Breast Feeding

Choosing whether to breast feed or formula feed your baby is one of the early decisions  parents face. Although there's no right or wrong choice, the American Academy of Pediatrics joins other organizations such as the American Medical Association, the American Dietetic Association , and the World Health Organization in recommending breastfeeding as the best for babies.

Breastfeeding is not necessarily "second nature" to either the mother or the baby. The following will help you understand breastfeeding issues.

The beginnings of breast milk

Throughout the last 2nd trimester and 3rd trimester of pregnancy a woman's body produces hormones which stimulate the growth of the milk duct system in the breasts.

By the fifth or sixth month of pregnancy, the breasts are sufficiently developed to produce milk. During the latter part of pregnancy, the woman's breasts are making colostrum (a thick, sometimes yellowish fluid), but high levels of progesterone inhibit most milk secretion and keep the volume down. 

The colostrum is the first milk the baby receives.  After a baby has been nursing for 3-4 days, the colostrum in the breast slowly begins the process of changing into mature breast milk over the next two weeks. At this stage, milk production follows the law of supply and demand.  The more milk removed from the breast, the more milk the breast will produce. Thus milk supply is strongly influenced by how often the baby feeds and well it is able to transfer milk out of the breast. In the initial breastfeeding period, breastfeeding experts recommend at least one feeding every two to three hours to maintain the milk supply.

Benefits of breastfeeding

The benefits of breastfeeding are both physical and psychological for both mother and child. Nutrients and antibodies are passed to the baby while hormones are released into the mother's system. Breast milk, when fed directly from the breast, is immediately available with no wait and is at body temperature.  Breast-fed babies have a decreased risk for several infant conditions including sudden infant death syndrome (SIDS).

Breastfeeding also benefits the mother. Breastfeeding as soon as possible after giving birth encourages the uterus to contract more quickly and this helps to decrease bleeding after the birth. Breastfeeding can also help the mother to return to her previous weight as the fat accumulated during pregnancy is used in milk production.  The maternal bond is strengthened through breastfeeding, with the hormonal releases strengthening the mother's nurturing feelings towards the child. Strengthening the maternal bond is very important as studies show that up to 80% of mothers suffer from some form of postpartum depression, though most cases are very mild.

For additional information please visit the page Breast Feeding versus formula Feeding.  An excellent resource for breastfeeding is La Leche League International at 800-LA LECHE.

The following, adapted from the websites listed at the bottom of this page, presents some of the most frequently asked questions about breastfeeding.

When will my milk come in?

During the first few days after the birth of your baby, your body will produce colostrum, a sort of pre-milk. This thick and yellowish fluid contains many protective properties.  The flow of colostrum is very slow, which allows your baby to learn how to nurse and also how to coordinate sucking, breathing, and swallowing.

After about 3 to 4 days of nursing, your breasts will start to feel less soft and more firm as your milk changes from colostrum to milk that looks kind of like skim milk. Your milk will be transitional for the first 10 days, after which it's considered to be mature milk.

Sometimes a mother's milk may take a few days or longer to come in. This is perfectly normal and is usually no cause for concern. If your milk still has not come in within 72 hours after the birth of your baby, you may want to talk to your health care provider.  Do not be alarmed if your baby drops a little weight at first since most babies typically lose up to 10% of their body weight in the first week and don't start gaining weight until the end of the first week.

How can I tell that my milk is coming in for a feeding?

Many women can feel the milk ejection reflex (or let-down) - when the milk starts coming into their breasts for a feeding. When and how it happens is different for everyone.  During the first few days to weeks after delivery, you may feel strong cramps in your uterus when your milk lets down. Let-down may also begin before you start nursing or it may happen after your baby is latched on and has sucked a few times.

You may also feel a sense of engorgement, like your breasts are filling up and becoming firm, or a sort of tingling sensation in your breasts. You also may feel or see some milk leaking from your nipples. Some women, however, never have a feeling of let-down. If you do not feel it, you should see milk coming from your nipple and hear your baby swallowing.

How soon after my baby is born should I start trying to breast feed?

If possible, try to start nursing within a few hours after the birth. Even if your baby does not correctly attach to your breast, starting early helps you and your little one to practice and get used to the idea of breastfeeding.  It may take a few times before getting it right, but it's important that your baby nurses with a wide-open mouth and takes as much as possible of your areola (the dark-colored area of the breast) in his or her mouth (not just the tip of the nipple).

What are the signs that my baby is hungry?

Crying is a late sign of hunger. You should try to nurse before your baby is so hungry that he or she gets really upset and becomes difficult to calm down.  Signs that babies are hungry include:

How do I make sure my baby is latched on correctly?

This is often the main reason that new mothers have a hard time with breastfeeding; the baby does not latched on to their breasts properly, which can be frustrating for the babies and downright painful for their mothers.

