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Nursing Angel is proud to bring you a very extensive free online breastfeeding resources page. Our resident lactation consultant Heidi Humphries is an International Board Certified Lactation Consultant with a wealth of experience. She is also a Neonatal Registered Nurse with a Bachelors Degree in Nursing and the owner of a successful breastfeeding centre and retail store in the US (which she started in 1999 after the birth of her son). Heidi has written for South Florida Parenting magazine and we’re excited to have her on board writing about everything breastfeeding for us!
Although Heidi isn’t available for private consultation, each month she answers more of your questions for this page so please email them through to her at heidi@nursingangel.com.au.
The advice on this page is for general information only. Please see a Lactation Consultant for your specific circumstances and needs. Visit the Australian Lactation Consultants Association's website to find an International Board Certified Lactation Consultant in your area.
For Pregnant Mums-To-Be
• I’m pregnant and want to breastfeed. How can I prepare?
• I couldn’t breastfeed my first child – should I try again when I have this baby?
• I’m having a caesarean and am worried I’ll be in too much pain to breastfeed.
• I have had breast surgery. Will I be able to breastfeed?
• I’ve just found out I’m pregnant again – should I keep breastfeeding my 6 month old?
• I have inverted nipples. Will I be able to breastfeed?
For Pregnant Mums-To-Be
I’m pregnant and want to breastfeed. How can I prepare?
Good for you! You have made the BEST decision for you and your baby. Here are some things you can do to help prepare yourself for breastfeeding.
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Get in touch with a lactation consultant, preferably one with the letters "IBCLC" after her name. You may want to hire a postpartum doula also. Support is of utmost importance in breastfeeding success.
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Join one of the 400 breastfeeding support groups run by the Australian Breastfeeding Association. Pregnant mums-to-be are welcome to attend. The ABA mums know so much and they’re just a phone call away.
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Read up! Babies may not come with a manual…but breastfeeding does have plenty of literature. Don’t be afraid to do some research!
- Do not allow any formula to enter the household. You need to make sure that everyone who will be caring for the baby knows that nothing compares to your breast milk.
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Keep in mind that baby’s stomach is about the size of a marble when he/she is born. Frequent feedings are necessary, as baby's stomach fills quickly.
- Prepare a breastfeeding area at home. You will need a comfortable space in which to breastfeed, pillows for support, a stand for water, some reading materials, a foot rest, and some sort of snack. You should drink while baby drinks, so always have a large bottle of water at your nursing space. You may want a lamp to read by. Extra pillows should also be in your bed so you can easily and comfortably breastfeed at night and between naps. Let your family know that you will need their help through bringing you water and snacks and encouraging you.
Remember to have a few people you can call if you have any problems and call them as soon as you have a problem at all. Getting support early could mean the difference between sticking with it and quitting. You can do this! The rewards that come from breastfeeding are endless!
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I couldn’t breastfeed my first child – should I try again when I have this baby?
Most definitely! Just as every baby is different, so is every breastfeeding experience.
I hear it all the time: “I couldn’t breastfeed my baby.” In fact, a large number of mothers that I see tell me that their own mothers and/or grandmothers couldn't breastfeed. There's a very simple reason to explain this phenomenon. Women during the 50's, 60's and 70's were not encouraged to nurse their babies. There was really little or no help available to them. Even in today’s culture, many women have never even seen a baby breastfed prior to nursing their own. Their own mothers, sisters, and aunts can't help because they didn't nurse either. Statistics show that the majority of women who start out breastfeeding have quit by the second or third week! This is not because of medical problems, but because they are not given the information, support, and help that they need.
Are there some women who really can’t breastfeed? The answer is yes, but it is a very small number - estimated by many to be less than 1%. So, for the next time around, the best advice I can give you is to educate yourself. I promise you, it will be worth it!
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I’m having a caesarean and am worried I’ll be in too much pain to breastfeed.
Understandable! A caesarean is surgery and the short period after surgery can be uncomfortable. But, you are in luck! Most of the medications associated with caesareans are compatible with breastfeeding. This includes pain medications. So, to start, the pain should be lessened, if not alleviated by the medication. By the time your milk comes in, you many not even need the pain medication. I am quite sure you will be surprised how quickly you can be up and around after a caesarean.
It may take some more effort on your part to breastfeed after a caesarean, but do not hesitate to ask for help! Your hospital should have a lactation consultant on hand to help you get started. If the lactation consultant isn’t available right away, get family and friends involved. Start breastfeeding as soon as possible following the birth of your baby. Having someone arrange pillows to support you and the baby, or actually hold the baby in place, can make it more comfortable for you to breastfeed right away.
There are different positions that will be helpful to you in breastfeeding after a caesarean. The side lying position is often preferred during the first day or so after surgery. The football, or clutch hold, can also be a more comfortable alternative to the traditional cradle hold, especially during the first week or so after a caesarean.
Even though you may have to overcome some additional challenges in the beginning after a caesarean birth, there is no reason why you can’t nurse your baby happily and successfully. Go for it!
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I have had breast surgery. Will I be able to breastfeed?
It is definitely possible to breastfeed after breast augmentation surgery. It really depends on the type of surgery you had. Milk production is a wonderful system of feedback based on a baby sucking at the breast, and the successful removal of milk. There are many nerves in the nipple area that are ready to deliver messages back and forth about milk needs. If those nerves were severed in your breast surgery, then the chances of you being able to fully sustain your baby at the breast are decreased.
Some reduction surgery is designed to deliberately avoid severing the nerves, and breastfeeding is generally more successful in those cases.
If you had the kind of surgery in which your nipples were completely detached and sewn back on in a new location, then most likely those nerves were severed. Amazingly, some women who have had this kind of breast surgery have had the nerves grow back. There isn't any way to predict this however. Do you have any feeling in your nipples? That would be a good sign if you do!
