Pregnancy and Children

Breast Feeding

Breastfeeding     Breastfeeding

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 in recommending breastfeeding as the best for babies.

Breastfeeding Introduction

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 months 5-6 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 2-3 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.

Breastfeeding Questions and Answers

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.

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. 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.

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 the dark-colored area of the breast in his or her mouth and not just the tip of the nipple.

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:

  1. Make sure your baby's mouth is opened wide and his or her tongue is down when latching on.

  2. Support your breast with your hand, positioning your thumb on top and your fingers at the bottom, keeping your thumb and fingers back far enough so that your baby has enough of the nipple and areola (the circle of skin around the nipple) to latch onto.

  3. Gently glide your nipple from the middle of your baby's bottom lip down to his or her chin to help prompt your baby to open his or her mouth.

  4. When your baby opens his or her mouth wide and the tongue comes down, quickly bring your baby to your breast (not your breast to your baby). Your baby should take as much of your areola into his or her mouth as possible, with more areola showing at the top lip than at the bottom.

  5. Make sure your baby's nose is almost touching your breast (not pressed against it), his or her lips are turned out (or flanged), and you see and hear your baby swallowing. (You should be able to tell by seeing movement along your baby's lower jaw and even in your baby's ear and temple.)

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.

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 and after discharge make sure to discuss any concerns with your health care provider.

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, 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, 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.

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.

How long should I plan to breast feed my baby?

The American Academy of Pediatrics 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?

Since the nutritional requirements of the baby must be satisfied solely by the breast milk in exclusive breastfeeding it is important for the mother to maintain a healthy lifestyle, especially her diet.

You will also need to drink and eat enough so that your body can make milk.  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.

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.

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.

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, 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.  However, considering the known dangers of alcohol exposure, many medical professionals believe it is preferable to eliminate any alcohol intake.

Can breastfeeding women have caffeine?

As is the case during pregnancy, it is best to limit caffeine consumption while breastfeeding. Remember that the more caffeine you drink (tea, soda, coffee), the more it may affect your baby's mood and/or sleep.  Excessive by the mother can cause irritability, sleeplessness, nervousness and increased feeding in the breastfed infant.

Additional Information

Kids Health: Breastfeeding questions and answers

Breastfeeding-how much, how often?

Breastfeeding: Some common concerns

Breastfeeding pain and discomfort

Wikipedia: Breastfeeding information

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