptive Nursing
Babies with Special Needs: Downs Syndrome, Cleft Lip and/or Palate
Expressing and Storing Breast Milk....................................................... 27
Hospitalized Baby
Full-term Healthy Baby at Home with Mom
Combining Breastfeeding with Work or School .................................. 30
Weaning................................................................................................... 32
Resources................................................................................................. 33
Books
Supplies
Organizations
Feeding Diary........................................................................................... 34
• H
elen Curless, RN, IBCLC, as the original author of this booklet. She
has been an International Board Certified Lactation Consultant since
1986 and was the first person in the Greater Cincinnati area to be
employed in this capacity by a hospital.
Congratulations
Benefits of Breastfeeding
Breast Milk Basics: Anatomy
Your decision to breastfeed is a
healthy, rewarding and satisfying
beginning for you and your baby.
You and your baby are working
together to fulfill many needs:
nutritional, physical and emotional.
• B
reast milk is the best food for your baby. It has the exact nutrients
needed for early development.
Lactation = Breastfeeding
The first few days and weeks
are considered the adjustment
period for both of you. Let’s not
forget your partner, who is a very
important part of the new family
unit. A partner’s total support
helps you to succeed and makes
breastfeeding a family affair.
• B
reast milk has many antibodies, which lower the baby’s risk of
allergies and illnesses including: respiratory infections, ear infections
and gastrointestinal illnesses.
• B
reast milk is easy to digest and babies have less diarrhea or
constipation. Many professionals note that breastfed babies have
less dental and orthodontic problems later.
Alveoli
(milk-producing sacs)
Montgomery Glands
(secrete oils to cleanse breast)
• B
reastfeeding lowers the risk of sudden infant death syndrome
(SIDS).
• Breastfeeding lowers the risk of adult-onset obesity.
• Breastfeeding enhances a baby’s IQ.
Remember in the days ahead that
a few temporary concerns may
occur, but with assistance, most
can be overcome. THE REWARDS
ARE WORTH THE EFFORT.
The staff at The Christ Hospital
Birthing Center will be happy to
help - JUST ASK. This booklet is
an additional reference guide for you.
• B
reast milk is convenient: It’s always the right temperature, always
available and there is no need to transport bottles, sterilizers, etc.
Congratulations and best wishes
to your new family.
A Message to the Baby’s Father
And remember, babies love to
breastfeed!
Milk Sinuses
(squeezed during sucking)
• Breastfeeding is less expensive than formula feeding.
• B
reastfeeding lowers a mother’s risk of pre-menopausal breast
cancer, ovarian cancer and osteoporosis.
Milk Ducts
(transport milk)
Areola
(dark area surrounding the nipple)
• Breastfeeding helps a mother return to her pre-pregnancy weight.
• Breastfeeding enhances the bond between a mother and her baby.
A father’s support can have a profoundly positive impact on
breastfeeding and the encouragement of mom while she and baby are
learning. Though during the adjustment period you will not be feeding
the baby, there are many important contributions you can make to a
mother and baby’s well-being. Holding your baby, rocking, burping,
bathing and diaper changing can provide special time with the baby and
relieve mom of these responsibilities while she is recuperating from
birth. Your voice and skin contact will provide the baby with valuable
bonding time and beneficial infant stimulation. In the early days after the
birth, you can help monitor calls and visits so that both you and mom
are getting the rest you need. Assisting with meal preparation and other
household chores are other activities that can help. Fatigue, emotions
and hormones (for mom) can make the first week feel overwhelming for
both parents, but particularly for a new mother. Your loving support can
be an anchor during this time of adjustment.
1
Milk Production
Breast size is usually not related to the amount of milk produced. The
amount of milk produced is based on regular stimulation by proper
breastfeeding or by frequent stimulation with a breast pump if mother
and baby are separated. As the milk is being removed from the breasts, a
message is sent to the pituitary gland to release prolactin into the blood
stream. This hormone causes the milk sacs to secrete more milk. Breast
milk goes through different stages of development. Those stages are as
follows:
1. Colostrum - The first milk which contains protein, calcium, vitamins,
small amounts of iron and fluoride, plus antibodies to fight infection. It
may be white, clear or yellow and is present from the second trimester
of your pregnancy up through the first few days postpartum. It is all your
healthy baby needs.
2. Transitional milk - Combination of colostrum and mature milk that
meets the needs of a growing baby.
3. Mature milk - May be various colors and while it may appear thin, it
provides adequate nutrition for your baby. It is present after copious milk
secretion. Normally by day four.
2
Breast Milk Basics: Anatomy
Before Your Baby is Born
There are different types of mature breast milk:
1. O
btain current information on breastfeeding. (See Resources on pg. 33)
a. check with bookstores
b. visit your library for books and tapes
c. attend a Mother-to-Mother support group such as La Leche League (See pg. 31)
d. Web sites. (See pg. 33)
1.Foremilk - The milk first received by your baby as he begins to
breastfeed. It collects in the milk sinuses between feedings, is rich
in protein, low in fat and looks watery. This satisfies a baby’s thirst.
2.Hindmilk - The milk received by your baby toward the end of
breastfeeding on any one side. More hindmilk is available with each
let-down reflex. This milk is higher in fat and promotes weight gain.
It appears creamier and satisfies a baby’s hunger.
2. Attend a breastfeeding class offered by the The Christ Hospital.
3. Avoid washing the breasts with soap, as this can dry your nipples.
It is important to allow the baby to receive both kinds of milk. Offer one
breast until baby finishes and releases the grasp spontaneously, then
burp and offer the other side.
4. If you have concerns about a medical condition, breast surgery, breast shape, pituitary
gland disorder or nipple inversion, contact a lactation consultant and/or your physician for
advice.
Milk Ejection Reflex or Let-down Reflex
5. In the last month of pregnancy, many moms will shop for a nursing bra. Make sure the bra
is supportive, fits correctly and is adjustable, to allow for fullness that will occur later on.
As the baby breastfeeds, a message is sent to the brain to release
the hormone oxytocin. This hormone acts on the milk sacs and causes
them to contract and “eject” milk out to the milk ducts. The baby then
begins to swallow more. This may happen several times in the course
of a feeding. This same hormone makes the uterus contract during the
feeding. This may or may not be felt as uterine cramps during the first
few days after the birth. After a few days, some mothers say they feel a
tingling sensation in the breast during the let-down reflex and leak from
the unused breast at that time. This is also the cause of milk leakage
when a mother says that she leaks at the sound of a baby’s cry.
6. A
llow your breasts to air-dry after showering and also during the day if you are leaking
colostrum. (If you are leaking colostrum, you may want to purchase breast pads that are not
lined in plastic.)
7. Review page 37 for breastfeeding supplies.
Nipple Exam
Breastfeeding is often easier when nipples protrude (stick out). You may perform a simple
nipple exam to determine this. Place your thumb and index finger at the 6 & 12 o’clock
positions (top and bottom) at the edges of your areola (the darker area) and gently squeeze. If
the nipple tucks inward, you may benefit
from wearing breast shells. These shells
can put gentle pressure on the areola to
help draw the nipple out. You may wear
them the last three weeks of pregnancy
and then between feedings until the baby
is breastfeeding well.
Protrudes
Flat
Inverted
3
4
In the Hospital
Exercises
Gentle Nipple Stretching (Figure 3)
These exercises may be used only after delivery. They are meant to take
only a few minutes right before you breastfeed. For many women, they may
not be necessary. USE AS NEEDED.
Purpose:
a. To increase elasticity of areola.
Breast Massage (Figure 1)
Technique:
a. Place index fingers on either side of the nipple base at 9 and 3
o’clock position. (side to side)
Purpose:
a. To improve circulation, thereby decreasing swelling
or engorgement.
b. To make you familiar with what feels normal to you.
c. Enhance milk flow with pumping or nursing.
