Women have been breastfeeding successfully for centuries. You can use the experiences of others to help make breastfeeding go more smoothly for you. This section offers some suggestions to make your experience easier.
One of your most important preparations is to choose your pediatrician carefully. Meet with him well before your due date to discuss your feelings and his ideas about breastfeeding. Ask him what percentage of his newborn patients are breastfed, how he treats jaundice, and if he refers women with breastfeeding problems to a certified lactation consultant. The early months with your baby will be much easier if you and your pediatrician agree on the use of supplements, the introduction of solid foods, and weaning. If you see eye to eye concerning rooming-in and “nothing but the breast” while in the hospital, have him write it on your record.
The use of nipple preparation to prevent sore nipples has varied over the years. It is now known that sore nipples are the result of improper positioning of the baby on the breast, not of inadequate nipple preparation. What you can do during pregnancy is to check to make sure that your nipples are not inverted. (For instructions, see “Flat or Inverted Nipples”.) If they are inverted, contact a breastfeeding counselor or certified lactation consultant for assistance. Otherwise, you can massage your breasts, or apply a lubricant or skin cream to your nipples, but it is not necessary. Avoid nipple stimulation if you have a history of preterm labor. Do not use soap or alcohol on them, as these tend to dry out the nipples. Washing with plain water will keep them clean. “Toughening” the nipples with a towel is no longer recommended.
Begin attending La Leche League meetings early in your pregnancy. You will get excellent advice on both breastfeeding and mothering. The advice on “getting started” will be invaluable once your baby comes. See a certified lactation consultant for classes or a personal visit. These consultants are available through most hospitals or on an independent basis. They are specially trained to detect breastfeeding problems and to help new mothers find solutions to breastfeeding difficulties. If you establish this support system of breastfeeding experts before you deliver, it will be much easier to get help if breastfeeding problems or questions come up later.
In the Hospital or Birth Center
Nurse your baby as soon as you can after delivery. The earlier you begin breastfeeding, the easier it will be for you and your baby. If the baby is born after an unmedicated labor, he will probably be eager to breastfeed, and the sooner he begins, the better he will nurse. His sucking reflex will be the strongest in the first hours after delivery. The longer you delay, the more difficult it will become. If the light in the birthing room is very bright, shield your baby’s eyes or ask that it be dimmed.
Nursing will get off to its best start if you room-in with the baby day and night. You can nurse your baby when he is hungry and become familiar with his awake and sleep pattern. If you do send the baby to the nursery for any reason, place a note on the crib that states, “No bottles or pacifiers, please.” Nursing on demand uses a baby’s natural cues that he is ready to nurse and stimulates the milk to come in.
Some babies are very sleepy the first 1 to 2 days. Watch for your baby’s quiet alert times and encourage him to nurse every 2 hours when he is awake. During the day, if he sleeps over 3 hours, you may want to try to wake him up so that his longer deep sleep will occur at night. Nursings are timed from the start of the feeding. Your baby should nurse eight to twelve times in a 24-hour period. Between the second and third day, these sleepy babies often become more alert and may want to nurse very frequently. Allow him to nurse, since his sucking will stimulate your mature milk to come in. Occasionally, a mother will give a bottle at these times because her “milk is not in and the baby is hungry,” but this is counterproductive. Remember, breastfeeding is supply and demand. His demand builds your supply.
Proper positioning of your baby is very important. To nurse your baby in the cradle position, place his head in the bend of your arm, using a pillow under your arm and the baby to help raise his mouth up to your nipple. You can tuck his lower arm under your arm. With the baby facing you, tummy to tummy, cup your breast with your fingers in a C position, making sure that your fingers do not cover the areola. Tickle the baby’s lips with your nipple, wait until he opens his mouth wide with his tongue down and extended over the bottom gum, and then pull him toward you. The nipple should be centered in the baby’s mouth, with his jaw positioned behind the nipple and on the are-ola. The tip of his nose should touch the breast, and his lips should flare outward. If you are concerned that he cannot breathe, draw his bottom in closer or slightly lift the breast with your hand. Avoid pressing down on the breast as this may cause his jaw to slide down closer to the tip of the nipple. The baby should nurse in bursts of sucking, swallowing, and pausing. The sucking should not be painful for you. If it is, gently place your finger into the comer of the baby’s mouth to release the suction, then try again. Do not allow the baby to slowly draw the nipple into his mouth because he will simply chew on the tip of the nipple and cause soreness. Also, make sure that your baby faces you and does not need to turn his head to the side to feed.
