Nursing Angel is proud to bring you an extensive free online breastfeeding Q&A page written by Heidi Humphries, International Board Certified Lactation Consultant and Neonatal Registered Nurse. This page is for general information only and is not intended to substitute or replace the advice of your healthcare professional. Please see your healthcare professional for specific advice about your unique circumstances and needs.
- Is it safe to breastfeed someone else's baby?
- I think my milk supply is low - how can I increase it?
- Is it safe to use a second hand breast pump?
For Pregnant Mums-To-Be:
- I’m pregnant and want to breastfeed. How can I prepare?
- Is there anything I can do during pregnancy to increase or optimise my milk production?
- 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 six month old?
- I have inverted nipples. Will I be able to breastfeed?
The First Week:
- Is it normal to feel pain when breastfeeding?
- How often should I feed my baby to bring in my milk supply?
- My milk has come in and my breasts feel like they’re going to explode. How can I get relief?
- Do I always have to offer both breasts at each feeding?
- Everyone talks about correct positioning and attachment but I’m not sure what they mean.
- What are the different positions for breastfeeding?
- My nipples are sore, cracked and bleeding! What can I do to ease the pain and how long will this continue for?
- I think I have a blocked milk duct. What should I do?
- I have another bout of mastitis. How can I prevent it from happening again and what treatments are available?
- How do I treat nipple thrush?
- What is a breast abscess? Do you have to stop breastfeeding if you have one?
Milk Supply & Feeding:
- How do I know if my baby is getting enough breast milk?
- I think my milk supply is low – how can I increase it?
- My baby wants to nurse all the time and I’m exhausted. What can I do?
- My baby keeps going to sleep during feeds. How can I keep her awake?
- My baby gets distressed after let-down as my milk only dribbles out very slowly. Nothing I do will speed it up and my baby is starting to refuse the breast after let-down. What can I do to increase milk flow?
- How do I do breast compression?
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.
- 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.
- Is it true that formula-fed babies sleep better at night?
- My baby seems constantly hungry. Should I give formula as well?
Expressing & Pumping:
- How do I hand express milk?
- How do I express milk with a breast pump?
- I tried pumping but only got 20ml!
- Is it safe to use a second hand breast pump?
- For a number of reasons I am now exclusively pumping. How can I ensure my milk supply remains adequate for baby?
- I’m returning to work soon – can I still breastfeed?
- I won’t have time to pump milk at work – can I just breastfeed my baby at night?
- I’m returning to work in a month and would like my baby to be fed expressed breast milk when I’m away. How can I avoid nipple confusion?
Storing Breast Milk:
- What foods should I avoid when breastfeeding?
- Will my poor diet affect the quality of my breast milk?
- I’ve heard about all the benefits for a baby if it’s breastfed – but are there any benefits for the mother?
- Should I keep breastfeeding if I get sick?
- I have food poisoning and am wondering if I should stop breastfeeding until I get better.
- I stopped breastfeeding my baby a few weeks ago but would like to start again – is this possible?
- Is it legal to breastfeed in public?
- Is it safe to breastfeed someone else's baby?
- Can I still breastfeed if I’ve had alcohol, caffeine or cigarettes?
- Is Chamomile Tea safe to drink when breastfeeding?
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.
- Read up! Babies may not come with a manual…but breastfeeding does have plenty of literature. Buy a book that is specifically about breastfeeding, rather than a general baby reference book, as this will have more detailed information.
- Consider attending a breastfeeding education class. These are now run by many hospitals, centres and through the Australian Breastfeeding Association. Enquire with your doctor, hospital or clinic for a class in your area.
- Get in touch with a lactation consultant (or at least get a name and phone number so you know who to call if help is needed), preferably one with the letters "IBCLC" after her name. Ask your doctor, hospital or clinic for local Lactation Consultants they recommend, or find one in your area by searching at the Australian Lactation Consultant Association's website. You may also want to look at hiring a postpartum doula or lactation support person. Support is of utmost importance in breastfeeding success.
- Prepare a breastfeeding area at home. Find a quiet space that will be your nursing space. You'll need a comfortable chair, pillows for support and a stand for your water (you should drink while baby drinks, so always have a large bottle of water at your nursing space). You may also like a foot rest, reading lamp and side table within arm's reach. 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, snacks and of course encouragement.
- Prepare a list of names and numbers that you will be able to call if a breastfeeding problem arises. Do this before baby arrives and keep the list by the phone, on the fridge or somewhere easily accessible. Getting support early could mean the difference between sticking with it and quitting.
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Is there anything I can do during pregnancy to increase or optimise my milk production? I had problems with milk supply with my first baby and want to do everything possible to ensure I have a good milk supply this time around.
