Comprehensive Breast Feeding Guide
Breastfeeding Made Simple
You have made sacrifices and taken steps during your pregnancy to give your baby a healthy start to life. Now you are ready for the next step – breastfeeding your newborn!
The Benefits of Breastfeeding are tremendous!
- Infection Protection – Your milk contains antibodies. These special proteins are made by your immune system. If you happen to catch a cold, your body will make antibodies to help you fight off the cold. Some of those antibodies will pass through your breast milk and help protect your newborn from the cold germ.
- Digestion Ease – Your breast milk contains enzymes and proteins that help your newborn digest your milk and absorb the nutrients very efficiently. Formulas are made from cow milk or soy milk protein which are common causes of intestinal irritation for newborns. Human milk protein is the best for your baby!
- Allergy Prevention – Some studies have shown that infants fed only breast milk had fewer episodes of cow milk allergy, wheezing and eczema (allergic skin rashes) during the first 4 months of life. Your baby will be introduced to food proteins that you eat while breastfeeding. This may help him adjust to solid foods later.
- Development Boost – Some studies have shown that infants who are breastfed exclusively until 6 months of age and in combination with solid foods from 6-12 months of age have better speech development by 3 years of age and higher IQ scores by school age in comparison to babies who are formula fed.
- SIDS Protection – Sudden Infant Death Syndrome has decreased since the 1990s when new mothers were taught to put their babies to sleep facing up (on the infant’s back), but approximately 1500 babies still died from SIDS in 2014 (http://www.cdc.gov/sids/data.htm). Breastfeeding your newborn during at least the first 6 months of life when SIDS rates are highest can help reduce risk of SIDS.
- Obesity Prevention – Obesity is an epidemic health problem for children in the USA. You can help prevent obesity from being an issue for your child by breastfeeding her as an infant. This effect on obesity risk later in life may be due to lower insulin levels (hormone that helps deposit fat), higher leptin levels (hormone that controls appetite) and less risk of overfeeding when an infant is breastfed in comparison to being bottle-fed formula.
- Maternal Benefits – Mothers who breastfeed immediately after birth have lower risk of bleeding (oxytocin effect) and report feeling more calm (prolactin effect). Mothers who breastfeed also have lower risk of developing many diseases (ovarian and breast cancer, Type 2 Diabetes, heart disease). Most mothers say the biggest benefit is knowing that are doing something wonderful for their baby’s health!
Latch techniques – tricks of the trade:
- Have a big glass of water at arms length. Make it a habit to drink water every time you nurse as you need 12 cups of water a day to maintain optimal milk supply.
- Find a comfortable chair with soft arm support and good back support.
- Unbundle your baby so that he can move his arms and neck easily and to avoid overheating. An excessively warm baby will be too drowsy to nurse!
- Try out several methods such as the football hold and the cradle hold. When using the cradle position initially it is best to put your hand under your newborn’s head and neck (cross cradle hold) to support her and move her into alignment with your breast. Even though newborns have relatively strong neck muscles, they need help directing their mouth onto the nipple. The rooting reflex is a God-given reflex to help the newborn find the areola, but some assistance by mother makes it easier.
- If you have tried for a while on one side and have not been able to latch your baby, switch to the other side. Almost all newborns have a preference for one side over the other initially, and eventually nurse well on both sides.
- As soon as you have your infant latched, help yourself relax by taking 3 deep breaths and purposefully relaxing and lowering your shoulders. Did you know that your infant must stretch your nipple almost 1 inch to have it in correct position for nursing? That is really uncomfortable for most mothers at the beginning of the latch, so make your best effort to do some relaxing techniques. The discomfort will pass in just a couple minutes or less.
- If the initial discomfort of the latch does not improve in a couple minutes check to see that your infant’s lower lip is visible below the areola. If it is not, gently give his chin a nudge down to pull out the lower lip. This will help him open his mouth wider and hold more of your areola which lessens pain and makes nursing more efficient.
- If you feel clicking during the breastfeeding… meet with your pediatrician or meet with a licensed lactation consultant. Sometimes clicking means your infant is not able to keep the tongue out beyond the lower gum due to a thick or long lower frenulum (tongue tie).
- The soreness of nursing is usually most intense at Day 5-7 of your newborn’s life. Try out the products listed under “Nipple Pain – Help!” below.
- If breast pain persists past Day 7 or is too intense for you to feel that you can continue nursing, there may be other latch issues that need adjustment. Please seek care of a licensed lactation consultant. See list below.
Nipple pain – help!
- Lanolin cream – safe for use after each breastfeeding. Apply generously, but wipe off excess before latching your baby as lanolin can make baby acne worsen.
- Lansinoh Soothies Gel Pads – can be applied after nursing for immediate cooling relief.
- Homemade Cool packs – you can make your own cool pack with some crushed ice in a leak-proof baggie. The coolness will also help stiffen flat nipples to aid in infant latch.
- If you have itchy, red or painful skin, consult your obstetrician or pediatrician as this can be a sign of infection that may require treatment.
