Women's Health Resources

Breast Feeding Essentials

Breast-feeding can be very rewarding for both mother and baby. Breast milk is an excellent source of nutrition for your baby. The American Academy of Pediatrics recommends breastfeeding for the first year of your baby’s life. Breast milk has antibodies to fight diseases such as respiratory infections, ear infections, and urinary tract infections and it is more agreeable to baby’s digestive system. The incidence of Sudden Infant Death Syndrome (SIDS) is lower in breast fed babies. There are no bottles to sterilize or formula to warm up. Breast milk is always the right temperature. If allergies are common in your family, it is possible your baby may develop allergies as well. Babies who are breast-fed have fewer infections and allergies during the first year of life than babies who are given infant formula. Breast milk is also economic and convenient when traveling. Overall, breast milk is nature’s best food for young babies. Breasts fed babies have an enhancement of cognitive (brain) development. If you do choose to breast feed, do not get discouraged if it does not go perfectly at first. Successful breast-feeding requires learning and practice for both you and your baby. There are some common problems that can be easily overcome if you know what to do. Some are described below. In other cases, a talk with your physician or lactation specialist before deciding to give it up may be all you need to make this a healthy and enjoyable experience for both you and your baby. However, breast-feeding is not for everyone. There is no reason for guilt in choosing not to breast feed your baby. You will be making many important decisions throughout your baby’s life. Infant formulas can nourish very well. If you are having trouble deciding, consider breast-feeding for a while before you make your final choice.

There are benefits to you from breast-feeding. Mothers who breastfeed have less post-partum bleeding, earlier return to pre-pregnancy weight, and a decreased incidence of premenopausal breast cancer. The size of your breasts makes no difference in the success of nursing. Women with large breasts or small breasts can nurse successfully. Breast size has no bearing on the amount of breast milk you can produce. Even if you have inverted nipples, you can nurse. If you did not nurse your last baby or any of your other children, you still can nurse your baby. There are rare instances when women should not nurse: if you have active TB (tuberculosis), take illegal drugs, are HIV positive, or on certain medications (like chemotherapeutic agents) that when passed through the breast milk would be harmful to your baby. Check with your doctor when taking any medications while nursing. Many medications are harmless to the baby such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and certain antibiotics. Women who nurse can resume sexual relations soon after giving birth just the same as women who do not nurse. However, some nursing mothers may experience vaginal dryness and need to use a vaginal lubricant prior to sexual intercourse. While it is true that nursing mothers often do not ovulate while nursing, it is not a fail-safe method of birth control. You can still take birth control pills if you nurse. Discuss this with your doctor. You can also use a diaphragm or condoms with spermicidal jelly as well.

Getting started:

It is a good idea to nurse your baby soon after he arrives. Many women nurse their babies in the delivery room within an hour after birth. Your breasts are full of colostrum, the very important nourishment that is rich with antibodies and vitamins. Colostrum is baby’s first milk. Your milk will come in about 2-5 days after delivery. Colostrum is all your baby will need until your milk comes in. There is no need to supplement your baby’s diet. Babies are born with a strong sucking reflex. First, get yourself into a comfortable position so that your body can relax. Hold your baby so that he faces you (tummy to tummy), hold your breast with your hand shaped in the letter “C” (the thumb is opposite the other fingers), tickle the baby’s lower lip so he opens his mouth wide, and place your nipple and areola into his mouth as you pull him towards you. He will begin to suck. Latching on is the process where the baby gets on to the breast for successful nursing. This is the hardest part. To make sure the baby is latched on properly, the bottom of his ear lobes will move a bit as he sucks and swallows and you should not be in pain. His lip will probably be slightly folded outward as he nurses. If the baby is not latched on properly, he will not get milk, your nipples will get sore, and both of you will become frustrated. Try to latch on correctly. To try again or to take the baby off the breast, put your finger towards the corner of his mouth and “break the suction” as you push inward toward your breast and pull the baby away from you slightly. Do not just pull him off your breast otherwise you will get sore nipples. The breasts will “let down” the milk after 1-3 minutes of nursing. This is the process where the milk moves from the milk glands to the milk ducts and out through the nipple. You may feel a tingling in the breast. Relaxation is necessary for “let down” to occur. Let down is developed well after 2-3 weeks of nursing. Nurse on the first side for about 10 minutes, burp the baby, and then let him finish on the other side. He may nurse 5 minutes or 20 minutes. Burp him again after the second breast. For the next feeding, start on the breast you finished on the last time. Every baby nurses differently. You will get to know your baby in a very short time. He will develop a pattern of nursing. Eventually, you want to nurse 15-20 minutes on each side. It is important that the baby be seen by his doctor 24-48 hours after delivery to ensure he is getting adequate nutrition. The 2-week check up is also important for your baby, as his weight will be checked. It can be very helpful to your doctor and yourself if you keep a nursing record. List the time of the feeding and how long the baby nursed on each side.