Unfortunately, I don't know of anything you can do during your pregnancy to increase your milk production for when the baby is born (besides eating healthy foods!) I can assure you that many mums who had problems nursing their first baby have a much easier time with the second. The best way to prevent problems is to educate yourself beforehand about the basics of latch on and positioning and what to expect when the baby is born. Also have a good support system in place in the event that problems do develop.
I don't know what kind of support/advice you had before, but if you gave up on nursing because of low milk supply, then something was wrong. There are only a small percentage of mothers who can't breastfeed, and most of the time this is due to medical problems that can be corrected. A good lactation professional will be able to work with you to discover the cause of the problem and make recommendations to fix it early on, whether the problem is soreness or low supply or whatever.
It is very important to have a good support system in place so that you will have someone to call for advice at the first sign of problems. Find out if there are any lactation consultants (IBCLCs - International Board Certified Lactation Consultants) in your area. These are healthcare professionals who have received extensive training in lactation, above and beyond the training that doctors or nurses receive. They are the only members of your baby care team whose focus is primarily breastfeeding. Most major hospitals have IBCLCs on staff, and some IBCLCs are in private practice.
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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 many 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 and pain relief are compatible with breastfeeding, however let your doctor know prior to surgery that you are planning to breastfeed your baby.
After a C-section, the pain should be lessened, if not alleviated by the pain medication. By the time your milk comes in, you may not even need the pain medication at all. You may be surprised how quickly you can be up and around after a caesarean.
Initially 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 surgery (augmentation or reduction) or other chest surgery although 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 work with a lactation consultant - preferably an International Board Certified Lactation Consultant (IBCLC) - 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 six 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 labour 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, making you want to quit breastfeeding. 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. Talk to your lactation consultant about the issue and the possible use of nipple shields to assist or try the Avent Niplette or Pigeon Nipple Puller
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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For New Mums
Is it normal to feel pain when breastfeeding?
Breastfeeding is not supposed to hurt...although for many mothers it does! While some discomfort is normal 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 and what you can do about it:
- 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. If you continue to feel pain, stop feeding momentarily and reposition your baby correctly on the breast.
- Pain can arise if baby latches on wrong, such as sucking on the nipple without getting much of the areola in his/her mouth. It's important for baby to latch on properly, not only to get rid of the pain but to ensure proper stimulation to extract milk. Speak with your healthcare professional to learn proper latch on techniques.
- 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, contact your doctor immediately. If he or she finds that you have mastitis, the infection can be easily treated with antibiotics. We also encourage the use of Breast warmers. If pumping we encourage the use of a soft silicone shield.
- 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. More information is available a few questions down!
- Cracked and sore nipples is common. Rub some breast milk on and let it dry. Many mothers use Lanolin and find it very effective.
- 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.
- Use cold packs on the breasts for 20 minutes after nursing and about once an hour between feedings.
- 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.
- Warm heat can be applied to breasts for 3 to 5 minutes just before nursing infant to help milk "let down".
- 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.
- If you have excess then store the milk for a later date
- 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:
- 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.
- 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.
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 a number of positions you can use to feed your baby; the favourite three are cradle hold, football hold, and lying down (described in detail in the next section).
Let's 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.
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What are the different positions for breastfeeding?
There are a number of different positions you can use to feed your baby, however the three favourites are cradle hold, football hold, and lying down.
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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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:
- Nurse frequently - at least every 2 hours. This will ensure that your baby does not become too hungry between feedings causing him to nurse ravenously and aggressively at your breast.
- Pump for a few minutes before the feeding. This will initiate a letdown and elongate the nipple for the baby so that he does not nurse so aggressively.
- After feeding, pat dry your nipples and express some breast milk to rub into them. Breast milk has Vitamin E in it which is very healing to the skin. NOTE: Do not use Vitamin E oil from capsules etc as this can be toxic to your baby!
- You may want to apply a 100% USP modified lanolin such as Lansinoh or Purelan preparation to your nipples after nursing. Apply enough to thoroughly coat the entire nipple/areola area. Breastfeeding specific lanolin preparations do not need to be washed off prior to nursing as it is safe for baby to ingest. Recent studies seem to indicate that using 100% lanolin may quicken the healing process by maintaining the internal moisture of the skin. Avoid using general body creams and lotions as these may actually impede healing by preventing air circulation and drying out the skin. Some of these preparations may also be toxic to your baby and will need to washed off prior to nursing. Over-washing of the nipple area results in a loss of the natural lubricants that protect it and provide it with antibacterial properties.
- Try Hydrogel pads or Discs. I have found these to be helpful in healing sore, cracked nipples. These can be used in conjunction with a lanolin preparation.
- Change your nursing pads immediately once they become even slightly damp. Moisture against your nipples can slow down healing. If your pad sticks to your nipple moisten it with water before attempting to remove it. Also avoid nursing pads with plastic linings. They prevent the flow of air which is essential to healthy nipples. Stick with 100% cotton nursing pads.