- If you have deep pain within the breast, consult your obstetrician as this may be as simple as a clogged duct or a sign of something more serious.
There are many lactation consultants in the community that can help you:
Breastfeeding classes, supplies, consultants at A Woman’s Work (West University)
Breastfeeding support through The Lactation Foundation
Breastfeeding support through Texas Children’s Pavilion for Women
Breastfeeding support through The Woman’s Hospital of Texas
BreastFeeding with Love by Betty Greenman, RN
Nipple confusion, bottles and pacifiers.
It is possible for your baby may develop nipple confusion if a bottle is introduced too early or too frequently in the first few weeks of life.
While breastfeeding, your baby’s mouth covers the areola and she must stretch out her tongue beneath your nipple and over her lower gum to help create the vacuum needed for nursing.
In bottle feeding, only the lips are needed to latch and the baby must keep her tongue covering the bottle nipple (in the back of the mouth) to stop the flow of milk while she swallows.
When an infant is “rewarded with milk” the muscle memory of the tongue will be quickly reinforced. For this reason, unless your infant requires a supplement of milk through a bottle as advised by your pediatrician or neonatologist, it is best to stick with exclusive breastfeeding until the latch is excellent! Once your infant knows how to latch well (usually by 2 weeks of life), a pacifier is safe to use; it will not significantly change the way the baby sucks as there is no milk reward.
Most exclusively breast fed infants will need to be taught how to use a bottle during the second month of life if the mother would like to have an alternative method to feed her infant. This is a great time to pump once a day in the evening hours and allow another caregiver to feed the infant from a bottle while the new mother goes to sleep for a few hours. Also, most mothers find their milk supply to be quite low by 8-10 pm and pumping for 20 minutes at this time with a dual electric pump is an efficient method to remove the milk. This will allow the 1-2 month old infant to have a quick full feeding of the pumped milk rather than falling asleep at the breast and “snack nursing” as he waits for the milk to “letdown.” It is best for this evening time feeding to be given by another family member to allow rest for the new mother and time for her milk supply to replenish.
Breast milk comes naturally!
You may have noticed breast tenderness when you first realized you were pregnant. That was your body preparing to breastfeed your new baby! Your breast glands have increased and will make colostrum even before your baby is born. This first milk is yellow in color and higher in protein and immune factors – just what a newborn with a very small stomach needs for the first couple of days. The colostrum will also signal your baby to pass meconium (sticky dark stool).
You will find that after the first 2 days, your newborn wants to latch-on and nurse a lot!!! This is a natural process that aids in producing the prolactin hormone in your own body. Prolactin signals your breasts to make more mature milk. Try not to use a pacifier during these first 2-3 days as it may interfere in this natural process of signaling your body to make more milk.
By 3-5 days of age, your newborn will generally take up to 1 oz (about 30 mL) of milk per feeding every 2-3 hours. The more you allow your baby to latch-on and nurse, the more milk your body will produce. You do not need to pump and measure your milk as long as you see brown or yellow stools 2 times per day and 3-4 wet diapers per day.
By Day 6-7 of life, your newborn will desire 1½ to 2 oz of breastmilk every 2-3 hours and should pass stools after almost every feeding and make 4 or more wet diapers per day. Sometimes your baby may “cluster feed” – breastfeed every 1 hour for several times in a row then later sleep for a 3 hour stretch. This is a normal pattern for a newborn. If your baby wants to sleep for more than 3 hours at a stretch when he is in his first 2 weeks of life, it is best to wake him up to nurse.
How do I know if my baby is getting enough milk?
Be sure you visit a board certified pediatrician by Day 5-7 of your newborn’s life.
Contact your doctor sooner if your baby does not follow a typical pattern as noted in the chart below:
|Day of Life||Stools per 24 hrs||Wet diapers per 24hr|
|1||Usually 1- 3||at least 1||Stool is meconium (black stool).|
|2||Usually 1- 2||at least 2||May have urate crystals (pink color) in urine.|
|3||Usually 1||at least 3||Stool should become brown/yellow.|
|4||Usually 2||at least 4||No more urate crystals in urine.|
|5||Usually 2- 3||4 or more||Stool should be brown/yellow and seedy.|
|6-7||Usually 4-8||4 or more||Yellow, seedy, liquidy stools after each feed.|
If your baby makes more than the stools and urine noted above, that is great!
Create a strong attachment and reap the benefits!
It is best to breastfeed on demand initially. Look for signs of hunger such as rooting, sucking, and looking more alert. You will create a strong attachment with your newborn during this time. By 2 months of life you may notice that your infant is no longer feeding vigorously with the night feedings. This is a sign that he may not require as much milk at night and can learn to sleep at night time. During the Two Month Well Check with your pediatrician discuss your infant’s weight gain and if it might be time to create a feeding schedule that fits your family’s routine.
Your diet really does make a difference to your infant’s health!
