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BREASTFEEDING
Benefits

How to Get Started

How to Tell if the Baby is Getting Enough

How to Treat Sore Nipples

Questions & Myths

Expressing, Storing & Thawing Breast Milk

Getting Help

Benefits

Portions taken from "Breastfeeding Guide" Reg. 3 Breastfeeding Task Force

  • Breastmilk alone is all your baby needs to grow and develop for the first 6 months of life.
  • The slow introduction of iron-enriched solids from six months on is recommended.
  • Breastfeeding should continue for at least 12 months and thereafter for as long as desired.

Infants benefit from breastfeeding because it is easily digested and does not cause allergies. Breastfed babies have a higher IQ, straighter teeth and fewer speech impediments. Breastmilk also protects against cancer and diabetes, ear and respiratory infections. The immune system is stimulated with breastmilk to help protect against disease and give a better response to vaccines. Breastmilk has a role in protecting against SIDS (Sudden Infant Death Syndrome) and more.

Mothers benefit from breastfeeding because it protects against ovarian and premenopausal breast cancer, helps get uterus back to pre-pregnancy size and shape, creates special time for mother - baby bonding, delays ovulation and menstruation, decreases osteoporosis, decreases missed school or work days due to baby's illness, no worries about formula recalls, takes less time (preparing, shopping for and cleaning bottles), and more sleep at night.

Families benefit from breastfeeding because it is more economical, makes babies healthier, and allows families to spend more time together.

The community and earth benefit from breastfeeding because it is a natural resource that is ecologically sound. There is no plastic, waste or packaging involved. Artificial formula does not contain secretory IgA, lysozymes, macrophages, hormones, enzymes, growth factors, or long chain polyunsaturated fatty acids. In fact, artificial formula is missing hundreds of ingredients compared to human breastmilk.

TRICARE Newsletter on Benefits of Breastfeeding

La Leche League International

How to get started

Portions taken from "Breastfeeding Guide" Reg. 3 Breastfeeding Task Force

Your baby will let you know when he/she is ready to eat by mouthing, rooting, hand to mouth activity, lip smacking, sucking on hands and fingers, small fussy sounds, and pre-cry grimaces. There are relaxed first cues. If you wait for a cry the baby is then tense and may feed poorly, or have difficulty latching on and usually will swallow more air. Crying is a very late cue.

Find a comfortable place where you can relax. Use pillows for support as needed. Hold the baby so that you are belly to belly.

Gently support your breast with four fingers under the breast and your thumb on top. Make sure your fingers are clear of the areola so they will not interfere with correct latch-on.

Brush the baby's lips, top lip down to the bottom, gently, with your nipple, until he opens WIDE. Then quickly bring him/her onto your breast with chin touching first.

You should not feel pain. You may feel some tugging. Keeping in mind that when your baby is correctly positioned or "latched-on" your nipple and much of the areola are pulled well into the baby's mouth. A correct latch-on is important because: milk flows better, stimulates a good milk supply, baby grows well, prevents sore nipples, and helps prevent engorgement, plugged ducts and mastitis.

Let the baby nurse long enough - What is long enough? Watch your baby closely, you will note your baby is showing signs of swallowing. Watch and listen. The baby is drinking well when you see a pause between the open and close of a swallow. Not the pause between suckles but the pause during one suckle as the baby opens his/her mouth fully. When babies have had enough milk, they will stop on their own and show signs of satisfaction. But in the early days many babies will stop sucking as the milk flow slows down. You may need to use breast compression/stimulation to increase swallowing. Ask your care provider to help you identify swallowing and teach you breast compression/stimulation. In the early days, your baby may need waking up. Offer both breasts at each feeding, but there may be some feedings when your baby breastfeeds on one side only. At the next feeding start on the side that was used the least during the previous feeding.

Newborns need to be nursed 8 -12 times in 24 hours. They may not display feeding cues. You may need to unwrap, change a diaper or massage a newborn to feed often enough.

How to tell that the baby is getting enough

Portions taken from "Breastfeeding Guide" Reg. 3 Breastfeeding Task Force

During the first weeks of breastfeeding, it is normal to wonder if the baby is getting enough to eat. Many new parents share this concern. As long as he/she has at least 8-12 feedings every 24 hours with regular swallowing, he is probably getting enough. Most babies lose a few ounces initially and may not regain it until the second or third week. Start counting weight gain from the lowest measure of weight at 3-4 days old, not from birth weight. Babies should regain their birth weight within 2-3 weeks after birth.