- Warm, moist compresses often bring relief to nipples both before and after nursing.
- If you find it impossible to nurse your baby due to nipple soreness, you may opt to feed him with an alternative feeding device such as a feeding cup, while your nipples heal. If bottles must be used so with advanced teats that closely mimick the mothers nipples. Contact a lactation consultant for assistance in using a feeding cup. If only one nipple is very sore, you may decide to feed your baby from the well side only while pumping the other side. The baby can get all that he needs from one side as long as you allow him to nurse frequently. You will want to pump the other side as often as your baby nurses for 10-15 minutes each time. If taking the baby off both breasts and pumping instead for a few days is necessary, it's preferable to use a high quality double electric breast pump which will maintain your supply more efficiently till your baby is back to nursing.
Sore nipples shouldn’t last more than a week or so, so hang in there as it does get better! If pain persists or worsens, you should see your health care professional as soon as possible.
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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 usually resolve spontaneously within 24 to 48 hours after onset. 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 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.
Blocked ducts usually resolve pretty quickly. However if it doesn't or you can still feel a lump, see 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 enter the breast through an opening in the nipple (especially cracked, irritated nipples) or any break in the skin of the breast. Once the bacteria enter 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 or soak breasts in a pan of warm water. 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, 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 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 re-infection.
- 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 but creams containing zinc oxide work best for Nappy rash
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 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 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 colour and consistency of bowel movements as your mature milk comes in. They will change from the 'tarry' meconium to a mustard coloured (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 milk consider using a Supplemental Nursing system or supply line, talk with your health care professional before you reach for the 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.
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 methods commonly used to increase milk supply:
- Nurse frequently. The key is to remove more milk from the breast and to do this frequently, so that less milk accumulates in the breast between feedings. Plan to nurse at least every 1 1/2 to 2 hours during the day and at least every three hours at night even if you must awaken your baby. Time your feedings from the beginning of one to the beginning of another.
- Offer both breasts at each feeding. Allow baby to stay at the first breast as long as he is actively sucking and swallowing. Offer the second breast when baby slows down or stops. "Finish the first breast first," is a good general rule. (This technique gives baby lots of the fatty "hindmilk.")
- Allow your baby to end the feeding. He may do this by falling asleep and detaching from the breast after about 10 to 30 minutes of active sucking and swallowing.
- Although nursing is preferable, if the baby cannot nurse directly at the breast, use a high quality electric pump instead. Using a double pump has been shown to increase prolactin levels. Prolactin is the hormone which stimulates milk production. Pump for 10-15 minutes per session. Longer sessions have not been proven to be any more beneficial at increasing supply.
- Along with nursing, you may want to add a pumping session or two sometime during your day. You also may want to add a few extra minutes (5-10) of pumping after the baby has finished nursing.
- Allow the baby to meet all of his sucking needs at the breast. Avoid any bottles or dummies/pacifiers during this time. Your baby's need to suck ensures that he spends adequate time at the breast to stimulate your supply.
- Pay attention to your own need for relaxation, proper diet and enough fluids.
- Consider natural herbs, such as Fenugreek or Blessed Thistle. Some women have found that these herbs can help in increasing supply. Please ask your doctor first before adding any herb to your diet.
- Rest as much as you can. You would be surprised how much this can help! Consider taking the baby to bed with you during this time period. The rest will benefit you and the close skin-to-skin contact may encourage your baby to nurse more often.
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 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:
- Uncover baby. Removing blankets or socks, opening clothing or undressing baby, or changing the nappy, may waken her.
- Dab some expressed breast milk onto your nipples and baby's lips. This may stimulate sucking even though she isn't fully awake.
- Apply a cool (not cold) wash cloth to her cheeks or forehead.
- Try gentle body manipulations (such as gently pulling her into a supported sitting position) or baby massage to stimulate her. When doing "sit ups", make sure the baby bends at the hips, rather than at the waist.
- Keep room light dim, as bright lights may encourage her to close her eyes.
- Change nappy in between breastfeeding sides.
- Stroke baby gently around the lips and under the chin.
- Gently jostle your nipple when you notice your baby's sucking pattern slow down.
- Rub or pat her back; walk your fingers up her spine; gently rub her hands and feet; massage her crown in a circular motion while nursing.
- Chatter or sing spiritedly to her as she nurses; try to maintain eye contact.
- Try "switch nursing". Whenever you notice your baby's sucking pattern slowing down, remove her from the breast, burp her, and offer the other breast. When her sucking pattern slows on the second side, remove her, burp her and return to the first side. Try to nurse at least twice on each side.
- 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 she can in her mouth. The stimulation of the nipple well-positioned in her mouth may also help rouse her. You can also try gently compressing the breast to increase flow.
