Breastfeeding

Introduction

When you breast-feed, you provide your baby with the best possible nutrition. The best way to stimulate milk production is to have your baby feed directly from your breast. If this isn't possible, your baby can drink expressed breast milk from a bottle. The first few weeks of breast-feeding can be challenging because of all the changes to your body and routine. Breast-feeding becomes easier over time, once your body has adjusted and you have learned breast-feeding techniques and how to manage common minor problems.

This PDF newsletter has some of the main points that we share with our moms about how to best care for your baby.

What do I need to know to breast-feed successfully?

Breast-feeding is the process of using breast milk to provide some or all of a baby's nutritional needs. You can feed a baby breast milk directly from the breast (the best way to stimulate milk production) or from a bottle after expressing the milk with a pump. Be aware that only using a breast pump without ever feeding your baby at the breast will reduce your milk supply after a while.

To breast-feed successfully, it is important to:

Plan. Make sure to discuss your breast-feeding plans with all the doctors who are involved in the care of you and your baby.
Learn proper breast-feeding positions and techniques. Breast-feeding becomes easier with knowledge and skills.
Recognize and treat problems early. If you can anticipate and manage challenges right away, you are more likely to have a positive breast-feeding experience.
Have a support system. Know when and how to get help.
Take a breast-feeding class while you are pregnant, and join a support group to attend after your baby's birth.

Why is breast-feeding important?

Breast milk is the healthiest food for babies and offers the most complete nutrition, such as antibodies to help fight illness. Most doctors suggest daily vitamin D supplements too, starting by age 2 months. Breast-fed babies are less likely to get sick or need to be hospitalized. Breast milk is the best source of nutrition during the first 6 months of life. At 4 to 6 months, iron-fortified foods are gradually introduced as you continue to breast-feed. All major professional medical organizations that focus on children, such as the American Academy of Pediatrics, recommend breast-feeding for at least the first year of a baby's life or longer if desired. Your baby receives more health benefits the longer you breast-feed. Also, your breast milk changes to meet your baby's nutritional needs as he or she grows.

Breast-feeding helps your body recover from the stresses of pregnancy, labor, and delivery. It also lowers your risk for breast cancer or diabetes later in life., The longer you breast-feed, the more your risk for breast cancer is reduced.

The first few weeks of breast-feeding typically are the most difficult. You are recovering from childbirth, adjusting to hormonal changes, and operating with little sleep. Many women are also mentally and emotionally exhausted. Minor problems, such as sore or cracked nipples, may seem overwhelming. But most breast-feeding problems are easily prevented or solved. Overcoming these challenges during these first few weeks boosts your confidence, which makes you more likely to continue breast-feeding for a full year. Most women who persevere with breast-feeding have a great sense of accomplishment and recognize the importance of providing their child with the best possible nutrition.

How to breast-feed successfully

Breast-feeding is a learned skill that becomes easier over time. You are more likely to succeed with long-term breast-feeding by having a plan, becoming familiar with basic techniques, learning how to handle minor physical problems, and getting help quickly when you need it.

Breast-feeding plan

Plan ahead for breast-feeding while you are pregnant. Doing so before you deliver allows you time to think about how to manage the daily logistics of breast-feeding before you become too busy with caring for your newborn.

Talk to your doctor early in your prenatal care about your plans to breast-feed. Before each visit, write down any breast-feeding questions or concerns. While you are pregnant is the time to talk to your doctor about any plans you have to breast-feed both an older child and your newborn.
Arrange to attend a breast-feeding class and possibly join a breast-feeding support group. These are offered at many hospitals and birthing centers by nurses, nurse-midwives, or lactation consultants. Classes and support groups can help you anticipate and manage breast-feeding difficulties, should they arise.
Talk to friends and family members about your decision. Discuss how their support is important in your efforts.
Check the breast-feeding policies of the hospital and birthing centers you are considering. It is much easier to breast-feed when you are in a supportive environment, such as in a facility that has a lactation consultant on staff, encourages keeping the baby in the room with you (rooming in), and has a policy of not supplementing your baby's diet unless medically necessary.
Purchase breast-feeding items, such as breast pads, extra pillows, and nursing bras. Check with your hospital to see whether they have handheld breast pumps available for you to use after your baby is born. This may be helpful if your milk comes in during your stay. In addition, explore your options for renting or purchasing a breast pump so you won't have to worry about it after your baby arrives.

Basic breast-feeding techniques

Take a breast-feeding class while you are pregnant. These classes usually are offered through your local hospital or birthing center.

A baby is typically very alert during the first 2 to 4 hours after birth. This is the best time to start breast-feeding. A nurse or other doctor will help you with proper latching and getting started. View a slideshow on latching to learn how to get your baby to latch on.

After this alert wakeful time, your baby will become sleepy and less likely to eat regularly for the next several hours. Usually, a hospital staff person checks in with you routinely. Be sure to try breast-feeding your baby every 1 to 3 hours (even if you have to wake your baby). If available, a lactation consultant may help you learn other breast-feeding techniques and positions. Common feeding positions include:

Cradle hold.
Cross-cradle hold.
Football hold.
Side-lying position.
Australian hold.

To ensure that all areas of the breast are drained of milk, try alternating positions at each feeding. By changing positions frequently, you help prevent blocked milk ducts and sore nipples. Also, alternate which breast you use at the start of each feeding. This practice ensures that both breasts empty well.

