CHAPTER 3

Breastfeeding Basics

They make it look so easy, those nursing mothers you’ve seen. Without skipping a beat of conversation or a bite of salad, they lift their shirts and put their babies to breast. Deftly, nonchalantly, as though it were the most natural process in the world.

The fact is, however, that while the source may be natural, nursing comfort and know-how—especially for first-time mothers—are often not. Sometimes there are physical factors that foil those first few attempts; at other times, it’s just a simple lack of experience on the part of both participants.

Your early nursing experiences might be blissful—with baby latching on quickly and suckling until satiated. Or, more likely, they might go something like this: Even with your most concerted efforts, you can’t seem to get baby to hold on to your nipple, never mind to suck on it. The baby’s fussy; you’re frustrated; soon you’re both in tears.

If that second scenario has been playing out for you and your baby as you begin breastfeeding, don’t throw in the nursing bra. You’re not failing, you’re just getting started. Nursing, like most other fundamentals of parenting, is learned, not instinctive. After a little time, and a little instruction, it won’t be long before your baby and breasts are in perfect synch. Some of the most mutually satisfying breast-baby relationships begin with several days, or even weeks, of fumbling, of bungled efforts, and of tears on both sides. Before you know it, you’ll be making it look easy—and natural, too.

Getting Started Breastfeeding

There’s no magic formula (so to speak) for a successful breastfeeding relationship. But there are plenty of steps you can take, right from the very beginning, to give you and your baby an edge in breastfeeding success:

Get an early start. Early-bird nursers tend to catch on sooner, not to mention latch on sooner. If both you and baby are up to it, nurse as soon as possible after birth—right in the birthing or delivery room is best. Babies show an eagerness and readiness to suck during the first two hours after birth, with the sucking reflex most powerful about thirty minutes after delivery. But don’t worry if you and baby aren’t successful right off the bat. Trying to force the feeding when you’re both exhausted from a difficult delivery only sets the stage for a disappointing experience. Cuddling at the breast can be just as satisfying as nursing in the first few moments of your baby’s life. If you don’t get around to feeding right after delivery, ask to have the baby brought to your room for nursing as soon as possible after all necessary nursery procedures have been completed. Keep in mind, too, that even an early start doesn’t guarantee instant success. No matter when you first get going, plenty of practice may be needed before you and your baby make perfect.

Beat the system. Many hospitals and most birthing centers recognize the importance of getting a mother and baby off to a good breastfeeding start. But even the most enlightened hospitals are usually run for the greater good—which sometimes doesn’t coincide with the needs of the breastfeeding mother and baby. To make sure you aren’t thwarted in your efforts by arbitrary regulations, ask your practitioner in advance to make your preferences (demand feeding, no bottles, no pacifiers) known to the staff, or explain them to the nurses yourself.

Get together. Making sure you and your baby are together most or all of the time can give early breastfeeding a much better chance of success, which is why rooming-in can be ideal. If you’re tired from a difficult delivery, or don’t feel confident enough yet to deal with the baby on a twenty-four-hour basis, partial rooming-in (days, but not nights) may be preferable. With this system you can have your baby with you all day for demand feeding, and have a nurse bring you the baby for night feedings when he or she wakes, perhaps allowing you to get much-needed sleep.

If twenty-four-hour rooming-in isn’t available, isn’t possible (some hospitals allow rooming-in only in private rooms or when both patients in a shared room want to keep their babies with them), or doesn’t appeal to you, you can ask to have the baby brought to you when he or she is awake and hungry, or at least every two to three hours.

Ban the bottle. Make sure your baby’s appetite and sucking instincts aren’t sabotaged. Some hospital nurseries still try to quiet a crying baby between breastfeeding sessions with a bottle of sugar water. Even a few sips of sugar water will satisfy tender appetites and early sucking needs, leaving baby more sleepy than hungry when brought to you later. You may also find your baby reluctant to struggle with the breast nipple after a few encounters with an artificial one, which yields results with a lot less effort. Worse still, if your breasts aren’t stimulated to produce enough milk, a vicious cycle begins—one that interferes with the establishment of a good demand-and-supply system.

Pacifiers and formula feedings can also interfere with nursing. So issue strict orders through your baby’s doctor that, as recommended by the American Academy of Pediatrics, supplementary feedings and pacifiers not be given to your baby in the nursery unless medically necessary. You may even want to put a sign on the baby’s bassinet that reads: “Breastfeeding only—no bottles please.”

Take requests. Feeding on demand—when baby is hungry, not when a schedule mandates—is generally best for breastfeeding success. But in the early days, when baby’s less hungry than sleepy, chances are there won’t be much demand, and you’ll have to initiate most of the feedings. Strive for at least eight to twelve feedings a day, even if the demand isn’t up to that level yet. Not only will this keep your baby happy but it will also increase your milk supply to meet the demand as it grows. Imposing a four-hour feeding schedule, on the other hand, can worsen breast engorgement early on and result in an undernourished baby later.

Don’t let sleeping babies lie. Some babies, especially in the first few days of life, may be a lot more interested in sleeping than feeding and may not wake for nourishment often enough. Although babies don’t need that much milk (or colostrum) in the first few days, your breasts need all the stimulation they can get to make sure that when your week-old baby does wake up for his feedings, you’ll have enough milk to combat his or her hunger. For tips on waking a sleeping baby for feeding, see page 122.

Know the signs. Ideally, you should feed your baby when he or she first shows the signs of hunger or interest in sucking, which might include mouthing the hands or rooting around for the nipple, or just being particularly alert. Crying is not a feeding cue, so try not to wait until frantic crying—a late sign of hunger—begins. But if crying has started, do some rocking and soothing before you start nursing. Or offer your finger to suck on until baby calms down. After all, it’s hard enough for an inexperienced sucker to find the nipple when calm; when your baby has worked up to a full-fledged frenzy, it may be impossible.

Practice, practice, practice. Consider the feedings before your milk comes in as “dry runs,” and don’t be concerned that baby is getting very little in the way of nourishment. Your milk supply is tailored to your baby’s needs. Right now those needs are minimal. In fact, the newborn stomach can’t tolerate a lot of food, and the tiny quantity of colostrum you’re producing is just right. Use those initial feeding sessions to work on your nursing technique rather than to fill baby’s belly, and be assured that he or she isn’t starving while you’re both learning.

Give it time. No successful breastfeeding relationship was built in a day. Baby, fresh out of the womb, is certainly inexperienced—and so are you if this is your first time. You both have a lot to learn, and you’ll both have to be patient while you learn it. There will be plenty of trial and even more error before supplier and demander are working in concert. Even if you’ve successfully nursed another baby before, each newborn is different, and the road to breastfeeding harmony may take different turns this time around.

Keep in mind that things may go even more slowly if one or both of you had a difficult time during labor and delivery, or if you had anesthesia. Drowsy mothers and sluggish infants may not be up to tackling the art of breastfeeding just yet. Sleep it off (and let baby do the same) before getting serious about the task ahead of you.

Don’t go it alone. Get some professional help, if you can. Hopefully, a lactation specialist will join you during at least a couple of your baby’s first feedings to provide hands-on instruction, helpful hints, and perhaps literature—as is routine in some hospitals and most birthing centers. If this service isn’t offered to you, ask if a lactation consultant or a nurse who is knowledgeable about breastfeeding can observe your technique and redirect you if you and your baby are not on target. If you leave the hospital or birthing center before getting help, someone with Breastfeeding expertise—either the baby’s doctor, a home nurse, a doula, or an outside lactation consultant—should evaluate your technique within a few days. (Look for a lactation consultant who has passed an exam given by the International Board of Lactation Consultant Examiners—IBLCE; see the box above.)

GETTING HELP

There are many resources for the Breastfeeding mom. Here are some places to contact for help and more information:

La Leche League International
1400 N. Meacham Road
Schaumburg, IL 60168
800-525-3243 or 847-519-7730
www.lalecheleague.org

Nursing Mothers Counsel, Inc.
P.O. Box 50063
Palo Alto, CA 94303
408-291-8008
www.nursingmothers.org

International Lactation Consultant
Association
1500 Sunday Drive, Suite 102
Raleigh, NC 27607
919-861-5577; www.ilca.org

National Women’s Health
Information Center
Breastfeeding Helpline
800-944-9662

Breastfeeding National Network
(Medela, Inc.)
800-835-5968; www.medela.com

You can also find empathy and advice by calling your local La Leche League chapter. Volunteers at La Leche are experienced nursing mothers who are trained to become accredited leaders. They hold regular meetings and are available for telephone consultations. Or enlist the support of friends, relatives, and others who have breastfed successfully.

Keep your cool. This isn’t easy to do when you’re a brand-new mother, but it’s vital for breastfeeding success. Tension can inhibit the let-down of milk, which means that even if you are producing milk, it may not be dispensed until you relax. If you’re feeling edgy, banish visitors from the room before you feed your baby. Do relaxation exercises if you feel they might help, pick up a book or magazine, or just close your eyes and listen to soft music for a few minutes.

Breastfeeding 101

Building a successful breastfeeding relationship with your baby will depend on proper technique and know-how. Understanding how lactation works, learning how to properly position your baby at the breast, being sure that your baby is correctly latched on, and knowing when a feeding is over or when baby needs another meal will all gradually lead to a growing sense of confidence, the comforting feeling that you’re “doing it right.” To enhance your chances of success, boost your nursing savvy before you put baby to breast by taking this minicourse first.

HOW LACTATION WORKS

Lactation, or breastfeeding, is the natural completion of the reproductive cycle; here’s how it works:

How it’s made. The process of milk production is automatically initiated the instant you push out the placenta, as your body, which has spent nine months feeding your baby inside you, busily gears up for the shifts in hormones that will allow you to feed baby from the outside. The levels of the hormones estrogen and progesterone decline dramatically in the moments after delivery, and the level of the hormone prolactin (one of the hormones responsible for lactation) rises dramatically, activating the milk-producing cells of your breasts. But while hormones trigger the start of lactation, they can’t keep milk production going without some help—and the help comes in the form of a tiny mouth, namely your baby’s. As that tiny mouth suckles at your breast, your prolactin level increases, stepping up milk production. Just as important, a cycle begins—one that ensures that a steady production of milk will continue: Your baby removes milk from your breasts (creating demand), your breasts produce milk (creating supply). The more the demand, the more the supply. Anything that keeps your baby from removing milk from your breasts will inhibit the supply. Infrequent feeding, feedings that are too brief, or ineffective suckling can all quickly result in diminished milk production. Think of it this way: The more milk the baby takes, the more milk the breast will make.