- A sleepy baby requires stimulation to stay awake. Avoid quieting manoeuvres such as rocking, too much non-nutritive sucking (especially dummies / 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 her awake during feedings.
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My baby gets distressed after let-down as my milk only dribbles out very slowly. Nothing I do will speed it up and my baby is starting to refuse the breast after let-down. What can I do to increase milk flow?
Sounds like your baby loves your milk!!! GREAT job! But, to decrease any frustrations after let down, there are some things you can do. An easy and effective way to maximise removal of milk, increase milk flow and even initiate another let-down is to massage the breasts. Along with breast massage, breast compression can really help to increase the flow. Not only will it increase the flow, but your baby will be getting the hind milk, with higher fat content. It will keep baby full longer too! Please see the step-by-step guide to breast compression below. This technique can really help to increase the flow and should decrease your baby’s frustration. Lots of luck!
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How do I do breast compression?
Here are the steps to performing the breast compression technique:
- Hold the breast, cupping the breast from underneath with your thumb on one side of the breast and your fingers on the other.
- Watch for the baby’s swallowing. The milk flows more rapidly when baby is drinking with an open—pause—close type of suck. Open—pause—close is one suck; the pause is not a pause between sucks, but of milk flowing into his mouth before a swallow. You may notice the same pause yourself when fluid flows in as you drink deeply and continuously. If using compressions while pumping, watch for sprays of milk.
- When baby is nibbling or no longer drinking with the open—pause—close type of suck, compress the breast gently but firmly (not so hard that it hurts) and try not to change the shape of the areola (the part of the breast near the baby’s mouth). With the compression, baby should start drinking again briefly with the open—pause—close type of suck.
- Keep the pressure up until the baby no longer drinks even with the compression, then release the pressure. Often the baby will stop sucking altogether when the pressure is released, but will start again shortly as milk starts to flow. If the baby does not stop sucking with the release of pressure, wait a short time before compressing again.
- Releasing the pressure allows your hand to rest and milk to start flowing to the baby again. If the baby stops sucking when you release the pressure, he will start again when he starts to taste milk.
- When the baby starts sucking again, he may drink (open—pause—close). If not, rotate your hand position and compress again as above.
- Continue on the first side until the baby does not drink even with compression. You should allow the baby to stay on that side for a short time longer, since you may occasionally get another milk ejection and the baby will start drinking again, on his own. If the baby no longer drinks, however, allow him to come off or take him off the breast.
- If the baby wants more, offer the other side and repeat the process.
- You may wish to switch sides back and forth in this way a few times.
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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 choice, 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.
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 some 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. If you reside in a non-fluoridated area please see your doctor for advice and recommendations.
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. 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?
Here is the best way to hand express:
- Choose a time to express when your breasts aren't too full. This will make it easier to get a good flow.
- Wash hands and prepare a clean area for expressing. A comfortable chair by the kitchen table is a good option.
- Have a clean sterilised milk collection container ready (or breastmilk storage bag). For beginners it is easier to use a collection bottle at first.
- Clean and dry your breasts. As you express, dry your breast as needed to help with grip.
- While massaging above your breast to promote let-down. Hand expressing can also be done right after baby nurses while milk is still flowing.
- 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.
- Continue the push and roll until a flow is established. Express each breast for 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?
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 are some tips for pumping below.
Preparing to pump:
- Read the pump instruction manual carefully before using it for the first time.
- Make sure pump parts are properly cleaned before use and assembly.
- Wash hands before handling any of the breast pump parts, the breasts or expressed breast milk.
- Make yourself comfortable before pumping. Sit with your shoulders relaxed and back supported. Have everything you need, including something to drink, within arm's 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.
- Centre the breast shield over the nipple so the nipple can move in and out without rubbing against the sides. Moisten the breast before placing the shield on the breast to create a "seal."
- If using an electric pump, always begin pumping with the suction regulator on minimum.
- Double pumping (pumping both breasts at the same time with a double electric breast pump) 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:
- See your pump instruction manual for the recommended pumping time.
- If using a single pump, switch breasts when the milk flow decreases (or about every five minutes).
- 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.
- Remember that pumping and/or hand expression is a learned skill. Effectiveness improves with practice. 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.
- Remember that breastmilk 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.
- Remember that 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 your milk supply.
- Most nursing mothers these days use a pumping bustier, which really makes life simple; you can play with your baby or use the computer. They make pumping seem much less of a chore.
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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 new to pumping and 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 should adjust to this new technique and you will soon see an increase in expressed milk.
As always, see your healthcare professional if you think you have a problem, if low expression persists or if pumping is an important source of breastmilk for baby.
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Is it safe to use a second hand breast pump? My sister has offered to lend me hers.
Concerned about buying a used breast pump? You definitely should be!!! Although a used pump may be less expensive than a new one (or in your case, free of charge), there are real health issues involved.