Here are some ways to make sure your baby is latched on correctly every time:

When properly latched on, you may have 30 to 60 seconds of latch-on pain (this is caused by the nipple and areola being pulled into your baby's mouth) then the pain should subside.  Your baby should give four to five sucks, followed by a 5- 10-second pause. Your baby's sucks will increase in number as the quantity of your milk increases. As the milk flow slows, your baby's pattern will probably change to three or four sucks and pauses that last longer than 10 seconds.

Most babies will release the breast on their own. If your baby doesn't release your breast but the sucks now seem limited to the front of his or her mouth, you can slip your finger in the side of your baby's mouth (between the gums) and then turn your finger a quarter turn to break the suction. Then, try to burp your baby and switch him or her to the other breast.

How can I tell if my baby is latched on wrong?

If your baby tends to suck on the tip of your nipple, without getting much of your areola, he or she is latched on incorrectly. Babies who tend to latch on wrong will also frequently sleep at the breast and may not seem satisfied because they may not be getting enough. If either of these occurs, break the suction and reposition your baby onto your breast to include the nipple and areola.

I'm having a hard time getting the hang of breastfeeding. What can I do?

This is completely normal. Nursing can take some adjustment and practice.  While you are in the hospital, do not hesitate to use the expertise of the nursing staff.

Additionally, doctors and midwives may want to weigh your baby and evaluate breastfeeding 48-72 hours after you leave the hospital. You can use this as an opportunity to talk about any concerns.

I have breast and nipple pain.  Is this common?

Breastfeeding may hurt some women. Sometimes this is related to an incorrect technique, but it usually eases over time. Milk ducts can block up on occasion, leading to breast engorgement or mastitis, and should be addressed with massage and by encouraging the baby to suck from that side to keep it as empty as possible until the problem goes away. The presence of thrush in the nipples can also be painful. Limiting feeding time does not prevent soreness.

Although it is said that fair skinned mothers are most likely to experience cracked nipples, cracked nipples can happen to anyone whose baby is not positioned correctly. The baby's rough tongue can also cause grazes and the suction can cause bruising if the mother and baby have not learned to latch and unlatch. The use of nursing pads or tight bras can lead to breast and nipple pain, as can hair dryers, sun lamps, soap, alcohol, perfume, deodorant, hair spray, body powder and incorrect use of breast pumps.

Some mothers apply medical grade lanolin to sooth nipples; La Leche League International has endorsed Lansinoh, an ultra pure medical grade lanolin cream designed for breastfeeding mothers. Mothers can also express milk and rub it on the nipples. After six weeks of breastfeeding, the process usually becomes easier, as both mother and baby learn the best technique.

Is there more than one way to hold my baby during nursing?

Yes. It is essential for the infant to feed in the correct position and with an adequate latch. You can experiment with several different nursing positions (or holds) to figure out which one is the most comfortable for both you and your baby.

While for some people the process of breastfeeding seems natural there is a level of skill required for successful feeding and a correct technique to use. Incorrect positioning is one of the main reasons for unsuccessful feeding and can easily cause pain in the nipple or breast. By stroking the baby's cheek with the nipple the baby will open its mouth and turn toward the nipple, which should then be pushed in so that the baby has a mouthful of nipple and areola; the nipple should be at the back of the baby's throat.

There are many positions and ways in which the feeding infant can be held. This depends upon the comfort of the mother and child and the feeding preference of the baby.  Positions include the following:

When is it necessary to use a breast pump?

When direct breastfeeding is not possible a baby may still be fed breast milk. Expression can be used to maintain lactation, such as when the mother and child are separated for an extended period. If the baby is unable to feed.  By expressing (artificially removing and storing) her milk, a mother can enable her child to be fed while she is away from the child. With expression through the use of a breast pump the woman can draw out her milk and keep it in supplemental nursing system or a bottle ready for use. This bottle may be kept on the counter for up to seven hours, refrigerated for up to eight days or frozen for up to four months.

The American Academy of Pediatrics (AAP) now recommends that babies should be breastfed exclusively (without offering formula, water, juice, non-breast-milk, or food) for the first 6 months and that breastfeeding should continue until 12 months (and beyond) if both the mother and baby are willing.

What should my diet be like when I'm breastfeeding?

There are no foods which are absolutely contraindicated during lactation, although a baby may show sensitivity to particular foods in the mother's diet. Some breastfeeding advisers suggest mothers avoid certain food, such as beans, cauliflower, or broccoli if the baby starts to develop colic or gas.  Foods that a nursing mother should steer clear of are peanuts and peanut butter.

You will also need to drink and eat enough so that your body can make milk. Make sure you consume plenty of liquids but before you start adding on more calories, talk to your health care provider about how many more you should consume every day based on your weight and height.