How it flows. It’s not enough to produce milk; if it’s not released from the tiny sacs where the milk is manufactured, baby doesn’t get fed and further production is suppressed. That’s why the single most important function that affects the success of Breastfeeding is the let-down reflex, which allows the milk to flow. Let-down occurs when your baby suckles, prompting the release of the hormone oxytocin, which in turn stimulates the flow of milk. Later on, when your breasts get the hang of let-down, it may occur whenever suckling seems (at least, to your body) imminent—as when your baby’s due for a feeding, or even when you’re just thinking about your baby.

How it changes. The milk your baby gets is not a uniform fluid in the way that formula is. The composition of your milk changes from feeding to feeding and even within the same nursing session. The first milk to flow when your baby starts suckling is the foremilk. This milk has been dubbed the “thirst quencher” because it is dilute and low in fat. As the nursing session progresses, your breast produces and secretes hind milk—milk that is high in protein, fat, and calories. If you cut a nursing session short, your baby will be getting only the foremilk and not the fattier, more nutritious hind milk, causing hunger to strike sooner, and even inhibiting weight gain. Be sure at least one breast is well drained at each feed to guarantee your baby is getting the hind milk. You’ll be able to tell if baby has emptied enough of the breast if it feels much softer when the feeding is finished than it did when you began. (Keep in mind that a lactating breast is never truly empty; there’s always some milk available, and there’s always some being produced.) You’ll also notice the milk flow has decreased to a trickle and your baby swallows less often than when your breast was full of milk.

BEGINNING TO BREASTFEED

Here’s how to make sure the milk gets where it’s supposed to go:

Seek some peace and quiet. Until breastfeeding becomes second nature to you and baby (and it will!), you’ll need to focus as you feed. To do this, set yourselves up in an area that has few distractions and a low noise level. As you become more comfortable with breastfeeding, you can keep a book or magazine handy to occupy you during long feeding sessions. (But don’t forget to put your reading material down periodically so you can interact with your nursing infant; that’s not just part of the fun of nursing, it’s part of the benefit for baby.) Talking on the telephone can be too distracting in the early weeks, so turn down the ringer and let voice mail pick up messages. You may also want to avoid watching television during feedings until you get the hang of breastfeeding.

Get comfy. Settle into a position that’s comfortable for you and your baby. Try sitting on the living room couch (as long as it’s not too deep), a glider in the baby’s room, an armchair in the den, or propped up in bed. You can even nurse lying down in bed. If you’re sitting up, a pillow across your lap will help raise your baby to a comfortable height. Plus, if you’ve had a cesarean, the pillow prevents baby from putting pressure on your scar. Make sure, too, that your arms are propped up on a pillow or chair arms; trying to hold 6 to 9 pounds without support can lead to arm cramps and pain. Elevate your legs, too, if you can. Experiment to find the position that works best for you—preferably one you can hold for a long time without feeling strained or stiff.

Quench your own thirst. Have a drink—of milk, juice, or water—by your side to replenish fluids as you nurse. Avoid hot drinks (which could scald you or your baby, should they spill). If you don’t feel like having a cold drink, opt for something lukewarm. And add a healthy snack if it’s been a while since your last meal; the better fed you are, the better fed baby will be.

BREASTFEEDING POSITIONS

There are plenty of positions you and your baby can eventually explore while breastfeeding. But the most important one to know is the “basic” position, the one from which most other positions take form: Position your baby on his or her side, facing your nipple. Make sure that baby’s whole tiny body is facing you—you’re tummy to tummy—with his or her ear, shoulder, and hip in a straight line. You don’t want your baby’s head turned to the side; rather it should be straight in line with his or her body. (Imagine how difficult it would be for you to drink and swallow while turning your head to the side. It’s the same for your baby.)

Lactation specialists recommend two nursing positions during the first few weeks: the crossover hold and the football (or clutch) hold. Once you’re more comfortable with breastfeeding, you can add the cradle hold and the side-lying position. So get into your starting position, and try:

Crossover hold: Hold your baby’s head with the hand opposite to the breast from which you’ll be nursing (if you’re nursing on the right breast, hold your baby’s head with your left hand). Your wrist should rest between your baby’s shoulder blades, your thumb behind one ear, your other fingers behind the other ear. Using your right hand, cup your right breast, placing your thumb above your nipple and areola at the spot where your baby’s nose will touch your breast. Your index finger should be at the spot where your baby’s chin will touch the breast. Lightly compress your breast. This will give your breast a shape that more closely matches the shape of your baby’s mouth. You are now ready to have the baby latch on.

Crossover hold

Cradle hold

Football or clutch hold: This position is especially useful if you’ve had a cesarean and you want to avoid placing your baby against your abdomen, if your breasts are large, if your baby is small or premature, or if you’re nursing twins. No previous experience on the gridiron required. Just tuck your baby under your arm like a football: Position your baby at your side in a semisitting position facing you, with baby’s legs under your arm (your right arm if you are nursing on the right breast). Use pillows to bring the baby up to the level of your nipple. Support your baby’s head with your right hand and cup your breast with your left hand as you would for the crossover hold.

Football hold

Side-lying position

Cradle hold: In this classic Breastfeeding position, your baby’s head rests in the bend of your elbow and your hand holds your baby’s thigh or buttocks. Baby’s lower arm (if you’re nursing from your right breast, it’s baby’s left arm) is tucked away, under your arm and around your waist. Cup your breast with your left hand (if nursing from the right breast) as in the crossover hold.

Side-lying position: This position is a good choice when you’re nursing in the middle of the night or when you need some rest (or, rather, when you can have some rest; you’ll always need it). Lie on your side with a pillow supporting your head. Position your baby on her side facing you, tummy to tummy. Make sure her mouth is in line with your nipple. Support your breast with your hand as in the other nursing positions. You may want to put a small pillow behind your baby’s back to hold her close.

Whichever position you choose, be sure you bring baby to the breast—not breast to the baby. Many latching-on problems occur because mom is hunched over baby, trying to shove her breast in baby’s mouth. Instead, keep your back straight and bring your baby to the breast.

A PROPER LATCH

A good position is a great place to start. But for breastfeeding to succeed, a proper latch—making sure that baby and breast hook up just right—is a skill you’ll have to master. For some mothers and infants it’s effortless; for others, it takes a lot of practice.

What a good latch looks like: A proper latch encompasses both the nipple and the areola (the dark area surrounding the nipple). Baby’s gums need to compress the areola and the milk sinuses located underneath it in order to start the flow. Sucking on just the nipple will not only leave your infant hungry (because the glands that secrete the milk won’t be compressed) but will also make your nipples sore and even cracked. Be sure, too, that your baby hasn’t completely missed the mark and started sucking on another part of the breast entirely. Newborns are eager to suck even if no milk is forthcoming and can cause a painful bruise by gumming sensitive breast tissue.

Get ready for a good latch: Once you and your baby are in a comfortable position, gently tickle your baby’s lips with your nipple until his or her mouth is open very wide—like a yawn. Some lactation specialists suggest directing your nipple toward your baby’s nose and then down to the lower part of the upper lip to get your baby to open his or her mouth very wide. This prevents the lower lip from getting tucked in during nursing. If your baby isn’t opening up, you might try to squeeze some colostrum (and later on, milk) onto his or her lips to encourage latching on.

If your baby turns away, gently stroke the cheek on the side nearest you. The rooting reflex will make baby turn his or her head toward your breast. (Don’t press on both cheeks to open your baby’s mouth; that will just cause confusion.) Once baby gets the hang of nursing, just the feel of the breast, and sometimes even the smell of milk, will cause him or her to turn toward your nipple.

Seal the deal: Once the mouth is open wide, move your baby closer. Do not move your breast toward the baby, and don’t push your baby’s head into your breast. And be sure not to stuff your nipple into your baby’s unwilling mouth; let your baby take the initiative. It might take a couple of attempts before your baby opens his or her mouth wide enough to latch on properly. Remember to keep your hold on your breast until baby has a firm grasp and is suckling well; don’t let go of your breast too quickly.

Tickling baby’s lip

Latching on

Check the latch: You’ll know your baby is properly latched on when the chin and the tip of the nose are touching your breast. As your baby nurses, your nipple will be drawn to the rear of his or her throat, and those tiny gums will be compressing your areola. Baby’s lips should be flanged outward, like fish lips, rather than tucked in. Also check to be sure your baby isn’t sucking his or her own lower lip (newborns will suck on anything) or tongue (because your nipple is positioned underneath the tongue instead of over it). You can check by pulling the lower lip down during nursing. If it does seem to be the tongue that’s being sucked, break the suction with your finger, remove your nipple, and make certain baby’s tongue is lowered before you start again. If it’s the lip, gently ease it out while baby suckles.

Baby opens wide

Breaking suction

SUCKING VERSUS SUCKLING

It’s a subtle distinction that can make all the difference in the success of breastfeeding. To make sure your baby is suckling (that is, extracting milk from your breast), not just sucking (gumming your breast with no results), watch for a strong, steady, suck-swallow-breath pattern. You’ll notice a rhythmic motion in baby’s cheek, jaw, and ear. Later, when your milk comes in, you’ll also want to listen for the sound of swallowing (sometimes even gulping) that will let you know that suckling is in progress.

Breastfeeding will not be painful if your baby is latched on properly (unless, of course, you have a cracked nipple or a breast infection; see pages 83 and 88). If you feel nipple pain while nursing, your baby is probably chewing on your nipple instead of gumming the entire nipple and areola. Take the baby off your breast (see below) and latch him or her on again. Your baby is also not latched on properly if you hear clicking noises.