Technique:
a. Support the breast with one hand. Use the other
hand to massage the breast thoroughly in a stroking
or circular massage manner, beginning next to your
body and moving toward the nipple.
b. To help reduce a tendency for the nipple to pull back.
b. Stretch nipple and dark area out to each side by increasing the
distance between your fingers. Repeat 10 times.
c. Repeat stretching exercises all the way around the nipples.
Figure 3
Gentle Hand Expressing (Figure 4)
Figure 1
b. Overlap stroking until the entire breast has been covered. Repeat as
needed.
Gentle Nipple Pulling and Rolling (Figure 2)
Purpose:
a. To make the entire nipple more elastic to ensure baby will get proper
grasp.
b. To make the nipple more erect.
Technique:
a. Grasp immediately behind the nipple at 12 and 6
o’clock position. (top & bottom)
b. Stretch nipple out until you can feel the pull. The
nipple should stretch easily, like your earlobe.
c. Roll stretched nipple between your fingers. Repeat
several times.
If your nipple doesn’t feel stretchy and the baby is
Figure 2
having a difficult time grasping, do the pulling and rolling
more often and for longer periods. If this exercise hurts,
check to be sure you are grasping behind the nipple. If
you are still unable to do this exercise, wear breast shells. Discard any milk
that collects in these shells.
Purpose:
a. To relieve excess fullness and to soften nipple so baby can easily
grasp areola (this may happen during the engorgement phase or
before morning nursing if your baby slept through the night).
b. To collect colostrum or milk to feed baby if mother and baby are
separated for any reason.
Technique:
a. With thumb and first finger in a C formation,
place them about 1/2 to 1 inch on either side of
the nipple in a 12 and 6 o’clock position. Press
back toward chest wall keeping C position. Do
not spread fingers or bring them together at this
time.
b. With fingers back at chest wall, squeeze fingers
together into an “O” position.
c. R
epeat three to four times in each clock position.
You may see colostrum milk at tip of the nipple
Figure 4
pores.
If no colostrum is expressed, repeat exercises 2 and 3. It
could mean that your fingers are not in the right place. The fingers compress
the milk sinuses just as the baby compresses these sinuses with his gums.
Reposition the fingers one inch either toward or away from the nipple and
try again.
7
5
6
B.R.E.A.S.T.F.E.D.
Helpful Breastfeeding Positions
B B
egin breastfeeding within the first hour after you deliver when you
and your baby are stable. Feeding cues are signs the baby is ready
to feed. They include: licking lips, rooting, sucking on fist, moving the
tongue or turning toward the breast.
Cross Cradle or Cuddle Position
R R
ooming-in with the baby enables you to breastfeed every two-three
hours. You are encouraged to keep your baby with you day and night.
E E
ffective breastfeeding occurs when the baby is latched on about
one inch behind the nipple and sucks with deep jaw movements and
long sucking bursts (approximately 10 sucks before brief breathing
pauses) with swallowing heard more each day.
A A
wakening the baby to feed is often needed until the baby is gaining
weight. After the first day, expect the baby to eat 8–12 times per 24hour day.
S S
upplemental bottles (and pacifiers) are discouraged in the first
weeks, unless there is a medical or special need. The more the baby
feeds properly, the more milk you will produce.
• U
se pillows and a footstool as needed. A footstool helps level
your lap and gives you better back support.
• Y
our baby should face you when you’re feeding: (If your baby is
on the right breast, hold that breast with your right hand; when
feeding on the left breast, hold your breast with your left hand.
• Hold your baby tummy to tummy.
• S
upport your baby by placing the palm of your hand between his
shoulder blades. Place your fingers on either side of the head to
stabilize his head and neck.
• Y
our baby’s nose should be at the level of your nipple before
latching on.
Football Hold or Clutch Position
• Sit with pillows and a footstool as mentioned above.
T T
ry to offer one breast until the baby finishes and releases the grasp
spontaneously. Burp and offer the other side. If the baby is no longer
hungry, use this side first at the next feeding.
• Place pillows at your side.
F F
eeding time varies. Encourage the baby to feed at least 10 minutes.
He may suck longer (20-40 minutes) as he becomes more alert.
Feeding should not be painful. If it is, take the baby off and latch on
again. Ask for help while you are learning.
• H
old him so his bottom is against the back of the chair
or bed.
E E
xpect two to three wet and soiled diapers per day in the first twothree days. By day three or four the breasts should become more
noticeably full of milk. Wet diapers will increase to five to six per day.
Stools will become yellow, loose and seedy (two-eight per day).
D Deciding to breastfeed is a healthy choice for you and your baby!
7
Figure 5
• Tuck your baby under your arm at your side.
• S
upport the baby with your arm. Place your hand
between his shoulder blades and make a neck support
with your fingers to stabilize his head and neck.
• K
eep your baby close to you. His nose should be at
the level of your nipple before latching on.
These positions work best during the first few weeks.
Figure 6
8
Latch-On
Cradle Position
• S
it in a comfortable chair and raise your baby to breast level by
using pillows.
Getting the baby to latch-on correctly is an important step in successful
breastfeeding. The baby must attach, or latch-on, properly to cause a release
of milk and to prevent nipple damage to the mother.
• Using a footstool levels your lap and helps support your back.
• Place your baby tummy to tummy, facing you.
Steps for proper latch-on:
• Cradle baby’s head near the crook of your arm.
1. Prepare yourself by getting into a comfortable position.
• Support his back with your hand on his hips.
2. A
lign your baby so that you are in a “tummy to tummy” position. Refer
to the different positions previously discussed. Align baby’s nose level
with your nipple.
• Support your breast with your free hand.
• Y
our baby’s nose should be at the level of your nipple before
latching on.
3. H
old your breast like a sandwich by placing your thumb by the baby’s
nose and your fingers under your breast near baby’s chin. All fingers
should be behind the areola, as shown in Figure 9. This will allow you to
support your breast without your fingers getting in the way of your baby
latching back far enough.
Side-lying or Lying Down Position
• Mom and baby should be on their sides.
• Your baby is placed tummy to tummy.
Figure 7
4. Gently tickle the baby’s lip with your nipple. He should begin to
root. Keep repeating this until his mouth is open wide. When
the mouth is the widest, quickly bring your baby’s mouth to your
nipple. DO NOT let him latch on to just the end of the nipple, as
this will be painful and can cause sore nipples.
• Place a rolled blanket behind your baby.
• Use pillows to support your back and head.
• B
aby’s nose should be at the level of your nipple before
latching on.
5. Signs of a proper latch-on:
These positions work best after mom and baby are more
experienced.
Figure 8
a. A
ll of the nipple and at least one inch of the areola is in the
baby’s mouth
b. Your baby’s lips are shaped like “fish lips.” His chin indents the
breast and his nose touches the breast.
c. Y
our baby’s tongue is over the lower gum. There are no
clicking sounds while sucking.
d. Your baby stays on the breast. His cheeks are full and do not
pucker inward during sucking.
e. You do not feel pain, only gentle tugs during sucking.
f. H
is lower lip should be close to the edge of the areola (at least 1 1/2” below your nipple).
10
Figure 9
11
8
10
Taking your baby off
the breast
If breastfeeding hurts, remove
your baby and begin again or ask
for help. To take your baby off the
breast, slide your finger into the
corner of his mouth between the
jaws. Gently break the suction
and slide baby off the breast. Do
not pull the baby off the breast
as this can cause pain and nipple
trauma. Burp your baby and offer
the other breast.
Cesarean Birth and Breastfeeding
Signs your Baby is Getting Enough
1. B
reastfeed your infant in the recovery room as soon as you are
able. If your baby is sick or premature, begin pumping as soon as
possible.
Most mothers can produce enough milk to nourish their babies. If
your breasts enlarged during the pregnancy and you have no untreated
thyroid, pituitary or hormonal condition, and if you have no history of
breast surgery involving many milk ducts, then your colostrum should
be enough during the first three days. On day three or four, your breasts
will be noticeably fuller (maybe tight and lumpy). Sometimes this stage,
which marks the arrival of your transitional milk, can be delayed. If you
have a medical complication, you may not notice this fullness until later.
