Breastfeeding

Breast-feeding your baby is encouraged. While you are in the hospital, take advantage of the wealth of knowledge of your nurses to help you get started the right way. If you need help and support after you go home, please call our office. Your milk will not “come in” until your baby is 2-4 days old, yet it is important to start nursing your baby as soon as possible after birth. Your baby will get a thick, yellow substance called colostrum, which is high in calories, protein and infection fighting components.

During the first few days of “learning”, offer the breast whenever your baby is awake and interested. Since adequate milk production depends on suckling by your baby, frequent short feedings are preferable at this time than longer, more infrequent feedings. It is preferred that you do not offer your breast-fed baby a supplemental bottle until after the first few weeks of life. If this is something you would like to do, it can be discussed at our baby’s 2-week check-up.

Proper positioning of your baby is essential to successful breast-feeding. There are a number of different positions for you to try. No matter which position you prefer, there are some things that remain the same. Your baby should be elevated to the height of the breast, so you may need pillows for extra support for you or the baby. Your baby’s whole body should be turned to face you. Support the baby’s head with one hand, and support your breast with your thumb above and fingers below the areola. Your fingers can pull backward slightly to make the nipple thrust out, making it easier for your baby to latch on to the nipple. You should touch the nipple to your baby’s cheek, and when your baby’s mouth opens up widely, pull your baby close and insert as much of the nipple and areola as possible.

Sore Nipple Management
Sore nipples often result from improper positioning and latching on. The following considerations are suggested for the prevention or treatment of sore nipples.

• Use deep breathing exercises before and during a feeding
• Express a small amount of milk either by hand or pump prior to feeding to encourage letdown and decrease the vigorous nursing of a hungry baby at the start of a feeding
• Limit the nursing time in the sore nipple with short, frequent feedings about every 2 hours for 5-10 minutes after the letdown has occurred
• Nurse on the least sore side first
• Your baby must be latched on and positioned properly. Use pillows for support
• Use different positions with each feeding
• Release your baby's suction before removing him from the breast by inserting a finger in the side of his mouth. Don't take him off the breast until you feel the suction break
• Do not use soap, alcohol or breast creams on your breasts or nipples. Water is all that is needed to clean your breasts
• Allow the nipples to air dry after each feeding and keep the bra flaps down several times a day to increase air circulation
• Do not use plastic bra liners or pads as they keep in the moisture
• Use a small amount of USP Modified Lanolin as a moisture barrier for dry or cracked nipples
• Wear multiple holed breast shells between feedings to prevent the bra from rubbing on the sore nipples. (Ask your lactation consultant or local maternity shop)
• Do not use rubber nipple shields
• Taking a mild analgesic such as acetaminophen is fine

Feeding Schedule
Feeding time will vary with your baby’s particular nursing style. Breast fed babies usually eat frequently, averaging 2 to 3 hours from the start of one feeding to the start of the next. Your baby may occasionally need to eat more often. Expect your baby to eat between 8 and 12 times in a 24-hour period. A typical feeding is 10-20 minutes on the first side and as long as your baby desires on the other breast. It is important to feed your baby until he is content and avoid watching the clock. Start the next feeding on the breast used at the end of the last feeding.

After your milk supply is in, you will know your baby is getting enough to eat if:

• Your baby has at least 6 wet and 2 dirty diapers in a 24-hour period
• Your baby is content for 1 to 2 hours between most feedings
• During the feeding, you hear him swallowing milk

Storage of Breast Milk
Eventually, the time will come when you need to separate from your baby for a short time. During your absence, your baby can be fed pumped breast milk in a bottle. There are a variety of breast pumps on the market to meet your individual pumping needs. Ask your lactation consultant which pump would be appropriate for your situation.

If you are pumping breast milk, it is important to follow these storage guidelines to ensure a safe milk supply.

Freshly pumped milk

• Store up to 6 hours at room temperature
• Store up to 72 hours in the refrigerator
• Store up to 3 months in home freezer
• Store up to 6 months in deep freezer

Thawed milk (Previously frozen)

• Do not store at room temperature
• Store up to 24 hours in refrigerator
• Do not refreeze thawed milk

Because the properties of breast milk change throughout the lactation phases, it is advisable to use the milk within 30 days of freezing it. All frozen milk should be labeled and dated. It is suggested that breast milk be frozen in quantities of 2-4 ounces to avoid wasting thawed milk. Breast milk should be thawed under running water, starting with cool water and increasing the water temperature until the milk has thawed.

Breast Pumps
There are many different breast pumps available for nursing mothers in many price ranges. Unfortunately, the take home advice generally is – “you get what you pay for”. Hand held pumps are generally only for moms who intend to express milk with little frequency – the best one is the Avent brand and is widely available.

The key to using a hand held pump is to ensure that the milk is adequately drained from your breast or you will risk getting plugged milk ducts which can lead to an infection called mastitis. This means repositioning the pump at various intervals to ensure complete emptying. The dual electric pumps may be pricy but also may be the best choice for the majority of mothers. Some of the brands include Ameda and Medela. These pumps are a cost effective choice for mothers who plan on having more than one child and who intend to express breast milk on a regular basis. They pay for themselves in a short time. Hospital grade pumps are great for mothers who will be expressing milk often. They are the most expensive, but they are very efficient and breast milk can be expressed very fast! The pumps must be rented either from a hospital or from a drug store or medical supply company. Personal tubing is then purchased and used with the pump to ensure sterility.

The invention of a breast pump bra means nursing moms can multi task and pump hands free. There is a new device with 2 strategically placed elastic holes on a stretchy strapless bustier that can keep the breast pump cups in place allowing mother’s hands to be free to: feed or read a story to another child, talk on the phone, surf the internet, etc. The place where you can find these wonderful “mother’s little helper” is www.easyexpression.com.

A phone number to call to check for breast pumps to rent or to buy is offered by La Leche League 1-800-TELL-YOU – just give your zip code and a list of places will be provided. Check with your provider if you have other questions about breast pumps, pumping or other nursing advice. Another web site that may be helpful for more information about expressing milk is www.mayoclinic.com/invoke.cfm?id=PR00002.

Read about nutritious diets for a breastfeeding mother or find out more information about general breastfeeding topics.