Some other reliable signs of adequate intake are:

  • There should be a gradual increase in the number of wet diapers each day until the fifth day: at least 6-8 wet cloth or 5 or 6 disposable diapers in 24 hours after the fifth day. (On day 2 or 3 pink, orange or red urine is normal.)
  • The first stools are dark in color (meconium). By day 3 the stools become lighter in color. By 5 days old, at least 3 loose yellow stools every 24 hours for the first 4-6 weeks (older babies may not stool every day, yet some babies will stool as often as they feed).
  • You can see or hear the baby swallowing throughout most of the feeding.
  • Your baby appears healthy, has good skin color, and has some alert times each day.
  • Your baby is latching on well for most feedings.
  • Your baby gradually begins to fill out his/her clothing and gains at least four ounces per week or a pound a month after the first two to three weeks of age through the first six months.

What is regular swallowing?

Start with a correct latch - open mouth with the chin touching first. The sucking pattern will have a fairly open mouth as he/she sucks and swallows in slow steady rhythm. Lips are turned out. Watching his chin you will see a pause. (Not the pause between suckles but the pause during one suckle as the baby opens his mouth fully.) This pause means a mouth full of milk. This pattern will slow and change during a feeding. But throughout a feeding several minutes of this pause type feeding means the baby is getting plenty of milk. Thus, the baby is removing the breastmilk.

FUSSINESS and GROWTH SPURTS: What to expect!

Some people interpret all fussiness as a sign of hunger. Just because your baby is crying does not necessarily mean that he/she is not getting enough to eat. If it has been less than one and a half to two hours since the last feeding, you may wish to look for other sources of distress and try other comforting techniques. If these do not console the baby, it is okay to nurse again. You cannot "spoil" your baby from too much holding or feeding. Breastmilk is digested very rapidly and efficiently and it may indeed be time to feed again. As the baby gets older, he/she will go longer between feedings.

"Growth spurts" commonly occur around 2 weeks, 6 weeks, 3 months, and 6 months. During these times, your baby may suddenly be fussier than usual and want to nurse more often. This increases your milk supply until the next growth spurt. He/she will probably nurse every hour and a half to two hours for 2-3 days, then things will get back to normal. It is best to avoid pacifiers during these growth spurts and allow the baby to nurse on request. Around the 3 month growth spurt you may be advised to introduce solids. Most nutritionists and healthcare providers recommend you wait until about 6 months to introduce solids.

How to increase milk supply:

If your baby's health care provider is concerned that your baby has not gained weight rapidly enough or if you want to increase your milk supply for other reasons, just remember - suckling makes milk! The more your baby nurses, the more milk you will make. You can offer both breasts each feeding, and repeat if necessary. Switching breasts when the baby slows it's sucking down and swallows less often, will increase your milk and keep the baby interested. Switch 2 or 3 times. You will then use each side twice at a feeding. If the supply does not improve, seek further advice. Remember to take care of yourself. Rest, relax, get your thirst needs met and eat well.

How to treat sore nipples

Portions taken from "Breastfeeding Guide" Reg. 3 Breastfeeding Task Force

You may feel some tenderness during the first few days of breastfeeding. If you have a lot of pain during feedings, or if your nipples are blistered or scabbed, it is usually best to continue breastfeeding and consider the following tips:

  • Check the way you hold your baby (use proper positioning, which means your baby's body should be facing yours, and tucked in close). Change positions often (cradle hold, underarm hold, lying down) to change areas of pressure.
  • You may need to support the weight of your breast with your hand or a rolled up towel.
  • Check your baby's latch-on (which means the mouth is wide open, lips are turned outward and not tucked in - the baby needs to take a "large mouthful of breast" not just the nipple, with the chin pressed into the breast and the nose may touch lightly).
  • Massage breastmilk onto sore areas and allow to dry. (If treating thrush, do not use this treatment).
  • Do not use drying soaps, alcohol, Vaseline, A & D Ointment, Bag Balm or other creams or lotions on the nipple. Some types of lanolin, such as Purelan and Lansinoh have been approved and may promote healing.
  • Begin each feeding on the least sore side until the milk begins to flow rapidly. Then switch to the affected breast. Continue to breastfeed on that side until active swallowing slows. Then switch back to the other side. Remember to start feeding your baby at early feeding cues.
  • Massage the breast and hand express a small amount of breastmilk before nursing to stimulate the milk to flow. Nurse often to keep the breasts from getting too full (at least every 2-3 hours until healed).
  • Allow the baby to end the feeding, or break the suction carefully with your index finger between the jaws. DO NOT pull the nipple out of the baby's mouth or pull the baby off the breast.
  • Leave scabs alone. Do not break blisters, but it may be helpful to soften blisters before nursing with breastmilk or warm water.
  • If there are no signs of improvement within 48 hours, contact your health care professional and lactation consultant.
  • It is not harmful for the baby to nurse on a nipple if they happen to bleed.
Engorgement and plugged ducts