Women who have had a cesarean delivery may prefer positions in which the baby doesn't rest on the abdomen, such as the side-lying position or the football hold.

A lactation consultant can also help determine whether you are breast-feeding correctly and can suggest techniques and help if you:

Have inverted nipples, which fold inward instead of pointing out.
Have had a cesarean delivery. This procedure requires medicine that may make you sleepy and make it more of a challenge for you to breast-feed in the first few hours after your baby is born.
Have given birth to multiple infants. Most mothers can produce enough milk to feed two or more babies. But guidance and assistance are usually needed.

Breast-feed your baby on demand rather than setting a strict schedule. You will begin to recognize your baby's hunger signs. For the first few days, plan to breast-feed every 1 to 3 hours, or about 8 to 12 times in a 24-hour period. Wake a sleepy baby to feed if necessary. More frequent breast-feeding stimulates your breasts to produce more milk.

Taking care of yourself will also help you to establish your milk supply. Eat right and get rest when you are able. Also, avoid bottle-feeding your baby breast milk until breast-feeding and milk supply are well established, which is usually about 4 to 6 weeks. This helps build your milk supply. Not using bottles also helps prevent your baby from developing nipple confusion, which is a preference for an artificial nipple over the breast.

Some doctors recommend also not allowing babies to suck on pacifiers for the first 4 to 6 weeks of breast-feeding. Talk to your doctor if you wish to allow your baby to use pacifiers before this time.

Plan to have help with chores, diaper changes, and other duties for the first few weeks after your baby is born. Getting help can let you focus on caring for and feeding your newborn.

Look for signs that your baby is getting enough milk, such as eagerness to eat and feeding sessions that last at least 15 to 25 minutes. By 6 days of age, your baby should need about 6 to 8 diaper changes, settle well after feeding, and usually awaken on his or her own to feed every 1 to 3 hours. Talk to your doctor if you have any concerns.

Managing common problems

Minor problems can develop while breast-feeding and are most common during the first few weeks. Because you likely are physically, mentally, and emotionally exhausted, minor problems can seem overwhelming. Home treatment measures can be used for:

Breast engorgement, which can cause painful breasts and flattened nipples, making it difficult for a baby to latch on for feeding. For more information, see the topic Breast Engorgement.
Blocked milk ducts, which may cause a painful lump in the breast that can lead to a breast infection (mastitis). Help clear blocked ducts by using warm compresses and massaging the lump toward the nipple before and during feedings. Also, breast-feed more frequently and in different positions. Offer your baby the affected breast first at each feeding.
Sore or cracked nipples. You can help relieve the pain from sore or cracked nipples with drops of expressed breast milk or lanolin. Gel pads help soothe sore nipples for some women; however, they should be used on dry breasts. Gently drying breasts with a hair dryer may also help. Focus on using proper breast-feeding positions, softening engorged breasts before feeding, and using proper latching to help prevent further irritation. View a slideshow on latching to learn how to get your baby to latch on.
Poor let-down. Practice relaxation techniques before and during breast-feeding, stay warm, eat properly, and drink plenty of fluids. If poor milk let-down is a problem after the first few days after starting breast-feeding, your doctor can help you solve the problem.
Breast milk leaking. Your let-down reflex may be stimulated unintentionally. Be prepared by using absorbent pads that you change frequently.
Low milk supply. Generally, increasing the frequency of breast-feeding will help build your milk supply. Other factors sometimes affect milk production; however, it is rare to have a true milk deficiency.

Get help when needed

See your doctor right away if:

Your baby shows signs of infection or illness, such as fever or a bulging soft spot on the head when he or she is not crying.
You have signs of a breast infection (mastitis), such as flu-like symptoms and red streaks extending from a breast.
You or your baby shows signs of a yeast infection. Babies may have white spots in the mouth (thrush), and you may have red or very pink and painful nipples.

Special care from your doctor also is needed if your baby:

Has a cow's milk protein sensitivity. Although this is not common, some babies are sensitive to milk protein and sugars from dairy products a mother eats and passes on through breast milk.
Is premature. Babies who are born early may need special care that can make breast-feeding more challenging. They may also have developmental issues, such as problems sucking and swallowing, that require you to make adjustments for breast-feeding.
Needs supplements. Sometimes healthy breast-feeding infants need other nutritional supplements besides vitamin D. But this is rare.

In some cases a baby is not able or willing to feed at the breast. Alternatives include using a cup or supplemental nursing system. One of these methods may also be used if your baby requires supplementation but you do not want to bottle-feed. Bottle-feeding pumped breast milk is more likely to interfere with establishing a breast-feeding routine in the first few weeks. A supplemental nursing system allows the baby to feed at the breast while getting a supplement. Occasionally a baby needs feedings given through a tube that is inserted into the stomach.

If a minor problem arises that does not quickly resolve, get prompt assistance from a breast-feeding specialist such as a lactation consultant or other doctor who is knowledgeable about breast-feeding issues. Quickly addressing breast-feeding issues helps solve problems and increases your likelihood of successful long-term breast-feeding. If possible, arrange to have a specialist visit you at home, or make plans to visit the specialist's office.

Have a list of resources available to call, such as:

Your doctor.
A lactation consultant.
Friends and family who are experienced with and supportive of breast-feeding.
Breast-feeding support groups.