Guide for a Healthy Pregnancy

BREASTFEEDING

Soon you’ll need to decide how to feed your new baby. This section is to help you understand why breastfeeding is so good for babies and mothers. Whatever you choose to do, your health care team will be glad to answer any questions that you have.

Why is breast milk best for your baby?

Breast milk has important advantages formulas can’t match:

It has just the right mix of nutrients, vitamins, minerals, and fat to help your baby grow and develop. Your body even adjusts the mix as your baby grows.
It is easy for babies to digest, so they have fewer stomach upsets. Breastfed babies tend to spit up less often than babies fed with formula too. When they do spit up, they smell better.
It has antibodies and other substances that fight off illnesses. Breastfed babies have fewer colds, ear infections, and bouts of diarrhea.
It helps prevent some food allergies.
It helps prevent long-term health problems, such as diabetes and asthma, some cancers and chronic digestive diseases like obesity.
Breastfed babies are less likely to be hospitalized.
Some studies suggest that breastfed babies learn faster.

Breastfeeding avoids tooth decay caused by putting a baby to bed with a bottle. (Of course, all parents can avoid this by not putting a baby to bed with a bottle!)

Why is breastfeeding good for mothers?

Breastfeeding helps mothers too:

It’s a special way for mothers and babies to become close.
Your uterus shrinks to normal size faster. Breastfeeding moms sometimes lose weight more easily too, because they are using extra calories to make milk.
Breastfeeding saves several hundred dollars in the first year. Breastfeeding is more convenient than formulas. You don’t have to prepare formula, clean bottles, or carry supplies in a cooler pack when you leave home.
Breast milk is always clean and at the right temperature. You can feed your baby right away.
The smell of bowel movements and spit-up is not unpleasant in breastfed babies, but can be in formula-fed babies. Also, breast milk doesn’t stain fabric like some formulas do.
Breastfeeding makes women less likely to get breast cancer and ovarian cancer and osteoporosis later in life.
Breastfeeding delays resumption of periods and can help with child spacing.

Your clinician can answer questions about breastfeeding and tell you about helpful classes and publications.

What are your concerns about breastfeeding?

While breastfeeding is natural, it often takes a while to learn to do it and gain confidence. If you’ve never breastfed, you probably have many questions. Remember, with some good advice and practice, most moms can breastfeed successfully. Try to find people you’ll feel comfortable calling for advice in the early weeks, like friends and relatives who enjoyed breastfeeding or volunteers at La Leche League. Ask your clinician to suggest breastfeeding experts you can call for help too.

I’m afraid I’ll feel embarrassed when I breastfeed, especially if I need to feed the baby when other people are around.

You may not feel comfortable with breastfeeding right away. It may seem awkward to handle your breasts, or feed the baby in front of family or friends or in public. For a while, you might want to find a private place to breastfeed or ask others to leave the room. Later, as you get more comfortable, you’ll find you don’t need to expose your breasts to breastfeed. Loose sweaters or pullovers can be easily pulled up from the bottom without drawing attention. A shawl, blanket, or scarf placed over your shoulder will cover your breasts and the baby’s head. Or you may want to borrow or buy a few tops made with hidden slits for easy, discrete breastfeeding.

Are my breasts the right size and shape?

You don’t need to worry about this. Breast size and shape have no effect on breastfeeding. Even women with nipples that are flat or inverted (turned inward) can usually breastfeed with a little help.

Will I make enough milk?

Yes. As your baby sucks and empties your breasts, your body responds by making more milk. When your baby goes through growth spurts and needs extra milk, he or she starts to breastfeed more often. This signals your body to make more milk, which it can easily do. Once your milk supply increases, your baby will go back to feeding as usual.