Saving a few dollars by purchasing a second hand pump or borrowing a used pump from a friend can have potentially serious consequences for your baby! Retail breast pumps are designed for single mum user only, and use by more than one person 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.
In addition, even if you replace parts or get a new collection kit, it is possible that air-born pathogens or droplets of milk that are not visible to the naked eye remain in the internal pump motor and can 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. Some pumps claim to be 'Hospital Grade", this has become a very loosly used word. Hospital grade breast pumps are used in Hospitals, don't be sucked in!
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 breast milk 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.
Most breast pumps come with a warranty, but this only applies to the original owner. If you purchase a second hand pump, the warranty is not transferrable and there is no recourse in the event of motor failure or pump problems.
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 labelled 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."
Please consider the health risks very carefully if you are considering purchasing a second hand pump or borrowing a used pump.
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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.
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.
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.
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.
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.
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.Supplements and teas can help, don't be afraid to try them.
Many people swear by eating regular (not instant) oatmeal…basically a big bowl of porridge!
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.
Galactagogues (substances that increases milk supply) can be used. Herbal supplements, such as Fenugreek or Blessed Thistle can be taken in capsules. There are some fantastic herbal tea blends which contain traditional milk producing remedies. There are also 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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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 have a greater “starter” collection of milk in the freezer. See your lactation consultant for assistance at least a month before returning to work.
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 breast milk for your baby are worth the extra effort and time.
Here are some helpful hints for pumping breast milk at work:
- Invest in a quality electric breast pump, preferrably double, to make pumping quick and easy.
- A quiet, relaxed environment will encourage your milk ejection reflex (let-down).
- Workplace bathrooms are typically not appropriate for pumping breast milk because they lack the privacy, cleanliness, and electrical outlets you need.
- Think of your baby when pumping. Look at his picture. Some women bring small clothing items belonging to their babies to touch and smell to encourage the milk ejection reflex.
- Massage your breasts while you pump to increase production.
- Have a glass of water or juice nearby as you pump. Drink plenty of water throughout the day and keep nutritious snacks, such as trail mix or similar high-protein foods, at your desk.
- Plan your working wardrobe with pumping in mind. Invest in some nursing tops in neutral colours which can be worn with your existing work wardrobe.with easy access. Wear 100% cotton nursing pads because they are absorbent and ventilate well.
- Above all, do not be discouraged by employees or your employer. Stay with it and remember you are providing a health benefit for your baby, yourself and your employer. Breastfeeding decreases the incidence of illnesses and may reduce maternal absenteeism.
Keep up the good work!
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I won’t have time to pump milk at work – can I just breastfeed my baby at night?
Are you sure you can’t pump at work? With a good quality electric breast pump, you should be able to pump both breasts in less than 15 minutes. Even if you use a break to pump, it would be best to keep your milk supply on task. If you absolutely cannot pump at work, you can still breastfeed whenever you are with your baby. I suggest nursing right before you go to work and immediately following work (and for the rest of the evening, of course!).
Just keep in mind that if you don't pump at all at work, your breasts will stop making milk during your workday. For the first few days, your breasts may become overly full and leak; try using Milk Saver. You can use nursing pads in your bra to catch leaking milk. If your breasts become very uncomfortable, you can go to the bathroom and express (either with your hands or with a breast pump) just enough milk to feel better. Within 4-6 days, your milk supply will decrease enough where you will be comfortable at work.
Again, it would be best to pump at least once during your workday, especially if you want to keep your body producing enough to give your baby breast milk exclusively. If that is not feasible, breastfeed as often as you can. You and your baby will still reap the rewards of breastfeeding!
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I’m returning to work in a month and would like my baby to be fed expressed breast milk when I’m away. How can I avoid nipple confusion?
Generally speaking, the risk of nipple confusion is highest from birth to six weeks of age. It is not actually a case of confusion of the nipples, but rather more one of laziness. It takes less work to drink from a bottle's nipple than from a mother's nipple. If he is already fine with drinking from a bottle occasionally and returning to the breast without problems, you should not have a problem going back to work and breastfeeding.
The main thing I recommend is to use a newborn (slow flow) teat on your baby’s bottle. Milk is much easier to drink from a bottle than it is from a breast, and you don’t want your baby to develop a preference for the bottle. Also, it is very easy to over-feed a breast-fed baby with a bottle since the milk comes out so much more quickly. Using a newborn teat will make the milk come out slower so that your caregiver doesn’t accidentally give your baby more milk that he needs.
Pumping and working can be stressful, so try to find some things that help you relax: play some music; kick off your shoes; use a hands-free pumping bra so that you feel “productive” while pumping; close your eyes and think about your baby’s smiling face. And don’t forget to take pride in what you are doing: you are taking good care of your baby! Both you and your baby will benefit from your efforts to pump at work!
