Breastfeeding basics

Although breastfeeding is a natural process, it's not entirely instinctive. Remember to give yourself and your baby plenty of time to learn this new skill. It may take three to four weeks before you feel comfortable and confident.


Before delivery
You may need help learning how to nurse your baby, especially if you're a first-time mom.
Learn as much about breastfeeding as possible. Before the delivery, attend a breastfeeding class. Read about breastfeeding. Talk to women who've successfully nursed their babies.

Seek support. Check out local support groups for breastfeeding mothers. Find a lactation consultant (a professional who specializes in breastfeeding). Contact the La Leche League, a nonprofit organization that provides education, information and encouragement in breastfeeding through support groups with specially trained leaders.

Understand the breastfeeding policy at the facility you're planning to use for delivery. If their policies differ from your preferences, discuss your wishes with the staff and your doctor. Even if you or your baby need special care after delivery, breastfeeding is typically still possible.


Breastfeeding in the hospital
The American Academy of Pediatrics (AAP) promotes breastfeeding as the best possible source of nutrition for babies. According to the AAP, breastfeeding should begin as soon as possible after birth, preferably within the first hour.
Here are a few other AAP recommendations:

Unless medically inadvisable, keep the baby with you throughout the recovery period. During the hospital stay, keep the baby in your room to make it easier to nurse whenever he or she is hungry. This is known as "rooming-in."

Have professionals trained in breastfeeding evaluate how well you're nursing and help you work through any problems.

Unless medically necessary, don't give the baby supplements of water, sugar water or formula. You may want to avoid pacifiers as well.

Consult the baby's doctor when the baby is two to four days old to re-evaluate breastfeeding success.

Milk production
During the first few days after delivery, your body will produce a special yellow-white milk called colostrum. The colostrum contains concentrated nutrition and important elements that help protect your baby from disease. Although your body won't produce much colostrum, there will be enough to meet your baby's needs in the first few days of life.
After two to five days, the colostrum will begin to change in appearance as it's replaced by more abundant breast milk. It may take up to two weeks for the colostrum to be completely replaced by breast milk, which may be white to bluish white and thin in appearance. Some women describe it as looking like skim milk.

From this point on, the production of breast milk is based on supply and demand. Simply put, the more you breastfeed, the more milk your body will produce. Supplemental formula feedings are discouraged when you begin breastfeeding because each nursing session replaced with formula leads to less milk production.


Let-down
Let-down is the release of breast milk from the nipple. Let-down occurs in response to nipple stimulation or emotions produced in response to your baby, such as when you see your baby or hear your baby cry. This may occur several times during a feeding.
The let-down reflex develops during the first few weeks after delivery. Improper latching-on, emotional stress, illness, pain, sore nipples, smoking, alcohol, caffeine and certain medications can interfere, however.

To encourage let-down:

Take steps to relieve any pain from the delivery.

Place warm compresses on your breasts, take a warm shower or gently massage your breasts before nursing.

Nurse frequently on both sides.

Choose a relaxing setting.

Make sure you and the baby are positioned correctly and comfortably. You may even want to take the phone off the hook and put a "Do not disturb" sign on the door.
When let-down has occurred, you may notice leaking milk or feel a tingling in your breast, a sharp pain in your nipple or lower abdominal cramping. When let-down occurs while you're breastfeeding, your baby may begin to gulp or lose milk from the mouth and then suck more slowly and swallow regularly.


Timing
At first, your baby will need to breastfeed eight to 12 times a day -- about every two to three hours. During the first few weeks, you may need to awaken your baby regularly to nurse so you can breastfeed every two to three hours. Later, the baby will go longer between feedings.
You may notice your baby wants to nurse more often at a certain time of day, such as during the evening, and goes longer between feedings at other times.

It's important to nurse your baby whenever signs of hunger occur. For example, the baby may be more alert, suck on his or her hand, and search for the nipple with his or her mouth (a behavior known as rooting). Crying is typically a late sign of hunger.