I would encourage you to find a lactation consultant - preferably an International Board Certified Lactation Consultant (IBCLC) - to work with before and after your baby is born. Find out as much as you can about your surgery, and also about how breastfeeding is SUPPOSED to work. That will help you identify how things are going early on, and you can monitor how things are going. You may be able to partially breastfeed at least, and supplement as necessary. ANY breast is better than none!
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I’ve just found out I’m pregnant again – should I keep breastfeeding my 6 month old?
Yes, you can continue to breastfeed! Your body will continue producing milk throughout your pregnancy. It's even possible to continue feeding your older child after your new baby is born - this is called tandem feeding.
Breastfeeding during pregnancy is fine for most women, although it's important to eat well. Hormonal changes in the early days may give you sensitive nipples making breastfeeding difficult. Nipple stimulation through breastfeeding or making love will cause mild uterine contractions, but, for most women, these are not strong enough to create a problem. However, if you have a history of premature labor or miscarriage, or if you are bleeding, then you might need to think about weaning your older child.
During the fourth or fifth months of your pregnancy, your milk reverts to colostrum (the nourishing pre-milk produced by your breasts in the first few days after birth), so the taste changes and volume decreases. Some children decide to wean themselves at this point, although others persevere. If your baby wants to continue, don't worry about using your colostrum up; your body will continue to produce this special milk until your new baby needs it. You might need to keep track of your older baby’s weight gain at this point, since the volume decreases.
It is also worth thinking about whether you want to continue feeding your older baby once your new baby arrives. If tandem feeding is not for you, it will probably be less traumatic to wean your older child while you are pregnant rather then waiting until the new baby arrives and he is in danger of feeling usurped anyway. If you are not yet pregnant, but trying, bear in mind that it can be harder to conceive while breastfeeding, as some women find they don't ovulate until they wean.
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I have inverted nipples. Will I be able to breastfeed?
Absolutely! The baby feeds at the breast (really the areola) and not on the nipple. In many women who seem to have flat/inverted nipples, the situation seems to correct itself during the last trimester of pregnancy or when breastfeeding is initiated. Truly inverted nipples are rare. There are many types and shapes of nipples and breasts, all perfectly normal. A perceived "anomaly" and the expectation of a problem are what seem to create an obstacle to breastfeeding. In fact, worrying about the adequacy of your nipple and feeling that they are not right may zap your confidence and make you give up and give him a bottle too soon.
However, for mothers with flatter nipples, it is possible that early feedings may require closer attention, but this is by no means a contra-indication. In this situation, it is even more important to avoid artificial nipples, since the difference in stimulation from the artificial nipple compared to that of the mother's is even more marked. That being said, don't forget that no woman's nipple resembles an artificial nipple! My last advice is believe in yourself. You can do this! If you expect to fail, you will. And always remember you breastfeed not nipplefeed!
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The First Week
Is it normal to feel pain when breastfeeding?
Breastfeeding is not supposed to hurt! While it isn’t uncommon to hear of discomfort during the first week or two of breastfeeding, pain DEFINITELY shouldn’t be a part of your breastfeeding routine! Here are some of the causes of breast/nipple pain while breastfeeding.
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At the beginning, even if your baby is latched on properly, you may have 30 to 60 seconds of discomfort (from the nipple and areola being pulled into your baby's mouth), then the discomfort should subside. But if you continue to feel pain, stop feeding momentarily and reposition your baby on your breast.
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A baby who consistently latches on wrong, sucking on the nipple without getting much of the areola in his/her mouth, it can cause discomfort throughout each feeding. Some mums say it's painful or feels like a pinch as their babies nurse. A little education for baby on latching-on should prevent any further pain in this situation.
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If breasts become sore and you have flu-like symptoms as well as fever and red streaks on your breast, you may have an infection in your milk ducts called mastitis. If you have any of these symptoms, call your doctor. If he or she finds that you have mastitis, the infection can be easily treated with antibiotics.
- Pain can also mean a yeast (or thrush) infection in your breast. It's important that you call your doctor if you have any of these symptoms: shooting breast pain either during or after feedings, pain deep within your breast, strong pain in the breasts or nipples that doesn't get better after properly latching on and positioning your baby, nipples that are cracked, itchy, burning, and are pink, red, shiny, flaky, or have a rash with little blisters. Babies with oral thrush may have cracked skin in the corners of the mouth, and whitish or yellowish patches on the lips, tongue, or inside the cheeks.
- Sore breasts also may be a sign of a plugged milk duct, in which a particular duct gets clogged.
- Women who have inverted nipples (that turn inward rather than protrude out) or flat nipples (that don't become erect as they should when your baby is nursing) also may have trouble breastfeeding and may experience frequent nipple pain. If either is the case, talk to your doctor or a lactation consultation about ways to make nursing easier and reduce any pain. There are techniques that really work!
There is an answer and cure to almost ANY breastfeeding challenge, including nipple pain. If you find that you're consistently unable to nurse your baby without pain, be sure to call your doctor or a lactation consultant. They will be able to help.
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How often should I feed my baby to bring in my milk supply?
Good question! A new baby needs to nurse at least 8-12 times in 24 hours. To breastfeed successfully, it's important to nurse whenever the baby is hungry. Usually this works out to a feeding every 1 ½ - 3 hours (timed from the start of one feed to the start of the next). Some babies like to bunch several feedings into only a few hours, and then may take a longer nap. It sounds like a lot but remember that this is only at the beginning. Your baby will begin to take more at each feeding and will start to go longer between feedings in a couple of months.