You may have heard stories about women who gave up on feeding because they didn’t make enough milk or their milk wasn’t right for the baby. Keep in mind that:

Your breasts take a few days after birth to start making large quantities of milk. Right from the start, though, babies get important health benefits from small amounts of early milk (called colostrum). Plus, they learn how to suck properly while you learn to breastfeed.
Breast milk changes as your baby grows. As long as you keep breastfeeding, she or he will get the right food.
If you do have some problems at first, it doesn’t mean you can’t breastfeed. Your clinician or a breastfeeding expert can help you solve most problems. For many mothers, this extra help and the will to keep trying are all that’s needed. (Some women, even with good advice and much effort, cannot breastfeed exclusively.)
Very rarely, babies are allergic to their mothers’ milk. Allergies to formula are much more common.

How will I know if I’m making enough milk?

Because you can’t see exactly how much breast milk a baby is drinking, some parents (and relatives) worry that it’s not enough. But there are ways to tell if your baby is getting enough milk. She or he should:

Have six to eight wet diapers a day after the fifth day.
Have two to three yellow bowel movements (stools) in 24 hours. (At first, stools are sticky and tar-colored, but they become very loose and yellow once breastfeeding is working well. It’s normal for a breastfed baby to have a stool at almost every feeding during the early weeks. After the first month, some breastfed babies only have a stool every few days.)
Gain three to eight ounces a week.
Nurse 8 to 12 times in 24 hours (and you should hear him or her swallowing).

Learn to recognize your baby swallowing. Some women, even with good advice and much effort, cannot breastfeed exclusively.

Will my partner or family feel left out?

Partners and families are bound to have their own feelings about breastfeeding, just as they will about other ways to care for your baby. If you decide to breastfeed, it’s a good idea to talk about why you feel this is the right decision. Family members can find special ways to care for the new baby other than feeding, such as bathing, rocking and cuddling. Once breastfeeding is established (usually within three to four weeks,) you can pump or express milk into a bottle so family members can share in feedings, if you choose.

Does breastfeeding hurt?

The first few days or weeks of breastfeeding can be awkward and uncomfortable. For example, the breasts may become very full (engorged) and feel swollen, warm, or painful. Some women have sore nipples for a while.

Problems like these can be quite uncomfortable, but they are only temporary. Your clinicians or a breastfeeding expert can help you find ways to relieve them if necessary. If you learn about breastfeeding through classes, books, or experienced moms before you have your baby, you will know how to handle discomforts and even prevent them.

Remember, with a bit of time and practice, most women find breastfeeding doesn’t hurt and gives them special, enjoyable time with their babies.

Can I breastfeed if I have a cesarean birth?

Yes. Almost all mothers can breastfeed regardless of pregnancy or birth complications. If you have a cesarean, you may need help finding comfortable positions for breastfeeding at first.

I plan to go back to work soon after my baby is born. Can I still breastfeed?

Many working mothers are able to continue breastfeeding with a little planning:

Breastfeed at home in the morning and evening. While at work, pump or express milk into a bottle. (It needs to be kept cool in a refrigerator or with ice packs.) You can take it home for your baby to have the next day.
Or your baby can have formula during the hours when you can’t breastfeed. This is called supplementing. It works well for many mothers who can continue to nurse when they are at home.

If your baby will be in day care, remember that breastfeeding helps prevent many of the illnesses – like ear infections and colds – babies can get when they’re exposed to other children.

Some women decide to breastfeed only until they go back to work. Breastfeeding is good for your baby and you even if you can only do it for a short time.

Can I breastfeed and bottle-feed?

Yes, many women combine breastfeeding and bottle-feeding successfully. Wait three to four weeks until breastfeeding is well established before introducing a bottle. This helps insure a steady milk supply and gives the baby a chance to learn to suck at the breast.

I’m worried that I’ll feel overwhelmed or tied down because I’m the only one who can feed the baby.

At first, most new moms (breastfeeding or not) feel tired and overwhelmed as they adjust to life with a new baby. Breastfed newborns nurse quite often (usually every one to three hours). However, most formula-fed babies will eat eight or nine times a day during the first few weeks, too. As babies get older, they can go longer between feedings.