Give baby some room to breathe: If your breast is blocking your baby’s nose once he or she’s latched on, lightly depress the breast with your finger. Elevating your baby slightly may also help provide a little breathing room. But as you maneuver, be sure not to loosen that latch you both worked so hard to achieve.

Unlatch with care: If your baby has finished suckling but is still holding on to your breast, pulling it out abruptly can cause injury to the nipple. Instead, break the suction first by putting your finger into the corner of the baby’s mouth to admit some air and gently pushing your finger between his or her gums until you feel the release.

HOW LONG TO FEED

It used to be thought that keeping initial feedings short (five minutes on each breast) would prevent sore nipples by allowing them to toughen up gradually. Sore nipples, however, result from improper positioning of the baby on the breast and have little to do with the length of the feeding. As long as your positioning is correct, there is no need to limit the time your baby spends at the breast. Instead, let your baby be your guide; all babies set their own nursing patterns, and following that pattern will help ensure both baby and breasts are satisfied. Expect feedings to be marathon sessions at first. Some newborns can take up to forty-five minutes to complete a feeding (though the average time is twenty to thirty minutes). So don’t pull the plug just because your baby has fed for fifteen minutes on breast number one. Wait until he or she seems ready to quit, then offer the second breast, but don’t force it.

Ideally, at least one breast should be emptied at each feeding (though, again, your breast is never truly “empty,” just well drained). This is more important than being sure that baby feeds from both breasts. Then you can be certain your baby gets the hind (or fatty) milk that comes at the end of a feeding, and not just the foremilk that comes at the start (see page 70).

The best way to end a feeding is to wait until your baby lets go of the nipple. If your baby does not let go of the nipple (babies often drift off to sleep on the job), you’ll know to end the feeding when the rhythmic suck-swallow pattern slows down to four sucks per one swallow. Often, your baby will fall asleep at the end of the first breast and either awaken to nurse from the second (after a good burp, see page 140) or sleep through until the next feeding. Start the next feeding on the breast that baby didn’t nurse on at all last time or didn’t drain thoroughly. As a reminder, you can fasten a safety pin to your nursing bra on the side you started with at the previous feeding, or you can tuck a nursing pad or tissue in the bra cup on that side. The pad also will absorb any leakage from the breast you’re not nursing on (which will be letting down with anticipation).

WHAT TYPE OF NURSER IS YOUR BABY?

Just as every baby has a unique personality, so does each baby have a unique nursing style. Your baby may fall into one of these categories classified by researchers. Or you may find your baby has developed a nursing persona all his or her own.

Barracuda: Your baby’s nursing style is barracuda-like if he or she latches on to the breast tenaciously and suckles voraciously for ten to twenty minutes. A barracuda baby doesn’t dawdle—feeding time is no-nonsense for him or her. Occasionally, a barracuda baby’s suck is so vigorous that it actually hurts at first. If your nipples fall victim to your barracuda baby’s strong suck, don’t worry—they’ll toughen up quickly as they acclimate to nursing with the sharks. (See tips for soothing sore nipples on page 83).

Excited Ineffective: If your baby becomes so wound up with excitement when presented with a breast that he or she often loses grasp of it—and then screams and cries in frustration—it’s likely you have an excited ineffective on your hands. Mothers of this type of nurser have to practice extra patience; you’ll need to get your baby nice and calm before putting him or her back on the job. Usually, excited ineffectives become less excited and more effective as they get the hang of nursing, at which point they’ll be able to hold on to the prize without incident.

Procrastinator: Procrastinators do just that—procrastinate. These slowpoke babies show no particular interest or ability in sucking until the fourth or fifth day, when the milk comes in. Forcing a procrastinator to feed before he or she’s game will do no good (as forcing one to do homework before the last minute will surely backfire, but you’ll find that out later on). Instead, waiting it out seems to be the best bet; procrastinators tend to get down to the business of nursing when they’re good and ready.

Gourmet: If your baby likes to play with your nipple, mouth it, taste a little milk, smack his or her lips, and then slowly savor each mouthful of milk as though composing a review for Zagat’s, he or she is likely a gourmet. As far as the gourmet is concerned, breast milk is not fast food. Try to rush gourmets through their meals and they’ll become thoroughly furious—so let them take their time enjoying the feeding experience.

Rester: Resters like to nurse a few minutes and then rest a few minutes. Some even prefer the nip-and-nap approach: nurse for fifteen minutes, fall asleep for fifteen minutes, then wake to continue the feeding. Nursing this type of baby will take time and it will take patience, but hurrying a rester through his or her courses, like hurrying a gourmet, will do no good.

HOW OFTEN TO FEED

At first, you’ll need to nurse often—at least eight to twelve times in twenty-four hours (sometimes even more if baby demands it), draining at least one breast at each feeding. Break that down, and it means you’ll be nursing every two to three hours (counting from the beginning of each nursing session). But don’t let the clock be your guide. Follow your baby’s lead (unless he or she is not waking up for feedings), keeping in mind that feeding patterns vary widely from baby to baby. Some newborns will need to nurse more often (every one and a half to two hours), others a little less frequently (every three hours). If you have a more frequent nipper, you may be going from one feeding to the next with only a little over an hour in between—not much rest for your weary breasts. But don’t worry. This frequency is only temporary, and as your milk supply increases and your baby gets bigger, the breaks between feedings will get longer.

How regularly spaced your baby’s feedings are may vary, too, from those of the baby down the block. Some thoughtful babies feed every one and a half hours during the day, but stretch the time between night feedings to three or even four hours. Consider yourself lucky if your baby falls into that category—just be sure to keep track of your baby’s wet diapers to ensure he or she is getting enough milk with all that sleep (see page 167). Other babies might operate like clockwork around the clock—waking every two and a half hours for a feeding whether it’s the middle of the morning or the middle of the night. Even these babies will settle down into a more civilized pattern over the next few months; as they begin to differentiate between day and night, their grateful parents will welcome the gradually longer stretches between nighttime feedings.

But while the temptation will be great to stretch out the time between feedings early on, resist. Milk production is influenced by the frequency, intensity, and duration of suckling, especially in the first weeks of life. Cutting down on that necessarily frequent demand—or cutting nursing sessions short—will quickly sabotage your supply. So will letting baby sleep through feedings when he or she should be eating instead; if it’s been three hours since your newborn last fed, then it’s time for a wake-up call. (See page 122 for techniques to wake your baby.)

What You May Be Concerned About

COLOSTRUM

“I just gave birth a few hours ago; I’m beat and my daughter’s really sleepy. Do I really need to nurse right away? I don’t even have any milk yet.”

The sooner you nurse, the sooner you’ll have milk to nurse with, since milk supply depends on milk demand. But nursing early and often does more than ensure that you’ll be producing milk in the coming days; it also ensures that your baby will receive her full quota of colostrum, the ideal food for the first few days of life. This thick yellow (or sometimes clear) liquid, dubbed “liquid gold” for its potent formula, is rich with antibodies and white blood cells that can defend against harmful bacteria and viruses and even, according to researchers, stimulate the production of antibodies in the newborn’s own immune system. Colostrum also coats the inside of baby’s intestines, effectively preventing harmful bacteria from invading her immature digestive system, and protecting against allergies and digestive upset. And if that’s not enough, colostrum stimulates the passage of your baby’s first bowel movement (meconium; see page 131) and helps to eliminate bilirubin, reducing any potential jaundice in your newborn (see page 129).

A little colostrum goes a long way. All in all, your baby will extract only teaspoons of it—but amazingly, that’s all she needs. And since colostrum is easy to digest—it’s high in protein, vitamins, and minerals, and low in fat and sugar—it serves as the perfect appetizer to the alimentary adventures that lie ahead.

Suckling on colostrum for a few days satisfies your baby’s tender appetite while getting her off to the healthiest start in life. But it also stimulates the production of the next course: transitional milk. Transitional milk, which your breasts serve up between colostrum and mature milk, often resembles milk mixed with orange juice (fortunately, it tastes much better than that to new babies) and is the milk that appears when your milk “comes in.” It contains lower levels of immunoglobulins and protein than colostrum does, but it has more lactose, fat, and calories. Mature milk, arriving between the tenth day and second week postpartum, is thin and white (sometimes appearing slightly bluish). Though it looks like watery skim milk, it’s actually power packed with all the fat and other nutrients that growing babies need.

ENGORGED BREASTS

“Since my milk came in today, my breasts are swollen to three times their normal size, hard and so painful I can barely stand it. How am I supposed to nurse this way?”

They grew and grew through nine months of pregnancy—and just when you thought they couldn’t get any bigger (at least, without visiting a plastic surgeon), that’s exactly what happens in the first postpartum week. And they hurt, a lot—so much so that putting on a bra can be agonizing. What’s worse, now that the milk’s finally arrived, nursing can actually be even more challenging than it was before the milk was there—not just because your breasts are painfully tender, but also because they’re so hard and swollen that the nipples may be flat and difficult for your baby to get a grasp on.

The engorgement that accompanies the arrival of a mother’s milk (and which can be worse when nursing gets off to a slow start) comes on suddenly and dramatically, in a matter of a few hours. It most often occurs on the third or fourth day postpartum, though occasionally as early as the second day or as late as the seventh. Though engorgement is a sign that your breasts are beginning to fill up with milk, the pain and swelling are also a result of blood rushing to the site, ensuring that the milk factory is in full swing.

Engorgement is more uncomfortable for some women than for others, is typically more pronounced with first babies, and also occurs later with first babies than with subsequent ones. Some lucky women (usually second- and third-timers) get their milk without paying the price of engorgement, especially if they’re nursing regularly from the start.

Fortunately, engorgement is blessedly temporary; it gradually diminishes as a well-coordinated milk supply-and-demand system is established. For most women, the swelling and pain last no longer than twenty-four to forty-eight hours, though some suffer through it for as long as a week.

Until then, there are some steps you can take to reduce the discomfort:

Use heat briefly to help soften the areola and encourage let-down at the beginning of a nursing session. To do this, place a washcloth dipped in warm, not hot, water on just the areola, or lean into a bowl of warm water. You can also encourage milk flow by gently massaging the breast your baby is suckling.