To nurse using the clutch position or football hold, place your baby’s body next to your side and support his head with your hand. Use pillows as necessary. This position is very comfortable for large-breasted women and for mothers who delivered by cesarean section. In addition, large-breasted women may want to fold a diaper or hand towel, and place it under the breast for support. Some mothers prefer side-lying, especially for nighttime feedings.
Look for cues that your baby is ready to nurse. As he wakes up, he will stretch and squirm. Do not wait for him to begin crying. Look for him to make sucking motions or to move his hand to his mouth. If you wait until he screams, you will have to settle him down before nursing him.
Avoid supplements with the bottle. The extra liquid would fill him up and decrease his interest in nursing. Occasionally, you may be advised to let the baby spend the night in the nursery and be given a bottle by the nurse to allow you a night of rest. You may be told that it will not matter because “your milk is not in yet.” While this may sound like a good idea, offering a bottle can cause nipple confusion. Since babies suck differently on the breast than on a rubber nipple, he might become confused and refuse the breast. Also, your baby does receive your rich colostrum; and the more he nurses, the sooner your mature milk will come in. Pacifiers can also cause nipple confusion. If the baby wants to suck, he should nurse at the breast to stimulate your milk production.
Do not use soap, oil, lotion, or a drying agent such as alcohol on your nipples. You will not need to wash them before each feeding, since they will secrete a substance that will keep them clean. If you are requested to wash your nipples while in the hospital, you can use water.
Do not try to prevent nipple soreness by restricting the length of the nursings. Nipple soreness is caused by improper positioning of the baby’s mouth on the breast. Let the baby nurse for 10 to 15 minutes on the first breast, then switch him to the other breast and let him nurse until he is finished, about 5 to 20 minutes more. If he continues to act hungry, allow him to nurse on the first breast again.
Alternate the breast that you offer your baby first at each feeding because his initial sucking will be the strongest. By alternating the starting breast, you will ensure that an adequate supply of milk is built up in both breasts. To remind yourself which breast to offer first the next time, attach a safety pin to your bra on that side.
Do not use nipple shields for sore breasts. They inhibit adequate stimulation of the breasts and thus interfere with milk production. Their use creates more problems than it solves.
Do not be discouraged if you and your baby have trouble getting started with breastfeeding. He will be learning how to coordinate sucking and swallowing, and will create the stimulus for increasing your milk supply. If your hospital has a certified lactation consultant on staff, ask her to observe a feeding so you can be sure you are using proper technique. Remember, breastfeeding is new for both of you. Have patience. Before long, you both will be pros.
Give yourself about 6 weeks to establish a good nursing relationship. These first weeks may seem hectic and difficult, but any newborn, breastfed or not, is demanding. Just imagine having to wash bottles and prepare formula besides! After about 6 weeks, your life will calm down a bit as you and your baby adjust to each other.
Continue attending La Leche League meetings or seeking the counsel of a certified lactation consultant. Encouragement and support from other nursing mothers or professionals can be a lifesaver for you, particularly when problems arise.
Feed your baby whenever he is hungry. Because breastmilk is more easily digested than formula, breastfed babies need to eat more often, sometimes every 2 hours. Also, when many babies experience a growth spurt—usually at around 10 to 14 days, 4 to 6 weeks, 3 months, and 6 months—they want to nurse all day. By giving your baby extra nursings, you ensure that your milk supply will respond to his increased need. When the supply has built up sufficiently, the baby will cut back to his regular number of nursings.
Even though your breasts will be somewhat engorged at first, your milk supply will even out after a few weeks and your breasts will return to a more normal size. Do not confuse this with “losing your milk.” You will still have plenty of milk for your baby.
Some babies have greater sucking needs than others. You can easily soothe your baby by putting him to the breast. Even if his need is not so much hunger as to be held close and to be comforted by the breast, it is still important. You will not be spoiling him by nursing him, but will simply be meeting his needs. It will be crucial to his security that you meet his needs as soon as possible. As New York Medical College professor Dr. Herbert Ratner says, “The quickest way to make your child independent is to take care of his needs when he is dependent.”
In the early weeks, your baby may have five or more bowel movements a day, sometimes as often as after every nursing. After 6 weeks of age, he may have a bowel movement as infrequently as once every 5 days. He may even switch from one routine to the other. You will soon know what is “normal” for your baby and will be able to recognize variations. The stools of a totally breastfed baby are yellow in color, and mushy or loose. These loose stools do not indicate diarrhea unless they are also green in color, contain mucus, or have a strong unpleasant odor.