Is it normal for my baby to spit up after feedings?

Spitting up is usually perfectly normal.  Sometimes, babies often spit up when they have eaten too much or burp (the notorious "wet burp"),  Many infants will spit up a little after eating or during burping because their digestive tracts are immature. That's perfectly normal. But spitting up isn't the same as vomiting all or most of a feeding.  If you're concerned or your baby is vomiting (that is, forcefully vomiting much of a feeding) more than once a day, call your child's health care provider.  Also, keep in mind that many babies grow out of spitting up by the time they're sitting up.

Things you can do to help alleviate spitting up include:

How can I tell when my baby is hungry?

It's generally recommended that you feed your baby whenever he or she seems hungry, which is called demand feeding (or feeding on demand). But despite what some new parents might think, crying is a late sign of hunger. You should try to feed before your baby gets so hungry that he or she gets really upset and becomes difficult to calm down.

It's also important, however, to realize that every time your baby cries it is not necessarily because of hunger. Sometimes babies just need to be cuddled or changed. Or they could be over stimulated, bored, or too hot or too cold.  One way to tell if your baby is, indeed, ready to eat is to check the clock. If your baby is crying only an hour after a good feeding, there may be something else causing the distress.

Do I need to give my breastfed baby vitamins or supplements of any kind?

A healthy infant being nursed by a healthy mother may not need any additional vitamins or nutritional supplements, although it is best to check with your child's health care provider.

The AAP states that infants, whether breastfed or formula-fed, do not need fluoride supplements during the first 6 months. From 6 months to 3 years, babies require fluoride supplements only if the water supply is severely lacking in fluoride. Well water and bottled water, for example, don't contain fluoride. Again, ask your child's doctor about your baby's needs.

I think I'm coming down with something. Can I still breast feed my baby?

In most cases, yes since the majority of illnesses and medications are not dangerous to a breastfeeding infant. In rare cases, though (such as HIV), a mother's health may interfere with her ability to breast feed her baby.

If an illness in either you or your baby requires a brief interruption in nursing, you can pump and discard the breast milk until you're able to start nursing again. To maintain your milk production, it's important that you continue to pump your breast milk during this time. And if you're taking any medications for your illness, talk with your doctor to find out whether or not it's OK for you to breast feed your baby.

Does my breastfed baby have an allergy?

A breastfed baby may have an allergy or sensitivity reaction after the mother consumes certain foods or drinks (such as common food allergens like cow's milk, eggs, nuts and peanuts, etc.). Some signs of such a reaction to food might include consistent spitting up or vomiting, apparent belly pain (lots of gas and/or pulling up the knees in pain), and bloody and/or mucousy stools (poop).  If you think your baby has had an allergic or sensitivity reaction to food, call your child's health care provider.

Can I breastfeeding in public?

There are numerous laws around the U.S. and in other countries that have made public breastfeeding legal and disallow companies from prohibiting it in the workplace. Yet, the public reaction at the sight of breastfeeding can make the situation uncomfortable for those involved.  Many U.S. states have laws prohibiting breastfeeding in public places.

Can breastfeeding women drink alcohol?

Unlike when you're pregnant, you can have an occasional drink or two as a breastfeeding mother without causing any harm to your baby. The American Academy of Pediatrics (AAP) indicates that one or two drinks a week is not harmful.

The amount of alcohol in breast milk depends on the amount of alcohol in the blood. It takes anywhere from 60 to 90 minutes from the consumption of a drink to when alcohol appears in the breast milk and about 2 to 3 hours after a drink for the alcohol to be metabolized and no longer be a concern for nursing.

Heavy alcohol consumption is known to harm the infant, causing problems with the development of motor skills and decreasing the speed of weight gain. There is no consensus on how much alcohol may be consumed safely, but it is generally agreed that small amounts of alcohol may be occasionally consumed by a breastfeeding mother. However, some believe that a single daily glass of wine is enough to cause distress.  Considering the known dangers of alcohol exposure to the developing fetus, many medical professionals believe it is preferable to err on the side of caution and have breastfeeding women restrict or eliminate their alcoholic intake.

Can breastfeeding women have caffeine?

As is the case during pregnancy, it is best to limit the amount of caffeine you consume while breastfeeding. One or two cups of coffee a day are fine, but remember that the more caffeine you drink (tea, soda, coffee), the more it may affect your baby's mood and/or sleep.

Excessive caffeine consumption by the mother can cause irritability, sleeplessness, nervousness and increased feeding in the breastfed infant. Moderate use (one to two cups per day) usually produces no effect. However, to be on the safe side, breastfeeding mothers are advised to avoid or restrict caffeine intake.

Can breastfeeding may be harmful to my baby?

Breastfeeding may be harmful to the infant or the mother if the mother: