Breastfeeding (AAP)

The Benefits of Breastfeeding

Human milk and infant formula are different. Not only does human milk provide all the protein, sugar, fat, and vitamins your baby needs to be healthy, but it has special benefits that formulas cannot match. It helps protect your baby against certain diseases and infections. Because of the protective substances in human milk, breastfed children are less likely to have the following:

* Ear infections (otitis media)
* Allergies
* Vomiting
* Diarrhea
* Pneumonia, wheezing, and bronchiolitis
* Meningitis

Research also suggests that breastfeeding may help to protect against Sudden Infant Death Syndrome (SIDS).

Other reasons why human milk is good for your child include the following:

* It is easier for babies to digest.
* It does not need to be prepared.
* It costs nothing to make and is always in supply.
* It is even good for the environment since there are no bottles, cans, and boxes to put in the garbage.
* Breastfeeding also provides physical contact, warmth, and closeness, which help to create a special bond between a mother and her baby.

There are also many health benefits for you because breastfeeding does the following:

* Burns more calories and helps you get back to your prepregnancy weight more quickly.
* Reduces the risk of ovarian cancer and, in premenopausal women, breast cancer.
* Builds bone strength to protect against bone fractures in older age.
* Delays the return of your menstrual period, which may help extend the time between pregnancies. (Keep in mind that breastfeeding alone will not prevent pregnancy.)
* Helps the uterus return to its regular size more quickly.

Breastfeeding: getting started

Immediately after delivery, your baby should be placed on your chest or abdomen, skin to skin. Babies are very alert after they are born, and they are usually hungry, too! Your baby’s first feeding can take place within 30 minutes to an hour after delivery. The protection against infection that human milk provides is important immediately after birth. Your milk will also give the baby nutrients to prevent a low blood sugar level. This early taste of your milk also stimulates the baby to nurse better later.

If you had a vaginal delivery, you can nurse in bed or in a chair in the following ways:

* Lie on your side with your baby facing you.
* Hold your baby in the cradle position, with the head in the crook of your arm. Firmly support the baby’s back and buttocks. When feeding this way, make sure your baby’s entire body is facing your body, not the ceiling.

If you had a Cesarean-section delivery you can nurse your baby in the following ways:

* Sit up using one or two extra pillows to support your baby and protect your incision.
* Lie down on your side with your baby facing you.
* Use a side-sitting or “football” hold.

Always take time to make yourself comfortable. Do not be shy about asking for help during the first few feedings. Just as with learning anything new, it may take several feedings before you and your baby become a skilled nursing team.

How do I take care of my breasts during breastfeeding?

By the third or fourth day of breastfeeding, your milk will change from colostrum to what looks more like skim milk. Your breasts will also go from feeling soft to firm. If your nipples leak, use a nursing pad or clean folded handkerchief squares inside your bra to catch the leaking milk. Be sure to change these often. Do not use plastic-lined pads because they will prevent air from circulating around your nipples.

Between feedings, gently pat your nipples dry. This helps prevent them from getting irritated. You may also want to apply a little expressed colostrum, human milk, or medical grade modified lanolin on your nipples to prevent dryness.

How often should I nurse?

Breastfed babies tend to feed more often than formula-fed babies, usually 8 to 12 times a day. The main reason for this is that their stomachs empty much more quickly because human milk is so easy to digest.

Initially, your newborn will probably nurse every couple of hours, regardless of whether it’s day or night. By the end of the first month, your baby may start sleeping longer at night. Let your baby feed on demand—that is, whenever he is hungry. Watch for different signals from your baby, rather than the clock to decide when to nurse. When your baby is hungry, he may do any of the following:

* nuzzle against your breast.
* show the rooting reflex.
* make sucking motions or put hand to mouth.
* cry.

It is best not to wait until your baby is overly hungry before you breastfeed.

Some newborns can be sleepy and hard to wake. Do not let your baby sleep through feedings until your milk supply has been developed, usually about 2 to 3 weeks. If your baby is not demanding to be fed, wake her if 3 to 4 hours have passed since the last feeding. If this persists, call your pediatrician.

How long does breastfeeding take?

While some infants nurse for only 10 minutes on one breast, it is quite common for others to stay on one side for much longer. Some feedings may be longer than others depending on your baby’s schedule and the time of day. Some babies may be nursing even though they appear to be sleeping. If your baby has fallen asleep at your breast, or if you need to stop a feeding before your baby is finished, gently break the suction with your finger. Do this by slipping a finger into your baby’s mouth while he or she is still latched-on. Never pull the baby off the breast without releasing the suction.

