Breastfeeding Your Baby
Whenever possible, breastfeeding is the best source of nutrition for your baby. We understand that there are certain circumstances in which mothers will be unable to breastfeed their baby. Should you decide to feed your baby formula, we want you to know that this is certainly acceptable to us as well. The important thing is that you and your baby are happy and are bonding well.
When you first begin to breastfeed, especially for new mothers, it is a time for learning. Both you and your baby need to learn the best way to work together to develop a comfortable feeding method and schedule. Most mothers will have to try multiple times before their baby will get the hang of latching on. This is completely normal. Remember to have patience during the first few days, and do not give up. Your baby will catch on eventually. Some parents become concerned during the first 1-2 days that their baby is not getting enough nutrition and will begin to supplement. While supplementing will provide extra nutrition, it sometimes will interfere with your baby’s ability to latch on to your breast. He will learn to latch on to the bottle and may have difficulty or even refuse the breast. As long as your baby is latching on and is getting some breastmilk, there is no need to supplement with formula. It is expected that your baby will lose 5-10% of his birthweight during the first few days of life as he learns how to feed.
During the first few days of breastfeeding, your milk will not have come in yet. When your baby feeds he will be getting a clear yellow fluid known as colostrum. This substance is full of nutrients, and although the amount produced seems small, it is appropriate for what your newborn is able to eat. Typically, your baby will nurse every two to three hours, even through the night. After the first few days, you will begin to produce breastmilk, and the volume will gradually increase. Remember that your milk production relies on the supply and demand principle. The more your baby nurses, the more milk you will produce. Likewise, the less your baby nurses, the less milk you will produce. Therefore, if you begin supplementing because you feel you are not producing enough milk, your baby will not be nursing as often, and your milk supply will diminish even more. It is best to continue breastfeeding and to encourage your baby to do so.
Before beginning a feeding, it is always a good idea to rinse your breast with water and dry. The best way to encourage your baby to latch on is to rest the baby’s head on your arm or hand and to stroke the baby’s cheek with your nipple. Your baby is born with a rooting reflex which will cause him to turn his head towards the cheek that you stroke, in search for your breast. Make sure that you do not try to turn your baby’s head with your hand as this will upset him and disrupt your attempt to feed. Typically babies should feed from both breasts each time they feed. You want to start each feed with the breast you ended on during the last feed. The reason for this is because your baby will typically empty the first breast and then finish his feed on the second breast leaving milk remaining in that breast. When it is time for the next feed, the second breast is more likely to be engorged. An easy way to remember which breast you last fed on is to pin a safety pin to the bra on that side.
At the end of a feed, many mothers have found that placing lanolin on the breasts will help to prevent sore cracked nipples that result from the frequent feeding that babies require. Lanolin is completely safe for the baby and you do not need to worry about putting this on your breasts. It does not need to be washed off, but some women find it helpful to rinse or wipe off excess prior to breastfeeding.
Sore Nipples
Sore nipples are frequently a normal processes for the first 7-10 days while you and your baby are getting used to breastfeeding. There are several other reasons that can lead to soreness that should be considered as well. The first consideration when you are dealing with sore nipples should be to make sure that your baby is latching on properly. This is the number one cause of sore nipples. Make sure that your baby is taking the entire nipple and areola (dark area surrounding the nipple) into his mouth. Soreness occurs when the baby is only nursing on the nipple. If you have one nipple that is bothering you, try beginning each feed on the opposite side. Babies tend to nurse most vigorously on the first breast. Remember to return to the usual pattern once your nipples are no longer sore. If you are experiencing severe discomfort and feel you must stop feeding for a short period, make sure that you express your milk with a pump to keep your supply up.
Medications While Breastfeeding
Many medications taken by nursing mothers will be passed on to the baby in the breastmilk. Make sure that you check with your pediatrician prior to taking any medications, either prescription or over-the-counter. If we are unsure, we will investigate and let you know whether or not the medication is safe to use while nursing.
Alcohol and Breastfeeding
As with medications, alcohol is passed into your breastmilk and will affect your baby. It is best to avoid alcohol while breastfeeding. If you decide to have a social drink, be sure to do so right after you breastfeed (while your breasts are depleted of milk). You may also choose to dispose of the following feed by expressing your milk and throwing it away. To do this, you must either have stored breastmilk to give your baby or use formula for that feed.
Smoking and Breastfeeding
Nicotine is passed to the breastmilk as well. It is currently unclear what effects this may have on your baby. Additionally, mothers who smoke while breastfeeding are exposing their babies to secondhand smoke. This exposure increases your baby’s risk of Sudden Infant Death Syndrome (SIDS), respiratory illnesses, and ear infections.
Your Diet While Breastfeeding
It is very important for a nursing mother to maintain a healthy, well-balanced diet consisting of at least three meals/day. Make sure you drink plenty of fluids (avoiding caffeine) as breastfeeding depletes your body of fluid more rapidly than if you weren’t nursing. There are certain foods that can cause your baby to become gassy, colicky, or have loose stools. These foods to avoid include tomatoes, onions, cabbage, broccoli, chocolate, and spicy foods. The best way to assess if any foods are causing problems for your baby is to keep a food diary for 24 hours as typically this is the time period during which the problem will present and resolve. Once you figure out the “problem” food, cut it out of your diet and watch for improvement of your baby’s symptoms. If you cannot find a trigger or if the symptoms are persistent (>24 hours), your baby may have true colic which will be addressed in a later section of this book.
On a rare occasion, babies can be allergic to cow’s milk in a mother’s diet. Symptoms typically present within minutes to an hour after breastfeeding and include diarrhea, rash, fussiness, and gas. The best way to determine if this is occurring is to cut out all dairy from your diet for two weeks, then return the dairy items one at a time to your diet to see which item causes a problem for your baby. Before doing this, please talk to your pediatrician about your concerns, as there may be other causes for your baby’s discomfort.
Supplementing With Formula
Some mothers choose to or need to supplement with formula for various reasons. Remember that you need to express your breastmilk at regular feeding intervals in order to keep your supply up. If you do not do this, your milk supply will decrease. Also remember that you can express the milk and refrigerate or freeze it and use it to supplement.
Storing Breast Milk
Breastmilk needs to be stored properly, if not used within 30 minutes after expressing. Remember that you should not use the bottle from which your baby fed to store fresh breastmilk. You should always store milk in either a sterilized container or appropriate breast milk storage bags. Breastmilk can be refridgerated for up to 24 hours. If frozen in a standard freezer, you may keep the milk for 2 months. If stored in a deep freezer at 0ºF you can keep it for up to 6 months. When heating or thawing breastmilk, always use a container with warm water and sit the bag or container of milk in the water. Never microwave the breast milk! Always check the temperature of the milk by shaking a few drops from the nipple onto your wrist to assure that it is not too warm before feeding your baby. Only thaw the amount of milk that your baby can consume within 24 hours. Refrigerate any leftover milk after each feeding and never refreeze the milk.
For more information on breastfeeding, check out the AAP Women’s Guide to Breastfeeding on the internet at http://www.aap.org/family/brstguid.htm.