Watch for feeding cues, even if he is asleep. Try to feed him before he starts crying. Watch and listen for:
- Sucking movements of mouth and tongue
- Restlessness or increased body movements, especially hand to mouth movements
- Rooting- when baby turns head to the side and opens up his/her mouth
- Crying (a late feeding cue)
Leave the baby on the first breast until he will no longer suck and swallow when you massage the breast. Then (after a nice burp!) nurse on the other side if he is willing. It's fine to nurse on just one breast per feeding if your baby is satisfied. Let the baby decide when the feeding is over - he will let go on his own and probably fall asleep.
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My milk has come in and my breasts feel like they’re going to explode. How can I get relief?
Ouch! Breast engorgement can hurt! It typically occurs when the milk comes in somewhere between day 2-5. Some mothers will experience only slight fullness and others will become very full, tender and lumpy. Engorgement usually is relieved within 24 to 48 hours, but the following suggestions will help to give you some relief even sooner.
- Nurse your baby frequently (every 2 -2 1/2 hours or sooner); do not let him go longer than 3 hours between feeding in the first week of life.
- Nurse baby at least 15 to 20 minutes after "let down" has occurred. Breasts should feel softer after feeding.
- Let baby "finish" first breast before offering second breast.
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Use cold packs on the breasts for 20 minutes after nursing and about once an hour between feedings.
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Fresh cold cabbage leaves may be applied to decrease swelling: (1) Wash leaves of cabbage and crush in hand or roll to break veins of cabbage, (2) Apply enough cold leaves to cover entire breast and underarm area, (3) Lay down on back to elevate breasts higher than heart. Ice packs may be applied over cabbage, (4) When cabbage is warm and wilted remove and reapply new cold leaves if engorgement is still present. Caution: Use only long enough to make yourself comfortable - cabbage can "dry milk up" if used after engorgement is over.
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Warm heat can be applied to breasts for 3 to 5 minutes just before nursing infant to help milk "let down".
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Hand express or pump breasts to soften areola if infant is having difficulty latching on to breast. Remember to pump only until comfortable because you don’t want to increase your milk supply.
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Ask your doctor about taking pain relief medication if needed for discomfort.
Remember, engorgement is a temporary condition and a GREAT sign that you have a wonderful milk supply. So, keep up the good work!
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Do I always have to offer both breasts at each feeding?
One or both breasts? That is the question! Many mums wonder whether they should feed from one breast or both at each feeding. Really, there is no set rule. But, here is what I have found to work best.
1. Feed your baby on one breast, for as long as he/she is actually getting milk from the breast(typically until the baby comes off himself, or is asleep at the breast). If your baby feeds for a short time only, you can compress the breast to keep the baby feeding, not just sucking. Please note that a baby may be on the breast for two hours, but may actually feed for only a few minutes. In that case the milk taken by the baby may still be relatively low in fat. This is the rationale for compressing the breast. The longer the baby feeds, the higher in fat the milk (which means longer spurts in between feedings). If, after "finishing" on the first side, the baby still wants to feed, offer the other side.
2. At the next feeding, you should start the baby on the opposite breast in the same way. Keep track of which breast baby fed from last.
3. Your body will adjust quickly to this method and you will not become engorged or lop sided.
There is no “rule” for feeding both breasts at each feeding. Do what is comfortable for you and your baby. A growing, happy baby is the goal! Whatever works for you will be perfect for your baby.
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Everyone talks about correct positioning and attachment but I’m not sure what they mean.
Positioning and correct attachment means everything in breastfeeding. Breastfeeding is a natural function and most babies know what to do intuitively. Chances are, your child will be eager to begin suckling soon after birth. But don't be surprised if you both need a little help getting started, especially if you've had a long and difficult delivery or baby is not hungry right after being born. Learning to latch on may take a bit of time and patience, but you'll both soon get the hang of it. There are many positions you can use to feed our baby. I will explain the favourite three positions you may use to feed your baby: cradle hold, football hold, and lying down.
Let's first talk about how to latch on properly (using the cradle hold). Get comfortable in bed with pillows to support your back, or in a chair. Place baby in the crook of your arm, rotating his entire body toward you. Bring baby's head up to your breast. Check to see that he is facing straight toward you and that his head, chest, and abdomen are all aligned. Using the opposite hand, take one of your breasts and tickle baby's lips lightly with your nipple. Stroking his lips with the nipple stimulates the rooting reflex, and he is inclined to open wide to get the breast in his mouth. Use your other arm to cradle baby and support his head.
Now comes the tricky part! Once baby's mouth is fully open (should look like he is yawning), swiftly bring him to the breast. Your baby's instinct will tell him to latch on and begin nursing. Avoid the urge to lean closer to baby to get the breast in his mouth. It's tempting to go to baby, rather than bring baby to you, but it causes you to hunch over, which could lead to back strain.
How do you know baby's on the breast the right way? Pain can be your guide. It shouldn’t hurt! The goal is getting baby to compress the areola (the dark area around the nipple) to get milk, not to nurse from your nipple. In fact, your nipple needs to be in the back of baby's mouth during nursing in order for him to correctly compress the areola and activate milk flow. The correct latch will be fairly tight, and you can check correct positioning by looking to see whether most of the areola is in baby's mouth. If nursing hurts, chances are your baby is latching on to the nipple. This is a sign to remove the baby and reposition. Gently insert your pinkie finger into the corner of your baby's mouth to break his grip on the breast and begin again.
Cradle
The cradle position is rather self-explanatory. Your baby lies in the crook of your arm, which you use to move her around to get close to your breast. Sit up with plenty of support for your back. I also put a pillow on my lap to help lessen the strain on the arm that I was using to cradle the baby. A pillow also helps when you are switching sides, as it provides a soft place for baby to take a short time-out between breasts.