Use ice packs after nursing to reduce engorgement. And though it may sound a little strange and look even stranger, chilled cabbage leaves may also prove surprisingly soothing (use large outer leaves, rinse and pat dry, and make an opening in the center of each for your nipple). Or use specially designed cooling bra inserts.

Wear a well-fitting nursing bra (with wide straps and no plastic lining) round the clock. Pressure against your sore and engorged breasts can be painful, however, so make sure the bra is not too tight. And wear loose clothing that doesn’t rub against your sensitive breasts.

The best treatment for engorgement is breastfeeding frequently, so don’t be tempted to skip or skimp on a feeding because of pain. The less your baby sucks, the more engorged your breasts will become, and the more pain you’ll have to suffer. The more you nurse your newborn, on the other hand, the more quickly engorgement will subside. If your baby doesn’t nurse vigorously enough to relieve the engorgement in both breasts at each feeding, use a breast pump to do this yourself. But don’t pump too much, just enough to relieve the engorgement. Otherwise, your breasts will produce more milk than the baby is taking, leading to an off-balance supply-and-demand system and further engorgement.

Hand-express a bit of milk from each breast before nursing to lessen the engorgement. This will get your milk flowing and soften the nipple so that your baby can get a better hold on it.

Alter the position of your baby from one feeding to the next (try the football hold at one feeding, the cradle hold at the next; see page 71). This will ensure that all the milk ducts are being emptied and may help lessen the pain of engorgement.

For severe pain, you might consider taking acetaminophen or another mild pain reliever prescribed by your practitioner. If you do take a pain reliever, be sure to take it just after a feeding.

“I just had my second baby. My breasts are much less engorged than with my first. Does this mean I’m going to have less milk?”

No, it means that you’re going to have less pain and less difficulty nursing—a good thing all around. Though some veteran moms are unlucky enough to experience the same amount of engorgement, or occasionally more, with their second baby than with their first, it’s much more common for the breasts to engorge less with the second and subsequent pregnancies. Perhaps it’s because your breasts, having been there and done that before, are having less trouble adjusting to the influx of milk. Or perhaps it’s because your experience has resulted in more efficient nursing (and draining of the breasts) right from the start. After all, the sooner a baby begins breastfeeding well, the less engorgement typically occurs.

Very rarely, a lack of engorgement and of a sensation of milk let-down does indicate inadequate milk production, but only in first-time mothers. And even most first-timers who don’t experience engorgement turn out to have copious milk supplies nevertheless. In fact, there’s no reason to worry that a milk supply might be not be up to par unless a baby isn’t thriving (see page 165).

OVERABUNDANT MILK

“Even though my breasts are no longer engorged, I have so much milk that my baby chokes every time she nurses. Could I have too much?”

Though it may seem right now like you have enough milk to feed the entire neighborhood—or, at least, a small day care center—rest assured, you’ll soon have just the right amount to feed one hungry baby, namely yours. Many women find there’s too much of a good thing in the first few weeks of nursing, often so much that their babies have a hard time keeping up with the flow and end up gasping, sputtering, and choking as they attempt to swallow all that’s pouring out. You may find, too, that the overflow causes leaking and spraying, which can be uncomfortable and embarrassing (especially when it occurs in public). It may be that you’re producing more milk than the baby needs right now, or it may be that you’re just letting it down more quickly than your baby can drink it. Either way, your supply and delivery system are likely to work out the kinks gradually over the next month or so, becoming more in synch with your baby’s demand, which means that the overflowing will taper off. Until then, keep a towel handy for drying you and baby during feedings, and try these techniques for slowing the flow:

If your baby gulps frantically and gasps just after you have let-down, try taking her off the breast for a moment as the milk rushes out. Once the flood slows to a steady stream she can handle, put baby back to the breast.

Nurse from only one breast at a feeding. This way, your breast will be drained more completely and your baby will be inundated with the heavy downpour of milk only once in a feeding, instead of twice.

Gently apply pressure to the areola while nursing to help stem the flow of milk during let-down.

Reposition your baby slightly so that she sits up more. Some babies will let the overflow trickle out of their mouth to alleviate the problem.

Try nursing against gravity by sitting back slightly or even nursing while lying on your back with your baby on top of your chest (though this may be unwieldy to do often).

Pump before each feeding just until the initial heavy flow has slowed. Then you can put your baby to the breast knowing she won’t be flooded with milk.

Don’t be tempted to decrease your fluid intake. Neither increasing nor decreasing your fluid intake has any correlation to milk production. Drinking less will not cause you to produce less milk, but it can lead to health problems for you.

Some women continue to be prodigious producers of milk throughout lactation. If that turns out to be the case with you, don’t worry. As your baby becomes bigger, hungrier, and a more efficient nurser, chances are she’ll eventually learn to go with the flow.

LEAKING AND SPRAYING

“I seem to be leaking milk from my breasts all the time. Is this normal? Is it going to last?”

There’s no contest when it comes to wet T-shirts (and wet sweatshirts, and wet sweaters, and wet nightgowns, sopping wet bras, and even wet pillows): Newly nursing mothers win hands down. The first few weeks of nursing are almost always very damp ones, with milk leaking, dripping, or even spraying frequently. The leaks spring anytime, anywhere, and usually without much warning. Suddenly, you’ll feel that telltale tingle of let-down, and before you can grab a new nursing pad to stem the flow or a towel or sweater to cover it up, you’ll look down to see yet another wet circle on one or both breasts.

Because let-down is a physical process that has a powerful mind connection, you’re most likely to leak when you’re thinking about your baby, talking about your baby, or hearing your baby cry. A warm shower may sometimes stimulate the drip, too. But you may also find yourself springing spontaneous leaks at seemingly random times—times when baby’s the last thing on your mind (like when you’re sleeping or paying bills), and times that couldn’t be more public or less opportune (like when you’re waiting on line at the post office or about to give a presentation at work or in the middle of making love). Milk may drip when you’re late for a feeding or in anticipation of it (especially if baby has settled into a somewhat regular feeding schedule), or it may leak from one breast while you nurse from the other.

Living with leaky breasts certainly isn’t fun, and it can be uncomfortable, unpleasant, and endlessly embarrassing, too. But this common side effect of breastfeeding is completely normal, particularly early on. (Not leaking at all or leaking only a little can be just as normal, and in fact, many second-time mothers might notice that their breasts leak less than they did the first time around.) Over time, as the demand for milk starts meeting the supply, and as breastfeeding becomes better regulated, breasts begin to leak considerably less. While you’re waiting for that dryer day to dawn, try these tips:

Keep a stash of nursing pads. These can be a lifesaver (or, at least, a shirt saver) for women who leak. Put a supply of nursing pads in the diaper bag, in your purse, and next to your bed, and change them whenever they become wet, which may be as often as you nurse, sometimes even more often. Don’t use pads that have a plastic or waterproof liner. These trap moisture, rather than absorbing it, and can lead to nipple irritation. Experiment to find the variety that works for you; some women favor disposables, while others prefer the feel of washable cotton pads.

Don’t wet the bed. If you find you leak a lot at night, line your bra with extra nursing pads before going to bed, or place a large towel under you while you sleep. The last thing you’ll want to be doing now is changing your sheets every day—or worse, shopping for a new mattress.

Opt for prints, especially dark ones. You’ll soon figure out that these clothes camouflage the milk stains best. And as if you’re looking for another reason to wear washable clothes when there’s a newborn around, leaking should seal it.

Don’t pump to prevent leaking. Not only will extra pumping not contain the leak, it will also encourage it. After all, the more your breasts are stimulated, the more milk they produce.

Apply pressure. When nursing is well established and your milk production has leveled off (but not before), you can try to stem the leak when you feel it starting by pressing your nipples (probably not a good idea in public) or folding your arms tightly against your breasts. Don’t do this often in the first few weeks, however, because it may inhibit milk let-down and can lead to a clogged milk duct.

LET-DOWN

“Every time I put my baby to the breast, I feel a strange sensation in my breasts as my milk starts to come out. Is this normal?”

The feeling you’re describing is what’s known in the breastfeeding business as “let-down.” Not only is it normal, it’s also a necessary part of the nursing process—a signal that milk is being released from the ducts that produce it. Let-down can be experienced as a tingling sensation, as pins and needles (sometimes uncomfortably sharp ones), and often as a full or warm feeling. It’s usually more intense in the early months of breastfeeding (and at the beginning of a feeding, though several let-downs may occur each time you nurse) and may be somewhat less noticeable as your baby gets older. Let-down can also occur in one breast when your baby is suckling on the other, in anticipation of nursing, and at times when nursing’s not even on the schedule (see previous question).

Let-down may take as long as a few minutes (from first suckle to first drip) in the early weeks of breastfeeding. Once breast and baby get the hang of nursing, let-down usually occurs within a few seconds. Later, as milk production decreases (when you introduce solids or formula, for instance), let-down may once again take longer.

Stress, anxiety, fatigue, illness, or distraction can inhibit the let-down reflex, as can large amounts of alcohol. So if you’re finding your let-down reflex isn’t optimal or is taking a long time to get going, try doing some relaxation techniques before putting baby to breast, choosing a quiet locale for feeding sessions, and limiting yourself to only a single occasional alcoholic drink. Gently stroking your breast before nursing may also stimulate the flow. But don’t worry about your let-down. True let-down problems are extremely rare.

A deep, shooting pain in your breasts right after a nursing session is a sign that they’re starting to fill up with milk once again; generally those post-feeding pains don’t continue past the first few weeks. Stinging or burning pain during nursing may be related to thrush (an infection passed from baby’s mouth to mother’s nipples; see page 128). Nipple pain during nursing can usually be linked to incorrect latching (see page 74).

CLUSTER FEEDINGS

“My two-week-old baby had been nursing pretty regularly—every two to three hours. But all of a sudden, he’s demanding to be fed every hour. Does that mean he’s not getting enough?”

Sounds like you have a hungry boy on your hands—or, rather, at your breast. He might be going through a growth spurt (most common at three weeks and again at six), or he might just need more milk to keep him satisfied. Either way, what he’s doing to make sure he gets that milk is called “cluster feeding.” His instincts tell him that nursing for twenty minutes every hour is a more efficient way of coercing your breasts to produce the extra milk he needs than nursing for thirty minutes every two or three hours. And so he treats you like a snack bar rather than a restaurant. No sooner does he happily finish a meal than he’s rooting around again, looking for something to eat. Put him to the breast again, and he’ll do another feed.