Having family or friends help with household chores or baby care will help. After three to four weeks, you can also pump or express breast milk so that others can feed the baby while you take a break.

How can I learn more about breastfeeding?

There are many excellent books on breastfeeding including: Breastfeeding by Mary Renfew, Chloe Fisher, and Suzanne Arms; Nursing Mother’s Companion by Kathleen Huggins; The Womanly Art of Breastfeeding by La Leche League International, Working Mother, Nursing Mother by Gail Pryor. Try your library or local bookstore.
Ask your clinician about free or low-cost classes on breastfeeding that you can take during pregnancy.
Talk to experienced moms.
La Leche League International (847-519-7730 or www.lalecheleague.org) will send information and phone numbers for local groups that offer support for breastfeeding moms.
Check out the web site at www.breastfeeding.com.

What if I decide to feed my baby formula?

You can feed your baby with the formulas made today, though the two of you won’t get the health benefits of breastfeeding. If you have questions about choosing or using formula, talk to your pediatric clinician.

Women who may have trouble breastfeeding include:

Women with inverted or flat nipples.
Women with breast implants.
Women who have had surgery on their breasts.

Women who shouldn’t breastfeed include:

Women who have infections such as HIV and active tuberculosis that is not treated.
Women who take certain medications. These medications include ergotamine, lithium, some drugs used to treat high blood pressure and chemotherapy drugs. Women worry about continuing antidepressant medications while they breastfeed. Often times, it’s good to continue taking your medications. Talk to your clinician and find out if breastfeeding is safe for your baby.
Women who use illegal drugs or abuse alcohol.
There is some controversy about breastfeeding mothers and smoking. Smoke is not good for a baby whether the baby is breast or bottle-fed.

Breastfeeding Resources

Lactation Consultants who have the initials IBCLC after their names have completed rigorous training including hundreds of hours of supervised experience, and passed a certifying exam given by the International Board of Lactation Consultant Examiners, which is independently accredited. This is the highest level of professional qualification, and they are required to re-certify every five years. An IBCLC may charge a fee, which may not be covered by insurance.

Lactation Counselors, including members of La Leche League International and Nursing Mothers Council, are women who have breastfed their own babies and have attended some training courses. They can provide advice about normal situations that arise during the course of breastfeeding, and their services are generally free of charge.

Members of Nursing Mothers Council are volunteers who have completed a four-day training and passed an exam. They re-certify every two years by completing breastfeeding education courses.

La Leche League Leaders are experienced breastfeeding mothers who have been accredited to represent La Leche League. Accreditation includes education regarding evidence-based breastfeeding information as well as communication skills. In addition to offering support to individual mothers many Leaders facilitate regular support meetings to allow for mother-to-mother support. All women interested in breastfeeding are welcome at meetings. Contact your local La Leche League Leader for meeting times and locations.

Certified Lactation Counselors (CLC) have completed a 5-day training program and received a certificate of completion. They may or may not have personal breastfeeding experience.

WIC program leaders support breastfeeding mothers enrolled in the federal program for Women, Infants, and Children. Many WIC offices have peer counselors that can provide for nursing families. Contact your local WIC office to find out what services are available.

Community breastfeeding groups listed on our website are led by IBCLCs. These groups offer a chance to meet other mothers and get expert advice on breastfeeding. Group times and locations are subject to change. Please call to confirm before attending a group meeting.

Massachusetts Breastfeeding Coalition
www.massbfc.org
254 Conant Road
Weston, MA 02493

*For an updated list of resources in your zip code area, log on to www.Zipmilk.com.

Breastfeeding Your Baby – Quick Tips

If you plan to breastfeed, be sure you understand the tips in this publication and know how to use this chart before you leave the hospital. If you have any questions, ask your nurse or a breastfeeding specialist for help before you go home.

How to know if your baby is getting enough milk

During the first week with your new baby, you will want to make sure that s/he is getting enough milk. After the first day, your baby should feed at least 8 to 12 times in 24 hours. Use this chart (available as PDF) to check off the number of feedings and the number of wet diapers and bowel movements each day. If on any day your baby has fewer wet or soiled diapers than the number given on the chart, call your pediatric clinician.