In these situations, the baby must be monitored closely to make sure he
is getting enough milk.
2. Y
ou may breastfeed while the anesthetic or pain medicine is still in
your system.
3. U
se pillows for support and position your baby in the football hold to
keep the baby off your incision. (See figure 6, pg. 11)
4. A
fter you finish feeding on one breast, ask for assistance with
positioning on the second breast. If your baby falls asleep after the
first side, that’s okay too.
5. Keep your bedside rails up and the call light within reach.
Burping the baby
6. Rest as much as possible between feedings.
Try to burp your baby after feeding
on each breast. Some air may
enter the stomach during the
feeding, and burping will bring
the air up. If your baby did not
get much air in his stomach while
feeding, then he may not burp
at all. You may burp your baby by
putting him over your shoulder, by
lying him belly down across your
lap or by sitting him in your lap
and supporting the chin. Gently
pat or stroke his back with an
upward motion until he burps.
If he has not burped after a few
minutes, perhaps he has not
taken in any air.
7. Let someone else burp the baby.
8. E
at well and drink plenty of fluids. Your diet will be advanced to
solids when your physician or midwife sees that you are ready.
9. W
hen you begin to sit in a chair for feedings, make sure you’re
comfortable. Using pillows and a footstool will help.
10. Try to have someone spend the night with you. They can help by
handing your baby to you, burping and by placing the baby back in
the crib. If this is not possible, use the call light to ask for help.
Although you can’t “see” the baby getting the milk, the following is a
guideline to help you know if the baby is getting enough.
• M
ore swallowing will be heard each day. The tongue and lips will be
moist.
• After day 3-4, the breast will feel softer after the feedings.
• T
he baby will have periods of alertness each day and be easy to
arouse.
• By day 4-5, the stools should look yellow, loose and seedy.
• After day 1, the baby should feed 8-12 times per day.
• The baby’s wet and dirty diaper count should increase each day:
Day 1–2
1–2 wets and 1–2 stools (bowel movements)
Day 3–4
3–4 wets and 3–4 stools
After Day 4
5–6 wets (disposable diapers)
6–8 wets (cloth diapers)
2–8 stools per day
While all babies lose some weight at first, your baby should begin to
regain weight by day four or five. Babies should not lose over 10 percent
of their birth weight, and should regain to birth weight by the time they
are two weeks old. During the first month, most babies should gain 1.0
ounce per day.
11
12
NOTE: Urine may be hard to
notice in the first few days. Sliding
a tissue into the diaper will make
it easier to notice. Frequent stools
are also very important.
Keep a feeding diary until the
baby is gaining well on breast milk
alone, ie: four to eight ounces per
week. If you have concerns about
your baby, contact the baby’s
health care provider.
Sleepy Babies
If Baby Is Not Breastfeeding Well After 2-3 Days
Many newborns are sleepy for the
first few days. This is common.
Sometimes it is more pronounced
because of medications they
were exposed to while you were
in labor. Don’t panic if the baby is
not feeding often on the first day.
The staff will monitor your baby.
However, do take advantage of
the times when he is rooting,
alert, moving the tongue or
sucking on his fist.
When breastfeeding isn’t going as smoothly as you had planned, it’s
easy to get stressed. Often your own sleep deprivation adds to this.
Getting some extra sleep, arranging for further help after you are
discharged and keeping a sense of calm can help you get through this
period. Some insurance companies will pay for home nurse visits, visits
from a lactation consultant in private practice or follow-up visits with a
Christ Hospital lactation consultant. Call for help.
These are early hunger cues. If
the baby is sleepy or reluctant
to feed, try taking your shirt and
bra and his shirt off and placing
his skin to your chest skin. (Place
a blanket over his back.) Often
this arouses the baby after thirty
minutes or so. You can also rub
his chin or back to keep him
awake to feed. Don’t wiggle the
nipple while it’s in your baby’s
mouth.
• medications from labor are still in their system
While in the hospital, the staff is
available to help you nurse if your
baby’s sleepiness continues.
If you are at home, and the baby
is not breastfeeding often enough
(at least 8–12 times in 24 hours), contact your health
care provider. A baby can be
sleepy from not getting enough
milk (See pg. 12) or because he
is moderately jaundiced. (See pg.
24)
Most of the time we can identify the reasons you are having problems. The most common reasons babies don’t breastfeed well in the first
three days are:
• recovering from birth
• inverted nipples • tongue-tie
• overuse of bottles
• fullness from fluid in the areola.
With time these can usually be corrected. A mother whose milk supply
is never established is rare. If you have a deeply inverted nipple, a
lactation consultant may assist you with using a nipple shield. In these
situations, close follow-up, use of a hospital-grade electric pump and
assuring that the baby is fed are the three priorities.
Some mothers whose transitional milk has not come in at the usual 72
hours after baby’s birth, have found that at day six or seven, it arrives.
Keep the window of opportunity open by continuing to pump. Also see:
expressing pgs. 27-29, latch-on pg. 10.
Breastfeeding at Home
The Early Weeks
Note: If problems continue after the first few days of life, contact the
lactation consultant. She can help you maintain your milk supply and
the breastfeeding relationship when you are having difficulties. Your
baby’s health care provider will recommend the type of formula to use if
medically necessary. Learning a new skill and recovering from the birth
of a baby can seem overwhelming at times. Be patient with yourself and
your baby.
1. W
hen your breasts begin to feel heavier, it is important to wear a
well-fitted bra. Many mothers leak from one breast as the baby is
feeding on the other. Disposable or reusable pads can help absorb
leakage. To stop leakage, firmly press against the nipple with the
palm of your hand or arm for about one minute. (Problems with
extreme fullness, engorgement, are addressed on pg.17.)
2. O
nce your baby is gaining weight on breast milk alone, you can let
your baby set the schedule. This means you let your baby give you
the cues that it is time for a feeding. Sometimes babies cluster
feed (feed each hour for a few feedings in a row), and then sleep
for a longer period of time. This is normal. If your breasts get
uncomfortable it is always okay to wake the baby to feed, or you can
pump. Expect that your baby will feed a minimum of eight times per
24 hours for the first six weeks or so.
3. A
fter a while, most mothers find they are able to feed without the
support of extra pillows or holding the breast through the entire
feeding. Once your baby is gaining well, you may begin to offer an
occasional bottle, if you choose. This may be expressed breast milk.
(Remember that if you begin to use formula without expressing your
milk, your milk supply will decrease.)
4. Be patient. Many mothers feel breastfeeding doesn’t become easy
until after the first three or four weeks. Hang in there and seek help
if you need it!
13
14
Helpful Hints As
You Recover
1. B
reastfeed while lying down.
Keep your baby next to your
bed.
2. L
imit visitors and phone
calls. Let someone else or an
answering machine take calls.
3. K
eep meals simple. Prepare
some meals ahead and keep
in the freezer.
4. Let others help with
household chores or with
preparing meals.
5. Nap when your baby naps.
6. U
se an infant sling if your
baby needs to be held while
you’re trying to get light work
done.
Adjusting to Breastfeeding:
Overcoming Common Concerns
Family
Having a new baby is a wonderful experience. Adjustments on
everyone’s part will occur. The baby consumes a lot of a mother’s energy
and time in the first month. Both partners and siblings can feel left out in
the early weeks. Here are some tips to help adjust.
Read to your older child. Give them a doll or a special gift. Spend time
with them while the baby sleeps. Signs of jealousy will pass as they see
your love and affection for them is unchanged. Having partners develop
“special time” with the child while you are caring for the baby can be
helpful.
Partners can help by:
• learning about breastfeeding and encouraging mom
• screening calls and visitors
• holding the baby during fussy periods to give mom a break
• providing reassurance, TLC and back rubs
• o
rganizing meals and doing the shopping and other household
chores
• talking openly about concerns
• bathing and rocking the baby
Women may experience a temporary disinterest in lovemaking. It
will resume as you become more rested. Breastfeeding prior to sex
decreases milk leakage during sex. Sometimes a vaginal cream is
necessary, as hormone changes can make the vagina slightly drier than
usual. It is helpful to discuss your feelings openly with each other. You
may want to plan time alone with each other.