Such marathon sessions are exhausting—you may begin to feel as though your baby is permanently attached to your breast. But the good news is that the cluster feeding usually lasts only a day or two, the time it takes for your milk supply to catch up with your growing baby’s demand; he’s then likely to return to a more consistent—and civilized—pattern of nursing. In the meantime, bring on the feed as often as your little bottomless pit seems to want it.

SORE NIPPLES

“Breastfeeding is something I always wanted to do. But my nipples have become so excruciatingly sore that I’m not sure I can continue nursing my daughter.”

At first you wonder if your newborn will ever catch on to nursing; then, before you know it, she’s suckling so vigorously your nipples become sore, even painful. And such tender nipples can make nursing a miserable—and frustrating—experience. Fortunately, most women don’t suffer for long; their nipples toughen up quickly, and breastfeeding stops being a pain and starts being a pleasure. But some women, particularly those whose babies are incorrectly positioned, and those who have a “barracuda baby” (one with a very vigorous suck, see page 76), have continued trouble, with soreness and cracking so painful they may come to dread each feeding. There are, however, routes to relief from sore nipples:

Be sure your baby is correctly positioned, facing your breast with the entire areola (not just the nipple) in her mouth when nursing, Not only will her sucking on the nipple alone leave you sore, it will also leave her frustrated, since she won’t get much milk. If engorgement makes it difficult for her to grasp the full areola, express a little milk manually or with a breast pump before nursing to reduce the engorgement and make it easier for her to get a good grip.

Expose sore or cracked nipples to the air briefly after each feeding. Protect them from clothing and other irritations and surround them with a cushion of air by wearing breast shells (not shields). Change nursing pads often if leaking milk keeps them wet. Also, make sure the nursing pads don’t have a plastic liner, which will only trap moisture and increase irritation.

If you live in a humid climate, wave an electric hair dryer, set on warm, across the breast (about 6 to 8 inches away) for two or three minutes (no more). In a dry climate, moisture will be more helpful—let whatever milk is left on the breast after a feeding dry there. Or express a few drops of milk at the end of a feeding and rub it on your nipples, making sure to let your nipples dry before putting your bra back on.

Nipples are naturally protected and lubricated by sweat glands and skin oils. But using a commercial preparation of modified lanolin can prevent and/or heal nipple cracking. After nursing, apply ultrapurified, medical grade lanolin, such as Lansinoh, but avoid petroleum-based products and petroleum jelly itself (Vaseline) and other oily products. Wash nipples only with water—whether your nipples are sore or not. Never use soap, alcohol, tincture of benzoin, or premoistened towelettes. Your baby is already protected from your germs, and the milk itself is clean.

BUMPS ON THE ROAD TO SUCCESS?

Although you probably had access to a lactation specialist in the hospital right after delivery, chances are (unless you had a cesarean) that you left the hospital within two days of childbirth and before nursing was well established (and even before your milk came in). Unfortunately, most nursing problems don’t crop up when help is still as close as the call button next to the hospital bed. They surface once you’re home, usually in the first week or two postpartum. If you find the road to breastfeeding success is lined with more bumps than you’d anticipated, don’t give up. Instead, pick up the phone and schedule a home visit with a lactation consultant. Many new mothers who experience difficulties with breastfeeding find such visits immensely beneficial, putting them back on the road to success and making them better equipped to handle the bumps along the way. Don’t wait, hoping things will get better on their own; the earlier breastfeeding problems are managed, the less likely they’ll be to spiral into something less manageable (such as insufficient milk production or baby not getting enough), and the less likely you’ll be to give up nursing before you have to. So consider getting help before you consider throwing in the towel. You and your baby deserve it.

Wet regular tea bags with cool water and place them on your sore nipples. The properties in the tea will help to soothe and heal them.

Vary your nursing position so a different part of the nipple will be compressed at each feeding; but always keep baby facing your breasts.

Don’t favor one breast because it is less sore or because the nipple isn’t cracked. Try to use both breasts at every feeding, even if only for a few minutes, but nurse from the less sore one first, since the baby will suck more vigorously when hungry. If both nipples are equally sore (or not sore at all), start off the feeding with the breast you used last and didn’t drain thoroughly.

Relax for fifteen minutes or so before feeding. Relaxation will enhance the let-down of milk (which will mean that baby won’t have to suck as hard), whereas tension will hinder it. If the pain is severe, ask your practitioner about taking an over-the-counter pain medication to relieve it.

If your nipples are cracked, be especially alert to signs of breast infection, which can occur when germs enter a milk duct through a crack in the nipple. See pages 87 and 88 for information on clogged ducts and mastitis.

TIME SPENT BREASTFEEDING

“Why didn’t somebody tell me I’d be nursing my baby twenty-four hours a day?”

Maybe because you wouldn’t have believed it. Or because nobody wanted to discourage you. Either way, now you know. Nursing is, for many mothers, a nearly round-the-clock job in the early weeks. But take heart; as time passes, you’ll spend less of it as a captive of your baby’s eager suckling. As Breastfeeding becomes solidly established, the number of feedings will begin to trail off. By the time your baby’s sleeping through the night, you’ll probably be down to five or six feedings, taking a total of only three or four hours out of your day.

In the meantime, put everything else that’s clamoring to be done out of your mind; relax and savor these special moments that only you can share with your baby. Make double use of them by keeping a baby journal, reading a book, or scheduling your day on paper. Chances are that once your baby is weaned, you’ll look back and think how much you miss those many hours of nursing.

NURSING FASHIONS

“When I was pregnant I couldn’t wait to get back into my regular clothes. But now that I’m nursing my son, I’m finding that I’m still limited in what I can wear.”

It hardly seems fair. Now that you’ve finally got something that resembles a waist back (sort of), what you wear is still an issue. Fortunately, your fashion options are a lot less limited when you’re breastfeeding than they were while you were expecting. True, your wardrobe may need some adjusting, especially from that waist up. But with an eye toward practicality, it is possible to satisfy your baby’s appetite for milk and your appetite for style with the same wardrobe.

The right bra. Not surprisingly, the most important item in your breastfeeding wardrobe is the one only you, your baby, and your spouse will be seeing: a good nursing bra, or more likely, several. Ideally, you should purchase at least one nursing bra before your baby is born so that you’ll be able to use it right away in the hospital. But some mothers find their breast size expands so much once their milk comes in that buying a bra before then isn’t cost effective.

There are many different styles of nursing bras available—with or without underwires, no-nonsense and no-frills or lacy (though probably not racy), with cups that unhook on the shoulders or in the center of the bra, or those that just pull to the side. Try on a variety, making your decision with comfort and convenience top priorities—and keeping in mind that you’ll be unhooking the bra with one hand while holding a crying, hungry baby in the other. Whichever style you choose, make sure the bra is made of strong, breathable cotton, and that it has room to grow as your breasts do. A too-tight bra can cause clogged ducts, not to mention discomfort when breasts are engorged and nipples are sore.

Two-piece outfits. Two-piece is the fashion statement to make when you’re breastfeeding—especially when you can pull up the top of the outfit for nursing access (but avoid tight shells). Shirts or dresses that button or zipper down the front can also work (though you may be exposing more than you’d like in public if you need to unzip from the top for baby to reach his target; unbuttoning from the bottom is usually a better bet). You might also want to look for nursing dresses and tops that are designed with hidden flaps to facilitate discreet nursing and easy access for pumping. Such nursing wear is also designed to fit a nursing mother’s larger bust size, a big plus.

Stay away from solids. Solid colors, whites, and anything sheer will show milk leaks more obviously than dark patterns, which will mask not only your wet secrets but also the lumpiness of your breast pads.

Wear washables. Between leaking milk and baby spit-up, your local dry cleaner will be as happy as you are that there’s a new baby in your house—unless you wear clothes you can toss in the washer and dryer. And after a few incidents with your good silk blouses, chances are washables will be all you’ll be wearing.

Don’t forget to pad your bra. A Breastfeeding mother’s most important accessory is the nursing pad. No matter what else you’re wearing, always tuck one or two inside your bra (see page 81 for details).

NURSING IN PUBLIC

“I’m planning to breastfeed my daughter for at least six months, and I know I can’t stay in my house all the time. But I’m not so sure about nursing in public.”

In most parts of the world, a mother nursing her baby doesn’t attract any more attention than a mother bottle feeding her infant. But in the United States, acceptance of public breastfeeding has been slower in coming. Ironically, although the breast is celebrated in movies, in magazines, and on the runway, it can still be a tough sell when there’s a baby feeding from it.

Happily, nursing in public is becoming more accepted—and easier to do in more and more places. In fact, many states even have legislation guaranteeing the right of a mother to breastfeed her child in public, as well as mandating special areas for nursing and pumping in workplaces. So just because you’re nursing doesn’t mean you’ll have to be cooped up for the duration. With a little practice, you’ll learn how to breastfeed so discreetly that only you and your daughter will know she’s having lunch. To make public breastfeeding more private:

Dress the part. With the right outfit (see previous question), you can breastfeed your baby in front of a crowd without exposing even an inch of skin. Unbutton your blouse from the bottom, or lift your shirt up slightly. You baby’s head will cover any part of your breast that may be exposed.

Practice in front of a mirror before venturing out in public. You’ll see that, with strategic positioning, you’ll be completely covered up. Or enlist your spouse (or a friend) to watch you as you feed the baby the first few times in public; he can monitor for any mishaps.

Drape a blanket or shawl over your shoulder (see illustration) to form a tent over your baby. But be careful not to cover your baby completely. She’ll still need to breathe, so be sure her tent is well ventilated. When you and baby are eating out together, you can also use a large napkin.

Wear your baby. A sling makes breastfeeding in public extremely discreet; wearing your baby this way, you can eat, watch movies, even walk around while nursing. People will just think your baby is sleeping.

Create your own privacy zone. Find a bench under a tree, pick a corner with a roomy chair in a bookstore, or sit in a booth in a restaurant. Turn away from people while your baby is latching on, and turn back once your baby is well positioned at your breast.