Day	Feedings	Wet Diapers	Bowel Movements
1 (in the hospital)	6 per day	2 per day	1 per day (black, tarry, soiled diaper)
2	8 to 12 per day	3 per day	2 per day (brown, tarry, soiled diapers)
3	8 to 12 per day	3 or 4 per day	2 or 3 per day (green soiled diapers)
4	8 to 12 per day	4 per day	3 or more per day (yellow soiled diapers)
5	8 to 12 per day	4 or 5 per day	3 or more per day (yellow soiled diapers)
6	8 to 12 per day	6 or 8 per day	3 or more per day (yellow soiled diapers)
7	8 to 12 per day	8 or more per day	3 or more per day (yellow soiled diapers)
After day 7, your baby should continue to have at least 8 wet diapers a day. The number of bowel movements varies. If you are still concerned about how much milk your baby is getting, talk to your pediatric clinician. S/he may want to weigh the baby.
Fill in these important names and phone numbers
Pediatric clinician:		Breastfeeding expert:
Obstetric clinician: 781-682-8000		La Leche League: 1-800-LA LECHE for information on local chapters

Before you leave the hospital, you should know:

How to position baby at the breast and help him/her latch onto the nipple.

The nursing staff at the hospital can help you get started breastfeeding right after birth. They can also answer any questions you might have later. Remember that it should not hurt to breastfeed.

How often your baby should be fed and for how long on each side.

A new baby needs to be fed at least 8 to 12 times in 24 hours. Even though this may seem like a lot, you need to nurse your baby this often in order to breastfeed successfully. Usually this works out to a feeding every 2 to 3 hours (from the beginning of one feeding to the beginning of the next feeding). Some babies like to bunch several feedings into only a few hours.

Leave the baby on the breast until s/he will no longer suck and swallow when you massage and compress the breast. Then switch the baby to the other side.

How to tell when your baby will feed

Watch for “feeding cues” to tell you when your baby will feed, even if s/he is asleep. Try to feed the baby before s/he begins crying frantically. When your baby is awake, watch and listen for:

Sucking movements of the mouth and tongue
Restlessness or body movements such as trying to put hands in mouth
Small sounds
Crying

When your baby is asleep, you may notice some of the cues as above, plus:

Rapid eye movements beneath the lids
Signs of light sleep, such as smooth movements, irregular breathing and waking up occasionally
Smiles in sleep

How to know when your baby is swallowing

Once your milk comes in, your baby should swallow every 1 to 3 sucks. You can tell if your baby is swallowing if you:

Hear a puff of air from the baby’s nose
Hear the baby swallow
See the baby’s throat move
See the areola being drawn into the baby’s mouth as the jaw drops

How to know if your baby is getting enough milk

You can tell if your baby is getting enough milk by the number of wet and soiled diapers s/he has each day. (The easiest way to tell if a disposable diaper is wet is to put a dry piece of soft paper towel in the diaper.) Refer to the chart above for information on “typical” numbers of wet and soiled diapers for breastfed babies in the first week of life.

When to call for help

If you or your baby still has any of these problems, call your pediatric clinician:

Your baby still does not latch on to the breast on the first day home from the hospital. You and your baby need to be seen by a clinician skilled in helping breastfeeding mothers and babies.
Your baby sleeps most of the time and doesn’t awaken easily for feedings.
S/he appears yellow or orange (jaundiced,) especially in the whites of the eyes.
S/he seems to be nursing less and less energetically during the course of the first week.
It isn’t obvious that your milk has come in by the fourth day and you are worried that your baby might not be getting enough milk.

Call your obstetric clinician if:

You have problems with your breasts (such as sore or cracked nipples or prolonged engorgement).
You need extra help with breastfeeding.
You are thinking of supplementing breastfeeding with formula or stopping breastfeeding.