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How do I store breast milk?
Fresh milk should be stored in containers or bags that are designed specifically for breastmilk storage. Bottles are available in glass or plastic, many of which are now BPA free. Special storage bags and breastmilk freezer tray systems are ideal for freezing milk for later use. When freezing, don't fill containers right up as liquid expands when frozen.
It's best to freeze milk in small quantities to minimise waste and for easier thawing. Always remember to label and date frozen breastmilk, and add baby's full name and your phone number if taking milk to a day care centre, sitter or hospital.
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What are the recommended storage times for breast milk?
Breastmilk storage guidelines vary depending on where you read! Here is a general guide:
- Up to 5 days in refrigerator
- Up to 3 months in the refrigerator freezer
- Up to 6 months in the deep freezer (-18 C or below)
- Use thawed previously frozen breast milk within 24 hours.
- Do not refreeze previously frozen breast milk.
- Do not reheat breastmilk in the microwave as this can destory important nutrients!
What foods should I avoid when breastfeeding?
Eat up!!! Most mothers do not need to change their healthy diet while breastfeeding. However, if you have a family history of allergy, including asthma and atopic dermatitis, you may want to avoid dairy products, as well as any other foods you are allergic/sensitive to while breastfeeding. Be sure to speak with your health care provider about your diet and when making dietary changes, to be sure that all your nutritional needs are being met.
Some babies are indeed sensitive to foods in their mum's diet, but I would caution against arbitrarily limiting your diet unless you have reason to suspect a particular food is bothering your baby. In this case, try eliminating the food, which is the most likely culprit for at least one week. (Remember to read all labels.). If you do not see an improvement, you can add this food back into your diet and try another food to see if it is the offender. Keeping a journal with foods eaten and your baby's behaviour may be helpful.
Dairy products in a mum's diet can sometimes cause sensitivity. (This sensitivity to milk protein is not at all related to lactose intolerance.) Other foods you may consume that your baby may show sensitivity to include eggs, peanuts and other nuts, wheat, soy, corn, tomatoes, onions, cabbage, berries, nuts, spices, pork, seafood, citrus fruits and juice and chocolate.
Basically, while breastfeeding, it is best to eat a nutritious, well-balanced diet: choose foods that are close to their natural state, making sure to include at least five servings of fruits and vegetables each day. Try to go light on processed foods.
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I’m so exhausted and busy that I’m not eating properly and my diet is quite bad. Will my poor diet affect the quality of my breast milk?
While you are breastfeeding your baby, the components of your breastfeeding diet will affect your baby’s and your nutrition. Your body is working hard to produce the best food for your baby…you deserve the same nutrition! While a few days of sweets and snacks won’t harm you or your baby, long term good nutrition is necessary for you to stay healthy and keep your baby healthy too.
If you find it difficult during your busy day to eat as nutritiously as you should, cut up some fruit, vegies or healthy snacks the night before, ask your partner to help out or call on friends and family to stockpile the freezer with healthy meals. Having nutritious, easy-to-grab snacks and meals is important for new mums, who are often too tired to prepare anything for themselves. Foods that are considered a good diet for life also make a good diet for breastfeeding. Best wishes to you and your baby!
What is a healthy diet for a nursing mother?
- Good water consumption. Nursing women tend to be thirstier, especially during feeding sessions, because part of their water consumption goes directly to producing milk for their infants. Increase your water intake but be careful not to overdose on too much water as this can reduce the production of milk.
- Increased caloric intake as per the recommended guidelines for nursing mothers. This can actually be a little hard to do but it's important to do as the body is continually producing milk. It can help to spread calories over five smaller meals a day rather than three huge meals. Although it may be tempting to make up the calories with sweets or treats, stick with the healthy stuff!
- Breastfeeding mothers should eat food containing vitamin B9. Birth control pills accentuate a woman's vitamin B 9 deficit, and may even contribute to a vitamin B 6 deficiency. During pregnancy, folic acid is vital to the development of the baby's nervous system. Nursing mothers are well advised to continue taking their prenatal vitamins to maintain their body's supply of folic acid. Folic acid can also be found abundantly in asparagus, cabbage, corn, chickpeas, and spinach.
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I’ve heard about all the benefits for a baby if it’s breastfed – but are there any benefits for the mother?
Oh, my! You are right! There are so many benefits for babies who are breastfed. But, the list of benefits for mums is endless too. Here are a few benefits that stand out.
Mums who breastfeed:
- Are at less risk for postpartum depression
- Have less likelihood for anaemia and haemorrhage (heavy bleeding)
- Uterus shrinks back to pre-pregnancy size faster
- Burn extra 800 calories per day to return to pre-pregnancy weight sooner
- Less chance of osteoporosis
- Less likely to have breast cancer, ovarian cancer and uterine cancer
- Have delayed return of fertility and monthly period
- Less work absenteeism due to illness
- Get to have amazing bonding and relaxing time with their babies!