When you breastfeed, alternate between which breast you offer first. (You may want to keep a safety pin or short ribbon on your bra strap to help you remember on which breast your baby last nursed.) While you should try to breastfeed evenly on both sides, your baby may prefer one side over the other and nurse much longer on that side. When this happens, the breast adapts its milk production to your baby’s feedings. Remember, your baby’s feedings control how much milk your breasts produce. It is important to let your baby nurse on both sides so that each breast gets stimulation over the course of a day.

You will soon get to know your baby’s feeding patterns. Each baby has a particular style of eating, some slower, some faster. Learning your own baby’s eating patterns makes it easier to determine when she is hungry, when she has had enough, how often she needs to eat, and how much time she needs for feedings.

For some mothers and babies, breastfeeding goes smoothly from the start. For others, it takes a little time and several attempts to get the process going effectively. Like anything new, breastfeeding takes some practice. This is perfectly normal. If you need help, ask the nurses while you are still in the hospital, your child’s pediatrician, a lactation consultant, or a breastfeeding support group. Remember, the most important keys to successful breastfeeding are proper positioning and correct latch-on.

Until you and your baby develop a feeding routine, stay positive and try not to get discouraged. Remember, your milk gives your baby more than just food. It also provides important antibodies to fight off infection and has medical and psychological benefits for both of you. Breastfeeding is the most natural gift that you can give your baby.

Breastfeeding: latching-on and let-down

Correct positioning, or latch-on, is a key element of successful breastfeeding. You can encourage good latch-on by touching your breast to the center of your baby’s lips. This stimulates your baby to open his mouth widely. As this occurs, pull your baby straight forward onto the nipple and areola. Keep in mind that when a baby is correctly positioned, or “latched-on,” your nipple and much of the areola are pulled well into the baby’s mouth. Your baby’s lips and gums should be around the areola and not on the nipple. This is why it is important for the baby’s mouth to be open wide.

You can help your baby latch-on by holding the breast with your free hand. Place your fingers under the breast and rest your thumb lightly on top (back behind the areola). Make sure your baby is properly lined up at your breast. Also be sure your fingers are well back from the areola so they do not get in the way.

When the baby first nurses there will be a tugging sensation. If the latch-on hurts, pinches, or produces pain, the latch-on may be incorrect. Break the latch-on by slipping your finger into the corner of your baby’s mouth, reposition, and try again. It can take several tries.

If your nipples are not sore, breastfeeding should not be painful. If it hurts while you breastfeed, then your baby may not be latched-on correctly and may need to be repositioned.

Correct latch-on is very important as it:

* makes milk flow better
* prevents sore nipples
* keeps your baby satisfied
* stimulates a good milk supply
* helps to prevent overly full (engorged) breasts

If your baby is latched-on correctly but you still have pain while breastfeeding, talk with your pediatrician.

Babies use their lips, gums, and tongues to get the milk to flow from the breast. This is known as suckling. Simply sucking on the nipple will not draw milk and may hurt the nipple.

Most babies will nurse actively if they are hungry and positioned correctly. For the first few weeks after birth until breastfeeding is well-established, breastfeeding newborns should not be given any supplements (water, sugar water, formula, etc.) unless there is a medical reason for it. A baby who is breastfeeding regularly and effectively will get all of the water and nutrients she needs. Some authorities believe that introducing a bottle or using a pacifier may cause nipple confusion and interfere with the establishment of breastfeeding. Others disagree and feel that nonnutritive sucking is good and does not interfere with breastfeeding. Ask your pediatrician for more information.

As you become more familiar with breastfeeding, you’ll notice another aspect of the process: the let-down reflex. The let-down reflex occurs every time you breastfeed. The first few times you breastfeed this let-down reflex may take a few minutes. Afterward, let-down will occur much more quickly, usually within a few seconds.

The signs of let-down are different for each woman. Sometimes when your baby starts to nurse, you may feel a brief prickle, tingle, or even slight pain in your breast. Or, milk may start dripping from the breast that’s not being used. These feelings and milk flow are signs of the let-down reflex. This means your body is making it easier for your baby to nurse.

You may feel strong cramping in your uterus when your milk lets-down. The hormone oxytocin, which stimulates milk flow, also causes the muscles of the uterus to contract. Nursing helps your uterus go back to its original size. This cramping is totally normal and is actually a sign of successful nursing. The cramping should go away in a week or so.

To help the let-down process along, try these tips:

* Sit in a comfortable chair with good support for your arms and back. Many nursing mothers find that rocking chairs work well.
* Make sure your baby is in the proper position on your breast. Correct positioning is one of the most important factors in successful breastfeeding.
* Listen to soothing music and sip a nutritious drink during feedings.
* Do not smoke, drink alcohol, or use illegal drugs. These all contain substances that can interfere with let-down and affect the content of breast milk. They are not good for you and not good for your baby.
* Wear nursing bras and clothes that are easy to undo. Nursing bras have front closing flaps that come down to expose your nipple and part of your breast.
* If your household is very busy, set aside a quiet place ahead of time where you will not be disturbed during feedings.
* Sometimes just thinking about your baby helps let-down take place.