Most babies nurse 10 to 15 minutes on each breast. When the baby is finished with one breast, his or her grip on your nipple may loosen.

Keep in mind that the milk at the end of the feeding (hindmilk) contains more fat than the milk at the beginning of the feeding (foremilk). This fat is fundamental for your baby's growth. Therefore, it's important to let your baby finish the first breast before changing to the other.

If your baby falls asleep shortly after beginning to nurse from the first breast, awaken him or her to finish the feeding.

At about ages 2 to 3 weeks, 6 weeks and 3 months, you may notice that your baby begins to nurse every hour or two. During these growth spurts, your baby needs more milk. By nursing more often rather than offering supplemental formula feedings, you'll increase your milk supply. The baby will return to less frequent feedings when your milk supply is sufficiently increased.


Breastfeeding technique
To help ensure your success and prevent unnecessary problems, consider the following breastfeeding technique. At first you may have to think about each step, but as time goes on it will feel natural. Of course, you may find variations on the technique that work well for you and your baby.
Wash your hands. Before breastfeeding, wash your hands well with soap and water to prevent spreading any infections to your baby.

Awaken or calm your baby. If your baby is sleepy, try gentle massage, dimmer lights, or fewer clothes or blankets. It may also help to stroke a cool cloth across your baby's forehead or change his or her diaper. If your baby is crying and too upset to begin breastfeeding, calm him or her by rocking or cuddling.

Alternate the breast you start with. Your baby will suck more vigorously on the first breast. To make sure each breast is emptied well, it's important to start with the other breast at the next feeding. To help you remember which breast to use first, you may want to attach a safety pin to your bra strap on the side you'll start nursing from at the next feeding. Or switch a ring or bracelet from side to side at each feeding.

Position your baby at the breast. To prevent sore nipples, make sure you're comfortably situated, with your back and arms well supported. The baby must be positioned directly facing your breast. You may want to try the cradle or cuddle hold (the baby's chest lies across your chest), the football hold (the baby's chest is along your side) or the side lying position (the baby lies next to you).

Although the first few times you nurse there may be no position in which you feel really at ease, you may eventually feel comfortable in most positions.

Help your baby latch on to the breast. With your thumb on top and the other fingers underneath, grasp your breast with the opposite hand. You'll form a "C" with your fingers.

To encourage your baby to seek the breast, gently touch your nipple to your baby's lips. When the baby's mouth opens wide, place the breast as far back into the mouth as possible. Your baby should take as much of the nipple and areola (brown area) into the mouth as possible.

Be careful not to tip the nipple upward so it rubs on the roof of the baby's mouth. When correctly positioned, the baby will directly face the breast with the chin pressed into the breast. The baby's nose may rest on your breast. The baby's tongue will be cupped under your breast, not pushed back into the mouth.

If you have large breasts and the babyken a sleepy baby. Consider a diaper change or the other suggestions listed above.

Burp the baby. It's important to burp your baby after nursing on each breast, and possibly more often for a baby who has excessive gas or spits up frequently. You can gently pat the baby's back while he or she lies against your shoulder, lies across your lap facing down, or sits up leaning slightly forward with your other hand supporting his or her jaw.


Making sure your baby is getting enough
Because you can't see how much your baby drinks at each feeding, you may wonder if he or she gets enough milk. To help answer this common question, consider the following signs of adequate breastfeeding:
Your baby nurses at least eight to 12 times a day.

Your baby has periods of rhythmic sucking and swallowing during each feeding.

Your baby seems content after each feeding and sleeps well between feedings.

Your breasts are softer after each feeding.

After your milk comes in, your baby has at least five to six wet disposable diapers or six to eight wet cloth diapers a day. (Before your milk comes in, the baby may only have one to two wet diapers a day.)

After the fifth day, your baby has at least three to four soft, yellow stools that are at least the diameter of a quarter every day.
If you're concerned that your baby may not be getting enough milk, contact his or her doctor. The doctor will weigh your baby and check for signs of inadequate nutrition.