Football
I think this position offers more control when trying to get baby to latch on properly, largely because you can better guide his head. To begin, you'll need at least two pillows. Place one pillow on your lap and the other pillow to the side of you. Put the baby on your lap with his legs pointing toward your back, keeping your hand under his head and back for support. Make sure his mouth is level with your nipple before you begin. This is a great position for nursing twins because you can feed two simultaneously. It's also good after caesarean delivery since it keeps pressure off your abdomen.
Lying Down
This position was invented for tired mums! Begin by lying next to baby on the side you want to nurse on. Turn baby to face you, making sure his mouth is level with your nipple while you support his head and back with your free arm. This is a great nursing position for women recovering from a caesarean birth too.
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Common Problems
My nipples are sore, cracked and bleeding! What can I do to ease the pain and how long will this continue for?
Oohh….sore, cracked nipples! They hurt. Poor positioning and latch-on is the most common cause of nipple soreness in the early weeks of nursing. Sometimes only a minor change of positioning and latch-on is all that is needed. While you are working on the latch-on, here are some measures you can take to help heal your nipples:
Sore nipples shouldn’t last more than a week or so, so hang in there! It does get better.
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I think I have a blocked milk duct. What should I do?
If you have a tender lump on your breast, chances are it’s a blocked milk duct. Milk ducts can become blocked when the lactating breasts become very engorged and are not emptied regularly. Blocked ducts will almost always resolve spontaneously within 24 to 48 hours after onset, even without any treatment at all. During the time the block is present, you may find that your baby is fussy when nursing on that side, as milk flow may be slower than usual, probably due to pressure, causing collapse of other ducts.
You can treat a blocked duct with self-care measures, such as warm, wet compresses or showers and massages before breastfeeding. Try to massage towards the nipple to encourage the blocked duct to empty. Applying pressure on the blocked duct while your baby nurses can quicken the emptying process too. Also, empty the affected breast more effectively by feeding from it first, breastfeeding more often, and using different nursing holds. You can also try using ibuprofen (such as Advil) to reduce swelling as it can help relieve a blocked duct too.
Luckily, blocked ducts resolve pretty quickly. But if it's taking too long and you still feel a lump, call your doctor or lactation consultant for an examination.
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I have another bout of mastitis. How can I prevent it from happening again and what treatments are available?
Mastitis is a breast infection of the milk ducts. It happens when bacteria enters the breast through an opening in the nipple (especially cracked, irritated nipples) or any break in the skin of the breast. Once the bacteria enters the breast, the damaged tissue becomes infected. With mastitis, you will need to contact your doctor to get a prescription for antibiotics. Mastitis will not clear up on its own, so please don’t delay getting treatment. Complete the entire treatment of antibiotics to avoid a recurrence.
As with engorgement and blocked ducts, there are some comfort measures you can use until the breast heals. Use warm heat on the infected area before breastfeeding to aid let-down and relieve pain. You could try a warm shower using the Shower Hug or soaking the breasts in a pan of warm water works well. Continue to breastfeed frequently on both breasts. Your milk is not infected and is perfectly fine for your baby. Apply cold packs after each breastfeeding to relieve pain and reduce swelling. Drink enough fluid to satisfy your thirst. Water and unsweetened fruit juices are best. Ask your doctor for pain relief medication if needed. And, most importantly, get plenty of rest (I know, easier said than done with a new baby!)
Here are some tips you can use to prevent further occurrences of mastitis:
- Position the baby correctly on the breast and use 2-3 different breastfeeding positions each day.
- Do not delay or miss feedings, but if you do, or if the baby breastfeeds poorly, hand express or pump to soften the breasts and relieve fullness.
- Avoid bras that are too tight or that bind and bras with underwires.
- If you’re weaning, do it gradually. Pump or hand express to soften the breasts and relieve fullness.
As always, if you have any further questions regarding mastitis, please contact your doctor or lactation consultant. They are there to help you!
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How do I treat nipple thrush?
Thrush (Candida) is a yeast infection that can be passed back and forth between your nipples and your baby's mouth.
Symptoms may include the following:
- Pink or red (unusually so) nipples that may or may nor be cracked or rashy. Nipples may not have any visible symptoms.
- A burning sensation on nipples and possibly a deep stabbing or shooting pain within the breast.
- Your baby may have white patches in her mouth that do not come off when lightly wiped at.
- You may also be experiencing a vaginal yeast infection or your baby might have a yeast rash (a bright red or pink nappy rash that might be peeling or resemble a burn).
- Pain caused by thrush generally is constant throughout a nursing session.
Some things to know about thrush:
- If you or your baby have been on antibiotics recently, and you have some of the above symptoms, suspect thrush. The use of antibiotics can trigger yeast infections.
- Treatment for thrush takes several forms. Your doctor may prescribe a medication to treat you both, usually a topical ointment for your nipples and a syrup liquid for the baby's mouth. There are also some effective over-the-counter treatments available. Even without treatment, thrush will sometimes go away on its own, however I would emphatically recommend treatment as it can be painful and may eventually be detrimental to breastfeeding. Occasionally thrush just seems impossible to get rid of, and you can keep passing it back and forth if either you or your baby didn't get properly treated.
- Contact your doctor or a lactation consultant to verify thrush. Thrush is quite common and does NOT mean you should stop nursing.
Things you can do that may help prevent or get rid of thrush:
- Wash your hands frequently.
- Yeast thrives in dampness and warmth, so air your breasts often throughout the day and at night. Change your breast pads FREQUENTLY and do not use plastic lined pads. You might consider using disposable pads until the thrush is gone if you use cotton pads.
- Wash your bras, breast pads, nightgowns and other clothing that have come in contact with the breast in hot water. Boil any items that baby’s mouth has been in contact with for five minutes or replace to avoid reinfection.