Look for special accommodations. Many large stores, shopping malls, airports, and even amusement parks have rooms set aside for nursing mothers, complete with comfortable rocking chairs and changing tables. Or, seek out a bathroom with a separate lounge area for your baby’s dining pleasure. If none of these are options where you’ll be going, and you prefer to nurse without a crowd, feed baby in your parked car before heading out to your destination, temperature permitting.

Using a blanket to nurse in public

Feed before the frenzy. Don’t wait until your baby becomes hysterical to start nursing her. A screaming baby only attracts the attention you don’t want when you’re nursing in public. Instead, watch for your baby’s hunger cues, and whenever possible, preempt crying with a meal.

Know your rights—and feel good about exercising them. In more than twenty states, legislation has been passed stating that women have the right to breastfeed in public—that exposing a breast to nurse is not indecent and is not a criminal offense. In 1999, a federal law was enacted to ensure a woman’s right to nurse anywhere on federal property. Even if you’re in a state that doesn’t have such legislation yet, you still have every right to feed your baby when she is hungry—breastfeeding is not illegal anywhere (except in a moving car, where even a hungry baby must be secured in a child safety seat).

Do what comes naturally. If feeding your baby in public feels right, go ahead and do it. If it doesn’t, even after some practice, opt for privacy whenever you can.

LUMP IN BREAST

“I’ve suddenly discovered a lump in my breast. It’s tender and a little red. Could it be related to nursing—or something worse?”

Finding a lump in a breast strikes concern in any woman. But fortunately, what you describe is almost certainly related to nursing—a milk duct has probably become clogged, causing milk to back up. The clogged area usually appears as a lump that is red and tender. Though not serious in itself, a clogged duct can lead to breast infection, so it shouldn’t be neglected. The basis of treatment is to keep milk flowing:

Drain the affected breast thoroughly at each feeding. Offer it first, and encourage baby to take as much milk as possible. If there still seems to be a significant amount of milk left after nursing (if you can express a stream, rather than just a few drops), express the remaining milk by hand or with a breast pump.

Keep pressure off the clogged duct. Be sure your bra isn’t too tight or your clothes too constricting. Rotate your nursing positions to put pressure on different ducts at each nursing.

Enlist baby for a massage. Positioning your baby’s chin so that it massages the clogged duct during suckling will help clear it.

Put warm compresses on the clogged duct before each feeding. Gently massage the duct before and during the feeding.

Be sure that dried milk isn’t blocking the nipple. Clean any away with warm water.

Don’t stop nursing. Now is not the time to wean your baby, or to cut back on nursing. This would compound the problem.

Occasionally, in spite of best efforts, an infection can develop. If the tender area becomes increasingly painful, hard, and red, and/or if you develop a fever, call your doctor (see next question).

MASTITIS

“My little boy is an enthusiastic nurser, and though my nipples were a little cracked and sore, I thought everything was going pretty well. Now, all of a sudden, one breast is very tender and hard—worse than when my milk first came in.”

For most women the course of Breastfeeding, after a shaky initial startup, is relatively smooth. But for a few—and it sounds like you’re one of them—mastitis (an inflammation of the breast) comes along to complicate matters. This infection can occur anytime during lactation, but it is most common between the second and sixth postpartum weeks.

Mastitis is usually caused by the entry of germs, often from the baby’s mouth, into a milk duct through a crack in the skin of the nipple. Since cracked nipples are more common among first-time breastfeeders, whose nipples are not used to the rigors of infant sucking, mastitis strikes these women more often. The symptoms of mastitis include severe soreness, hardness, redness, heat, and swelling over the affected duct, with generalized chills and usually fever of about 101°F to 102°F—though occasionally the only symptoms are fever and fatigue. Prompt medical treatment is important, so report any such symptoms to your doctor immediately. Prescribed therapy will include antibiotics and possibly bed rest, pain relievers, and heat applications.

Though nursing from the affected breast will be painful, you should not avoid it. In fact, you should let your baby nurse frequently to keep the milk flowing and avoid clogging. Empty the breast thoroughly by hand or with a pump after each feeding if your baby doesn’t do a thorough job himself. Don’t worry about transmitting the infection to your baby; the germs that caused the infection probably came from his mouth in the first place.

Delay in treating mastitis could lead to the development of a breast abscess, the symptoms of which are excruciating, throbbing pain; swelling, tenderness, and heat in the area of the abscess; and temperature swings between 100° and 103°F. Treatment generally includes antibiotics, and frequently, surgical drainage under local anesthesia. If you develop an abscess, breastfeeding on the affected breast must be halted temporarily, though you should continue to empty it with a pump until healing is complete and nursing can resume. In the meantime, baby can continue nursing on the unaffected breast.

BREASTFEEDING DURING ILLNESS

“I’ve just come down with the flu. Can I still breastfeed my baby without her getting sick?”

Breastfeeding your baby is the best way to strengthen her resistance to your germs (and other germs around her) and to keep her healthy. She can’t catch cold germs through your breast milk, though she can become infected through other contact with you. To minimize the spread of infection, always wash your hands before handling your baby or her belongings and also before feedings; if she ends up getting sick in spite of your precautions, see the treatment tips starting on page 544.

To speed your own recovery as well as keep up your milk supply and your strength while you have a cold or flu, drink extra fluids (a cup of water, juice, soup, or decaffeinated tea every hour while you’re awake), be sure to take your vitamin supplement, and eat as balanced a diet as you can under the circumstances. Check with your doctor if you need medication—but don’t take any without medical approval.

If you come down with a “stomach virus,” or gastroenteritis, you should again take precautions against infecting your baby—though the risk is small, since breastfed babies appear to be protected against most such infections. Wash your hands, especially after you’ve gone to the bathroom, before touching your baby or anything that she might put into her mouth. Take plenty of fluids (such as diluted fruit juices or decaffeinated teas) to replace those lost through diarrhea or vomiting.

BREASTFEEDING WHILE MENSTRUATING

“My period has returned early even though I’m nursing. Will my milk be affected by my period? Can I still nurse my son?”

While it’s true that many women who are exclusively nursing don’t begin menstruating until they wean (or partially wean) their babies, some women, like you, find their period returning as early as three to six months postpartum.

The return of menstruation does not mean the end of breastfeeding. You can, and should, continue to breastfeed your baby even if you’ve started menstruating, even while you have your period. However, you might experience a temporary drop in your milk supply, probably because of the hormonal changes that occur during menstruation. Continuing to nurse your baby frequently, especially at the beginning of your cycle, may help, but this temporary reduction in supply may just be par for the menstruating course. Your supply will return in a few days once your hormone levels return to normal. The taste of your milk may also change slightly, just before or during your period, again, because of hormonal changes. Your baby may be unaffected by this (some infants are less picky eaters than others), or he may nurse less often or less enthusiastically, reject one breast or both, or just be more fussy than usual. Another way your cycle may affect breastfeeding: You may find your nipples are more tender during ovulation, during the days before your period, or at both times.

BIRTH CONTROL AND THE BREASTFEEDING MOTHER

In the past, nursing mothers had to rely on a barrier method of contraception such as the diaphragm or condom. But today, women who are breastfeeding have the option of taking the “minipill”—a progestin-only version of the Pill—as well as other hormonal methods that are safe for use during lactation. For more on birth control postpartum and while breastfeeding, see page 692.

EXERCISE AND NURSING

“Now that my baby is six weeks old, I’d like to resume my exercise routine. But I’ve heard exercise will make my milk turn sour.”

What you’ve heard about exercise and breast milk (that increased levels of lactic acid after exercise may sour milk) is now old news. Happily, the latest research shows that moderate to high-intensity exercise (such as an aerobic routine four or five times a week) doesn’t turn milk sour. And another recent study found that moderate exercise also doesn’t diminish the amount of vital fatty acids in breast milk.

So by all means, hit the running trail (or the step climber, or the pool). Just be careful not to overdo it (exercising to the point of exhaustion actually might increase lactic acid levels enough to sour your milk). To play it extra safe, try to schedule your workout for immediately after a feeding, so that in the very unlikely event that lactic acid levels reach milk-souring heights, they won’t affect baby’s next meal. Another advantage to exercising right after a feeding: Your breasts will not be as uncomfortably full. If for some reason you can’t fit a feeding in before a very strenuous exercise session, try to pump and store your milk ahead of time, and then feed the preexercise milk in a bottle when your baby is ready. And since salty milk doesn’t taste any better than sour milk, if you’re breastfeeding after a workout, hit the showers first (or, at least, wash the remnants of salty sweat off your breasts).

Keep in mind that if you exercise excessively on a regular basis, you might have trouble maintaining your milk supply. This may have more to do with persistent motion of the breasts and excessive friction of clothes against the nipples than the actual exertion of the exercise. So be sure to wear a firm sports bra made of cotton any time you work out. Also, since strenuous arm exercises can cause clogged milk ducts in some women, pump iron with caution.

Finally, remember to drink a glass of water (or other liquid) before and after a workout to replace any fluid lost while exercising, especially during hot weather.

COMBINING BREAST AND BOTTLE

“I am aware of all the benefits of breastfeeding, but I’m not sure I want to nurse my daughter exclusively. Is it possible to combine breastfeeding and formula feeding?”

Though all might agree that exclusive breastfeeding is by far the best choice for baby, some women find that it’s unrealistic for their lifestyle (too many business trips away from home), too difficult (they experience extremely sore and cracked nipples, or suffer from multiple breast infections or chronic breast milk shortage), too time-consuming (between work and other obligations), or just plain exhausting. For these women, combining breastfeeding with formula-feeding may be the best choice. Though it’s not an option that’s often put on the table (women tend to assume that Breastfeeding and formula-feeding are all-or-nothing propositions), it’s one that can offer the best of both feeding arrangements in some situations. Keep in mind that any breast milk is better for a baby than none at all.

There are important things to remember, however, if you’re going to “do the combo”:

Put off the bottle. Try to delay giving your baby a formula bottle until Breastfeeding is established—at least two to three weeks. This way, your milk supply will be built up and your baby will be used to breastfeeding (which takes more effort) before the bottle (which takes less effort) is introduced.

