Breastfeeding is a wonderful and natural way to feed your baby, but it can take some practice and support. For more information, please contact our skilled lactation consultants at 617-667-5765.
Breastfeeding Support Group
A complimentary drop-in postpartum support group is offered on Wednesdays from 12pm-1:30pm at BIDMC, 330 Brookline Avenue, Feldberg 6 Solarium, led by an International Board Certified Lactation Consultant. Please join us for assistance and support around breastfeeding your baby. The group is free and registration is not required. For questions contact the Parent Connection at 617-667-BABY.
Benefits of Breastfeeding
There are many benefits for breastfeeding both for you and your baby. Breastfed babies enjoy a reduced risk of certain viruses, respiratory illnesses, allergies, ear infections, and childhood obesity. The longer women breastfeed, the greater the mothers' protection against breast and ovarian cancer, type 2 diabetes and cardiovascular disease.
We encourage skin-to-skin contact with your baby in the first moments, hours and days of life. Skin-to-skin contact benefits baby by staying warm from mothers skin, baby has more stable temperature, breathing and heart rates. Babies also breastfeed better, cry less and it has been found to improve parent bonding.
Breastfeeding Know How
Position
In preparation for a breastfeeding session, it is important that you have clean, washed hands and are in a comfortable position. A feeding is best done in an upright position and supporting your baby to bring him up to the level of your breasts will decrease strain on your arm, shoulder and back muscles.
Once you are comfortable, be sure that the baby and you are tummy-to-tummy-that he is completely turned toward you. In the tummy-to-tummy position, the infant's mouth will be directly in front of your nipple and areola (the dark part of skin surrounding the nipple tip). Now you are in a position for proper latch-on.
Latch-on
With the hand that is not holding the baby, shape your breast by forming the letter "C" with your free hand. Do this by placing the four palm fingers under your breast and your thumb on top, about an inch or so behind the areola. This technique of "cupping" your breast will help to shape the nipple and areola so that it will go easily into the baby's mouth for effective latch-on. Remember to keep the "C" hold wide. Do not collapse it by bringing the thumb and the fingers closer, as this might make your pointed nipple recede a little.
To get the baby to open her mouth wide for latch-on, stroke the middle of her lips (especially the lower lip) with your nipple tip to elicit the rooting reflex. Once she opens her mouth, direct your nipple so that it is centered in the baby's mouth. Be sure to get your nipple/areola above her tongue, which ideally should be lying slightly beyond her lower gum line and not touching the roof of her mouth.
Encourage your baby to get as much of the nipple and areola into her mouth as possible. She may not be able to get the entire areola into her mouth, but she should latch on to more than just the nipple tip. (The extent of latch-on depends on the size of the baby's mouth and your areola.) When your baby has an adequate amount of the nipple and areola in her mouth it will be wide and open with lips flared outward onto the breast rather than tightly pursed inward. This is important not only for your comfort but also for effective breastfeeding. When a baby sucks on only the nipple tip, it can hurt you, cause cracks in the nipple, and prevent the baby from getting enough milk.
Once your baby has latched-on she will not easily fall off the breast. You will see her jaws in motion and the breast tissue near the nipple/areola actually pulled in with the rhythm of her sucking. When the volume of milk increases, your baby will nurse in bursts of four to 10 sucks in a row, followed by a pause during which the nipple/areola stays in her mouth. A baby may slow down or pause in her sucking rate to swallow the milk. With colostrum, your baby will probably suck two or four times in a row before obtaining enough fluid in her mouth to cause her to swallow. It is important to try to notice the swallowing to be sure that she is taking milk in; you can sense this by a quiet "gulp" or a sound like a puff of air coming from her.
Switching Sides
When you want to switch sides, slide your finger into her mouth between her gums. This will partially open her mouth, breaking the high-pressure suction and preventing trauma to your nipple. Then burp the baby, change to the opposite side, and begin again. In the beginning it can be difficult to teach a baby to latch on correctly. It is important for your baby to suck properly — both for your comfort and for efficient breastfeeding. It may take several attempts before your baby opens her mouth wide enough and latches on properly, but persistence and patience on your part will teach her how to do this correctly and minimize your discomfort. As you both learn, it will get easier.