- Try rinsing your nipples several times a day with a mild vinegar solution (1 cup of water to 1 tablespoon distilled vinegar) Air dry.
- Many people have found that eliminating yeast and sugar from their diets can help avoid Candida infections and/or speed up recovery from them.
- Eat yogurt that has acidophilus in it or take acidophilus capsules. This can also be used as a preventative measure if you need to take oral antibiotics. Often if you take acidophilus while you are taking the antibiotics it can stave off a yeast infection. You can also try applying yogurt containing acidophilus to your nipples, and even your baby's bottom if he has a yeast rash there too.
Yeast is certainly not fun! But, if you follow these tips, you should be on your way to healthy nipples again. And, more importantly, you can prevent this annoying problem from ever happening again in the future.
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What is a breast abscess? Do you have to stop breastfeeding if you have one?
Depending on the location and the extent of the abscess, you may or may not be able to nurse on the infected breast. Normally, breastfeeding is not interrupted, even with an abscess. Your healthcare provider can help you determine whether breastfeeding will be ok in your particular case. If you are temporarily unable to breastfeed on the breast with an abscess, use an electric breast pump to empty the breast and nurse baby more frequently on the other breast. Apply moist heat to the affected area before nursing or pumping to help the milk flow.
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Milk Supply & Feeding
How do I know if my baby is getting enough breast milk?
This is the question almost ALL new mums ask me! Here are some sure signs that your baby is thriving on breast milk:
Wet nappies and bowel movements
An exclusively breastfed baby should average six to eight wet nappies and two to five plus bowel movements in 24 hours after the first 3 days of life. (Before that time, she should have at least one bowel movement per day of life. Example: 1st 24 hours = 1 BM, 2nd 24 hours = 2 BMs, etc. in addition to wet nappies.) Remember that disposable nappies can hold several wets in each. If you want to be sure, simply place quarter of a cup of water in a disposable nappy and place it next to the changing table. You can 'weigh' a nappy to estimate how many wets are in it. You will also notice a change in the color and consistency of bowel movements as your mature milk comes in. They will change from the 'tarry' meconium to a mustard colored (or green) cottage cheese consistency - this is the breast milk stool. It will be very loose, sometimes just a smudge on the diaper, and have a sweet odour.
Frequency of breastfeeding
In the early days, babies should be breastfed an average of every two to three hours during the day and at least every four hours at night. Nursings usually last approximately 30 minutes. Don't be surprised if your baby doesn't fall into the 'average' category. She may very well want to nurse more often and that is just fine. We do get worried when a baby is going for long stretches between nursings (more than four hours during the day) because usually these babies do not nurse well once they are put to the breast. Often termed 'sleepy babies', these babies are at most risk of getting insufficient milk. Don't be afraid to wake your baby to nurse. Again, don't be afraid to wake your baby to nurse! In time, these babies will begin to self-wake to feed, but you may need to coax them a bit in the beginning. We also look for other signs of breast milk transfer such as swallows during nursing and the baby acting satisfied at the end of the feeding. But remember that wet nappies and bowel movements are a more accurate way of judging how much your baby is getting. There are some babies who just come out being very efficient nursers who can get all the milk they need in a short amount of time.
Weight gain
On average, babies usually gain approximately 100-170 grams (4-6 ounces) a week during the early weeks. There are also other signs of growth such as length and head circumference. Also, genetic factors can play a part here. If you and/or your partner are thin/tall, then your baby may follow along your same path and grow quicker in length than in weight. Illness can also affect weight gain. It is very important to look at the entire picture when there is concern over weight gain. If a baby is otherwise doing well, with plenty of dirty nappies, then there is little reason to worry.
If you ever have a concern that your baby isn't getting enough, call and talk to a trained health care professional before you reach for the any formula. Often times, it is the mother's perception that the baby isn't getting enough, rather than fact. This is particularly true during growth spurts that occur around 2 weeks, 6 weeks, 3 months and 6 months. All of a sudden a baby will ask to nurse more often and the mother may think baby is not getting enough when in fact baby is simply trying to get the milk supply ready for the spurt. So, pick up the phone before rushing to the store.
Also, pop in to your Early Childhood Health Centre for a weight check if you need to. Anything that is going to give you the security you need to be sure your baby is doing well is fine. And remember that you know your baby best . . . there are many things that can be done to increase your milk supply should it become necessary.
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I think my milk supply is low – how can I increase it?
First, it's important to assess if you're truly dealing with a low milk supply. Sometimes mothers can perceive normal breastfeeding patterns and/or baby behaviour as an inadequate milk supply. If you determine that you really do have a low supply, consult with a lactation consultant to determine the “why” behind it so that you can get to work fixing the problem and prevent it from occurring again.
In most cases, it is just a matter of getting reassurance from a lactation consultant or health care professional that your milk supply is fine. But, there are cases where the need to increase milk production is necessary. If baby isn’t gaining weight quick enough or is losing weight, an increase in milk supply is crucial to baby’s health and wellbeing.
If you are one of those mums who need to increase your supply, take heart! It is easier than you think!
Here are some of the best ways to increase milk supply:
Don’t give up! There are ways to increase your milk supply or even bring back a supply that has completely dried up. Remember that your body grew your baby, and there is no better food than what your body custom-produces for your child. With a little effort and determination, you can overcome this breastfeeding obstacle and continue to give your baby the food that Mother Nature intended!
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My baby wants to nurse all the time and I’m exhausted. What can I do?
It can be very exhausting when baby wants to nurse all the time! But, there usually is a good reason! One reason your baby might feed more frequently is in response to sudden growth spurts. Babies can grow as much as 1.25cm in a 24-hour period. No wonder they need to breastfeed frequently for several days! Breastfeed as frequently as your baby indicates a desire. Your milk supply will soon catch up to the increased need. Giving bottles of formula at this time will only sabotage the natural supply and demand cycle, and you will be unable to catch up with your baby's needs.