Breastfeeding multiples
Breastfeeding multiples is possible. Some mothers prefer breastfeeding multiple babies simultaneously. At first, however, it may be better to breastfeed them separately -- especially if youin the football hold)

Breastfeeding while pregnant and tandem nursing
Some women choose to stop breastfeeding when they become pregnant. If you're nursing your baby and would like to continue during your pregnancy, discuss it with your doctor.
If you continue to breastfeed, you'll need to eat well enough to ensure normal growth and development for your newborn and the developing baby. If you develop sore nipples, a common symptom during pregnancy, it may help to vary your breastfeeding positions. You may also want to pump your breasts to start the milk flow before you begin nursing or use the breathing techniques of labor and childbirth.

Some pregnant women who nurse become restless or irritable. If this happens, you may want to distract yourself while nursing by reading a book or watching television.

As your pregnancy progresses and your body prepares for the upcoming birth, your breast milk will change to colostrum. This may deprive the nursing child of vital nutrients, especially if he or she isn't yet eating solid foods. Consult your child's doctor to determine what supplements or dietary changes your child may need. Some children begin to wean on their own at this time, possibly in response to the decreased milk production or a change in the taste of the milk.

Because your milk supply is based on supply and demand, it's possible to breastfeed both children after the baby is born. This is called tandem nursing. If the older baby still nurses often, however, the newborn may be deprived of vital nutrients during the first two weeks after birth. The colostrum production may be scanty compared to the mature milk.

If you choose tandem nursing, make sure your newborn nurses first during the first few weeks to help ensure proper nutrition. Itns while you're nursing, and it's important to drink plenty of fluids. (Although drinking to satisfy your thirst is usually adequate, it's best to drink before you get thirsty.)

Discuss the safety of any medications (including over-the-counter and prescription medications, as well as herbal remedies) with your doctor or the baby's doctor before taking them.

Although alcohol passes freely into breast milk, the American Academy of Pediatrics Committee on Drugs has found that an occasional drink or regular light drinking (defined as one or fewer drinks per day) isn't harmful for a nursing baby. You can time your drink around nursing to minimize the alcohol content in your breast milk. For a 120-pound woman, it generally takes about 30 to 60 minutes after one serving of beer or wine for the alcohol content in breast milk to peak (60 to 90 minutes if you have the drink with a meal), and about two to three hours for the alcohol content to return to nothing.

Nutrition
Eat a well-balanced diet, including fresh fruits and vegetables, whole-grain breads and cereals, protein-rich foods, and three or more servings of milk products. Rather than following complicated rules about how many servings from each food group to eat per day, the best guide for adequate nutrition is simply eating to satisfy your hunger.

You may find that you add between 200 to 500 calories to your daily diet. Some women find it helpful to have a healthy snack and something to drink each time they sit down to nurse. Good snack choices include cheese, yogurt, whole-grain bread or crackers, tomatoes, sprouts, fresh fruit, raw vegetables, hard-cooked eggs and nuts.

If you'd rather count servings from each food group, here are the general daily recommendations for women who are breastfeeding:


Milk, yogurt, cheese -- at least three servings. (One serving is 1 cup of milk or yogurt.)

Meat, fish, poultry, beans, eggs, nuts -- at least three servings. (One serving is 2 to 3 ounces of lean meat, poultry or fish. One egg, 2 tablespoons peanut butter or 1/3 cup nuts count as 1 ounce of meat.)

Vegetables -- at least three to five servings. (One serving is 1 cup raw leafy vegetables, 1/2 cup other vegetables, either cooked or chopped raw, and 3/4 cup vegetable juice.)

Fruit -- two to four servings. (One serving is one medium apple, banana or orange, 1/2 cup chopped, cooked or canned fruit, and 3/4 cup fruit juice.)