How Long and How Frequently to Feed?
No one can tell you exactly how long on each side your baby may want to breastfeed. Look for cues when your baby wants to breastfeed. Breastfeeding should occur at least eight times in any 24-hour period. A four-to-five-hour interval between breastfeeding may occur at night, but repeated long intervals without a feeding can hamper weight gain.
During the first few days you may notice that your baby appears to be sleepy. If your baby seems sleepy and not interested in feeding, try changing the diaper or unwrapping him from a swaddled blanket to expose him to the air in the room. Mild stimulation, such as light massage and skin-to-skin contact, also will help arouse your baby. If you cannot arouse him for a feeding, hold her skin-to-skin and wait. Try to feed again in one hour or observe him for hunger cues, such as hand-to-mouth motions, finger sucking, fussiness, arching of the back and stretching, or simply a quiet, alert state.
Once your baby appears alert and interested, find a comfortable position to begin feeding.
Once your baby is feeding, allow him to feed until he seems satisfied. Begin with the breast you ended with during the last feeding. Observe your baby's sucking and swallowing and how he occasionally rests before beginning to suck again (the bursts and pauses). At the onset of a feeding, these pauses are usually 10 to 15 seconds long. The average feeding per side is about 15 to 20 minutes after the milk comes in. But your baby may be different in the pace he sets. Let him lead the way! Note: If he is nursing very frequently, the duration of the feedings will be shorter (like snacking); this is okay.
When your baby becomes increasingly satisfied, the sucking will slow down and the rests will get longer. Then you can insert a clean finger between your baby's gums and gently break the suction. Try to burp him (some babies may not burp). Always offer the second breast. If the baby still seems hungry after taking the second side, you can continue the feeding by going back to the first breast. This is called switch nursing.
If, when switching sides, the baby does not resume active feeding after about four to five minutes, he likely got satisfied from the first side. This is common in the early weeks and has been shown not to be a problem for infant growth and intake. You may feel "lop-sided" for a couple of hours, but just start the next feeding on the "full" side.
After the feeding session is completed, the baby may still seem hungry. Overall, you will want to breastfeed your baby between eight and 12 times every 24 hours. These feedings may occur around the clock every two-and-a-half to three hours or closer together. It is perfectly normal for breastfed infants to want and need to be fed this frequently because human milk digests through their system significantly faster than commercial formula.
Storing Milk
|
Freezer |
Refrigerator |
Room Temperature |
Freshly Expressed Milk(in a sealed container) |
5 days |
• 1 hour while in hospital
•1 to 5 hours at home
Note: Although human milk can remain in room air longer without significant increase in bacteria, it is better to place in cold storage as soon as possible.
|
|
Previously Frozen Breast Milk |
Do not refreeze |
24 hours |
1 hour |
Cluster Feeding
Sometimes, especially in the first few weeks of life, your baby may want to feed more often. This is called "cluster feeding," when your baby demands to be breastfed very often over a short period of time (e.g., every 30 to 60 minutes for roughly five minutes a side). Then she may sleep for an extended period. This does not mean that your milk isn't enough for her. She is just making sure the supply will increase to keep up with her growth. You will discover that if you let her set the pace, she will breastfeed perhaps three or four sessions that way but will then settle down and sleep for a while. Watch her behavior rather than the clock, and you will discover when your baby is awake, alert, and giving cues that she is ready to feed.
Nipple Soreness
Mothers can experience nipple soreness at the start of a feeding session. This initial latch-on soreness decreases after 15-30 seconds and the baby begins to eat with a suck-swallow-suck-swallow feeding rhythm. If your nipples hurt after 15-30 seconds, you should make sure there was effective latch-on. You may need to break the suction and reposition him. Limiting the frequency or duration of feedings in the first few postpartum days does not prevent nipple soreness.
To help start milk flow, try massaging your breast, applying a warm towel or pack to it, and/or stimulating some milk to come out before your baby latches on (called "hand expression"). These actions ease his first strong sucking motions and may decrease the soreness. Soreness usually improves by 2-3 weeks or sooner.