While you may have some friends who advise you to avoid green beans and broccoli when you are breastfeeding, please eat those green veggies! Your infant’s sole source of nutrition is coming from you right now. He needs those vegetables just as much as you do even if he develops a little gas. Simethicone infant gas relief drops (over the counter in several brands) are a safe way to help with gas in newborns.
Avoid excessive cow milk as the proteins in milk products will make their way into your breast milk and can cause irritation on the stomach and intestines of your newborn. A typical sign of cow milk protein intolerance in an infant can be streaks of blood in the stool even though it is soft. Before blood appears there may be other signs of cow milk protein intolerance: excessive spitting up, excessive crying, excessive mucus in stools, or pain with passing stools. Generally babies drop their stool frequency from several per day to only 1 per day or 1 stool every 3-5 days during the second month of life. If your baby is constipated before one month of life or you notice the other signs listed above, contact your pediatrician.
Breastmilk is complete nutrition for your infant for the first 6 months of life.
For a full term healthy infant without jaundice, breast milk alone will give her everything she needs to grow well. Premature infants, infants who are at risk for jaundice (elevated bilirubin measurement while at the hospital), or infants with congenital health problems may require supplements, formula or medications.
Even in sunny Houston, studies have shown that our newborns do not generally have enough Vitamin D for development of strong bones and healthy immune systems. Studies have also shown that Vitamin D supplements taken by a breastfeeding mother are not sufficient to meet the Vitamin D requirements of the newborn. Breastfed infants should be given Vitamin D drops (400 IU – follow package instructions) per day directly into the mouth. You can talk with your pediatrician about what is best for your infant.
Breast pumps can be very helpful!
Types of breast pumps:
- Manual – hand express one breast at a time. Helpful to initially “pull out” a flattened or inverted nipple. Not practical for general pumping purposes.
- Electric Dual Home Pump – electric pump that can be purchased and can plug into an outlet, can be powered by a rechargeable battery pack or even plug into your car outlet. Essential for the working mother who will be pumping “on the go” several times per day. Also very helpful for a “stay at home” mother who wants to train her infant around 1 month of life to be able to drink from a bottle in addition to nursing at the breast.
- Hospital Grade Electric Pump – must be rented (see list of breastfeeding support). These are helpful for temporary use for a mother who is seeking to increase milk supply. Many insurance companies will cover some of the rental cost.
How long is expressed breast milk good at room temperature? In the refrigerator? In the freezer?
Freshly expressed breast milk should be used within 4 hours. Refrigerated expressed breast milk should be used within 72 hours. Breast milk can be frozen for one month in a freezer attached to a fridge or 3 months in a zero degree deep freezer. Keep the milk at the back of the freezer where it is the coldest and label it with the date
Reheating breast milk
- Frozen milk – thaw the bag overnight or for several hours in the refrigerator then warm in a bottle with a bottle warmer. You may also warm directly from frozen by putting the bag of frozen milk in a cup of warm water or kneading the bag until warm under running warm water for a few minutes.
- Fresh refrigerated milk – warm with a bottle warmer or by swirling the closed and capped bottle of milk in a cup of warm water.
- Microwaves are not a safe way of warming breastmilk.
Alcoholic beverages and breastfeeding
Just like everything else in your diet, alcohol passes through your breast milk to your baby and may directly impact the cognitive development of your infant. If you choose to have an alcoholic beverage, it is best to nurse or express milk before drinking any alcohol. Then wait 4 hours after your last drink and “pump and dump” your expressed milk before returning to breastfeeding.
Returning to work and pumping
Find a secure safe place to pump. Most employers support new mothers by providing them a safe spot for this important task. Pump for 20 minutes (dual electric) at least every 4 hours to maintain your milk supply. Immediately label/date and refrigerate your milk and rinse off your pumping supplies after your finish.
Multi-tasking tricks for pumping mothers:
- Purchase a hands free breast pump “bra” to hold the pump cups onto your breast so that you can type or do other tasks with your hands. Also helps to prevent wrist injury. Very worth the cost!
- Buy a nursing cover to use over your pump just in case someone opens the door.
- You can pump while driving in slow Houston traffic. Set up before you start driving and cover up with your nursing cover. Some pumps have car adaptors and rechargeable battery packs.
- “Lilypadz” and “Bamboobies” are great to prevent leakage of milk onto your clothing while working.
- Nursing blouses are convenient to use for pumping as you will not feel as exposed.
- Drink 12 cups of water per day and consider a Fenugreek supplement if you find your milk supply is dropping. Be sure to eat 3 meals per day and 1-2 snacks.
When breast feeding is just not working…
There are reasons why breastfeeding may not work out for every mother and baby. An experience that should be enjoyable can quickly cause pain, irritability and guilt if it is not proceeding as you imagined it would. Please talk with your pediatrician and obstetrician about those feelings and difficulties. We will not judge you. We are here to support you and your child and your developing relationship!
“Feelings of worth can flourish only in an atmosphere where individual differences are appreciated, mistakes are tolerated, communication is open, and rules are flexible – the kind of atmosphere that is found in a nurturing family.”
— Virginia Satir, American author and social worker (1916-1988)