Another adjustment that takes time, is learning to breastfeed with
others around. Once the feedings are going well, it is easy to be discreet
by wearing loose tops or by placing a receiving blanket over your
shoulder and baby. Pulling up your shirt from the waist, rather than unbuttoning the top buttons, is a simple way to stay covered.
Baby Blues
Many moms find that they are a little more teary-eyed than usual after
the birth of their baby. This mild, short-term mood is often called “baby
blues.” If you feel particularly depressed, with frequent crying bouts that
are not improving over time, call your health care provider. If it warrants
temporarily using an anti-depressant, there are several preferred
medications while breastfeeding. If you have further questions about
this, don’t hesitate to call us.
15
Sore Nipples
If your nipples are sore:
Sore nipples are almost always
caused by improper grasp of
the nipple. Latch-on MUST be
corrected in these cases. This will
increase your comfort and the
amount of milk the baby receives.
Before Each Feeding
Other less common causes
include: yeast infection of the
nipple (see Thrush, pg. 19), a baby
thrusting his tongue forward after
excessive bottle usage (breastfed
babies roll their tongues
backward), a high arch to the
baby’s hard palate (roof of mouth),
or tongue tie (when the skin tag
under the tongue is short or tight
making it difficult for the baby to
move his tongue in a way that
allows him to latch-on properly
and/or get enough milk when he
breastfeeds).
4. R
otate the way you hold your baby: cradle, side-lying, football (see
pgs. 8 – 9). Football hold may give you more control of how your
baby attaches to the breast.
Ask the nurse, midwife, physician
or lactation consultant to check
your latch-on technique and
assess your nipples and the
baby’s mouth. Nipple blisters,
cracking, bleeding and severe
pain are not normal. Mild nipple
tenderness may be experienced
as you are learning, but even this
should not persist.
After Feeding
1. Use warm compresses for five minutes before latch-on.
2. N
umb a sore nipple with ice for a few seconds immediately before
breastfeeding. (Use ice wrapped in a cloth.)
3. Begin on the least sore side.
5. Pump for a few minutes to relieve over-fullness if this is preventing
your baby from grasping deep onto the breast. (See pg. 17,
engorgement.)
While Feeding
1. P
revent baby from pulling or tugging on the nipple by using the
steps under Latch-on (pg. 10).
2. If the soreness is severe, it may be enough to warrant pumping
instead of direct breastfeeding. Call the lactation consultant for help
with choosing a feeding method which provides an alternative to
using a bottle.
1. Express colostrum and rub into the nipple for mild tenderness.
2. A
warm compress after the feeding is soothing. If your nipple also
has a blister on it , this will allow the blister to open naturally. The
blister may have clear fluids or a small amount of blood in it. This will
not hurt your baby.
3. F
or moderate to severe soreness, you may use anhydrous lanolin
(ex: PureLan or Lansinoh, both are made for breastfeeders and safe
for babies). Apply a small amount to each nipple. You do not need
to remove this before the next feeding. Do not use this if you are
allergic to lamb’s wool or lanolin.
4. F
or cracks, other treatment measures may be advised by your
lactation consultant, physician or midwife.
5. Air your nipples by leaving bra flaps down after feedings.
6. A
void soap or alcohol on your breasts. Avoid breast pads with plastic
liners.
7. Wear breast shells (with air holes) between feedings. (See pg. 33)
The only lasting cure for sore nipples is to correct the problem.
16
Engorgement
Plugged Milk Ducts
Mastitis (Breast Inflammation or Infection)
At birth, a woman experiences hormone changes that stimulate milk
production. At about day three the breasts begin to feel fuller, heavier
and sometimes tender and lumpy. (This is due to milk and extra fluids
in your breast.) If you are breastfeeding frequently, this stage lasts
about one – two days. At this point the milk doesn’t go away, only
the extra fluid does. When the breasts become overly full, it is called
engorgement. During this day or two it is necessary to soften the
breasts by frequent feeding or pumping. Relief can also be obtained
from the following:
A plugged duct is a hard lump
in the breast. Normally it is not
accompanied by a fever and may
be the size of a pea or larger. It
can be located anywhere on the
breast, including under the arm.
It can be caused by skipping a
feeding, the baby falling asleep
before the feeding is over or by a
tight fitting bra.
Mastitis is another name for breast inflammation. It is usually
accompanied by a fever or infection. Common signs include: redness,
lumps, tenderness and flu-like symptoms such as headache, chills,
nausea and vomiting. It usually involves one breast and breastfeeding
can and should continue. In rare cases where both breasts are
involved, your physician or midwife should be asked before continuing
to breastfeed. The most common causes of mastitis are: fatigue,
unresolved plugged duct or improper breastfeeding techniques.
1. A
pply a warm, wet compress to your breast for about five minutes
just prior to feeding. (Showering, wash cloth or warmed disposable
diapers work well.)
2. If breasts are still uncomfortably full after feeding, continue to
express the milk until the flow stops.
3. If your milk is not flowing when breastfeeding or pumping or you are
still uncomfortable, apply cold compresses after feeding for 10-15
minutes. This decreases the swelling. You can use ice bags or bags
of frozen vegetables, but protect the skin from direct application of
ice or plastic.
4. M
assage the breast with circular massage or stroking before and
during feeding.
5. D
o nipple exercises (pgs. 5 – 6) before feeding to soften the areola
and stretch the nipple. Sometimes immediately after birth, the
areola is full of fluid, making it too tight for the baby to grasp and
compress. An exercise that helps this specifically is: with fingers
together, place them at the sides of both areola and apply firm
pressure against your chest wall for a minute or two. This forces
extra fluid back into the chest. Complete this exercise by applying
the pressure at each area of the areola, i.e. 12 o’clock, 3 o’clock, 6
o’clock and 9 o’clock.
1. A
pply moist heat to the area.
Massage the area just before
and during the feeding. Use a
circular motion for massaging.
Treatment includes:
1. Get more rest immediately, bedrest if possible.
2. C
all your midwife or physician for a fever or other symptoms that
persist beyond 12–24 hours. Be sure to tell them you want to
continue to breastfeed.
2. B
egin feeding on the side with
the plug. Hold your baby so
that his nose or chin is pointing toward the plug
to drain these ducts first.
Leaning forward during the
feeding may also help your
milk to flow.
3. Breastfeed often, using the affected breast first.
3. B
e alert to fever and chills
which may indicate the
beginnings of a breast
infection.
7. If antibiotics are ordered, continue to take all of them, even though
your symptoms may go away after a day or two. Most antibiotics are
safe to take when breastfeeding, although some babies may have
watery stools while you are on them. Check with your baby’s doctor
if you are unsure about whether the medication you are taking is
safe for him.
4. Contact a lactation consultant,
physician or midwife if the
plug persists for more than 12 – 24 hours or is getting
larger instead of smaller.
4. Apply moist heat to the breast before the feeding.
5. Drink plenty of fluids.
6. C
heck your temperature every eight hours. Take acetaminophen
(e.g., Tylenol) or ibuprofen (e.g., Motrin or Advil) as needed for pain
and to reduce swelling.
6. H
and or electrically express a small amount of milk to soften the
areola, making it easier for the baby to latch deeply. (See Supplies,
pg. 33, Gentle Expression, pg. 6)
7. D
o not skip a feeding. Breastfeed frequently around the clock. Try
to avoid unneeded supplements at this time unless the baby is not
breastfeeding.
8. Call a La Leche League or a lactation consultant for help if needed.
(See pg. 33)
17
18
Thrush/Candida
Thrush is a yeast infection that may involve the nipples, the lining of a
baby’s mouth and the diaper area.
Common symptoms for a baby include white patches in his mouth and/
or a diaper rash. A baby is treated with anti-fungal drops and/or cream.