Adequate Milk Supply
Another common concern among breastfeeding mothers is whether babies need to supplement with water or formula. If breastfeeding is going well, babies usually are satisfied by breast milk alone. Some mothers wish to feed their babies both breast milk and an occasional bottle of formula. The American Academy of Pediatrics recommends that breastfeeding be the only source of feeding for your baby during the first six months of life (unless other feeds are medically indicated) to allow your body to build up an adequate supply of breast milk. Many mothers may also wonder if a breastfed baby needs to have supplementary water during hot summer weather. Supplementary water for breastfed infants is not necessary.
Expressing Breast Milk
You may choose to collect and store your breast milk for your baby if you expect to be away during a feeding. Use either hand expression or a breast pump to collect your milk. Begin by washing your hands and massaging your breasts several times. Place both hands around your breast, against your chest, and apply gentle pressure as you move your hands toward your nipple. Continue to massage around your entire breast. Applying a warm washcloth may help your milk to let down. Breast milk should be collected and stored in a clean plastic or glass container. Pre-sterilized, disposable plastic bags can be convenient for storage but can split and leak upon thawing; therefore, they are not recommended for long-term storage. Only specially-made mother's milk storage bags (these have a layering of plastic and nylon to prevent splitting) are recommended. These can be purchased from the major breast pump rental stations. Baby bottles with a tight-fitting cap are also effective.
Once you take your baby home breast milk may be stored for up to five days in a 40°F refrigerator, for six months in a 0°F freezer if self-defrosting (frost-free type), or for nine to 12 months in a regular freezer.
One of the best times to collect breast milk is after a feeding, especially in the morning since this is when your milk supply tends to be higher. If your baby has a long interval between some feedings, you can take advantage of this time to collect additional breast milk.
Remember, when you are away from your baby, you also may wish to express milk either for future feedings or to relieve breast fullness. Many types of manual, battery-operated, and electric breast pumps are available. To select the best pump for your needs, consult a nurse or lactation consultant after your baby is born.
Your Breasts
You may have noticed that, through your pregnancy, your breasts have been preparing for breastfeeding. Colostrum, the first milk, has been present since the third month of pregnancy. After delivery, your breasts will gradually begin producing increased amounts of mature milk. The breasts enlarge because more blood is sent there to provide nutrients and fluid for milk production. Increased normal breast fullness usually occurs on the third or fourth day after birth. This natural fullness partially subsides after 1-2 weeks. Softening of the breasts does not indicate that your milk supply is dropping off. It merely signals that your breasts are returning to a normal but functioning state and are producing milk more efficiently. While you are in the hospital, your nurse will be observing your breasts for signs of filling. She will assist you with feedings and make recommendations to prevent engorgement- a back-up of milk with congestion of fluids in the breast tissues.
Engorgement
Engorgement results in very firm, painful, warm breasts and possible flattening of the nipple. By breastfeeding right after delivery and for as long and as often as your baby demands, you may avoid painful engorgement.
If your nipples are so firm that your baby cannot get adequate hold of your nipple and areola, try taking a hot shower or applying hot, wet towels to your breasts three minutes before you nurse. Massage all around the breast from outer areas in toward the nipple. Hand expression of a small amount of breast milk before attempting to nurse also will help. Once the fullness around the areola is relieved, the baby will be able to latch on better. Feeding more frequently for a day or two will help, too. If your baby cannot nurse as frequently as needed to decrease the engorgement for you, try hand expressing or using a breast pump to remove the excess milk. All of these actions can allow your milk to let down, decreasing the discomfort from engorgement. If your breasts do not soften after these measures, apply ice wrapped in a thin towel for 20 minutes.
Wearing a well-fitted, supportive bra 24 hours a day, starting when you begin to feel your breasts becoming heavier, will help give your breasts the support they need while you are breastfeeding. In addition, wearing a bra continuously will provide more comfort when your breasts are very full. A nursing bra with flaps makes breastfeeding access easier.
Nipple Care
As mentioned above, most breastfeeding women experience some nipple soreness during the first 10 days of feedings. If you follow the techniques described in previous sections, nipple soreness should diminish.