- Have less doctor appointments and hospital visits
- Don't have to heat up bottles. Breast milk is always the right temperature!
- Save lots of money by not having to buy expensive formulas.
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Should I keep breastfeeding if I get sick?
In most cases yes, you should be able to continue breastfeeding during any 'ordinary' illness such as a cold, flu, fever etc. In fact, you'll be providing important antibodies to your baby through your breastmilk. If you see a doctor, please inform them that you are breastfeeding so that any medications prescribed will be compatible and safe with breastfeeding.
Viruses and bacteria cause infections, and most infections are most contagious before the mother even has any idea she is sick. By the time you have a fever (or runny nose, or diarrhoea, or cough, or rash, or vomiting etc), you have probably already passed on the infection to the baby. However, breastfeeding protects your baby against further infection so you should continue breastfeeding. If your baby does get sick, which is possible, he is likely to get less sick than if breastfeeding had stopped. But often mothers are pleasantly surprised that their babies do not get sick at all. In these cases, the baby was protected by the mother’s continuing breastfeeding.
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I have food poisoning and am wondering if I should stop breastfeeding until I get better. I am concerned the bug will be in my breast milk.
Not a fun illness! But, if you have food poisoning, breastfeeding should continue in most cases. Of course see your doctor for a proper diagnosis to make sure. As long as the symptoms are confined to the gastrointestinal tract (vomiting, diarrhoea, stomach cramps), breastfeeding should continue without interruption as there should be no risk to the baby. The majority of food poisoning is confined to the GI system and won’t affect breastfeeding. Feel better!
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I stopped breastfeeding my baby a few weeks ago but would like to start again – is this possible?
Good news! Breast milk doesn't completely dry up for about a month, so you still have time to get back to nursing your baby.
The first step is to speak with a lactation consultant, who can monitor the process and help you be sure that the baby is getting adequate nutrition as you move along.
Here are some things you can do to help re-establish a milk supply:
- Start each feeding with the baby on the breast. The fewer the bottles, the better over the next few weeks.
- Consider a supplemental nursing system such as Medela's SNS, where a tube taped to your breast drips formula into the baby's mouth, so that the baby gets instant gratification as she sucks.
- For added stimulation to your breasts, you probably should pump in addition to letting the baby nurse. I would suggest pumping for about 10 minutes after every other nursing session. Even if milk isn’t flowing, the pumping will “remind” your body to make more milk!
- Some mothers find that non-alcoholic beer increases their production of milk. Strange but true!
- As you start this process, feel proud that you are making a good decision for you baby. While it may be a lot of work, you can expect that you will be able to re-establish nursing within a few weeks.
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Is it legal to breastfeed in public? I was nursing my son at the shopping centre and I was told I must go to the parent’s room.
Breastfeeding in public IS legal in Australia, although sometimes people simply don't know it and therefore might complain about it. You can nurse your baby anywhere that you are allowed to be with the baby. Mothers have a right to breastfeed whereever they go with their baby, even if that is out in public.
If someone seems to be bothered by you nursing, or asks you to leave, you can kindly remind the person that breastfeeding is legal, normal and the best nutrition for the baby, or other facts about breastfeeding.
But it may still happen that you encounter difficulties. If you have had problems with public breastfeeding and have been asked to leave shopping centres, pools, restaurants, etc, or to go to the bathroom to nurse, or if you have had problems at workplace, you can report it to the local authorities or contact your MP. Please stand up for your right to nurse in public!
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Is it safe to breastfeed someone else's baby? A friend (who has a 10 month old) looked after my three month old son for a few hours. When I returned, she told me he was hungry, so she breastfed him! I was quite shocked. Is this safe?
Goodness, you must have been surprised! I am sure your friend was well meaning. But, as with any body fluid, breast milk can contain HIV, hepatitis, tuberculosis, syphilis and other viruses. They can be transmitted through breastmilk. La Leche League International advises its breastfeeding coaches about the potential problems with wet or cross-nursing. In addition to potential infection, regular cross-nursing can totally confuse and frustrate the baby, to the point that it might refuse to nurse at all. And milk from the baby's mother is exactly formulated for what her own baby needs. Another woman's milk probably won't meet the needs of the nursing child, especially if there is a big difference in age. That said, the personal nature of wet or cross-nursing can make people uncomfortable, but it is a decision as personal as breastfeeding itself.
Milk banks, which screen donors, are a possible solution for mums. At milk banks, the milk is pooled, pasteurised and checked for contamination. Many preemies and sick babies in the hospitals are receiving the milk from these banks. But, again, this milk is screened as much as donor blood would be screened for safety.