Go slow. Don’t switch to the combo abruptly; instead, make the transition slowly. Introduce the first formula bottle an hour or two after a breastfeeding session (when baby’s hungry but not starving). Gradually build up to more frequent bottles and decrease nursing sessions, preferably allowing a few days in between each new bottle addition, until you are offering a bottle instead of a breast every other feeding (or as often as you choose). Taking the slow approach to eliminating a breastfeed avoids clogged ducts and breast infections.

NIPPLE CONFUSION GOT YOU CONFUSED?

Maybe you’d like to try the “combo” of breast and bottle. Or maybe you’d just like to introduce a bottle so you have the option of falling back on one every now and then. But you’ve heard that bringing on the bottle too soon or in the wrong way can cause “nipple confusion,” and now you’re unsure how to proceed. Though many lactation consultants do warn new mothers about the perils of nipple confusion (and for good reason, since starting a bottle before baby has mastered basic breastfeeding skills can possibly sabotage nursing), most infants are able to switch effortlessly between breast and bottle.

Timing is key (bring the bottle on too soon, and baby may balk at the breast, because it suddenly seems like too much hard work; bring it on too late in the game, and baby may already be too attached to mom’s nipple to sample the factory-made variety). But personality plays a part, too (some babies are more open to new experiences, some are stubborn creatures of habit). Most important, however, is perseverance (yours and baby’s). While your baby may well be puzzled by the bottle at first, and may even reject the first few attempts, chances are he or she will soon get the hang of working the combo. Do keep in mind, however, that there are some babies who develop an inflexible preference for one method of feeding over the other and remain resistant to combining them. For more on introducing a bottle, see page 215.

Keep an eye on the supply. When you do begin supplementing, the decrease in demand for your breast milk may quickly result in a diminished supply. You’ll need to make sure that you fit in enough breastfeedings so that your milk supply doesn’t drop too much. (For most women, six thorough breastfeeds in a twenty-four-hour period is enough to maintain adequate milk production for a newborn). You might also need to pump occasionally to keep your milk supply up. If your baby doesn’t nurse enough (or if you’re not pumping to make up those missed nursings), you may find you don’t have enough milk to continue breastfeeding—and the combo can backfire.

Choose the right nipple. You’ve got the right nipple for the breastfeedings; now choose the right one for the bottle, too. Pick a nipple that resembles those made by nature, one with a wide base and a slow flow. The shape of such a nipple enables your baby to form a tight seal around the base, rather than just sucking the tip. And the slow flow ensures that your baby has to work for the milk, much as she has to when breastfeeding.

RELACTATION

“I’ve been feeding my ten-day-old baby both formula and breast milk since birth, but now I want to breastfeed him exclusively. Is this possible?”

It won’t be easy—even this short period of supplementing has cut down on supply—but it’ll definitely be possible. With time, dedication, patience—and a cooperatively hungry baby—you will soon be able to make the switch from the combo back to breast alone. The key to weaning your baby off formula will be to produce enough milk to make up the difference. Here’s how you can pump up your milk supply, and make a successful transition from partial breastfeeding to exclusive breastfeeding:

Go for empty. Because frequent and regular stimulation of your breasts is critical to milk production (the more you use, the more you’ll make), you’ll need to drain your breasts (either by nursing your baby or by pumping) at least every two and a half hours during the day and every three to four hours at night.

Top off with the pump. Finish each nursing session with five to ten minutes of pumping to ensure that your breasts are thoroughly drained, stimulating even further milk production. Either freeze the pumped milk for later use (see page 162) or feed it to your baby along with any supplemental formula.

Ease off the formula. Don’t take your baby off formula cold turkey. Until full milk production has been established, your baby will need supplemental feedings, but offer the bottle only after a nursing session. As your own milk supply increases, gradually feed less formula in each bottle. If you write down the amount of formula your baby takes daily, you should see a slow decrease in that amount as your milk supply increases.

Consider a supplementer. Using a supplemental nutrition system (SNS), such as the Medela Supplemental Nursing System or the Lact-Aid Nursing Trainer System may make your transition from breast and bottle to breast alone a lot smoother. Such a system enables you to feed your baby formula while he sucks at the breast (see page 167). This way, your breasts get the stimulation they need and your baby gets all the food he needs.

Do diaper counts. Remember to keep track of your baby’s wet diapers and bowel movements to make sure he’s getting enough to eat (see page 164). Also, keep in touch with your baby’s doctor and have the baby weighed often to make sure he’s getting enough to eat during the transition.

Possibly, try medication. There are herbal options (some lactation consultants recommend fenugreek in small amounts to stimulate milk production), and even a traditional medicinal one (a medication called Reglan that is sometimes used to stimulate milk production).¹ But, as with all herbs and medications, do not take anything to stimulate your milk production without the knowledge and direction of your practitioner, your baby’s pediatrician, and/or a certified lactation consultant familiar with your particular situation. And don’t even consider taking them unless you’re really struggling with milk production.

Be patient. Relactation is a time-consuming process, and your success is dependent on a good support system. Enlist help from your spouse, family, and friends, if possible. Get support and advice from a lactation consultant. You can find one through the hospital, your doctor, or midwife, or by contacting your local La Leche League.

Relactating will take round-the-clock effort on your part for at least a few days and as long as a few weeks. Though at times it may prove frustrating, chances are that it will ultimately be rewarding. Once in a while, however, even with best efforts, relactating doesn’t take. If that does end up being the case with you, and you end up having to bottle feed either partially or completely, don’t feel guilty. Your efforts to nurse should make you proud. And remember, any breastfeeding—even for a short time—benefits your baby greatly.

What It’s Important to Know: KEEPING YOUR MILK HEALTHY AND SAFE

Feeding your baby outside the womb doesn’t require quite the degree of dietary dedication—or monitoring—that feeding your baby inside the womb did. But for as long as you’re breastfeeding, you’ll need to pay a certain amount of attention to what goes into you in order to ensure that everything that goes into your baby is healthy and safe.

WHAT YOU EAT

Tired of watching your diet like an expectant hawk? Here’s some news you’ll be happy to hear: Compared to pregnancy, nursing actually makes minimal demands on your diet. The basic fat-protein-carbohydrate composition of human milk isn’t directly dependent on what a mother eats. In fact, all over the world, women produce adequate and abundant milk on inadequate diets. That’s because if a mother doesn’t consume enough calories and protein to produce milk, her body will tap its own stores of nutrients to fuel milk production—that is, until those stores are depleted.

But just because you can make milk on an inadequate diet doesn’t mean you should. Clearly, no matter how many nutrients your body may have stockpiled, the goal when you’re nursing should never be to deplete those stores—that’s too risky, setting you up for a variety of health problems, including the potential later in life for osteoporosis. So be sure to eat (no matter how eager you are to shed weight), and eat well (see the Postpartum Diet, page 665). But take comfort in the fact that nursing mothers—unlike expectant ones—don’t have to be quite as careful about what they eat and don’t eat. (There still are restrictions for safety’s sake, however; read about them on page 96.)

In fact, eating a wide variety of foods appears to be beneficial to your nursing baby, and not just from a nutrition standpoint. Because what you eat affects the taste and smell of your breast milk, your breastfed baby is exposed to different flavors well before he or she is ready to sit down at the dinner table, which may help shape future eating habits. The very early flavor experiences a breastfed baby has may actually provide the foundation for cultural and ethnic preferences in cuisine. A young Indian toddler, for instance, typically has no problem wolfing down curried food—probably because he or she has been exposed to it as a fetus (through the amniotic fluid) and as a nursing infant. For the same reason, a young Mexican child may be more accustomed to the smell and taste of hot salsas. On the other hand, a child whose mother ate a bland diet while she was pregnant and nursing may be more likely to push away a bowl of peppery chili once it’s time for solids.

CAN FOODS MAKE MILK?

Every breastfeeding mother has heard about at least one: Foods, drinks, and herbal potions with the supposed power to increase milk production. They run the gamut—from milk and beer, to teas made from fennel, blessed thistle, anise, nettle, and alfalfa; from garbanzo beans and licorice, to potatoes, olives, and carrots. Though some mothers swear by these cultural traditions and old wives’ standards, some experts say that the effects of such “milk-making potions” are largely psychological. If a mother believes that what she eats or drinks will make milk, she’ll be relaxed. If she’s relaxed, she’ll have a good let-down. If her let-down reflex is good, she’ll interpret it to mean she has more milk, and that the potion worked its magic after all. Remember: The best—and only proven—way to increase your milk supply is to have your baby nurse frequently.

Occasionally, a baby with a particularly discriminating palate may snub his or her mother’s milk after mom has eaten something with a distinctive taste, like garlic (again, possibly, because the flavor is unfamiliar). Others, perhaps because they became used to an infusion of garlic during their stay in the uterus, may even relish mom’s milk more when she’s been hitting the pesto and scampi. And if you’d like to give your child a taste for vegetables, here’s something else to chew on: In one study, infants whose mothers drank carrot juice when they were pregnant and breastfeeding lapped up cereal mixed with carrot juice more eagerly than infants of mothers who stayed away from carrots—evidence that what you eat now can have a positive effect on your nursing baby’s future eating habits, which is yet another good reason to eat your vegetables. Another plus: Your breastfed baby may have a leg up on his formula-fed contemporaries when it comes time to take a seat in the high chair. Breastfed babies have been shown to have an easier time transitioning to solid foods, probably because they’ve already acclimated to different flavors from drinking their mother’s milk.

But chances are that not all of what you eat will have a happy ending in baby’s tummy. Some mothers, after eating foods like cabbage, broccoli, onions, cauliflower, or Brussels sprouts, find their nursing babies get gassy (though scientific studies have failed to back up this anecdotal evidence). Colic in some babies has been linked to dairy products, caffeine, onions, cabbage, or beans in their mother’s diet. A maternal diet that’s heavy on melons, peaches, and other fruits can cause diarrhea in some babies. Red pepper can cause a rash in some breastfed infants. Other babies are actually allergic to foods in their mother’s diets, with the most common offenders being cow’s milk, eggs, citrus fruits, nuts, or wheat (see page 177 for more on allergies in breastfed babies). What you eat can also change the color of your milk, and even the color of your baby’s urine. For instance, a mom who drinks orange soda may find her breast milk a pink-orange color and her baby’s urine bright pink (pretty harmless, but definitely anxiety-producing). Kelp, seaweed (in the tablet form), and other natural vitamins from health food sources have been associated with green breast milk (fine for St. Patrick’s day, but probably not something you’d want to see on a regular basis).