Portions taken from "Breastfeeding Guide" Reg. 3 Breastfeeding Task Force

What is engorgement? During the first weeks of breastfeeding, your breasts might feel quite full. If they become firm, heavy and hot to the touch, they are engorged. The nipple may be flattened and difficult for the baby to grasp.

Normal breast fullness: Your breasts may feel heavier when colostrum changes to mature milk - around 3-5 days. Continue to feed the baby at least 8-12 times every 24 hours and whenever the baby gives cues. Wake the baby for feeding if your breasts become full and/or uncomfortable.

Moderate engorgement: Breasts are heavy, mildly tender, warm and lumpy to the touch; the skin may be shiny but not firm. Moderate engorgement can lead to severe engorgement if not resolved.

  • Hot moist packs to breast, areola, and nipple just before nursing
  • Manual or hand expression of areola to soften before latch-on
  • Nurse every 2-3 hours, 10 minutes or more on each side
  • May pump gently, just enough to relieve pressure or to soften areola (do not use pump if milk is not flowing because tissue damage may result)
  • Cool compresses to breasts, areola and nipples for 20 minutes after feeding, as desired

Severe Engorgement: Breasts are firm, heavy, very tender and painful, hot to the touch, the skin may appear to shine or look stretched. Firm or lumpy tissue may extend to under the arm. Please contact a lactation consultant if you have severe engorgement.

Plugged Ducts:

A plugged duct is a clogging of a milk duct. You may feel tenderness, warmth or redness and if the plug is near the surface it will be "pea"-like.

Plugged ducts occur more frequently in mothers with abundant milk supply and in the winter season. Causes may be: shortened or skipped feedings, a constricting bra, poor diet, dehydration, and stress.

  • Continue to breastfeed often. Begin feedings on side with plug first. Change baby's position to help remove the plugged duct.
  • Before breastfeeding, apply warm moist heat (wash cloth) to plugged duct area and massage area towards nipple with gentle and firm pressure while feeding or pumping. You may also soak affected breast over basin in warm water, or shower and massage just before feeding your baby.
  • Drink to thirst
  • Avoid constricting clothing

You will not have a fever with plugged ducts. If you develop fever and flu-like symptoms, which may mean you have mastitis, contact your health care provider or lactation consultant.

Breastfeeding questions and myths

Portions taken from "Breastfeeding Guide" Reg. 3 Breastfeeding Task Force

I have small breasts. Will I be able to make enough milk?

  • Breast size is determined by the amount of fatty tissue, NOT by the amount of milk glands. That means the ability to make milk does not depend on your breast size. Nearly all women who wish to nurse their babies are able to.

Will breastfeeding cause my breast size to change or get out of shape?

  • Changes are more due to pregnancy and gravity than breastfeeding. During the first few days of breastfeeding your breast may be noticeably larger than before, due to the beginning of the milk production. However, around 10-14 days later they may return nearer to your normal size as the supply and demand become better adjusted. Please do not misinterpret this reduction in fullness as a reduction in milk supply. It simply means that your breasts are making milk more efficiently.

My milk looks thin. Does that mean it's not rich enough?

  • Breastmilk may appear thin and much like cow's skim milk. This is due to the protein, which has a bluish tint. As long as your baby is nursing often enough and long enough, the milk will be rich enough and your baby will grow.

If my baby and I must be separated, is it okay to use formula?

  • Ideally, expressed breastmilk will be given during separations, rather than formula, in order to maintain milk supply. Using formula has consequences for you and your baby and it would be wise to consult your healthcare provider and a lactation consultant for your best options.

Can I learn to nurse in public or will I have to use formula?

  • It is not necessary to use formula when going out. You may nurse discreetly under a loose blouse or with a blanket over you. With more and more mothers breastfeeding, it is not unusual to see mothers nursing in public places. If you feel uncomfortable doing so in certain situations, you may wish to find a private spot or you can give expressed breastmilk.

What if I get a plugged duct or mastitis (breast infection)? What if I have a cold or flu?