Bread, cereal, rice, pasta -- six to 11 servings. (One serving is one slice of bread or 1/2 cup cooked cereal, rice or pasta.)
Finally, done's a family history of allergies to the particular food.

Keep in mind that too much caffeine can make your baby wakeful and fussy. A moderate amount doesn't usually cause problems. As a general guideline, limit your daily intake of caffeine to the amount found in five 5-ounce cups of coffee. Remember to count the caffeine in tea, soda, chocolate and certain medications.

Nipple care
Take a shower every day, but use only water on your breasts. Avoid using soap or shampoo near your nipples.

Don't wash your breasts before or after feedings. Instead, express a little milk after each feeding, spread it over each nipple and areola, and then let your breasts air dry.

If milk leaks from your breasts often, you may want to tuck nursing pads into your bra. Change them whenever they get wet, and avoid the plastic-lined variety.


Preventing sore nipples
At first, your nipples may be tender at the beginning of a feeding. More intense soreness that lasts throughout the feeding or between feedings isn't normal. Such soreness is often related to improper positioning at the breast or poor latching on. You may also be sore if your breasts are engorged (very full of milk), the baby is sucking incorrectly, or you take the baby off the breast without breaking the suction.
To prevent sore nipples, nurse frequently with the correct technique. Even when it hurts, avoid limiting the length of feedings. Cutting a feeding short hasn't been shown to decrease soreness. In fact, it may actually lead to increased soreness. It may help to start on the side that's the least sore. Also, make sure the baby is sucking correctly.

Sometimes, nipple soreness is caused by a thrush (yeast) infection of the nipples -- even after months of comfortable breastfeeding. The infection may cause nipple irritation or intense shooting pain in the breast during or after nursing. In some cases, thrush develops in the baby's mouth as well. Antifungal medication can clear up the condition for both mother and baby. Consult your doctor for details.

Identifying what's behind the soreness and taking immediate steps to correct the problem are vital. Consult your doctor or breastfeeding consultant with any questions or concerns.


Uterine contractions
It's normal to experience contractions or "afterpains" after delivery. These contractions, which may be especially noticeable during and just after breastfeeding, help prevent excessive bleeding by compressing the blood vessels in your uterus. Theyt experts recommend waiting to give your baby expressed milk in a bottle until nursing is well established, probably not before age 3 to 4 weeks. Once you've expressed the milk, proper handling and storage can keep it fresh and free of bacteria.
Here are some tips:

Wash your hands well whenever expressing milk or handling it. If you're using a breast pump, wash all parts of the pump carefully after each use.

After expressing, breast milk can be left at room temperatures of 66° F to 72° F for up to 10 hours or at a room temperature up to 79° F for four to six hours.

Label the container with the date. Refrigerate any breast milk you plan to use in sterile glass or plastic containers. If a refrigerator isn't available, store the milk in a cooler with ice packs. The milk can stay fresh for up to 24 hours in a cooler. Discard any breast milk that's been in the refrigerator more than eight days.

Breast milk can be safely frozen for two weeks in a freezer compartment located inside a refrigerator; three or four months in the self-contained freezer unit of a refrigerator; or six months or longer in a separate deep freeze. It's helpful to freeze milk in the amount you think your baby will take at a feeding -- 2 to 4 ounces is often a good starting point.

Thaw frozen breast milk gradually in the refrigerator or quickly under running warm (not hot) water. To avoid uneven heating, don't use a microwave. Frozen milk that's been thawed shouldn't be refrozen. It can be stored in the refrigerator for up to 24 hours.

Fresh milk can be added to frozen milk after the fresh milk has cooled for about 30 minutes. The amount of fresh milk should be less than the amount of frozen milk.

Discard any extra expressed breast milk at the end of each feeding. Don't freeze or refrigerate it again.

Breast milk can separate into milk and cream. Gently shake the milk to mix it before a feeding. Also, keep in mind that breast milk may look bluish, yellowish or brownish in color. This doesn't mean the milk is bad.