It takes between two and six hours from the time you eat a certain food until it affects the taste and odor of your milk. So, if you find your baby is gassy, spits up more, rejects the breast, or is fussy a few hours after you eat a certain food, try eliminating that food from your diet for a few days and see if your baby’s symptoms or reluctance to nurse disappear.

WHAT YOU DRINK

How much do you have to drink to make sure your baby gets enough to drink? Actually, no more than you have to drink at any other time in your adult life. Nursing mothers do not have to drink any more than those eight daily glasses—of water, milk, or other fluids—in order to ensure a good milk supply. In fact, too much fluid can actually decrease the amount of milk you make.

That said, most adults don’t drink their full fluid requirement every day, and nursing mothers are no exception. One way to make sure you drink your quota is to keep a bottle or glass of water close by when you’re nursing (which will be at least eight times a day at first); when your baby drinks, so should you. If you’re not drinking enough, your milk supply won’t tell you (it won’t decrease unless you’re seriously dehydrated), but your urine will; it will become darker and more scant. As a general rule, waiting until you’re thirsty to drink means you’re going too long without fluids. (You may be thirstier than usual after you deliver your baby, because of fluid loss and inadequate fluid intake during labor; replenishing those fluids is important for your health.)

There are some drinks you should avoid, or at least limit, when you’re breastfeeding. See page 96 for more.

WHAT MEDICATION YOU TAKE

Most medications—both over-the-counter and prescription—don’t have an effect on the quantity of milk a nursing mother makes or the well-being of her baby. While it’s true that what goes into your body usually does make its way into your milk supply, the amount that ultimately ends up in your baby’s meals is generally a tiny fraction of what you ingest. Many drugs appear to have no effect on a nursing baby at all, others a mild, transient effect, and a very few can have a significant detrimental effect. But since not enough is known about the long-term effects of medications on the nursing infant, you’ll need to practice prudence when it comes to taking over-the-counter or prescription drugs while you’re breastfeeding.

All medications that pose even a theoretical risk to the nursing baby carry a warning—on the label, the package, or both. When the benefits outweigh the possible risks, your physician will probably okay the occasional use of certain drugs without medical consultation (certain cold medications and mild pain relievers, for example) and prescribe others when your health requires it. Like an expectant mother, a nursing mother does neither herself nor her baby a favor by refusing to take prescribed medication under such circumstances. Do be sure, of course, that any doctor who prescribes a medication for you knows that you’re breastfeeding.

For the most up-to-date information on which drugs are believed safe during lactation and which aren’t, check with your child’s pediatrician or your local chapter of the March of Dimes, or visit their Web site at www.modimes.org. The most recent research indicates that most medicines (including acetaminophen, ibuprofen, most sedatives, antihistamines, decongestants, some antibiotics, antihypertensives, and antithyroid drugs, and even some antidepressants) are compatible with nursing. Some, however, including anticancer drugs, lithium, and ergots (drugs used to treat migraines) are clearly harmful. Others are suspect. In some cases, a medication can safely be discontinued for the duration of nursing; in others, it is possible to find a safer substitute. When medication that is not compatible with breastfeeding is needed short-term, nursing can be interrupted temporarily (with breasts pumped and milk discarded). Or dosing can be timed for just after nursing or before baby’s longest sleep period. As always, take medicines—and that includes herbals and supplements—only with your practitioner’s approval.

WHAT YOU SHOULD AVOID

Though nursing mothers have considerably more leeway when it comes to their diet and their lifestyle than pregnant women do, there are still a number of substances that are smart to avoid—or at least, cut back on—while you’re breastfeeding. Many are ones that you’ve probably already weaned yourself off of in preparation for or during pregnancy.

Nicotine. Many of the toxic substances in tobacco enter the bloodstream and eventually your milk. Heavy smoking (more than a pack a day) decreases milk production and can cause vomiting, diarrhea, rapid heart rate, and restlessness in babies. Though the long-term effects of these poisons on your baby aren’t known for sure, one can safely speculate that they aren’t positive. On top of that, it is known that secondhand smoke from parental smoking can cause a variety of health problems in offspring, including colic, respiratory infections, and an increase in the risk of SIDS (see page 259). If you can’t stop smoking, your baby’s still better off being breastfed than being bottle-fed; do, however, try cutting back on the number of cigarettes you smoke each day, and don’t smoke just before breastfeeding.

Alcohol. Alcohol does find its way into your breast milk, though the amount your baby gets is considerably less than the amount you drink. While it’s probably fine to have a few drinks a week (though no more than one in a single day), you should try to limit your consumption of alcoholic drinks in general while nursing.

Heavy drinking has other drawbacks as well. In large doses, alcohol can make baby sleepy, sluggish, unresponsive, and unable to suck well. In very large doses, it can interfere with breathing. Too many drinks can also impair your own functioning (whether you’re nursing or not), making you less able to care for, protect, and nourish your baby, and can make you more susceptible to depression, fatigue, and lapses in judgment. Also, it can weaken your let-down reflex. If you do choose to have an occasional drink, take it right after you nurse, rather than before, to allow a couple of hours for the alcohol to metabolize.

Caffeine. One or two cups of caffeinated coffee, tea, or cola a day won’t affect your baby or you—and during those early sleep-deprived postpartum weeks, a little jolt from your local coffee bar may be just what you need to keep going. More caffeine probably isn’t a good idea; too many cups could make one or both of you jittery, irritable, and sleepless (something you definitely don’t want). Caffeine has also been linked to reflux in some babies. Keep in mind that babies can’t get rid of caffeine as efficiently as adults, so it can build up in their systems. So limit your caffeine while you’re Breastfeeding, or switch over to or supplement with caffeine-free drinks.

Herbs. Although herbs are natural, they aren’t always safe, especially for Breastfeeding mothers. They can be just as powerful—and just as toxic—as some drugs. Like drugs, chemical ingredients from herbs do get into breast milk. Even herbs like fenugreek (which has been used for centuries to increase a nursing mother’s milk supply, and is sometimes recommended in small amounts by lactation consultants, though the scientific studies have been mixed) can have a very potent effect on blood pressure and heart rate when taken in large doses. In general, little is known about how herbs affect a nursing baby, because few studies have been done. There are no rules for the distribution of herbs, and the FDA doesn’t regulate them. Play it safe and consult with your doctor before taking any herbal remedy. Think twice before drinking herbal tea, too, which the FDA has urged caution on until more is known. For now, stick to reliable brands of herbal teas that are thought to be safe during lactation (these include orange spice, peppermint, raspberry, red bush, and rose hip), read labels carefully to make sure other herbs haven’t been added to the brew, and drink them only in moderation.

Chemicals. Eating a diet high in added chemicals is never a particularly good idea; during breastfeeding, as during pregnancy, it may be a particularly bad one. While it isn’t necessary to be obsessed about reading labels, a little prudence is warranted. Remember: Many of the substances that are added to your foods will be added, through you, to your baby’s. As a general rule, try to avoid processed foods that contain long lists of additives, and try the following tips for safer eating:

NO PEANUTS WHILE FEEDING YOUR LITTLE PEANUT?

If you have a family history of peanut—or other—allergies, it’s probably wise to avoid peanuts and foods that contain them while Breastfeeding. Research has found that peanut allergens can be passed through breast milk from the mother to the nursing baby. It has been theorized that this early exposure to peanut allergens causes the baby to become sensitized to them, eventually leading to potentially serious allergies later in childhood. If you have allergies, or if you have a family history of allergies, speak to your baby’s doctor or your allergist to determine what foods, if any, you should avoid while breastfeeding.

Sweeten safely. Aspartame is probably a better bet than saccharine (only tiny amounts of aspartame pass into breast milk), but since the long-term health consequences of the sweetener, if any, aren’t yet known, excess is definitely not best. (Don’t use aspartame at all if you have PKU or your baby does.) Sucralose (Splenda), however, is made from sugar and is considered safe and a good all-round calorie-free sugar substitute.

Go organic. Certified organic fruits and vegetables are now widely available in supermarkets, as are organic dairy products and organic poultry, meat, and eggs. But don’t feel you have to drive yourself crazy (or drive yourself all over town) in order to protect your baby’s milk from pesticides. Do what you can to avoid incidental pesticides (and choosing organic is the best way to do this), but realize that a certain amount will end up in your diet, and thus in your milk, despite your best efforts—and that these amounts won’t be harmful. When organic isn’t available, or you just don’t want to pay the higher price, peel or scrub fruits and vegetable skins well (use produce wash for extra protection).

Stay low-fat. As it was during pregnancy, it’s smart to choose fat-free or low-fat dairy products, as well as lean meats and poultry without the skin, for two reasons. First, a low-fat diet will make it easier to shed your pregnancy weight gain. Two, the pesticides and other chemicals ingested by animals are stored in their fat (and in their organs, such as liver, kidneys, and brain, which is why you should eat these meats only rarely while you’re breastfeeding). Organic dairy and meat products, of course, don’t pose the same potential risk—a good reason to select them when you can.

Fish selectively. The same EPA guidelines on fish safety that apply to pregnant women apply to breastfeeding ones. So to minimize your (and your baby’s) exposure to mercury avoid eating shark, swordfish, king mackerel, and tilefish, and limit your consumption to 6 ounces per week of tuna (chunk light tuna contains less mercury than tuna steaks and canned albacore) and 12 ounces (total) per week of salmon, sea bass, flounder, sole, haddock, halibut, ocean perch, pollack, cod, tuna (canned is safer than fresh), and farm-raised trout.

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1. Though Reglan is not approved by the FDA for the purposes of stimulating milk production, several studies have shown the drug to be safe for babies and effective in increasing a mother’s milk supply. The medication can make the mother sleepy.