  • Continue to nurse your baby frequently, changing positions. Get plenty of rest and fluids. Call you health care provider if you get a fever or if symptoms persist for more than 24 hours. Your milk is not infected. If you are sick, continue to breastfeed. You would expose your baby to the same germs if you were bottle-feeding. Drink plenty of fluids if you can. Your body is making protection to fight the illness and passing it to your baby.

Should I give bottles before my milk comes in?

  • Not unless there is a medical reason. A healthy baby has enough reserves of fluid and fat at birth to support him/her in the first few days of life. Drinking from a bottle may confuse him/her while she learns to breastfeed. Also, you don't want to dilute the colostrum or expose the baby to substances in formula that may contribute to later allergies.

Are there any foods that I should avoid while I am breastfeeding?

  • Most mothers can eat any foods they wish without observing a problem in the baby. If you suspect that a certain food is causing a reaction in your baby, eliminate it from your diet for 10 to 14 days, and then try to eat it again to see if the same reaction occurs. It would be wise to contact your healthcare provider and lactation consultant for more advice. Contrary to what many people are told, it is NOT necessary to drink milk in order to make milk. Eating a variety of foods and nutritious snacks will give you the energy you will need as a new mother, whether you are breastfeeding or bottle-feeding.

If I do become pregnant, I must stop breastfeeding.

  • This is not true. Mother and child can continue as long as mutually desired, even after the delivery of the new baby. The usual reason to wean an older child is if you have a premature labor risk.

If I breastfeed, I won't get pregnant, and this is a form or birth control. And if I take the pill, I'll have no milk.

  • The method of birth control is called the LAM (Lactation Amenorrhea Method). It is not foolproof, but no method is. The LAM offers the most protection in the first 6 months of exclusive breastfeeding. Ask your lactation consultant or healthcare provider more about his natural method of spacing children. There are safe birth control pills your health care provider may prescribe. A small number of women find a decrease in their milk supply. Often this is not enough of a decrease to cause a problem. The "mini pill" and "progestin-only" types are preferable.

Can I continue to nurse when I return to work?

  • Many women are successfully combining breastfeeding and working. It helps to learn as much as possible ahead of time by reading books, learning from other mothers who have done this, or speaking with a lactation consultant or WIC counselor.

What if the baby's father feels left out?

  • This is a common concern. When a mother breastfeeds her baby, they are bonding through skin-to-skin contact and eye-to-eye contact. There are many ways a father can bond with the new baby: giving baths, infant massage, cuddling, rocking, walking, talking to the baby, and even changing diapers can provide special contact. Many fathers enjoy the privilege of giving the first food, around six months. After three or four weeks of learning to breastfeed, it is okay for dad to give an occasional bottle of pumped breastmilk.

Isn't breastfeeding more work for the baby than bottlefeeding?

  • No. Studies done with premature babies found that babies had more stable temperature, breathing patterns and heart rates while breastfeeding compared with taking their mother's milk from a bottle.

Are drugs or medications safe when breastfeeding? Or a drink at my sister's wedding?

  • Many medications are safe when nursing, but you must check with your healthcare provider or lactation consultant. Social drugs are never safe if you are breastfeeding. Tobacco use should be avoided. Nicotine gets into breastmilk. It is best to stop smoking especially while pregnant or breastfeeding, but if you are unable to quit, limit your smoking to 10 or less cigarettes a day. It is never safe to smoke near your baby whether you breast or bottle feed. Smoking after feedings will reduce, but not get rid of the effects of nicotine in the milk. Alcohol does go into breastmilk and should rarely be consumed. If you do drink any alcoholic beverages limit it to two or less drinks in a day and drink only right after feeding your baby.

Will my baby need water or juice?

  • Breastmilk alone is sufficient nutrition for the first six months of your baby's life. Your milk has plenty of water, so the baby doesn't even need extra bottles of water.

My baby's bowel movements are very runny. Is this normal?

  • Breastfed babies stools will be yellow to yellow-green. They are soft and liquid and may include curds or birdseed like solids. This is normal because of the ease with which breastmilk is digested.

Is is time to wean when a baby gets a tooth?

  • The best time to wean is when either the baby or the mom decide it's time. This can vary a lot from baby to baby. Ideally, babies should breastfeed for at least one year. Some babies with teeth may bite by mistake or in play. They can easily learn to change this behavior. Babies often give clues they might bite. An advance warning is sometimes all a mom needs to prevent a bite.

I've had previous breast surgery. Will I be able to breastfeed?

