Breastfeeding Basics

Here are some breastfeeding basics that you may find helpful. Talk to your baby’s doctor, nurse or your lactation specialist if you have other questions.

Mother's Diet

No special foods or diets are needed for breastfeeding. Some helpful tips:
Choose a variety of healthy foods for your meals and snacks each day. Eating healthy will help you and your baby feel well.
Eat 4 to 5 servings of dairy products each day. A calcium supplement can help you get enough calcium.
Drink water or fruit juices when you are thirsty.
Take your prenatal vitamins as directed by your doctor.
Limit caffeine and artificial sweeteners in your diet. Caffeine is in chocolate, coffee, and tea. Artificial sweeteners are in diet soft drinks and in some low calorie or diet foods.
Avoid drinking alcohol. Alcohol takes about 2 to 3 hours per serving to leave breast milk.
It takes about 4 to 6 hours for the foods you eat to show up in your breast milk. If you have a family history of an allergy or your baby seems fussy after you eat a certain food, avoid that food and see if your baby feels better. Some babies have a hard time when a mother · eats dairy products or vegetables such as broccoli, beans, onions or peppers. If the problem persists, talk to your doctor.
Avoid weight-loss diets. To lose weight, walk more and limit high-calorie foods.

Getting Started

Colostrum, the first milk your body makes, is very good for your baby. Over the next few days, your breasts will feel fuller, and you will have more milk. Your milk supply will depend on how much milk and how often your baby takes from the breast. The more milk your baby takes, the more milk your breasts will make.

The nurses will help you and your baby learn how to breastfeed. Relax and give yourself time to learn.

Your baby may be very sleepy for the first few days. Your baby’s stomach is small so your baby will need to feed often. You may feel increased thirst while nursing, drowsiness during breastfeeding and mild uterine contractions while breastfeeding the first few days.

Avoid feeding your baby from a bottle, either breastmilk or formula, for the first 3 to 4 weeks or until your baby learns to feed well. Sucking from a bottle is a different mouth action. Bottle sucking may interfere with the baby’s nursing at the breast.

After the first 3 to 4 weeks, you can try to feed your baby breast milk through a bottle if you would like. If your baby is not able to breastfeed, you can pump your breast milk, feed your baby the breast milk through the bottle or freeze the breast milk in a closed container for later use.

Feeding Cues

Your baby will give you signs of hunger called feeding cues. Your baby’s feeding cues may include:

Clenched fists
Hands to mouth
Licking of lips
Moving of arms and legs
Turning the head towards your body
Sounds
Crying

Try to begin feeding your baby before he or she becomes too upset.

How is my baby doing with breastfeeding?

Watch for signs that your baby is latched on to your nipple well and getting milk. Signs may include:

Fast, shallow motion in the cheeks as your baby first latches on that changes to a deep, slow, rhythmic motion.
Motion near your baby’s ear and temple as your baby’s lower jaw moves up and down.
Seeing, hearing, or feeling your baby swallowing.
Feeling a tingling sensation in the breast.

Is my baby getting enough milk?

If your baby is getting enough milk, your breasts will be full of milk, soft after feedings and refill between feedings. Your baby will:

Have 6 or more wet diapers in a 24 hour period
Sleep between feedings
Have more than 2 bowel movements each day
Gain weight

A healthy, full-term baby who is nursing well does not need extra water· or formula. Do not feed your baby extra water or formula unless ordered to do so by your baby’s doctor. Talk to your baby’s doctor, nurse or your lactation specialist if you do not think that your baby is getting enough milk.

How often will my baby feed?

Feedings are timed from the start of one feeding to the start of the next. At first, try to feed your baby every 2 to 3 hours during the day and evening, and at least every 4 hours during the night. If your baby gives feeding cues, feed your baby. Your baby may want several feedings very close together. By the end of the first week, your baby will be nursing 8 to 12 times in 24 hours. As your baby and your milk supply grow, your baby may begin feeding less often.

Even after babies are able to sleep for longer periods, their sleep is sometimes disturbed by dreams, hunger or a busy day. Expect that your baby will wake at night and may need to be fed.

Babies have growth spurts in their first 6 months and will nurse more often during them. By feeding more often, your body will make more milk to get through the growth spurts. These spurts often last 3 to 5 days.

How long will my baby feed?

Feed your baby until he shows signs that he is full such as slowing down sucking and then detaching himself from the breast, and relaxing his hands, arms and legs. If you stop before your baby is done, your baby may not get the high-fat milk. This is the milk that is best for growth.