In addition to growth spurts, some babies love to be held and nursed frequently as a way of helping them to adjust to life outside the womb. In fact, the first three to four months of life for all babies is a transition from the womb to the world. During "increased appetite" days, set aside other commitments to focus your energies on your baby. Sleep when your baby sleeps to recharge your system after these high-need periods. "Wearing" your baby in a sling or front carrier may be helpful. Just as a toddler needs a periodic hug and kiss to make the world right again, a newborn may need to be cuddled and even nursed for a while.
As babies get older, they learn other ways of self-comforting, and breastfeeding sessions generally become shorter and less frequent. Don't worry...there will come a time when you will get plenty of rest! Believe me, you will miss the special bonding that occurs during these seemingly endless nursing sessions.
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My baby keeps going to sleep during feeds. How can I keep her awake?
Oh, those sleepy babies! This is the number one challenge I hear from new mums. Here are some suggestions to keeping baby awake:
1. Uncover baby. Removing blankets or socks, opening clothing or undressing baby, or changing the nappy, may waken him.
2. Express breast milk onto your nipples and baby's lips. This may stimulate sucking even though he isn't fully awake.
3. Apply a cool (not cold) wash cloth to his cheeks or forehead.
4. Try gentle body manipulations (such as gently pulling him into a sitting position) or infant massage to stimulate him. When doing "sit ups", make sure the baby bends at the hips, rather than at the waist.
5. Keep room light dim, as bright lights may encourage him to close his eyes.
6. Change the nappy between sides.
7. Stroke the baby gently around the lips and under the chin.
8. Gently jostle your nipple when you notice your baby's sucking pattern slow down.
9. Rub or pat his back; walk your fingers up his spine; gently rub his hands and feet; massage his crown in a circular motion while nursing.
10. Chatter or sing spiritedly to him as he nurses; try to maintain eye contact.
11. Try "switch nursing". Whenever you notice your baby's sucking pattern slowing down, remove him from the breast, burp him, and offer the other breast. When his sucking pattern slows on the second side, remove him, burp him and return to the first side. Try to nurse at least twice on each side.
12. Try using the clutch ("football") position rather than the cradle or lying down.
Make sure your sleepy baby is latching on well, getting all the nipple and as much of the areola as he can in his mouth. The stimulation of the nipple well-positioned in his mouth may also help rouse him. You can also try gently compressing the breast to increase flow. The sleepy baby requires lots of stimulation. Avoid quieting maneuvers such as rocking, too much non-nutritive sucking (especially pacifiers), and swings.
Be patient, Mum! Soon your baby will be awake for much longer periods of time and won’t require any work to keep him/her awake during feedings.
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Formula & Supplements
I am getting pressured by family to stop breastfeeding. My partner feels left out and my mother keeps telling me formula is much better for baby. I’m very tired but I really want to continue breastfeeding.
Everyone has an opinion about the "right" time to stop breastfeeding but weaning is a highly individual decision influenced by cultural norms, personal health issues, and family circumstances. There will be people in your life who think you've waited too long to make the transition from breast to bottle or cup and others who will question your decision to stop if you do so before the recommended one year.
It's perfectly normal for your husband or partner to feel left out of the breastfeeding equation, and to worry that your breasts are now off-limits to him. Feelings of inadequacy may be behind his resentment; try reassuring him that this phase in your lives will not last forever and encouraging him to spend lots of time snuggling with the baby and partaking in the many other caring roles of a new parent. It can also be hard for a man to take a back seat in your relationship whilst you are so closely involved with your baby. Try to remember to make some time for him, too.
Information and communication are also critical to winning your mum's support. Talk to her about the benefits of breastfeeding. These breastfeeding days will be gone before you know it, and you'll never be able to replace the vitamins, nutrients and protection against infection that your child has missed out on, if you discontinue breastfeeding. If your mum thinks that bottle-feeding is the way to go, remind her that, in addition to being far less healthy, formula milk is expensive and takes longer to prepare!
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Should I give my breastfed baby vitamin and mineral supplements? I’m worried he’s not getting the Vitamin D and fluoride that formula-fed babies get.
Human milk is nature's ideal diet for infants. When breastfeeding goes well, a baby will consume adequate quantities of human milk to meet all her nutrient requirements for about six months of life. The milk produced by a well-nourished woman has ample amounts of vitamins. Human milk is relatively low in vitamin D, but this vitamin is synthesised in the skin in ample amounts if a person is exposed to sunlight. Dark-skinned individuals require more sunlight exposure than light-skinned persons.
While vitamin and/or mineral supplements may be required for premature infants and those with special health problems, no vitamin or mineral supplements are necessary for healthy, breastfed infants of well-nourished mothers. Nevertheless, some doctors routinely prescribe liquid multivitamin preparations for breastfed infants "just in case." This practice probably does no harm beyond the added expense and hassle of trying to get your baby to take the vitamins. However, a few mothers report that their infants react adversely to vitamin preparations, either refusing them or acting fussy afterward. If that is the case with your baby, ask your doctor whether a valid indication exists for prescribing the supplements.
Babies, even those exclusively breastfed, should NOT be given fluoride supplements in the first six months of life. Thereafter, infants whose families reside in nonfluoridated areas should receive fluoride supplements, although the recommended dosage has been reduced over the first six years of life. The drops can be prescribed by a physician or dentist. If your community water supply is adequately fluoridated, your baby should NOT receive any supplemental fluoride, even after six months of age.
Rest, stay healthy, eat and drink well….in return, your body will make the most nutritious meal for your baby, your milk!