  • Whether you have had breast reduction, enlargement or breast tissue removed on one breast, you will still produce milk.
Expressing, storing and thawing breastmilk

Portions taken from "Breastfeeding Guide" Reg. 3 Breastfeeding Task Force

  • If you must be separated from your baby, you can hand express or pump your milk. Your milk combines the best possible nutrition with antibodies, live cells, and other substances that protect babies from infection and help them grow and develop. A simple manual pump is sufficient for most situations, but mothers who must pump frequently prefer using electric double pumps or hand expression.
  • Wash your hands. Containers should be sterile or washed in hot soapy water, rinsed well and allowed to air dry before use.
  • Do not fill containers to the top. Leave an inch of space to allow the milk to expand as it freezes.
  • When possible, babies should get milk that has been refrigerated, not frozen. Some anti-infective properties are lost when milk is frozen - though frozen milk still helps protect babies from disease and allergies and is much better for your baby that artificial formula.
  • Begin pumping/expressing 2 to 3 weeks before you return to work. If pumping daily, try to do it the same time each day.
  • Expressed human milk can be kept in a common refrigerator at the workplace or daycare center. Both the US Center of Disease Control and OSHA agree that human milk does not require the use of gloves or storage in a separate refrigerator. If you must be separated from your baby frequently, such as returning to work or school, it helps to nurse more frequently when you are home to maintain your milk supply. Be sure to rest when possible, eat nourishing foods, and drink to thirst.

When extracting breastmilk, remember the following:

  • Wash hands; collect clean equipment. Have damp cloth and/or tissues nearby.
  • Relax, sit comfortably or stand.
  • Apply warm moist towel, massage breasts by using a circular motion in one spot for a few seconds and move to a different spot like numbers on a clock face - similar to breast self-exam. This helps stimulate let down.

How do I store breastmilk?

For a full-term baby:

  • Can be stored at room temperature (66-72 F) for 6-10 hours
  • Can be stored in refrigerator (32-39 F) for 5-8 days
  • Can be stored in separate freezer section of refrigerator for 3-4 months
  • Can be stored at 0 degrees F for 6-12 months
  • Thawed milk can be stored in the refrigerator for 24 hours. Do not refreeze.

For a premature or ill baby:

  • Use room temperature breastmilk immediately
  • Can be stored in refrigerator for 24 hours
  • Can be stored in freezer section of refrigerator for 3 months
  • Can be stored at 0 degrees F for 6 months

Other storage tips:

  • It is not necessary to obtain large amounts before freezing. Small amounts may be layered by adding milk chilled for 30 minutes to already frozen milk.
  • For a young baby, 2-ounce portions may be adequate for a completed bottle.
  • If the baby does not finish a bottle, discard after one hour. Never add the unused portion to an existing supply.
  • Store the milk in the back of the freezer where it is the coldest.
  • Milk thawed outside the refrigerator in warm water may be stored in the refrigerator for 4 hours or until the next feeding.
  • Label each bottle with the date and use them in the order that you made them. If for use in childcare or hospital settings, remember to put the baby's name on the label.

How to thaw breastmilk:

  • Thaw the milk by running lukewarm water over the bottle; or leaving bottle in a bowl of warm water.
  • Thaw the milk by placing milk in the refrigerator the night before you are going to use it.
  • Gently shake the bottle to ensure an even temperature. Test a few drops on your wrist. The milk should be near body temperature.

Human milk may separate into a milk layer and a cream layer when it is stored. This is normal. Shake gently to redistribute the cream.

NEVER heat milk in a microwave oven. It can cause burns in the baby's mouth! The heating may be uneven and it will destroy some of the protective qualities of breastmilk.

Get Help!

Portions taken from "Breastfeeding Guide" Reg. 3 Breastfeeding Task Force

Seek help if your baby still has dark stools at 5 days or has only one bowel movement a day between the age of 5 days and 3 weeks. Also seek help if you do not see or hear swallowing, you have nipple pain throughout feeding or after feeding, you have severe engorgement, your baby is sleepy and hard to wake for nursing, you are nursing a newborn less than 6 times per day, your baby is premature or has jaundice, cleft lip or palate, your baby has poor weight gain, you have a breast infection or plugged ducts, you have low milk supply, you have breast pain, your baby is not latching on well, or your baby's skin color or the feel of your baby's skin is noticeably different than when you left the hospital.

If you need help or have questions, call a Certified Lactation Counselor, the Family Birthplace Patient Support line at (502) 624-9932 or your health care provider.

Ireland Army Community Hospital