How to express breast milk

You can express milk manually with your hands or with a breast pump. Breast pumps are used to ease engorged breasts or to collect milk when you are away from your baby (for example, if you are ill or at work). Pumping enables you to continue to breastfeed by keeping your milk production stimulated. If milk is not emptied from the breast regularly, it sends a message back to your body to stop making milk.

To express milk manually:

* Make sure your hands are clean. Wash them well with soap and water.
* Put a clean cup or container under your breast.
* Massage the breasts gently toward the nipples.
* Place your thumb about 1 inch back from the tip of the nipple and your first finger opposite.
Press back toward your chest, then gently press the areola between the thumb and finger and release with a rhythmic motion until the milk flows or squirts out.
* Rotate your thumb and finger around the areola to get milk from several positions.
* Transfer the milk into clean covered containers for storage in the refrigerator or freezer for possible later feeding for your baby. Always label the container and put a date on it. (See section on milk storage.)

Some women prefer hand expression because it can be done silently and does not require special equipment. Other women may find it easier and faster to express milk with a breast pump. Pumps are manual, battery-operated, or electric. You can find manual pumps in most pharmacies and baby stores. Do not buy those that look like a bicycle horn, because they can not be cleaned properly and milk may become contaminated.

Good hand pumps have two cylinders, one inside the other, attached to a rigid funnel-like device that fits over the breast. As you slide the outer cylinder up and down, negative pressure is created over the nipple area. This causes milk to collect in the bottom of the cylinder. This collecting cylinder can be used with a special nipple to feed your baby without transferring the milk. The entire pump can be cleaned in the dishwasher or by hand with soap and hot water.

Some hand pumps have a handle to squeeze that creates a negative pressure and draws the milk into a bottle. These may have a soft, pliable flange that fits around the nipple and areola and produces a milking action while pumping.

For most women, electric pumps stimulate the breast more effectively than manual expression or hand pumps. They are used mainly to keep breastfeeding going when a mother is not able to breastfeed for several days or more. These pumps are easier and more efficient than hand pumps, but they are much more expensive. However, you may be able to save money by renting an electric pump from your hospital or a medical supply store.

When shopping for an electric pump to buy or rent, make sure that it creates a milking action and is not simply a sucking device. Pumps that express milk from both breasts at the same time increase your amount of milk and save time. No matter which type of pump you choose, make sure that all parts of it that come into contact with your skin or milk can be removed and cleaned. Otherwise, the pump will become a breeding ground for bacteria, and the milk will not be safe for your baby.

After expressing your breastmilk, it’s important that it be stored properly. Proper storage will ensure the milk does not become contaminated or spoiled and that it retains all the nutrients your baby needs. Here are some safe storage and preparation tips to keep your expressed milk healthy for your baby:

* Always wash your hands before expressing or handling your milk.
* Be sure to use only clean containers to store expressed milk. Try to use screw cap bottles, hard plastic cups with tight caps or special heavy nursery bags that can be used to feed your baby. Do not use ordinary plastic storage bags or formula bottle bags for storing expressed milk.
* Use sealed and chilled milk within 24 hours if possible. Discard all milk that has been refrigerated more than 72 hours.
* Freeze milk if you will not be using it within 24 hours. Frozen milk is good for at least 1 month (3 to 6 months if kept in a 0° freezer). Store it at the back of the freezer and never in the door section. Make sure to label the milk with the date that you freeze it. Use the oldest milk first.
* Freeze 2 to 4 ounces of milk at a time, because that is the average amount of a single feeding. However, you may want some smaller amounts for some occasions.
* Do not add fresh milk to already frozen milk in a storage container.
* You may thaw milk in the refrigerator or you can thaw it more quickly by swirling it in a bowl of warm water.
* Do not use microwave ovens to heat bottles because they do not heat them evenly. Uneven heating can easily scald your baby or damage the milk. Bottles can also explode if left in the microwave too long. Excess heat can destroy important proteins and vitamins in the milk.
* Milk thawed in the refrigerator must be used within 24 hours.
* Do not re-freeze your milk.
* Do not save milk from used bottle for use at another feeding.

Breastfeeding: common concerns

One of the most common concerns of breastfeeding mothers is: how can I be sure my baby is getting enough milk? Well, there are several ways to tell. One is by the number of wet diapers he has in a day. Make sure he has at least six wet diapers per day with pale yellow urine, beginning around the third or fourth day of life.