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Is it true that formula-fed babies sleep better at night?
Formula requires a baby's digestive system to work overtime as baby tries to digest something not specific to the human body. Formula is harder to digest than human milk; thus formula-fed babies tend to go longer between feedings. While this may seem like a benefit, it's definitely not something we want for our babies' bodies unless there are no other alternatives. There are also other risks to formula use. There is absolutely nothing better to give to your baby than your milk. Formula certainly has a place in infant feeding, in certain situations, but shouldn't be used whenever mum's milk - either directly from the source or expressed - is available. Before you know it, your baby will be sleeping longer anyway! Why shouldn’t he have the best milk available(yours!) along the way?
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My baby seems constantly hungry. Should I give formula as well?
Chances are, your baby is going through a growth spurt. At about 10 to 14 days, six weeks, three months and six months of age, many babies appear to be hungry all the time. This is due to rapid growth and is known as the “growth spurt”. Mothers who don’t understand what’s happening often stop nursing at this time. Actually, you should meet your baby’s demands by nursing frequently. Assuming your baby is growing adequately and having enough wet nappies every day, you should not need to supplement with formula at all! Your milk supply will increase with the increase in feedings and your baby will usually settle down within 48 to 72 hours. Once your milk supply has increased, you’ll find that your baby will begin to sleep longer between feedings.
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Expressing & Pumping
How do I hand express milk?
Why express? Expressing and storing your breast milk is a great way for you to continue to feed your child when you return to work or when you simply just need me time.
Here is the best way to hand express.
Step 1: Choose a time to express when your breasts aren't too full. This will make it easier to get a good flow.
Step 2: Wash hands and prepare a clean area for expressing. A comfortable chair by the kitchen table is a good option.
Step 3: Sterilise container for collecting breast milk. You can express right into a pre-sterilised bottle liner. However, it may be easier collecting into a larger container the first few times.
Step 4: Clean and dry your breasts. As you express, dry your breast as needed to help with grip.
Step 5: While massaging above your breast to promote let-down. Hand expressing can also be done right after baby nurses while milk is still flowing.
Step 6: Place thumb at top of breast and two fingers below, about 2-3cm away from the areola. Push and roll fingers toward the nipple, avoiding pinching.
Step 7: Continue the push and roll until a flow is established. Express each breast 5 to 7 minutes, or until the flow slows down or stops.
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How do I express milk with a breast pump?
Getting tired expressing by hand? A pump may be best for you!
Here are some tips for pumping:
Preparing to pump:
- Wash hands before handling any of the breast pump parts, the breasts or expressed breast milk.
- Wash the parts of the breast pump that touch the breast or the expressed milk with hot soapy water and rinse.
- Read the instruction in the pump accessory kit before using the pump. Centre the breast shield over the nipple so the nipple can move in and out without rubbing against the sides. Turn on the pump after positioning the kit.
- If using an electric pump, always begin pumping with the suction regulator on minimum.
- Make yourself comfortable before pumping. Sit with your shoulders relaxed and back supported. Have everything you need, including something to drink, within reach.
- Relax to help your milk "let-down." Many women find that their milk lets down when they think about their baby or look at a picture of their baby while pumping.
- Try breast massage or warm compresses on the breasts before pumping. Some women gently stimulate the nipple before using the pump. Moisten the breast before placing the shield on the breast to create a "seal."
- Double pumping (pumping both breast at the same time) is effective for mothers who have limited time available for pumping breaks. This option can cut pumping time in half and milk production is stimulated more effectively by increasing prolactin levels.
Pumping breast milk:
- Pump about 15-20 minutes at a time when using a single pumping it. Switch breasts when the milk flow decreases (or about every five minutes). If double pumping, expect to pump for around 8-10 minutes.
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Human milk can vary in colour, consistency and smell depending upon the time of day the milk was expressed and the age of the baby at the time of pumping.
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Good times to express milk are upon awakening in the morning or when the baby has not completely emptied the breasts. If the baby is sleeping for long periods (4-6 hours) try pumping after baby has been asleep for 1-2 hours.
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Remember that pumping and/or hand expression is a learned skill. Effectiveness improves with practice.
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The amount of milk pumped depends on many things: how long it has been since baby nursed, how practiced the mother is at pumping, how comfortable she is in her pumping setting, the time of day, how established is her milk supply, and her level of stress.
- A nursing baby will always be more effective at emptying the breast than a pump. If the amount pumped in the beginning is small, that does not necessarily reflect the your milk supply.
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I tried pumping but only got 20ml!
Not being able to pump - or not pumping too much milk - is not a sign that your body isn’t producing enough milk. A baby is always more effective than any pump, and this is even more true when baby is very young (less than 2 months old) and/or you haven't been pumping daily at the same time for at least a full week. Also, if you are pumping 20mL after your baby nurses, that is a lot of milk. Remember that your baby is getting most of your milk so the 20ml is just extra!
If you are getting 20ml during a skipped feeding pumping session and were expecting much more, take heart! Unless you have a hormonal problem (usually thyroid problem or PCOS) or have had breast (or chest) surgery at any time in the past, it is almost certain that you are making plenty of milk. So, keep up the pumping. Your body will adjust to it and you will soon see an increase in expressed milk.
If, after reading the above, you still think you have a problem, then please contact a local Lactation consultant. She will be able to help you more because you can give her detailed information.
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My sister has offered me her breast pump – is it safe to use?
Concerned about buying a used breast pump? You definitely should be!!! Although a used pump may be slightly less expensive than a new one (or in your case, free of charge), there are real health issues involved.