You can be sure that you are producing enough milk if your baby has six or more wet diapers a day, along with two bowel movements per day, and is receiving only breastmilk. He will not need formula supplements or water. He will get plenty of water in your milk (breastmilk is 87.5 percent water), along with important nutrients, so do not fill him up on just plain water. In fact, researchers have found that giving a baby too much water could actually be dangerous. Oral water intoxication can occur when so much water has been ingested that the sodium in the blood becomes diluted. When this happens, the body cannot function properly. An altered mental state, abnormally low body temperature, bloating, or even seizures could result. Babies less than 1 month old are especially susceptible. While an infant may require more fluid in hot weather, encouraging him to nurse more frequently will ensure an adequate intake.
Babies are individuals and gain weight at different rates. If your baby gains weight slower than “average,” do not be alarmed. He is fine as long as he is happy and alert, and is feeding an average of eight to twelve times a day. Make sure your baby empties one breast before switching to the other to complete the feeding. Two kinds of milk are produced—the thinner foremilk and the more fatty hindmilk. Allowing him to empty one side will provide the proper balance of both kinds of milk and will encourage weight gain. Occasionally, a baby will nurse from only one breast at a feeding, but may nurse more frequently. If his weight gain is less than 4 ounces a week, however, you need to talk to a certified lactation consultant.
If your baby gains weight more rapidly than the average, he is probably fine also. You will not need to take any drastic action. An average weight is the median of all weights, from low to high. Even if your baby appears “fat,” if his only food is breastmilk, you will not need to worry. He will be receiving the perfect food, containing no empty calories. This fat will not remain with him throughout life. Your breastfed baby will not need a reducing diet. Continue nursing him as usual, and he will slim down as soon as he begins actively moving around.
Many women appreciate the support of a good nursing bra. Choose one in a cotton fabric and avoid underwires because they can cause plugged ducts. (For other hints, see “How to Select a Nursing Bra”.) You should begin wearing a nursing bra in the hospital. During the early weeks, you may be most comfortable wearing one 24 hours a day—even to sleep in.
If you have a problem with leaking, place nursing pads or folded cotton handkerchiefs inside your bra. Do not use plastic pads or liners because they tend to keep the nipples wet. After each feeding, leave your flaps down for a few minutes to allow your nipples to thoroughly dry.
You will find that a comfortable chair, preferably a rocker, is mandatory. At times, you may want to breastfeed lying down. You can lie on your side with your baby next to you and snooze while he does.
Breastfeeding is convenient, since it leaves one hand free to do other things. You can keep a book, magazine, or paper and pen by your chair and catch up on your reading or correspondence. How about your thank-you notes for all the baby and shower gifts you received? If you are a list maker, this provides a perfect opportunity. You can make grocery lists, “things to do” lists, or Christmas lists. (It is never too early f to start.)
If you have other children, nursing is a perfect time for reading to them, talking with them, or just being close. However, you should not feel that you always have to accomplish something while nursing. You might prefer to just enjoy this quiet time with your baby by cuddling, talking to him, or singing to him.
- Sucking on his hands or fingers.
- Being in a quiet alert state.
- Making sucking motions with his mouth.
- Exhibiting the rooting reflex.
- Starting to fuss.
Avoiding Harmful Substances
Check with your caregiver or certified lactation consultant before you take any medication or drug, even an over-the-counter drug. Some of them do show up in breastmilk and may affect your baby. Many medications can be safely used while nursing. If you are prescribed a drug that is contraindicated with nursing, your pediatrician or lactation consultant may be able to suggest an alternative. Do not take stimulant laxatives. These can upset your baby’s system.
The National Institutes of Health recommend that you refrain from drinking alcohol during lactation because its effects on nursing babies are not known. Any alcohol that you consume will be readily transmitted to your baby in much the same concentration as is in your blood. While an infrequent social drink may have a mildly sedative effect on your newborn, it will prob- ably not be harmful. The level of alcohol in milk is usually highest within the first 2 hours after drinking and gradually diminishes over the next hours. If you consume several drinks in an evening, it may be wise to avoid nursing until the next morning. Also, if you are intoxicated, you are in no condition to safely care for your baby. In addition, heavy alcohol consumption inhibits the flow of milk.