Common symptoms for a mother include: a sudden onset of sore
nipples when previously breastfeeding without soreness, a burning or
shooting pain from the nipple deep into your breast both during and after
feedings or itching of the nipples or areola. A mother may be treated
with anti-fungal cream. If symptoms persist, she may be prescribed a
pill that is taken for several days. If a mother has symptoms, usually it
is necessary to treat the baby as well. You may continue to breastfeed.
If you are pumping, give the milk to your baby fresh instead of freezing
until you and the baby are symptom-free.
Other treatments:
1. Change your breastpads often.
2. Wash bras in hot water with a 1/2 cup of white vinegar.
3. If pacifiers, artificial nipples or breast shells are being used, run them
through a dishwasher or boil them for 10 minutes once per day. You
may want to buy new ones after a week.
4. Wash your hands frequently.
5. D
o not use any creams on the nipples, other than what has been
prescribed.
6. Call a lactation consultant if yeast persists or returns after treatment.
Nutrition While Breastfeeding
While you breastfeed, continue the healthy, well-balanced diet that
was recommended while you were pregnant. If you have been on a
special food plan, consult a dietitian from The Christ Hospital for further
guidance. You do not have to eat a “perfect” diet to breastfeed, but
eating well helps keep you healthy and energetic and adds important
minerals and vitamins to your milk. Your body burns about 500 extra
calories a day making milk for a newborn. It is usually recommended
that you take in at least 2,200 calories per day. For twins or multiples,
2,700 calories is the recommended.
Use the basic food group pyramid and eat a variety of nutritious foods.
1. Cereal and grains.
6 or more servings/day Bread, pasta, grits, cereal, potatoes
2. Fruit.
2–4 servings/day
3. Vegetables.
3–5 servings/day
4. Protein.
2–3 servings/day
Fish, nuts, poultry, peanut butter, eggs, dried beans, pork, beef
5. Fats and simple sugars.
Use sparingly
6. Milk.
2–3 servings/day
If you have a sensitivity to cow’s milk, eat other calcium sources:
fortified orange juice, green leafy vegetables, tofu, liver, brazil nuts,
almonds, yogurt and cheese. (You do not have to drink milk to
produce breast milk.)
7. Liquids.
6–8 cups a day
Drink enough fluids so you are not thirsty or constipated. When you
are drinking enough fluid, your urine will be clear or light yellow.
19
20
Helpful Hints About your Nutrition
Special Situations & Other Concerns
1. Taking your prenatal vitamin is helpful.
Common signs of a
food sensitivity are:
2. E
ating raw fruits and vegetables provide valuable fiber and nutrients.
Cooking vegetables for short periods in small amounts of water will
also help preserve their nutrients.
• B
aby is fussy about six —
eight hours after you’ve eaten
a particular food.
Building and Maintaining Your Milk Supply
3. S
imple, handy foods can be quick and nutritious. These can be:
cheese, yogurt, fruit, whole-grain bread, hard-boiled eggs, nuts, raw
carrots, low-fat peanut butter on crackers.
• B
aby remains fussy for about
24 hours.
1. P
ay attention to the latch. After breastfeeding is established, some
babies start latching too close to the nipple. If this isn’t corrected, it
becomes a habit. This means your baby is not compressing the milk
sinuses close to the edge of the areola. (See pg. 10) There may be
three consequences if the latch is not corrected: loss of milk supply,
poor infant weight gain and sore nipples.
4. B
reastfeeding moms can usually lose their pregnancy weight
without much restriction of calories. Do not crash diet. If you can’t
loose those “last 10 pounds” ask a dietitian from The Christ Hospital
for guidance.
5. C
affeine, nicotine and alcohol can affect your milk let-down reflex
and thus decrease your milk supply. Limit intake of caffeine products
such as tea, pop and coffee to no more than one-two cups per
day. In excess, this can also make a baby fussy and wakeful. Some
medications also contain caffeine. Be sure to read labels.
Nicotine does cross into milk. If you have been unable to stop
completely, limit yourself to under 1/2 pack per day. The less you
smoke, the better. Postpone your cigarette until after you have
breastfed and remember: no one should smoke around the baby.
n occasional small glass of alcohol may be desired; ask your baby’s
A
doctor. However, larger amounts can affect the flavor and amount of
milk you make. It can also affect motor development and weight gain
in your baby.
6. Most mothers can eat any food without worrying that it will cause
fussiness in a baby. If there is a family history of a particular food
allergy, it would be wise for mom to avoid that food. The most
common food to cause a problem is cow’s milk in the mother’s diet.
Other foods are: citrus, some spicy foods, peanuts, vegetables from
the cabbage family, broccoli, cauliflower, chocolate, onions, eggs and
caffeine. Do not eliminate these foods if there is not a problem.
• B
aby may wake suddenly with
obvious discomfort, passing
gas and crying.
• B
aby gets a diaper rash or
general skin rash, eczema or
hives.
• B
aby develops signs of a
cold: nasal congestion, mild
wheezing.
If you are concerned that the baby
is reacting to something you ate,
eliminate it from your diet for
three — five weeks. Consult your
baby’s doctor and a dietitian if
problems persist.
Remember that the more milk is removed from the breast, the more milk
you produce.
9. S
low weight gain. Consult
the baby’s doctor and your
lactation consultant about
managing your breastfeeding.
Have your baby weighed
frequently.
ometimes natural remedies
S
are used to increase your milk
supply. (Brewer’s yeast and
fenugreek.) At times a baby
needs to be supplemented
until your milk supply is higher.
Some herbs/teas can be
harmful. Consult your doctor
and lactation consultant.
here are several ways to
T
supplement breast milk or
formula. One way is to use a
Supplemental Nursing System
(SNS) which attaches right to
the breast so that the baby
stimulates your supply while
getting the extra calories and
food. (See pg. 33)
se a hospital-grade double
U
electric pump after feedings
until your milk supply
increases. This milk can then
be fed to the baby with the
SNS, syringe, cup or slow-flow
bottle.
2. D
on’t overdo the use of a pacifier. Babies need calories. Delay
using a pacifier until breastfeeding is established.
3. Always allow the baby to feed on the first breast until active
sucking and swallowing stops. Then offer the second breast.
4. E
at a nutritious diet and drink plenty of fluids. Making milk uses
calories. This is not a time to crash diet. Drink about six to eight
glasses of fluid each day.
5. M
onitor your medications. For example, some birth controls pills
and sinus medications can decrease your milk supply. Check with
your health care provider or lactation consultant.
6.Rest. Fatigue affects the let-down reflex, and thus the milk supply.
7. E
liminate or reduce the use of cigarettes, alcohol and caffeine. In
certain quantities, these have been found to reduce a milk supply and
make babies fussy.
8.Growth spurts. These are periods of rapid growth in a baby. They
occur often in the first year, beginning at about 10 days, again at three
weeks, eight weeks, 12 weeks and six months (with some variation
in timing). Babies are hungrier and eat more often. It takes about two
to three days of more frequent feedings to increase your supply.
10.Have your baby examined for
tongue-tie. If he can’t extend
his tongue over the gum
line, he may not be getting
an adequate amount of your
milk. Some babies gain well,
but a mother may experience
persistent sore nipples, which
can diminish your supply. (See pg. 16)
11. Join La Leche League. This
is a mother-to-mother support
group.
21
22
Fussy Baby
Jaundice
Remember all babies have some fussy periods. Extra holding, rocking,
use of a baby carrier (sling) and more frequent burping are all ways to
calm a baby. Sometimes parents interpret fussy periods to mean that
the baby is not getting enough milk. If your baby is gaining weight and
having the proper number of wet and dirty diapers, your baby is getting
enough milk. When you are in doubt, contact the baby’s doctor or a
lactation consultant. (See pg. 22 about building a milk supply).
Your baby may become fussy for a variety of reasons. Some of these
reasons are:
• Y
our baby may be going through a growth spurt and will breastfeed
more often. These spurts last about two days and build your milk
supply.
• In late afternoon or early evening some babies want to eat more
often.