Cracks or blisters on the nipples may occur when the baby is not latched on correctly or is not sucking properly. It is essential to discover the reason for this trauma, and a lactation consultant can help to diagnose the problem. Until then, moistening your nipples with expressed milk and letting them air-dry before putting your bra back on may alleviate your discomfort. If the cracked nipple is absolutely too painful to have the baby nurse from, consider hand expressing or pumping on that side in place of direct infant feedings until the crack heals more. Many women report some relief with the proper use of a medical-grade lanolin product made specifically for breastfeeding mothers. Your healthcare provider may recommend this once all the important actions described above have been tried. It can be applied sparingly once expressed milk has been applied and allowed to air-dry. You may also want to work with a lactation consultant, who can assess how your baby latches on to determine if this is contributing to the problem.
- Care: The best advice for nipple care is to avoid drying agents like soaps or alcohol. Change moist nursing pads or bras as soon as they get wet, and avoid the routine application of creams and ointments to your nipples. Moisten your nipples with breast milk and allow them to dry for 10 minutes after each feeding and before covering your breasts.
- Plugged Ducts or Breast Infection: Occasionally, you may feel lumps (plugged ducts) forming in your breasts. If you also have a fever, localized pain, or redness in your breasts, you may have a breast infection (mastitis). Notify your obstetrician, nurse-midwife, or nurse practitioner. Most healthcare providers encourage you to continue nursing through mastitis and will prescribe an antibiotic to help clear the infection.
- Leaking: Many new mothers experience leaking at the onset of breastfeeding because muscles in the nipple pores may not be able to hold back the milk. You cannot control leaking, but be reassured that it tapers off by itself. To halt the flow when you sense it happening, gently put pressure against the nipple with your palms or by crossing your arms across your chest. If necessary, nursing pads, either disposable or reusable, can be placed inside your bra cups to absorb any leaking between feedings.
Taking Care of Yourself
Breastfeeding depletes somewhere between 400 and 600 calories from your body each day, so you will need some extra rest, calories, and fluid to make up for this loss. An adequate intake while breastfeeding is about two to two-and-a-half quarts per day, or six to eight eight-ounce glasses of fluids. Drinking water is best, but drinking milk or juice or eating soups, sherbets, sorbets, and Italian ice is sufficient.
You should maintain a healthy diet, and it is important to make sure you get 1,200 - 1,500 milligrams of calcium every day. However, for the most part, you do not need to worry about what you eat while breastfeeding. Once in a while, babies will be sensitive to some foods their mothers eat. If you suspect that your baby is fussy because of something you ate, wait a few days and try it again. If the problem recurs, consider limiting that food in your diet. If your baby does not have the same reaction, it probably was not food-related.
Drugs and Breastfeeding
Breast milk will absorb almost any medication you take, whether a prescription or over-the-counter drug. Some medications, including antihistamines and birth control pills, can decrease milk production when taken before lactation is fully established. Although you can breastfeed with most medications, you should check with your obstetrician, nurse, nurse-midwife, or pharmacist about their compatibility with breastfeeding.
How Long To Breastfeed and When to Wean
No one but you knows how long you should breastfeed your baby. The American Academy of Pediatrics (AAP) recommends that babies receive breast milk alone for the first six months, and any introduction of foods thereafter should serve as a complement to breast milk. The AAP further recommends breastfeeding for at least the first 12 months, or longer if mutually desired.
Feeding pumped breast milk is a reasonable alternative if breastfeeding is not possible or desired. It is possible to breastfeed and supplement with formula if pumping is not an option after returning to work. A lactation consultant will be able to help you do this successfully.
Building a Milk Supply
If you plan to go back to work while continuing to breastfeed, you may want to build up a supply of milk beforehand. One way to do so is to pump your breasts for extra milk during the week or two prior to your return date. This works best after the first two feedings each morning because milk supply is highest then. If you are planning to use a bottle, you may want to try to introduce the artificial nipple at three to five weeks after delivery so that your baby can become used to sucking from a bottle nipple. Some babies need time to master this new feeding method, but they usually do, especially if someone besides the mother begins the new process.
When you do decide to wean your baby, the recommended method is to eliminate one breastfeeding session per day, every two to three days. You may begin the weaning process by choosing to eliminate the feeding that is the least convenient for you or the feeding that the baby is the least interested in. Continue to eliminate feedings until the weaning process is complete. Most women can stop nursing over a 10-14 day period.