If you smoke over a pack of cigarettes a day, your baby may experience nausea, vomiting, abdominal cramps, and diarrhea. The level of vitamin C in your milk will also be reduced as your own stores are diminished. Women who smoke produce less milk, and the milk they produce has a lower fat content. Secondhand smoke is even more dangerous for babies. Children raised in smoking households experience more upper respiratory infections, pneumonia, bronchitis, and SIDS during their first year of life. If anyone in your home smokes, insist that he or she do it outside and not in the presence of the baby.
Illegal recreational drugs are very dangerous. They impair a mother’s ability to adequately care for her baby, and they pass into her breastmilk. Cocaine used by a nursing mother remains in her breastmilk for up to 36 hours and can be ingested by her infant. Children have become seriously ill and have even died as a result of cocaine use by a breastfeeding mother.
Pumping and Storing Breastmilk
You will want to learn how to use a breast pump or how to hand-express your milk for future use. This milk can then be given to your baby when you are not available to nurse him. To hand-express milk, gently squeeze the outer edge of the areola using your thumb and forefinger. Some women find this works very well, while others have a difficult time and get only a drop or two. You may be more successful if you try it while your baby is nursing on your other breast.
Using a breast pump is often more effective than hand expression, but it, too, requires practice and patience. Placing a warm moist towel on the breasts for 10 minutes and then massaging them for 3 to 4 minutes just prior to using the pump can help stimulate the flow of milk. Many types of pumps are available, from hand pumps to electric ones. Follow the directions for whichever pump you use. For any pump, moisten your breast before applying the breast shield to improve the suction. Begin slowly, or on the lowest setting, to avoid discomfort. Pumping in a quiet, relaxed setting usually helps to get your milk flowing.
If you use a single pump, pump for 5 to 7 minutes on each breast, followed by an additional 3 to 5 minutes on each breast, for a total of 15 to 20 minutes. If you use a double pump, the total time should be 10 to 15 minutes. Electric and battery-operated pumps are usually the most efficient. See a breastfeeding counselor or certified lactation consultant if you want to buy or rent a breast pump. She can provide you with a good quality pump that will meet your needs.
Always make sure that your hands and the container you use for collecting the milk are clean. A good option for storage is specially designed milk storage bags. These durable bags are self-sealing and presterilized. Another option is bottle liners, although they are less durable and require the use of twist ties or clips for closing. You can double them to avoid tearing. Plastic is preferable to glass for milk storage because the leukocytes (white cells) in breastmilk adhere to glass. Milk stored in glass would therefore lose protective properties. If the milk is to be frozen, glass and plastic are equally acceptable because freezing destroys the leukocytes anyway.
Amazingly, breastmilk has properties that protect it from bacterial contamination. It can, therefore, be left out at room temperature for up to 10 hours. Or, it can be refrigerated immediately and kept for up to 5 days. If you freeze the milk, it can be kept for 2 weeks in a freezer compartment located inside a refrigerator; 3 months, if stored in a separate freezer unit of a refrigerator; or 6 months, if in a separate deep freeze with a temperature of 0°F. Place the container in the back of the freezer, away from the door.
It is most convenient to store milk in 2- to 4-ounce portions. Small quantities thaw and warm quickly, and there will be less waste if the baby does not take it all. Also, because babies utilize breastmilk so completely, less breastmilk is needed at a feeding than if the baby were taking formula.
To defrost frozen milk, simply run it under cold water until it gets mushy. Then use warmer water to take the chill off. Do not thaw in the microwave. Microwaving not only produces hot spots that can bum the baby, it also destroys the antibodies. Once milk is thawed, it cannot be refrozen, but it can be safely returned to the refrigerator for up to 9 hours.
Some mothers are concerned about the appearance of their milk when they see it in a container. It may separate into milk and cream because it is not homogenized the way cow’s milk is. If this happens, shake the milk gently to mix before a feeding. Also, it is normal for human milk to be either bluish, yellowish, or even brownish in color. Frozen milk may turn yellow, but this does not mean it is spoiled unless it smells sour.
You will probably find that you will not want to go out very often without your baby. You will need him almost as much as he will need you. Breastfed babies are very portable and can be taken anywhere. However, you might want to keep some frozen milk on hand in case of an emergency or a situation in which you need to be away from your baby during a feeding.
Turn a deaf ear to criticism concerning breastfeeding or your method of caring for your baby. Your baby’s happiness and comfort will be of the utmost importance—not your neighbor’s (or your mother-in-law’s) opinion. Remember, this baby will be your child to raise in the manner that you feel is most comfortable. Read and become knowledgeable, then decide what works best for you.
Do not forget to keep your priorities straight. Baby’s happiness and your rest will be tops right now!