• Your baby may be reacting to something you ate. (See pg. 21)
• T
oo much lactose (sugar) from the foremilk may cause your baby to
cry. Feeding longer on one breast provides more hindmilk, which is
higher in fat. Pump as needed to stay comfortable.
• Some baby vitamins can cause fussiness in babies.
• Babies also cry when they are in pain.
• A diaper change may be needed.
• Your baby may be overly tired.
• Over stimulation can also cause fussiness.
See your health care provider to
make sure there is no medical
reason why the baby is fussy.
Sometimes the term “colic” is
used when a baby cries for long
periods of time for no apparent
reason. There are many theories
about why some babies go
through this. This crying may last
from about two weeks of age to
about three months of age. Some
physicians will prescribe medicine
to try to resolve the problem.
Sometimes the only solution is
time.
Never give herbs or over-thecounter medicine to baby without
discussing with the baby’s doctor
first.
You may need support and help to
care for your fussy baby. Ask for
help from family and friends and
keep in contact with your baby’s
doctor. Many parents have found
it helpful to read the book, The
Fussy Baby, by Dr. William Sears.
Jaundice is usually a normal part of the adjustment to life outside the
womb. The word means "yellow," describing the color of the skin. There
are different types of jaundice: physiologic, which is naturally occurring
and is usually mild; and pathologic, which is more severe; and feedingrelated.
Naturally occurring jaundice usually does not occur until the second
or third day of life. This type of jaundice is usually mild and can be
prevented and treated by frequent breastfeeding and exposing the baby
to indirect sunlight. Most of the time this jaundice doesn’t need any
other treatment. At times, if the jaundice becomes moderate, artificial
lights (phototherapy) may also be used.
When jaundice becomes more significant, it is called pathologic
jaundice. The most frequent cause for this type of jaundice is due to
blood type incompatibility between a mother and baby. Occurring during
the first day of life, phototherapy may be started and other tests may
also be ordered. Since this type of jaundice is not related to feeding,
breastfeeding may continue through the treatment. Contact your
lactation consultant or health care provider should you need help.
Lastly, feeding-related jaundice may be due to either inadequate
breast milk intake or to the breast milk itself. This jaundice occurs by
day three and can be managed by more frequent feedings, increasing
milk production and assuring the baby is getting the milk. Water does
not improve this condition. Breast milk jaundice, on the other hand, is
possibly due to an unknown substance in some mothers’ milk. It usually
appears after the fourth day of life in a baby who is otherwise feeding
well and gaining weight. These babies may require phototherapy and/or formula supplementation. In rare cases, breast milk
feeding may be interrupted for about 24 hours while the mother pumps
to maintain her supply. When breastfeeding resumes, the jaundice very
rarely returns.
Leaking
This is usually a temporary problem moms experience in the first eight
weeks or if feedings are missed. Use breast pads in the bra. Pressing
the palms of your hands or your arms over your nipples for about a
minute will stop the flow of milk. Some moms carry an extra blouse, or
jacket when they leave the house. Keep extra breast pads in the diaper
bag.
23
24
Feeding Schedules
and Sleep Patterns
There are many friends, family,
child care specialists and authors
who say conflicting things on the
subject of schedules, expectations
about breastfed babies sleeping
through the night and parenting
ideas in general. While we can’t
tell you the one right way to do
things, we offer a few comments.
During the first three to four
weeks babies schedules are
unpredictable. Sometimes they
have their days and nights mixed
up. Babies need to eat at least
eight times a day, including at
least once at night. Some feed 1012 times per day at first. By three
or four months of age, they may
have dropped a feeding or two
and nurse seven to eight times
per day.
How can you make sure your
baby sleeps well? There are no
guarantees. Feeding often and
having periods of playful time
may increase the length of time
your baby sleeps. You will need
to accommodate your baby’s
necessary comfort and hunger
needs. Keeping night feedings business and not play
and keeping a darkened, quiet
atmosphere will also help. Most
babies from all cultures breastfeed
to fall asleep. While it is the
norm, it is fine to experiment
with laying a baby down awake.
Use common sense, flexibility,
instincts and compassion.
Allowing a baby to cry himself to
sleep is generally not the answer.
The baby is counting on you to
meet his needs. This is a big and
sometimes overwhelming task.
Medications And
Street Drugs
Most medicines cross into breast
milk, but can be safely taken
while breastfeeding. However,
some require you to pump and
discard the milk until you are off
the particular medication. Consult
your baby’s doctor before taking
prescription or over-the-counter
medicines. Most often a doctor
can recommend an alternative
medicine that would not interfere
with breastfeeding.
All street drugs cross into breast
milk and can be extremely harmful
to the baby. These drugs can stay
in the baby’s system longer than
an adult’s and can accumulate and
make the baby very sick. Street
drugs are unacceptable while
breastfeeding. If you want more
information about this, contact a
lactation consultant.
Twins, Triplets and More
Adoptive Nursing
These are special circumstances which will require patience and
additional time to successfully breastfeed your babies. Some mothers
choose to combine bottle and breastfeeding, while other moms plan
to exclusively breastfeed. You must be flexible. Discuss your goals with
your baby’s doctor and lactation consultant. Some multiples will spend
time growing in the hospital before they can come home.
If you have adopted your baby, there are ways to breastfeed. As soon as
you know you are adopting and plan to breastfeed, call La Leche League
(357-MILK) or a lactation consultant. The younger the baby is when you
begin to breastfeed, the more successful you will be. Pumping and
using a supplemental nursing system (SNS) are ways to help the baby
learn to breastfeed and to build a milk supply. (See pg. 22) Patience,
flexibility and guidance can help you move toward your breastfeeding
goals. You’ve come a long way to get to this point! Some herbs may be
helpful—ask for more information.
When you plan to breastfeed more than one baby, it is helpful to begin
by learning with one at a time. You will need plenty of individualized
assistance. Feeding two babies at one time can be accomplished by
most moms after each baby is breastfeeding well. Breastfeeding pillows
(or extra pillows) can make feeding much easier. Keep a feeding diary
and track feedings, wet and dirty diapers until all babies are gaining and
you are meeting your breastfeeding goals.
Resources include: books, tapes and meetings about breastfeeding
multiples available through La Leche League (357-MILK), the hospital
lactation consultant, Mothers of Twins Club (through La Leche) and the
Triplet Connection. “Mothering Multiples” by Karen Kerkoff-Gromada is
an excellent resource.
Babies with Special Needs: Down’s Syndrome,
Cleft Lip and/or Palate
Babies with special medical needs benefit from breast milk. Whether
your baby will be able to directly feed from your breast depends on the
severity of his condition. Some babies with Down’s syndrome or a cleft
lip may breastfeed right from the beginning. If your baby is not breastfeeding, be sure to begin to pump your breasts as soon as you
feel able within the first day. (See pg. 27) Support and assistance are
available to you.
You should see the lactation consultant as soon as possible. La Leche
League (See pg. 33) offers informative booklets about breastfeeding or
pumping in your special circumstance. Medela also publishes Give Us A
Little Time about breastfeeding/pumping for a baby with a cleft. You will
need to work with a lacation consultant to make sure the baby is breastfeeding well.
25
26
Expressing and Storing Breast Milk
Milk for Hospitalized Babies
If your baby is unable to breastfeed after birth, we encourage you to
begin pumping your breasts as soon as you feel well enough. Hopefully
this can be within a few hours of the birth. Even if the baby is not eating
yet, it is important to begin to prepare your body to produce milk. The
hospital will provide you with the pump kit, labels and collection bottles
and caps. Keep the pump kit. It can be used at home with a rented
pump if you are pumping after discharge. While at the hospital, the
nurse will show you how to use a double electric pump. Until you are
producing enough milk for your baby, we may need to use a combination
of your colostrum/milk and formula. When the baby is ready for direct
breastfeeding, we will make every effort to help you succeed. The nurse
and lactation consultant are there to assist you.