Maybe next time you leave your baby with your friend, you can leave her with your breast milk and a baby cup. That way your baby will be getting your milk without any chance of possible contamination or nipple confusion. Good luck!
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Can I still breastfeed if I’ve had alcohol, caffeine or cigarettes?
If you are breastfeeding, the safest option is not to drink alcohol as it will be present in breastmilk. However the reality is that some mothers do wish to consume the occasional alcohol drink. If you do plan to have a drink, educate yourself beforehand and learn the best ways to minimise risk. Alcohol can remain in breastmilk for many hours so it may be necessary to 'pump and dump' and feed your baby previously expressed milk instead. We recommend testing with Milkscreen as it is better to play it safe. Speak with your healthcare professional and also look out for the government sponsored brochures that are readily available.
The best case scenario is to avoid caffeine altogther although one or two cups of coffee a day generally won't cause a problem....lucky for us mums! Try switching to decaffeinated coffee and tea or reducing caffeine intake. Remember that caffeine can also be found in chocolate, soft drinks, and some herbal teas and medications, in addition to coffee and tea. If you drink or ingest a lot of caffeine, some side effects are possible. Your baby may be more irritable and feed more frequently if you ingest a lot of caffeine. Babies can't get rid of caffeine efficiently, so it can build up in their systems. Too much caffeine can also cause sleep problems and nervousness. Some babies, particularly those under six months, may be more sensitive to mum's caffeine intake. Babies whose mothers avoided caffeine completely during pregnancy seem to react more to caffeine in mum's diet. Even if baby is sensitive to the caffeine now, he may not be when he's a little older- so if you do have to stop or limit your caffeine intake, you can try again when baby is older. If your baby is sensitive to caffeine, it will typically become less of an issue as baby gets older. Newborns have a much harder time metabolising caffeine than older infants. Preterm or ill infants might also have more problems with mum's caffeine intake. Try to limit your coffee intake as much as you can. The estimate we often hear is "less than five small cups of coffee" or 500 mg/day. Various sources suggest an upper limit for caffeine intake ranging from 300-750 mg/day.
If you smoke cigarettes, please try and quit. Your doctor should have good advice on how to do this. If you choose not to quit and are breastfeeding, try and reduce the amount of cigarettes smoked and only smoke immediately after breastfeeding.
Smoking and breastfeeding has been linked to:
- Earlier weaning. One study showed that the heaviest smokers tend to wean the earliest.
- Lower milk production.
- Interference with milk let-down.
- Lower levels of prolactin. The hormone prolactin must be present for milk synthesis to occur.
- One study (Laurberg 2004) indicated that smoking mothers who live in areas of mild to moderate iodine deficiency have less iodine in their breast milk (needed for baby's thyroid function) compared to nonsmoking mothers. The study authors suggested that breastfeeding mothers who smoke consider taking an iodine supplement.
How smoking can affect your baby:
- Babies and children who are exposed to cigarette smoke have a much higher incidence of pneumonia, asthma, ear infections, bronchitis, sinus infections, eye irritation, and croup.
- Colic occurs more often in babies whose mothers or fathers smoke or if a breastfeeding mother smokes. Researchers believe that not only does the nicotine transferred into mother's milk upset baby but the passive smoke in the home acts as an irritant. Babies of smoking parents fuss more, and mothers who smoke may be less able to cope with a colicky baby (due to lower levels of prolactin).
- Heavy smoking by breastfeeding mums occasionally causes symptoms in the breastfeeding baby such as nausea, vomiting, abdominal cramps and diarrhea.
- Babies of smoking mothers and fathers have a seven times greater chance of dying from sudden infant death syndrome (SIDS).
- Children of smoking parents have two to three times more visits to the doctor, usually from respiratory infections or allergy-related illnesses.
- Children who are exposed to passive smoke in the home have lower blood levels of HDL, the good cholesterol that helps protect against coronary artery disease.
- Children of smoking parents are more likely to become smokers themselves.
- A recent study found that growing up in a home in which two parents smoked could double the child's risk of lung cancer later in life.
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Is Chamomile Tea safe to drink when breastfeeding?
Chamomile (or Camomile) Flower is considered safe by the US Federal Drugs Administration (FDA), with no known adverse effects in pregnancy, lactation, or childhood. Chamomile tea is commonly used by nursing mums for relaxation. From my experience, it really works too! As with all herbal preparations, please seek the advice of your healthcare professional before using any herb.
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This page is for general information only and is not intended to substitute or replace the advice of your healthcare professional. Please see your healthcare professional for specific advice about your unique circumstances and needs. The opinions expressed on this page are that of Heidi Humphries IBCLC and do not necessarily reflect the views and opinions of Nursing Angel or other healthcare professionals. No action or inaction should be taken based solely on the information on this page.