Allow your baby to completely finish feeding on the first breast. This may take 10 to 25 minutes. Then offer the second breast. Your baby

may feed for a while on that breast, or not want the second breast at all. Alternate the breast you begin with at each feeding. Some mothers track which breast to begin with by pinning a safety pin to their bra strap.

Waking the Sleeping Baby

If your baby is in a deep sleep, do not wake your baby for a feeding. If your baby is asleep but has body motions such as eye motion under the lid, active mouth and tongue motion, or sucking in sleep, this is the best time to wake your baby for a feeding.

At night, dim the lights and keep the room quiet. Avoid startling movements. Wake the baby gently by moving your baby or you can change your baby’s diaper. If after 15 minutes your baby shows poor interest in breastfeeding, try an hour later.

Talk to a doctor; nurse or lactation specialist if you have any questions or concerns.

Pumping and Storing Breast Milk

You may need to express or pump breast milk to relieve engorgement, to increase your milk supply or to feed your baby breast milk with a bottle.

Why and When to Pump

To soften your breasts if your baby is having trouble latching on.
Pump for a few minutes and try your baby at your breast again.
To have a milk supply when your baby is unable to breastfeed or to store breast milk.
Pump every 2 to 4 hours through the day and one time at night.
To increase your milk supply.
Pump every 2 to 3 hours if you are not breastfeeding, or
Pump between feedings as often as you can.
Pump on the second breast if your baby only nurses on one side.
To prepare to return to work or school.
Pump one time each day, between feedings to store extra milk.
Morning is a good time to pump.
Pump extra milk and store it at least 2 weeks before your return date.
Pump at least every 4 hours when away.

Ways to Express Breast Milk

By hand
Massage breast toward nipple to express milk

With a pump:

There are manual and electric breast pumps.
Pump for about minutes on each breast any time you pump.

Getting Started

Wash your hands with soap and water.
Have a clean container ready for collecting the milk.
Find a relaxing position in a quiet spot and think about your baby.
Massage your breast and take slow easy breaths.
For privacy, while pumping, cover your breasts and pump container with a blanket or towel.

Collecting and Storing Breast Milk

Use sterile glass bottles, plastic bottles or milk storage bags made for breast milk. Do not use disposable bottle liners because they are too thin.

Store breast milk in 2 to 5-ounce portions to avoid wasting breast milk.
Breast milk from different pumpings can be added together if the milk is pumped during the same 24-hour day.
Breast milk should be chilled as soon as possible after it is pumped.
It is normal for pumped milk to vary in color and thickness.
Stored milk separates into layers. The cream will rise to the top as the milk warms. Mix the milk layers before feeding.
If you are not going to use the breast milk within 48 hours after pumping freeze the milk.
Always use freshly pumped milk first. Then use refrigerated or frozen milk by the oldest date first.
If breast milk has a sour or strange smell, throw it away. If there is any doubt, do not use the milk.

Handling Fresh Breast Milk

If you washed your hands well before pumping, fresh milk may remain at room temperature (no warmer than 77°F or 25°C) for use in 4 to 8 hours. If you are not going to use it, store it in the refrigerator as soon as possible.
Refrigerate milk right away if the room, car or outside air temperature is above 77°F or 25°C. When you are away from home, use a lunch box size cooler with an ice pack to keep milk cool.

Breast Milk Storage

These guidelines are for a full-term, healthy baby. You may be given different guidelines to follow.

Fresh

Store at room temperature (no warmer than 77°F or 25°C) for 4 to 8 hours. If the temperature is higher, cool the milk right away.
The milk can be stored in the refrigerator (32 to 39°F or 0 to 3.9°C) for 5 to 7 days.

Thawing Frozen Breast Milk

Thaw frozen milk in a cup of warm water. This takes 5 to 10 minutes.
You can also thaw frozen milk 8 to 12 hours or overnight in the refrigerator.
Thawed milk can remain refrigerated but should be used within 24 hours.

Do not thaw breast milk by sitting it on the counter at room temperature.

Do not warm breast milk in a microwave oven. It can change the breast milk and reduce the quality of the milk. Microwave ovens heat the milk unevenly to cause a chance of burning your baby’s mouth.

Do not refreeze thawed milk.

