FAQs about breastfeeding
What if my breasts can’t make enough milk?
It takes a while for you and your baby to get used to what you’re doing together. In the meantime, you can trust that the same body that grew your baby also knows how to feed her. The best way to make sure you have enough milk is to let your baby nurse whenever she wants to, day or night. Most newborns need to nurse about eight or nine times in a 24-hour period. Don’t worry about baby weight: All lose weight during the first three to four days after birth and then start gaining within 10 days to two weeks. After the first three to four days of nursing, your baby should be wetting or soiling about 6 diapers a day, a sure sign that the milk is working. At two weeks of age, about the same time your breasts start to get smaller, you can expect your baby to have a temporary surge when she seems to want to nurse all the time. This is the sign of a growth spurt, and is actually your baby helping you to boost your milk production.
How long should I breastfeed?
The answer is “as long as you want to.” Throughout human history, babies and young children were breastfed until their moms got pregnant again, and in other societies, nothing is thought about children who can walk and talk stopping every once in a while to have some milk, especially when going to sleep or first thing in the morning. The American Academy of Pediatrics recommends that babies be breastfed for at least 12 months, and thereafter for as long as mother and child desire. If you aren’t able to pull that off, then be proud of every month that you do breastfeed, because you’re helping your baby’s health.
How can I get my husband to stop wanting to give my baby formula?
Try to be logical about it rather than emotional. Explain all the health benefits your baby will gain from human milk, and let him know how important his support is to you. Show him ways that he can help with the baby, such as diapering, rocking, and soothing. If he continues to feel left out, consider pumping some milk in a bottle and freezing it so he can defrost it when he wants to have some dad-feeding moments.
Tip
If you have worries or problems breastfeeding, ask for help. There are a lot of well-trained people who want to help you succeed, including the nurses at the hospital, lactation consultants whom you can hire, and volunteer leaders from La Leche League International (www.LaLecheLeague.org), who are available 24/7 to advise mothers.
What should I say to my mother-in-law, who has told me she thinks breastfeeding is embarrassing?
Breastfeeding doesn’t have to be embarrassing. It doesn’t take long to figure out how to use a large scarf or special nursing shirt with side vents to cover your front while your baby nurses. Be especially vigilant about being covered when the baby’s going on or coming off the breast, or nurse privately when your mother-in-law is around. Also, it helps to understand that women who question your decision to breastfeed may really be examining their own choice to bottle feed, even if it was many years ago.
Ten cures for sore nipples
The friction from nursing your baby may cause your nipples to feel as if they’re sunburned. Sometimes nipple soreness may get more painful than that, and your nipples may develop scabs or bleed slightly.
Here’s what to do:
1. Check your position. Change your nursing position often. Your baby should be well supported at breast height, with his whole body facing you. Most of your areola should be stuffed into his mouth, with his chin pressed upward against your breast. (See Positioning for Breastfeeding on in this chapter.)
2. Cure with breastmilk. Apply your own milk to your nipples after nursing, and allow them to air dry. Human milk has antibacterial properties that can help your nipples to heal.
3. Infection protection. Apply a thin layer of antibiotic ointment, such as Bactroban® or Polysporin® after each feeding to help prevent infection.
4. Start the milk early. Once your milk has come in, wash your hands, try to relax, and express some milk so that your milk is already flowing when the baby latches on.
5. Expose yourself to air. Bathe your breasts in fresh air and sunlight as often as possible (but don’t get sunburned).
6. Avoid harsh cleaning. Use only water, not soap, to clean your nipples, then gently pat (not rub) them dry.
7. Use a lubricant. Apply USP-modified lanolin, such as Lansinoh Lanolin for Breastfeeding Mothers® to soothe your nipples between feedings.
8. Wear absorbent materials. Use bras and breast pads that are absorbent, and avoid those made of synthetic fabrics or lined with plastic.
9. Try tea. Apply warm, wet, black tea bags to your nipples like a compress. They contain tannin, which soothes skin.
10. Get help. Persistent or toecurling pain may mean you’ve got an infection. Your health-care provider will recommend an antibiotic or antifungal ointment.
Irritation symptons
If your nipples are cherry-red, itchy, and cracked, or bleeding, it may mean you’ve got a yeast infection, and you may have caught it from your baby. In babies, the yeast infection is called thrush. You may notice that your baby’s tongue and cheeks stay coated in white, milky-looking patches that won’t wipe away. Or the infection could appear as red, irritated patches in the folds of the skin, such as on the neck or in the armpits and thighs. And, some babies get a yeast-related, cherryred diaper rash that doesn’t clear up easily. Consult with your baby’s health-care provider for safe treatments to prevent the two of you from reinfecting each other.
Different nursing patterns
Every baby is unique: Different babies have different nursing patterns, and not every baby masters the art of breastfeeding efficiently.
Tip
Your baby is more likely to want to nurse in the evening and into the wee hours of the morning than in the middle of the night and early morning. Of course you can’t predict when your new baby will want to nurse.
