Breast Feeding

Breast feeding is a learning process for mom and baby. It usually takes about 2 weeks for both of you to learn to do it well. After that time it becomes easier to latch baby onto the breasts, and your nipple and breast tenderness should go away. Please ask for help as needed to get through this time!! Below are a few tips to help answer your questions. Please feel free to call during office hours for further advice. We will work with you when you come in for appointments and you can schedule more time for breastfeeding help if needed.

How often should I breastfeed my baby?

·  Watch you baby for signs that he/she is hungry- like putting his/her hands in the mouth, chewing on hands, moving head side to side, wiggling/fussing and crying. Try to feed the baby at the early signs of hunger so he/she doesn't become frantic.

·  During the first couple of weeks I recommend that you nurse the baby every 1 1/2-3 hours during the day and do not go longer than every 4 hours at night. (at least until baby is back above birth weight)

·  The baby should nurse at least 8-12 times in 24 hours. (milk supply will not increase adequately if you nurse/or pump less than 8 times a day.)

·  If the baby does not nurse well, and formula is given then you should pump to give the breasts stimulation to produce more milk.

How long should I nurse my baby?

Everyone has a different belief on how long to nurse the baby on each breast. New babies are difficult to keep awake for very long, so I recommend nursing for 5-10 on each breast, then go back to the first breast if the baby is still awake and continues to nurse. After nursing on the first breast, make sure infant is alert enough to nurse on the other side. (see below) This will allow the baby to get a larger quantity of milk at a feed along with some hind milk (The fattier milk that takes longer to digest). A nursing session should not last longer than 30-40 minutes. Making sure the baby nurses well on both breasts will help to avoid "snacking". As your baby gets older, he/she may just nurse on only 1 breast at a feed. Also, some babies nurse very quickly, taking 5-10min to nurse, while others still nurse for 20-30minutes per feed.

Tips on waking your baby up-

Gentle alerting methods:

Always unswaddle your baby.

Change diaper

Place baby upright on shoulder-preferable someone other than mom is less comforting.

Make eye contact with your baby

Talk to baby

Lightly stroke torso.

More active alerting methods:

Undress baby to diaper

Sit baby upright, and then lay him/her back-repeat (avoid bending body)

Roll infant from side to side

Hold baby upright away from your body

Rub his/her back

Stroke extremities with a damp cloth.

How do I know if my baby is getting enough milk?

·  Weight gain is the best way to tell that your baby is getting adequate breast milk. However, it is normal for all babies to loose up to 7% of their body weight after birth. They should regain this weight by 2-3 weeks of age. After that the baby should gain about one ounce per day for the first three months.

·  A baby that is getting enough breast milk should have 4 or more stools a day during the first month. This is the best well to tell at home if the baby is getting enough breast milk.

·  Babies that nurse 8 or more times a day are usually getting enough breast milk.

·  The baby should appear satisfied after a feed i.e.: he/she should not root around, cry, suck his/her hands when taken off the breast and the arms should be relaxed at his/her sides.

·  Minimize pacifier use unless you know the baby has fed well and breastfeeding is well established (about 2 weeks.)

If you have any concerns that your baby is not getting enough breast milk, then go ahead and offer formula after you nurse. Call us during office hours and we can try to determine if you need to continue supplementing.

How do I know if my baby is latching on well?

Your baby should have a wide mouth (flanged lips) with the lips rolled out. He/she should have a good portion of the areola in the mouth. For the first few days there may be tenderness of your nipple when the baby latches on, the pain should go away while you are nursing. If you have pain or a pinching feeling that persists past the initial latch, then the baby is not latched on properly and you need to take the baby off the breast and try again. (Place your finger inside your baby's mouth to break the seal) You may need help to check and make sure the bottom lip is rolled out and to assist with getting the lip rolled out. (pull gently down on the chin)

·  The baby's chin and nose should touch the breast when latched on well.

·  Make sure you baby's body is facing you so that he/she does not have to turn his/her head to eat.

·  Your baby should have a rhythmic/deep suck.

·  You should be able to hear an audible swallowing.

My nipples are raw and sore-is this normal?

How long will it last? How can I decrease the discomfort?

It is normal for nipples to have some rawness/scabbing and discomfort the first few days. Usually all of this has resolved by about 10-14 days. If pain/rawness persists then the baby may not be latching/sucking properly or it may be a sign of infection.

There are several things you can use to help minimize the discomfort:

·  breastfeed your baby before he/she becomes too hungry so the suck will be gentler.

·  nurse on both breasts at each feed

·  use a warm/wet washcloth on the nipple and massage the breast for a minute prior to feeding the baby-this will help the milk to flow more easily.