1. Begin by washing your hands.
2. T
he first few times you pump, you may not get any milk. Your body
is not used to responding to a machine. Give it time. Relaxation, soft
music and some of your baby’s clothing or his picture may help milk
flow. Heat helps make milk flow. Try using a warm wash cloth to
your breasts or showering and breast massage before pumping.
3. P
ump both breasts at the same time for 15 minutes every two to
three hours. The goal is eight sessions in 24 hours. After you’ve had
a good night’s sleep, we urge you to pump once every night as your
baby will be eating at night, too. Your milk supply is highest at night.
4. B
egin on minimum suction and gradually increase to a higher level.
Pumping should not hurt. When your transitional milk arrives, about
day three, you may feel uncomfortably full. Using moist compresses
before pumping will eliminate this problem. When this happens,
some moms find it necessary to use cold compresses for 10-15
minutes after pumping to reduce swelling. Call a lactation consultant
if pumping hurts.
5. S
it upright while pumping. At the end of the 15 minutes, lean
forward and tip the funnels so that even small amounts of pumped
colostrum/milk will drop into the bottle. Save any amount of milk
that you obtain. You can combine the milk from each breast into
one bottle. Cap and label it with your name, date and time you
pumped and any medications you’ve taken that day. While you’re
still hospitalized, send the milk to the nursery as soon as possible.
At home, freeze the milk and then transport it to the hospital chilled.
Fresh milk is preferred over frozen milk. Check with the baby’s nurse
once feeding begins to see if you should continue to freeze the milk.
27
6. Once you are obtaining more than one ounce of milk per pumping,
ask the nurses how full they would like to have the bottles.
Sometimes we begin feeding your baby with only very small
amounts of milk. Because we don’t like to throw away unused milk,
it’s important that the bottles not be overfilled. Always leave space
at the top of the container when freezing milk. Do not combine milk
pumped at different pumping sessions.
7. In the hospital, the funnel pieces that go over the breast must be
washed with mild soap and rinsed under hot water after each use.
At home, they should also be sterilized by running it through a
dishwasher or boiling these parts for 10 minutes once a day. After
use at other times, wash in hot, sudsy water. The tubing does not
come in contact with the milk and should not be washed. If you are
not pumping into new, sterile bottles each time you pump, then the
bottles will also need to be sterilized daily at home.
8. If the baby is transferred to another hospital, ask to speak to their
lactation consultant or a nutritionist. If a lactation consultant is
unavailable, be sure to obtain the information and equipment they
use.
9. Maintain a good diet and drink plenty of fluids. You are encouraged
to continue taking your prenatal vitamins. Limit caffeine to one cup
per day. For more tips on nutrition, see page 20.
10. Some moms find after several weeks of pumping their supply
decreases. Make sure you are pumping eight times a day, including
once at night. Review your lifestyle. Are you getting enough rest?
Have you started a new medication? Relaxing with soft music and an
article of your baby’s clothing to see and smell can actually improve
your supply. Speak with your lactation consultant about other ways
to increase your milk supply. (Examples include: skin-to-skin contact,
Brewer’s yeast and fenugreek. Check with your doctor/nurse midwife
before using herbs.)
11. Keep in close contact with your baby’s nurses and doctors so they
know you wish to be informed when the baby is ready to feed
directly from your breast. Even before that time, babies can begin
to be placed skin-to-skin, upright, between your breasts or nuzzle
against your nipple in preparation to begin breastfeeding.
28
12. You may want to rent a breast
pump. Rental is usually about
$1-3.50/day. Always call ahead
to make sure they have what
you need. A deposit is often
required. Some insurance
plans require pre-authorization
BEFORE you can rent a pump.
The baby’s physician may sign
a letter of medical necessity
or a prescription that may
help you obtain coverage.
Check with your insurance
company about this. They may
also want you to obtain the
pump from a particular vendor.
Do not borrow breast pump
equipment. Contact a lactation
consultant for a list of rental
places.
Pumping, Storing and Thawing Milk for a
Healthy Baby at Home with Mom
For occasional pumping, some mothers hand express their milk into
clean bottles. With the thumb and index finger at the edges of the
areola, push back against your chest wall, squeeze the finger and thumb
together and then release. Repeat until the breasts are softened. The
advantage of using this process is that it takes no manufactured pump.
The disadvantage is that it may take about 15-20 minutes per side to
complete. (See pg. 6)
Many types of pumps are now on the market. They vary in effectiveness
and cost. Check with La Leche League or a lactation consultant about
specific brands. Follow the manufacturer’s guidelines for cleaning before
and after use. The baby’s doctor will provide you with recommendations on whether you need to sterilize bottles and nipples.
1. Store milk in small amounts to prevent wasting any unused amount.
2. Breast milk may be refrigerated for five to eight days. It is safe at
room temperature for 6–10 hours. It can be kept in the back of a
refrigerator’s freezer for 6 months or in a deep freeze for 12 months.
3. Glass is the first choice for storing frozen milk. You can also use
hard, clear plastic containers or made-for-breast milk freezer bags, or
cloudy plastic bottles.
4. It is not a problem to add breast milk to already frozen breast milk,
provided you chill the milk first so as not to thaw the top layer of the
previously frozen milk. Date the bottle and thaw the oldest milk first.
5. Use thawed milk within 24 hours. Do not re-freeze. You may thaw
milk overnight in the refrigerator or by holding it under running
warm water until it is brought to room temperature. Never use the
microwave to warm or thaw milk. It destroys some of the nutrients
and it can create hot spots that could burn the baby.
6. Before giving the milk to your baby, swirl it gently and drip some on
your forearm to test for a suitable temperature. Gentle shaking will
also mix the foremilk and hindmilk which may appear to have layered
in the bottle.
Combining Breastfeeding with
Work or School
Combining work or school with raising a baby is both challenging and
rewarding. Some moms will have the flexibility to delay a return to these
activities for three months or longer.
Waiting this long makes it easier, but some moms must return to work
sooner. The following are suggestions to make this successful.
1. B
reastfeed often in the first weeks to assure your supply is well
established. Postpone introducing a bottle for about three to four
weeks, unless there is a medical necessity. Then begin to offer an
occasional bottle of pumped milk to teach your baby to take a bottle.
2. Your milk supply is highest at night and first thing in the morning.
Many moms pump about an hour after a morning feeding and then
refrigerate this milk for later use.
3. There are three basic approaches to feeding while you work:
• You can pump and have only breast milk given while you are
away.
• Y
ou may choose to wean your baby at this time. (check with your
baby’s doctor first- see pg. 32)
• Y
ou can breastfeed when you are home and have formula fed
while you are gone. The risk of this is some babies may become
reluctant to breastfeed when you are home, and since you are
not pumping, your milk supply will decrease. If you are working
part-time, this may not happen.
4. If you choose not to pump at work, begin to give a bottle for one
feeding per day for about two weeks before you return to work.
Give this during the hours you will be working. After five days, add
another bottle and eliminate another breastfeeding, again during the
hours you will be working.
7. It may be safest to discard leftover milk until further research on this
topic is complete.
8. We recommend silicone, dripless or slow-flow nipples for babies
under eight weeks of age. Check with your baby’s doctor about how
much milk to give at each feeding. Below is a guideline for average
feedings:
By Age 0–2 months..... 2–4 oz. per feeding.........8 feedings per day
2–4 months..... 3–5 oz. per feeding.....6–8 feedings per day
4–6 months..... 4–6 oz. per feeding.....6–8 feedings per day
29
30
5. Double pumping cuts the
pumping time to about
15 minutes. Cost and
effectiveness often go hand
in hand. Manual pumps or
battery-operated pumps are
not as effective as good brand
electrics. Several companies
make a full-size double
electric. These can be bought
or rented. You must buy kits
to go with the rental pumps.
The phone numbers for pump
rental are: Medela (800-TELLYOU) or Hollister (800-3238750). Rentals range from $13.50/day. The cost to purchase
pumps ranges from $60$350. Some pumps do not
have good reputations. Ask
around before you make your
decision or use the brands
your hospital uses, Medela or
Hollister.