The practice of re-using single user pumps may be dangerous because breast milk is a body fluid. As with any other body fluid, some disease organisms are known to be present in the breast milk of infected women. Additionally, if a woman has used the breast pump during an episode of cracked bleeding nipples, blood contamination may have also occurred. Home sterilisation methods cannot ensure the safe destruction of all pathogens especially in the rubber parts such as washers and diaphragms. Some pumps have internal diaphragms that cannot be removed and cleaned or replaced.
In addition, even if you get a new collection kit (the part that touches your breast and collects the milk) it may be possible for air-born pathogens or droplets of milk that are not visible to the naked eye to get into a pump motor and cause contamination to the next user. Most single user pumps are "open system" pumps and do not have any protective barrier to prevent cross contamination to multiple users.
Diseases that can be found in the milk or blood of infected women can be very serious or life threatening. Pathogens like Human immunodeficiency virus (HIV), hepatitis, cytomegalovirus (CMV) and others can be found in the breastmilk of infected women. These diseases frequently go undiagnosed for long periods of time, so even if the former user of the pump is trustworthy and willing to share this personal health information with you, she may not be aware she or her partner are carriers. It just isn't worth the risk!
Other very difficult to clear fungal infections like candidiasis, more commonly known as yeast or thrush, may also be transmitted. Yeast organisms are very stubborn pathogens that can live on surfaces for long periods. Some lactation consultants will go as far as recommending replacing old pump equipment when working with a mum who has an especially persistent yeast infection because of the difficulty in ensuring the complete destruction of the fungus even with careful cleaning.
In addition to the health risks of borrowing a pump there are ethical ones as well. I have worked with several mums who purchased or borrowed a used pump from a friend or relative, only to have that pump break or stop operating while they were using it. These mums then felt obligated to purchase a new pump, spending a lot of extra money in the process.
The approximate cost to formula feed a baby for one year is $2,600.00; a new breast pump is very reasonable compared to that price. Almost all breast pumps come with a warranty, but this only applies to the original owner: any sharing of the pump negates the warranty.
The Food & Drug Administration (FDA) in the US have a statement regarding used breast pumps: "The following statement is FDA's position on the matter of reuse of breast pumps labeled for a single user. FDA does not regulate the sale of individual breast pumps by individuals to other individuals. Rather, we regulate these medical devices when they are in interstate commerce. We have not said that this practice is legal or illegal. Instead, we have the following position, which recommends that if the pump cannot be adequately disinfected between uses by different mothers, that the pump not be used by different mothers." "FDA advises that there are certain risks presented by breast pumps that are reused by different mothers if they are not properly cleaned and sterilized. These risks include the transmission of infectious diseases or the risk of improper function. FDA believes that the proper cleaning and sterilization of breast pumps requires the removal of any fluid that has entered the pumping mechanism itself. If proper sterilization of the breast pump can not be achieved, FDA recommends that it not be reused by different mothers."
If you are considering buying a used breast pump, please determine whether or not the pump is a "single user" pump before purchasing it. You are giving your baby the absolute BEST milk by breastfeeding. Please consider the costs and health risks before purchasing a used breast pump. You and your baby are worth it!
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For a number of reasons I am now exclusively pumping. How can I ensure my milk supply remains adequate for baby?
Good for you! There are many reasons why mothers find themselves exclusively pumping. I think it is wonderful that you have decided to pump your precious milk for your baby!
Here are some things you can do to ensure adequate supply while exclusively pumping for your baby.
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Remember Rule #1 - For the first 12 weeks after delivery, you must pump 8-12 times a day (that's every 2-3 hours), for at least 15-20 minutes, or 5 minutes past milk flow. The extra time after milk stops, as well as the frequency, tells your body to make more milk. Try to make sure at least one of your pumps is between 1-5 AM when prolactin levels are at their highest.
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It's normal for your milk supply to build up over time. While some people have a fabulous supply from the get-go, most people will build up slowly. Don't see those collection bottles as a dare - it could be months before you fill them at a single pump (your best bet will be early AM for that!) Remember that milk is a supply-and-demand situation - you need to keep pumping to tell your body to make more milk.
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Power pumping involves pumping every 2-3 hours, no matter what, for 2-3 days. Especially during growth spurts, power pumping is highly recommended. Try to awaken throughout the night for optimal results. That is why it is recommended to do on weekends when your husband/significant other may be home to help with night feedings.
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There's no need to gorge on water, but make sure you're getting at least 8 glasses a day. Some people notice more drastic supply changes due to hydration than others.
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Make sure you're getting enough calories. It can be tough with all the new action in the house, but you need food to make milk.
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Many people swear by eating regular (not instant) oatmeal…basically a big bowl of porridge!
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Lack of sleep and stress can hurt your supply, as can the return of menstruation. Magnesium supplements will combat the supply dip associated with this.
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Galactagogues (substances that increases milk supply) can be used. Herbal supplements, such as Fenugreek can be taken in capsules. There are some fantastic herbal tea blends which contain Fenugreek or other milk producing remedies. Please There are prescription drugs available to increase milk supply, however, these may have some side effects. consult your lactation consultant and doctor to discuss what is the best solution for you.
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Working Mother
I’m returning to work soon – can I still breastfeed?
You can definitely continue breastfeeding your baby when you go back to work! The key to continuing to breastfeed after you return to work is planning ahead. To ease the transition back to work, start pumping 3 to 4 weeks prior to returning to work. Try to pump early in the morning(that’s when your milks supply is at its peak due to high prolactin levels) or immediately after feedings. Don’t expect to pump tons of milk after feedings, but if you add up the pumping sessions, you will be have a greater “starter” collection of milk in the freezer.
You will also want to pump at work to keep milk supply going! At first, you may find that it’s a challenge but once you get into a routine, pumping at work will become much easier. And the benefits of breastmilk for your baby are worth the extra effort and time.
Here are some helpful hints for pumping breast milk at work:
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