·  support the breast and use lots of pillows to hold your baby close to you throughout the feeding for the first couple of weeks. This will decrease the pull on your nipples.

·  use lanolin on your nipples after each feed (you do not need to wash it off prior to feeding your baby)

·  you can get some soothing patches to place on your nipples after feeds (available at Baby's R US). Soothies or Hydrogel patches.

My breasts are engorged-what can I do?

It is normal for breasts to become swollen and firm when your milk comes in. This can be uncomfortable. Some of this is due to increased milk volume in breasts, but mostly is swollen tissue, increased volume of blood in breasts and increased flow of fluids in the lymph system. This usually resolves within a couple of days. There are a few things you can do the help prevent or treat this:

·  Be sure your baby feeds or you pump at least 8-12 times per day.

·  You can put ice packs on your breasts for 5-10 minutes after you nurse the baby.

·  Take Ibuprofen every 6-8 hours for a couple of days.

·  Massage your breasts prior to feeding the baby to help with removal of milk from the breasts.

·  Wear a supportive, well fitting bra-make sure it doesn't constrict the breast. Some mom's are more comfortable in a sports bra while breasts are engorged.

Why does my baby want to nurse more frequently?

Babies grow very rapidly and go through growth spurts. The typical ages for growth spurts are:

3weeks | 6 weeks | 3 months | 6 months

Feed the baby as often and he/she wants to nurse. The milk supply will catch up to your baby's needs within a couple of days.

Newborns often want to nurse a lot in the evening. This is normal and usually passes quickly.

What can I do to increase my milk supply?

Breastfeeding is based on Supply and Demand. The more milk you empty from your breasts, the more milk you will make. Be sure you nurse 8-12 times per day.

·  Using a warm washcloth and massage on your breasts for a couple of minutes prior to nursing or pumping is one of the best ways to increase supply.

·  You can also pump for 10-15 minutes after you nurse.

·  Try to get some rest periods while your baby is sleeping or while someone else tends to the baby.

·  Too many visitors can make you tired and may prevent you from relaxing and spending the time needed to nurse your baby.

·  Do not forget to eat and try to drink 8 glasses of water per day.

What kind of bottle/nipple should I use?

The type of bottle you use does not matter too much. The nipple is most important-usually a Nuk type nipple is good because when placed all the way in the baby's mouth it causes your baby to have to open his/her lips wide which mimics breastfeeding. However, most babies do fine with any bottle/nipple once breastfeeding is well established.

Can I use a pacifier while breastfeeding?

Most babies do fine using a pacifier. Babies typically learn very quickly where the food comes from. Occasionally babies have nipple confusion. This occurs when the baby is looking for something a little firmer than your nipples to suck on. If you think this is happening, then call during office hours and we can discuss ways to help your baby get through this. Avoid pacifier use the first couple of weeks if your infant has had any difficulty with latching onto your breasts. Try not to use the pacifier unless you know your baby has fed well.

Which pump should I buy and when should I start pumping?

·  If you are going to be going to work, then I recommend buying an electric pump that will pump both breasts at once. The Medela Pump In Style is an excellent pump and is easy to use.

·  When your baby is 2-4 weeks old you should introduce a bottle to your baby. It is usually best if someone other than mom feeds the baby. (Babies like to nurse from their mom)!.

·  Practice using your breast pump at least 2-3 weeks prior to returning to work. It is common to not get a lot of milk the first few times you pump. Your body has to adjust to the different stimulation that the pump provides.

·  I recommend pumping at the same time every day. Your body will actually learn to make more milk at that time.

·  You can store your milk in any airtight container. Bottles or bags are fine. Be sure and label your milk with the date it was pumped and try to feed your baby the oldest milk first.

·  Milk can be kept in the refrigerator for 48 hours. It can then be frozen. Frozen breast milk is good for 3 months in a refrigerator freezer or 6 months in a deep freeze.

·  The milk can be defrosted in the refrigerator or in a cup of warm water. Never microwave or use hot water to thaw your breast milk because it destroys the enzymes and nutrients.

·  Try to give your baby the fresh milk when possible. For example: Your first day of work you can use milk that was frozen, then the next day feed your baby the pumped milk from the day before and so on.

My baby has a lot of gas, is it something I am eating?

·  It is normal for new babies to have a lot of gas because their intestines are getting use to having food in them.

·  There is not a lot that bother's a baby. Some however develop a lot of gas from mom's intake of dairy products. If you think your baby has too much gas, then try to decrease or eliminate diary products and see if it helps.

·  Other foods that upset some baby's stomachs are spicy or citrus food. However, most babies do fine with whatever mom wants to eat.