Warming Breast Milk

Remove the milk from the refrigerator just before using it.
Warm the milk by holding the container under warm running tap water or sit it in a bowl of warm water for 5 to 10 minutes.
Rotate the bottle gently and test the warmth of the milk by placing a drop on the inside of your wrist before feeding your baby.
Milk leftover in the container after feeding may be offered at the next feeding before discarding. Do not reheat milk that has been heated. Breast milk can safely stand at room temperature for 4 to 8 hours.

Do not warm breast milk by sitting it on the counter at room temperature.

Breastfeeding Problems

Breastfeeding problems are common, but they last a short time. These tips may help. If you find that the problems persist, call your doctor, nurse or lactation specialist.

Engorgement

Engorgement is when the breasts become full, firm, tender and sometimes painful as your breast starts to produce milk. This often occurs 3 to 5 days after delivery.

Signs of engorgement often last 24 to 48 hours. Signs include:

Larger, heavier and tender breasts
Breasts that are hard, painful and warm to the touch
Swelling of the breasts
Firm nipples and areola

Ways to Prevent Engorgement

Feed your baby at least 8 to 12 times each day.
Wear a support bra 24 hours a day while your breasts are heavy. Use a sport or comfort style bra without underwires. Some mothers find more comfort without a bra.

If your breasts become engorged:

Place a clean, hot, damp cloth over each breast for 3 to 5 minutes before nursing or get into a warm shower and let the very warm water flow over your shoulders. Heating the breasts will help your milk flow easily to your baby. After heating the breasts, massage them in a circular motion towards the areola and the nipple. Massaging will move the milk down. Massage under the arms and the collarbone area if this area is firm and uncomfortable.
Soften the breast using hand expression or a breast pump. Express enough breast milk to soften the areola so that baby can easily attach it.
Breastfeed right away. Gently massage your breasts while nursing.
If the breasts are still painful, full and swollen after breastfeeding, or refill within a half-hour after feeding, you may pump to soften the breasts.
Apply cold packs to the breasts for 20 minutes after nursing.

Nipple Soreness

Nipple soreness often occurs when the baby is not attached well to the breast or positioned correctly. Make sure your baby’s jaws are deeply over your areola and about 1/2 inch behind the base of your nipple. Your nipple should be rounded and erect after the baby detaches.

Ways to Prevent Nipple Soreness

If you feel pinching, rubbing or biting pain during the feeding, check the baby’s position and attachment.
Air-dry your nipples by leaving your bra flaps down for a couple of minutes after a feeding.
Express a small amount of colostrum or milk and spread it around the nipple and areola after air-drying.
Avoid the use of soap, alcohol and extra water on the breast. Clean your breasts by allowing water to flow over them when showering.

If You Have Nipple Soreness:

Feed your baby more often for shorter periods of time.
Do not allow your baby to become too hungry.
Do not use a mii:ficialnipple shield over the breast for feeding. They can cause damage to your nipple and interfere with milk flow.
Use a purified lanolin product or gel pad to heal cracked or open areas.
Begin feeding on the least sore nipple. Be sure to break suction carefully by sliding your finger inside your baby’s mouth.
If it remains painful when your baby first latches on, remove your baby and try again.
A fast, deep latch will put your baby’s jaws behind the nipple and tender areas.

Plugged Duct

A plugged duct is a tender or painful lump in the breast. If left untreated, it may lead to an infection. Plugs often occur from changes in the baby’s feeding pattern or pressure on the breast. Check your breast for pressure points that occur from a bra that is too tight or fi·om bunched clothing on the breast.

If You Have a Plugged Duct:

Apply moist heat to the breast 15 to 20 minutes before each feeding.
Massage the breast from the area behind the discomfort toward the nipple.
Change positions lining-up the baby’s chin and jaw toward the plug.
Let the baby nurse first on the affected breast. The stronger suck will help relieve the plug.

Breast Infection

A breast infection occurs from a blocked duct or from bacteria that has entered the breast, often through a cracked nipple. Even though the breast tissue is inflamed, the baby will not become ill from feeding on the infected breast.

Signs of breast infection may include:

A headache, aching joints, fever or chills
A hard, red and painful breast
A fussy or unwilling to nurse the baby when using the infected breast

Call your doctor right away if you think you may have a breast infection.

Your doctor may order medicine to treat the infection. Take the medicine for the full time ordered. Do not stop taking your medicine, even if you feel better, without first talking to your doctor.
Continue to breastfeed your baby often to drain the infected breast. If your breast is too painful to breastfeed, you may need to use a breast pump until you are able to breastfeed your baby again.
Rest often and drink a lot of fluids.

Talk to your doctor or nurse if you have any questions or concerns.