How often to feed:

In the beginning, it is important to feed your baby before she is really hungry. This is important for the baby’s health. Also, the baby is learning a very important concept called trust from you. Your baby will trust you earlier and bond with you sooner if she is not hungry. Until your milk supply is well established and your baby is gaining weight (around 2 weeks old), nurse whenever your baby cries or seems hungry. Crying is a late sign of hunger. Look for her to have increased alertness or activity, opening the mouth frequently (mouthing) and rooting (when something touches her cheek, she moves her head in that direction and opens her mouth). Most breast-fed newborns need to nurse every 1.5 – 3 hours or 8-12 times in a 24-hour period. At night, your baby can go 4 hours in between feedings. Do not let more than 5 hours pass in between feedings in a newborn. This is too long for her and can cause your breasts to become engorged (painful swollen breasts filled with milk). It is very important not to use any artificial nipples during the first 2-3 weeks of breast-feeding. Do not give your baby any water, sugar water, supplemental infant formula (unless directed by your doctor), cereal or other solid food, or pacifiers. This could cause “nipple confusion” and she may not take your breast again. It is important that you and your baby become proficient in nursing before you introduce her to an easier sucking mechanism. Sucking from a bottle requires no learning. Your milk production is based on the frequency and duration of nursing. If you “supplement” your nursing in these early days, your milk production will drop off and your baby will not get enough to eat. Milk production works off the supply and demand principal. After a few weeks, your baby will begin to go for longer times in between feedings, 2-5 hours, and will nurse about 6-10 times within a 24-hour period. After a few more weeks, your baby will continue to increase the time in between feedings and may start to “sleep through the night”, usually about 5-6 hours without nursing. When your baby is a few months old, she will nurse about every 4-5 hours or 5-7 times within a 24-hour period. Cereal and other solid foods are usually introduced to your baby when she is between 4-6 months old.

Breastfeeding is not painful. If you are experiencing breast or nipple pain while nursing, something is not right. Consult with your doctor, nurse, or lactation specialist for further instruction. Often, a minor mistake is easily corrected and you are on your way back to successful and painless nursing. During the first few days after delivery, you may feel your uterus contract while nursing, causing some discomfort. This is normal and healthy as your uterus is returning to its pre-pregnancy size.

Is your baby getting enough milk?

You can tell if your baby is getting enough breast milk by how many wet diapers he has in a 24-hour period. During the first 6-8 weeks, if your baby has at least 6 wet diapers and 4 bowel movements in a 24-hour period, he is getting enough breast milk. After 6-8 weeks, he may have less bowel movements. This does not mean he is not getting enough milk.

You will need to increase your caloric intake about 500-600 calories per day while you are nursing. Drink plenty of water, about 6-10 glasses a day. Your baby gets all of her nutrition from you, so eat healthy. Many nursing mothers continue to take their prenatal vitamins while nursing. Check with your doctor. Supplemental fluoride may be needed after your baby is 6 months old if your home water supply is severely deficient (<0.3 PPM). Bottled water often does not contain fluoride. Supplemental vitamin D may or may not be needed. Consult with your doctor about any supplements.

Care of your breasts:

It is important to keep the breast clean when breastfeeding. Do not use soap or alcohol on your breasts. This can dry the skin and leave a residue. Instead, wash the breasts daily with warm water. Generally, there is no need for lotions or ointments on the nipples. The milk itself is an excellent lubricant; rub some around the areola and then let air dry. Use a good support bra. Pat dry the areola after each feeding so that the breast is not moist when placed back into your bra. You may need to use a breast shield or pad if you are having some leakage. Be sure that the pads are not wet. If they get wet, change to a clean and dry one. If your breast or breasts become red and painful and you have a fever, you may have developed an infection called mastitis. You will need to contact your doctor for further information on treatment. It is a good idea to have a breast pump on hand. You may even want to rent a breast pump. Your doctor, nurse, or lactation specialist can provide you with information on what type to look for. Expressed milk can be stored in the refrigerator for 2-3 days or in the freezer for up to 6 months. When your baby is able to take a bottle (after several weeks of successful nursing), you may want to leave pumped milk so that you can be away from your baby for a short time. You will need to introduce your baby to the bottle and ensure he drinks from it before being away from your baby. After he is able to take an occasional bottle, then you can consider leaving him with a family member or baby sitter for a short period of time. If you are gone for a feeding, you will need to pump your breasts during the normal feeding time or your milk production may diminish or you may get engorged. If you return to work after having your baby, you may want to continue to nurse. You can do this successfully by pumping your breasts. This will keep your milk supply up.

When to wean?

If you wean your baby from breast-feeding before she is 12 months old, you must use an iron fortified infant formula. Whole cow’s milk is not suitable for children less than 12 months. After 12 months old, you may use whole cow’s milk. Check with your doctor for complete feeding instructions. If you wean her from the breast at 12 months, you can give her a sipper cup rather than a bottle. Weaning is generally done in a gradual manner. The number of daily feedings is reduced by one for about one week. The next week, another daily feeding is eliminated. Most babies will naturally wean as they grow older and take in more solid food.

Information and consultation about breast-feeding essentials are available through your doctor, nurse, lactation specialist, local hospital, La Leche League, or Department of Health. Consult with them if you have further questions.

Contact your doctor if you develop a fever, your breasts are red and swollen, you are engorged, you want to stop nursing, you have sore nipples, you are taking any medications besides acetaminophen (Tylenol), ibuprofen (Advil, Motrin) or any other approved drug, or your baby has less than 6 wet diapers in a 24 hour period.