Your infant should also have several small bowel movements daily (there may be one after every feeding in the first few weeks). During the first week of life, your infant should have at least two stools per day. From about 1 to 4 weeks old these should increase to at least 5 per day. As your baby gets older, bowel movements may occur less often, and may even skip a number of days. Bowel movements of breastfed babies usually smell somewhat sweeter than the stools of formula fed babies.

Your baby’s feeding patterns are also an important sign that he is feeding enough. A newborn may nurse every 1½ to 3 hours around the clock. If your baby sleeps for stretches of longer than 4 hours in the first 2 weeks, wake him for a feeding. It is most important that your baby is latched-on properly during feedings. Listen for gulping sounds to know that your baby is actually swallowing the milk and not just sucking. Also look for slow, steady jaw movement.

Your baby should be steadily gaining weight after the first week of life. During the first week, some infants lose several ounces of weight, but they should be back up to their birth weight by the end of the second week. Your pediatrician’s office will weigh your baby at each visit. Keep in mind that your baby may breastfeed more often during growth spurts.

Signs that baby is getting enough milk are as follows:

* at least six wet diapers per day and two to five loose yellow stools per day, depending on baby’s age. (Your baby’s stools should be loose and have a yellowish color to them. Be sure your child’s stools are not white or clay-colored.)
* steady weight gain, after the first week of age.
* pale yellow urine, not deep yellow or orange.
* sleeping well, yet baby looks alert and healthy when awake.

Most breastfeeding babies do not need any water, vitamins, or iron in addition to breast milk for at least the first 6 months. Human milk provides all the fluids and nutrients a baby needs to be healthy. By about 6 months of age, however, you should start to introduce your infant to baby foods that contain iron.

If your baby cannot or will not nurse, or if you are having problems with breastfeeding, it is important that you call your pediatrician as soon as possible. Refusal to breastfeed may be a sign of illness that needs prompt attention.

Another frequent concern for mothers is engorgement. Engorgement is uncomfortable for the mother and can make nursing more difficult for a baby. Feeding on demand not only ensures that your baby’s hunger is satisfied, but it also helps prevent engorgement. Engorgement occurs when your breasts become too full with milk. A little engorgement is normal, but excessive engorgement can be uncomfortable or painful. If your breasts do become engorged, try the following:

* Express some milk before you breastfeed, either manually or with a breast pump.
* Soak a cloth in warm water and put it on your breasts. Or take a warm shower before feeding your baby. For severe engorgement, warmth may not help. In this case, you may want to use cold compresses as you express milk. Ice packs used between feedings can relieve your discomfort and reduce swelling.
* Feed your baby in more than one position. Try sitting up, then lying down.
* Gently massage your breasts from under the arm and down toward the nipple. This will help reduce soreness and ease milk flow.
* Do not take any medications without approval from your doctor. Acetaminophen (eg, Tylenol) may relieve pain and is safe to take occasionally during breastfeeding.
* It is important to keep breastfeeding. Engorgement is a temporary condition and will be most quickly relieved by effective milk removal.

Once the engorgement passes, your breasts will become soft again. This is normal and is exactly what should happen.

Breastfeeding and working

Human milk has the same important benefits for older babies as it does for infants. Just because you are returning to work does not mean you have to stop breastfeeding. You can do both! Knowing that you are providing your milk for your baby while you are away and nursing when you are home will help ease the transition back to work.

The following are different ways working women manage breastfeeding:

* Extend maternity leave so as to have more time to get breastfeeding well-established.
* Nurse your baby once or more during the work day if he is in a child care facility at your workplace or nearby.
* Work at home.
* Work part-time, feed before going to work and upon return home.
* Express milk—usually every 3 to 4 hours while you are at work for your baby to drink later from a bottle or cup.
* Breastfeed when you are with your baby. When you are away the baby receives formula or solids (if approximately 6 months of age).

Be sure to select a child care provider or center that supports breastfeeding and can safely handle the milk and feedings per your instructions. Also, engage the support of your boss, human resources staff, occupational nurse, and coworkers. Assure them that pumping milk will not interfere with your work. And since studies show that breastfed infants do not get as sick as often as formula-fed infants, you may even miss fewer days of work to care for a sick baby.

If possible, go back to work on a part-time or flexible schedule at first. This can help you and your baby adjust to the new routine. If this is not possible, go back to work midweek to make it easier for you and your baby to adjust.

At work you will need to find a quiet, private place to express milk if your company does not have a lactation room or someplace else set aside for you. An office, break room, or wherever privacy can be assured can work just fine. You will need 15 to 30 minutes each time you express milk (usually twice a day). You will need access to soap and water to wash your hands before expressing. You will also need a refrigerator or a small cooler and ice packs where you can keep milk cold until you get home.