Sometimes, it just takes time. Once you and your baby settle into it, your baby will probably want to nurse continuously for a long time, then fall asleep, only to wake up and want to nurse again. Every baby has his own pattern. Some will only nurse for 10 minutes at a time and then want to sleep for 30 to 40 minutes and rouse up to nurse again.
Sometimes your baby’s experiences during labor and afterward may affect his ability to nurse. If you’ve had a c-section or a long and difficult labor, your baby may be sluggish and want to sleep instead of nurse, and his sucking may become weaker, too. If your baby has undergone painful procedures, such as having his heel punctured for a blood test or being given a shot or he has a sore throat from overly vigorous suctioning at birth, he may refuse to nurse for a while. Recent circumcision can affect a baby boy’s desire to nurse. Certain pain relievers can also affect a baby’s nursing behavior. For example, pethidine (Demerol®) used for labor pain has been found to delay and depress a baby’s skill at rooting and sucking if it’s given to the mother near the time of delivery.
FLASH FACTS: Things That Interfere with Breastfeeding
One study found that 15 out of 17 babies experienced sucking problems when they were separated from their mothers for 20 minutes after birth for weighing and measuring. If a mother was heavily medicated during labor, 19 out of 19 babies had trouble breastfeeding. On the other hand, when mothers weren’t medicated during labor and mother and baby were never separated, 16 out of 17 babies succeeded in breastfeeding. Another study found that 30 percent of mothers whose babies were given formula in the hospital later reported severe breastfeeding problems, while fewer than half of mothers whose babies had not been fed formula had breastfeeding problems.
If your newborn is sluggish and sleeps a lot, your lactation adviser may suggest that he be awakened periodically to nurse. Dehydration is rarely a problem for newborns because they come into the world filled with fluids. Just in case, though: The symptoms of dehydration are listlessness, sluggishness, dry mouth, a weak cry, only one or no wet diaper a day, and fever.
Nursing soon after birth is important
Getting separated from your newborn can be a setback when it comes to breastfeeding.
The most effective way to get your milk flowing abundantly is to allow your baby to nurse immediately after birth—or at least within the first two hours—and to let him stay latched on to your breast long enough to empty it completely. If nursing is delayed, you can still make up for lost time later, but you may experience engorgement.
In fact, early nursing is thought to increase the number of receptors in your breast that tell your body how much milk to produce for your baby.
“I really cherish the tender, quiet moments I remember sharing with my baby while nursing during that first year. I wouldn’t give up that experience for a million dollars now. It helped to form a close and lasting connection with him.”
Your baby’s three important nursing signs
1. I’m hungry! Your baby will turn his head back and forth (called rooting) as he searches for your nipple. He may try to suck his hand, make sucking movements with his lips, or open his mouth when you touch his lips. If he gets desperate, he’ll start crying.
2. I’m working. Your baby’s jaw motions will become rhythmical, and you’ll hear his swallowing or clucking. (And, if he could, he’d hang a DO NOT DISTURB sign on his diaper.)
3. I’m full. Your baby’s sucking slows down. He may fall asleep at the breast, or just snooze and make little jaw movements here and there when milk spurts come through, or he may pull away from the breast completely and let go. Most newborns nurse a little, sleep a little, and then nurse a little more.
Don’t mix formula and breastmilk
Giving your baby both breastmilk and formula can cause your breasts to begin reducing milk production. Feeding your baby artificial milk affects a baby’s demand for breastmilk, which in turn initiates the progressive shutting down of a mother’s milk-making system. Your breasts become engorged, and this causes milk to back up, which in turn starts the shutdown.
Some babies who are less than a month old will completely reject their mothers’ breasts after they’ve been given bottles. The problem is called nipple confusion. The baby adopts an incorrect sucking style and then has trouble changing back to milking the breast, which calls for an entirely different action. Once a baby decides to stop nursing, it can be hard to coax him back into it again.
Tip
Having your breasts emptied of all their milk signals your body to produce more. If you habitually favor one breast over the other, the breast you use the most will grow fuller and make more milk, while the ignored side will make less. Try attaching a safety pin to your bra to remind you which side to nurse next, and that way, you won’t favor one breast over the other.
Breastfed newborns who are given formula are also more vulnerable to allergic reactions to cow’s milk later on. Glucose water supplements aren’t helpful, either. They can contribute to babies losing more weight in the early days after birth.
If you’re going to nurse your baby, protect yourself from the influence of aggressive formula manufacturers. Ask the hospital nursing staff to note your breastfeeding plans in your record, and request that your baby have no other liquids by mouth. Don’t take free formula samples home if they are offered to you by the hospital staff, and donate formula samples that arrive on your doorstep to charities.
Storing breastmilk
After the first four weeks, when your milk supply is well-established and your baby has bonded with your breast, you can hand-express or pump an extra bottle of milk by using the milk from the opposite breast your baby is nursing on. This will allow your partner to feed your baby while you rest or run an errand without your baby developing nipple confusion.