6. Pump one to two times a day
for two weeks before you
return to work or school. (See
pg. 30 for storing breast milk)
7. M
any moms find returning to work later in the week allows for a
gradual adjustment. It may be helpful to discuss your desires with
your boss, assuring them that this won’t interfere with your job. You
will also need a private place to pump and a cooler or refrigerator to
store the pumped milk.
8. Generally, you need to pump as many times per day as you would
have been breastfeeding. For example, if the baby usually feeds
twice during an eight-hour period, pump twice at work. An easy
rule of thumb is to pump every three to four hours while you are
separated from your baby.
9. Make sure no one feeds your baby an hour or two before you return
so that you can breastfeed. (If the baby is fussy, a small amount can
be given.)
10. Many moms report their supply is high on Mondays but tends to be
low by Friday. If this happens drink more fluids toward the end of the
week.
11. Sometimes your baby will want to breastfeed more when you are
around. When this happens you may need help with basic chores
such as preparing dinner. Being flexible and having a good sense of
humor can go a long way!
12.Talk to mothers at work who have experience with pumping at work.
They will probably have lots of tips to help you.
13. Stay in touch with your support system. They can be a great help.
14.Jot down your reasons for continuing to breastfeed. Lots of people
will ask you about it. Take pride in those answers!
See page 33 for book resources on this topic.
Resources: The Working Woman’s Guide to Breastfeeding, Dana and
Price. Breastfeeding Success for the Working Mom, by Dr. Marilyn
Gram. These are available from the library or can be ordered through La
Leche League (LLL) or the International Childbirth Education Association
(ICEA). LLL has a working moms group, call 357-MILK for meeting
information.
31
Weaning
Breastfeeding for any length of time benefits your baby. (If you are thinking
about weaning because the first week has been difficult, ask for help before
making up your mind.) Sometimes weaning must be done abruptly due to
certain circumstances. Contact a lactation consultant and ask for guidance in
this situation. It’s easier if the weaning process is gradual. Babies then have
time to adjust and mothers don’t go through painful engorgement. Gradual
weaning can be accomplished by dropping one feeding at a time every
five to seven days, over the course of several weeks. At about six months
of age, you can introduce solids. It is important to breastfeed immediately
before feeding your baby solid food. Some babies wean right to a cup and
skip bottles altogether.
Normally, a baby would not choose to wean prior to a year. If at some point
in the first year the baby refuses to breastfeed (breastfeeding strike), it is
usually temporary. With time and patience a baby usually returns to feed
from the breast. It may be helpful to offer more skin contact during this
time, and be sure to express your milk. Call La Leche League or a lactation
consultant for advice during a “nursing strike” or if the baby bites during the
teething phase. Some possible reasons for a “nursing strike” are: mother’s
menstrual periods have returned and the supply may be lower, the baby
may have a cold or ear infection or the baby may be teething. In this last
situation, if the baby bites you while breastfeeding, pulling him closer to you
usually makes him release his grasp. If he continues, take him off the breast
and offer a chilled teething ring at this time. Babies are more likely to bite
when they are easily distracted. When you are no longer hearing swallows
after each chin drop, go ahead and take him off the breast.
The American Academy of Pediatrics recommends breastfeeding for the first
year of the baby’s life, and acknowledges that it is beneficial into the second
year. Breastfeeding a toddler has health benefits, too.
The Christ Hospital wishes you well as you approach this milestone in your
child’s development!
32
Breastfeeding Diary
Resources
Breastfeeding Books
uggins, Kathleen. Nursing Mother’s
H
Companion and Nursing Mother’s Guide
to Weaning. The Harvard Common
Press, current edition.
a Leche League. The Womanly Art of
L
Breastfeeding.
Breastfeeding Supplies
1. B
reast shells: Moms with sore or hard-to-grasp nipples may need
breast shells.
2. Breast pads: These can help absorb leaking milk and are available in
washable and disposable. Pads with plastic liners should be avoided.
3. N
ipple Cream: PureLan and Lansinoh are the only creams
recommended for breastfeeding mothers who are experiencing some
tenderness. It is safe for the baby. A small amount is applied to the
nipples after feeding. It is always important to correct the cause of the
soreness at the same time. Avoid use if you are allergic to lamb’s wool or lanolin.
Date Time
Y/N
Minutes
Wet
Each Side Diaper
L R
Keep a diary until baby is gaining weight. Record stools,
wet diapers and swallowing over a 24-hour period.
Y=swallowing heard
N=no audible swallowing
Stool
Diaper
Stool
Color
Date Time
Y/N
Minutes
Wet
Each Side Diaper
L R
Stool
Diaper
Stool
Color
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Internet Websites: lalecheleague.
org, breastfeeding.com, medela.com,
breastfeedingonline.com.
____________________________________________________
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International Childbirth Education
Association: 952-854-8660 or
www.icea.org
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Sears, William. Night-time Parenting and
The Fussy Baby.
ewman, Jack. The Ultimate Guide to
N
Breastfeeding.
aLeche League. Breastfeeding Your
L
Premature Baby.
These books and more are available
through the La Leche League (847)
519-9585, and may be found at many
bookstores as well.
Breastfeeding Organizations
a Leche League (LLL): Local groups of
L
women who provide mother-to-mother
support for breastfeeding. They are
available by phone and have a monthly
meeting each week around the area.
(Locally they can be reached by calling
357-MILK.) The national number offers support at 1-800-Laleche.
Their business number is 847-519-7730. They also sell parenting
books as well as pamphlets, and
sponsor both parent and professional
conferences. Their address on-line is:
www.lalecheleague.org
ational Organization of Mothers of
N
Twins Clubs: www.nomotc.org
The Triplet Connection: 435-851-1105 or
www.tripletconnection.org
hildbirth Education Association .
C
of Cincinnati: 513-661-5655 or
www.childbirthclassesofcincinnati.com
4. S
upplemental Nursing System (SNS): There are three types of SNS:
the starter kit, the full-sized and the finger-feeder. This is used to feed
the baby pumped breast milk or formula. The first two are attached
right to the breast. The finger-feeder is used when the baby is not
feeding directly from the breast. These are alternatives to giving a
bottle in the early weeks. They can also be used for babies who gain
weight slowly or for adopted babies.
5. N
ursing bras: These should be at least 70 percent cotton. Use
caution when considering an underwire bra. The wire should not be
so restrictive that it could potentially obstruct the flow of milk. Medela
makes bras in many sizes including F, G and H cups.
6. Nipple shields: These are not commonly used, but can be helpful
when used with the guidance of a lactation consultant. Specific
situations for use of nipple shields could include some premature
babies, moms with inverted nipples or when your baby is reluctant to feed after several days.
7. B
reastfeeding pillow: When a baby is placed on this pillow during a
feeding, it can help support his weight and keep him positioned directly
in front of the nipple. Moms feeding two babies at a time have found
this very helpful.
All of the above products are available through Medela (800-TELL-YOU).
Some are available through Hollister (800-323-8750) and local baby
specialty shops, department and discount stores. These two companies
also rent and sell quality breast pumps. While there are many pumps
on the market, not all have a good reputation. Ask other breastfeeding
mothers or consult with La Leche League or a lactation consultant for
suggestions before you buy.
33
34
Breastfeeding Diary
Date Time
Y/N
Minutes
Wet
Each Side Diaper
L R
Keep a diary until baby is gaining weight. Record stools,
wet diapers and swallowing over a 24-hour period.
Y=swallowing heard
N=no audible swallowing
Stool
Diaper
Stool
Color
Date Time
Y/N
Minutes
Wet
Each Side Diaper
L R
Stool
Diaper
Stool
Color
Breastfeeding Diary
Date Time
Y/N
Minutes
Wet
Each Side Diaper
L R
Keep a diary until baby is gaining weight. Record stools,
wet diapers and swallowing over a 24-hour period.
Y=swallowing heard
N=no audible swallowing
Stool
Diaper
Stool
Color
Date Time
Y/N
Minutes
Wet
Each Side Diaper
L R
Stool
Diaper
Stool
Color
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