Human milk has built-in, antibacterial properties that keep it fresh. One study even found that after 8 days of storage in the refrigerator, some milk samples had fewer bacteria than the day they were expressed.
The length of time that milk can be left out depends upon the temperature in the room. Colostrum, milk expressed within 6 days of delivery, can be stored for 12 hours at room temperature before needing refrigeration. Freshly expressed regular milk may be stored at slightly below room temperature (such as in a cooler with ice packs) for up to 24 hours.
Breastmilk can be stored at room temperature (less than 77° F) for 4 to 8 hours; at the back of a refrigerator for 3 to 8 days; at the back of separate freezer compartment of a refrigerator for up to 3 months. It will last for 6 months or longer in a deep freeze that holds the temperature at a constant 0° F.
When gathering milk to be stored, make sure that your hands are clean and, if you use a breast pump, that the components and bottles have been washed in hot, soapy water and allowed to air dry. Milk can be stored in a plastic or glass bottle with the top sealed and screwed on tight, or you can purchase freezer bags designed specifically for milk storage. You can add fresh milk to frozen milk as long as there is less fresh than frozen.
Remember that milk expands when it freezes, so allow adequate space. Date the bottles or bags by writing on masking tape with a marker or ballpoint pen. Defrost the milk under warm running water.
Breastfeeding and nutrition
While you’re breastfeeding, it’s important to eat a balanced diet for the health of both you and your baby. Here are eating tips for nursing moms:
• Go for energy. Don’t consume fewer than 1,800 calories a day while breastfeeding (which should be easy; breastfeeding makes you really hungry). An intake of 1,800 to 2,200 calories is a good amount for most women with an average activity level to maintain an abundant milk supply. The more frequently you breastfeed and the fewer body fat stores you have, the more calories you’ll need.
• Focus on protein and fats. Both of these nutrients will stabilize your blood-sugar levels and give your body sustained energy for milk making.
• Choose healthy carbs. Incorporate whole grains into your diet as much as possible. Eat whole-grain breads, and cereals like oats, barley, wheat, millet, and rye. Also try some less common grains, such as that from the herb quinoa (a good source of calcium) and spelt.
• Get calcium. The saying “You need to drink milk to make milk” simply isn’t true. In fact, many moms who are not of European descent are allergic to cow’s milk and develop gas, bloating, and diarrhea from drinking it. That said, three to four servings of dairy products a day will help provide both calcium and protein. But for substitutes, consider fortified soy, rice, or almond milk; orange juice with added calcium; leafy greens; canned salmon; and fresh tofu.
• Keep hydrated. Most moms get very thirsty while they’re nursing, so it makes sense to keep a jug of water with a straw on the table beside your favorite nursing place. Water is healthier for you than soda, because carbonated beverages contain chemicals that impede your calcium absorption. Alcoholic beverages dehydrate you and can cause a reduction in your milk supply by interfering with letdown. Studies show that babies drink less milk if their mothers have recently consumed alcohol, and tend to wake up more. A mother who drinks large amounts of alcohol can cause her baby to be sluggish or drowsy, which could interfere with her ability to nurse.
• Test for reactions. If your baby gets gassy and seems very uncomfortable while nursing, it may be a reaction to something that you’ve eaten in the past 24 hours. Keep a food journal to try to identify problematic foods. Cabbage, broccoli, milk, soy foods, and peanuts are common culprits.
Drugs and breastmilk
Before you take any medications or herbal supplements, make sure your health-care provider knows that you are breastfeeding. Most drugs taken by mothers pass to their babies through their milk, but usually in very small doses—less than 1 percent of what the mothers take. Most drugs are quite safe to use while breastfeeding; the risk of formula feeding almost always poses a greater risk to an infant.
The exception is certain radioactive compounds, and very harmful drugs such as heroin and methamphetamine. In most cases, if a drug has reported side effects for nursing babies, there’s usually an alternative available. If you have a choice, opt for a medication that’s been around for a while and has published data over one that is new to the market. Always use the minimal amount you need and follow dosage instructions.
If there is not enough information on the safety of a specific drug, your caregiver may be able to substitute another drug that will work equally as well and that is known to be safe.
Tip
If you need medication, consult a pharmacist as to whether a drug you plan to take will be safe for your nursing baby. There are also numerous Web sites that list drugs and whether they are safe for babies. La Leche League International can suggest good sources for further information on breastfeeding and drugs.
Your baby’s age may be an important factor in determining the safety of the drugs you take when breastfeeding. A premature baby, for example, may be vulnerable to even trace amounts of drugs in breastmilk, while an older baby or toddler will have more mature liver and kidney functioning to help him to process and eliminate drugs from him system.
Sometimes mothers and their health-care providers have to weigh a mother’s requirement for medication and the rare, or slight, possibility of side effects for the baby against the value of providing the baby with the excellent immune and health benefits of human milk.
Generally speaking, if a drug is available in a formulation for children, it is likely to be safe to take while breastfeeding.