Breastfeeding

Overview

Breastfeeding is one of the best ways to ensure your baby's health and development. It's a convenient, cost-effective, natural way to feed your baby.

Breastfeeding is one of the best ways to ensure your baby's health and development. It's a convenient, cost-effective, natural way to feed your baby.

Breastfeeding is widely recommended as the best way of feeding infants by leading health organizations, including, among others:

• The American Academy of Pediatrics
• The American Academy of Family Physicians
• The American Congress of Obstetricians and Gynecologists
• The American Dietetic Association
• The American College of Nurse-Midwives
• The U.S. Department of Health and Human Services, Office on Women's Health

Healthy mothers should consider breastfeeding exclusively (no formula) for the first six months of life and, if possible, continue until the baby is one year old and beyond. Ideally, solid foods should only be introduced after six months of age. They should be introduced gradually, under the guidance of your baby's pediatrician.

Breastfeeding offers so many health benefits to women and their babies and the environment that it is a major public health priority. Here are the Healthy People 2020 goals to increase breastfeeding.

Healthy People 2020 Goals

Diagnosis of Common Breastfeeding Problems

Breastfeeding is a natural and rewarding process; however, it can be harder than it looks. If you have trouble breastfeeding, contact your health care provider or consult a lactation consultant or counselor. Breastfeeding challenges are often easily overcome with some support and, occasionally, treatment, so don't give up.

What's a Lactation Consultant?

Lactation consultants are professionals who are trained to help mothers who want to breastfeed their babies. Most hospitals and clinics have lactation consultants on staff to help new moms learn to nurse, and these services are covered as part of your delivery care. They can provide encouragement and assist moms and babies with latching difficulties, painful nursing and other issues that may interfere with efforts to breastfeed. Once you are discharged from the hospital, if you need a lactation consultant you can visit the La Leche League's website. Your prenatal care provider's office or your baby's pediatrician may also have lactation specialists in their office or be able to refer you to one. Some insurances cover lactations specialists and some do not; you may want to call your insurance company before your baby is born to figure out what lactation services (including pumps) your insurance company will pay for.

See the Treatment section for descriptions of some common breastfeeding complications and how to treat or prevent them.

Treatment of Common Breastfeeding Problems

There are ways to treat or prevent problems that may develop because of breastfeeding. Even if you begin to have symptoms like sore nipples or other issues, it's important not to give up before speaking with your health care professional or lactation consultant—or even a friend who has successfully breastfed her children.

Here are some treatment options for the most common breastfeeding symptoms.

Sore or Cracked Nipples

This occurs most often because the baby is not "latching on" to your breast correctly.

To treat or prevent sore, cracked nipples:

• Make sure your baby is latched on and sucking properly. The baby's mouth should take your nipple and as much of the areola (darker area around the nipple) as possible. If it hurts, you may need to reposition and start again. Be careful not to pull the baby away from the breast quickly; instead gently interrupt the suction by placing a finger in your baby's mouth.
• Offer the less sore nipple first, as the baby may suck more vigorously at first.
• Let your nipples air dry between feedings. Do not dry by rubbing. You may want to expose your breast to sunlight briefly—for 15 minutes or less.
• You can use a cool compress on sore nipples after a feeding.
• Rub a small amount of breast milk or breast cream that contains lanolin and water to soothe the area after a feeding. Your milk will help heal cracks and kill bacteria, which can help prevent infections.
• If your nipples are cracked or bleeding, contact your provider because they may want you to use a prescription cream or special compress or bandage.
• Change wet nursing pads frequently. Use of washable cotton pads may cause less irritation than synthetic-backed (i.e., plastic) pads.
• Gently wash your nipples daily with warm water and pat dry. Avoid using soap or scrubbing or rubbing your nipples, which can remove protective natural oils.
• If you have an open crack in the skin, it may be better to nurse from the other breast temporarily, but be sure to pump or manually express the sore side until it heals a bit and isn't sore.

Nipple soreness and chapping should go away within several days. If it doesn't, you should contact your health care provider or lactation consultant.

Engorgement

When your breasts are engorged, they become swollen, hard and sore. They may become so full that the nipple flattens into the areola (the dark skin around the nipple). This can lead to plugged ducts or a breast infection.

To treat engorged breasts:

• Breastfeed frequently to help empty your breasts and relieve fullness and pain.
• If this is too painful, try to manually express some milk to provide a natural, soothing lubricant. This may also make it easier for the baby to latch on to the nipple.
• To ease engorgement, take a warm shower or apply warm compresses for a few minutes before breastfeeding.
• Gentle massage of the breasts before pumping or breastfeeding may also help.
• If your baby is not latching on well, use a pump to reduce engorgement and help your milk flow before trying to latch on baby.
• Use cool compresses between feedings to reduce swelling. Engorgement can lead to mastitis and other breastfeeding problems, so it is important to try to prevent it.
• Usually engorgement results when the breasts are not being emptied frequently or completely enough. You may need to adjust your feeding or pumping schedule to prevent engorgement from happening again.

Plugged Milk Ducts

These are common during breastfeeding and occur when the milk is not properly drained. The affected milk duct feels like a tender lump in the breast and can become inflamed and red, however, there are usually no other symptoms. The best treatment is prevention. Avoid breast engorgement by nursing or pumping frequently enough.

To treat plugged milk ducts:

• Get extra sleep or rest.
• Apply heat compresses or taking a hot shower.
• Massage the blocked milk duct toward the nipple during nursing.
• Breastfeeding from the affected breast to help loosen the plug.
• Apply cool compresses to your breasts after feeding.
• Make sure your bras fit well. They should provide firm support but not feel tight. Avoid underwire bras or other bras that can compress the breast tissue.

Mastitis

Also called breast infection, mastitis is often accompanied by a fever, chills and/or other flu-like symptoms. Mastitis is less common than other breast problems and occurs when bacteria from your skin or from your baby's mouth enters the breast through cracked skin. The affected breast may be red or have red streaks and may be painful and swollen.

If you suspect mastitis, you should consult your health care provider right away. Your provider will prescribe antibiotics and may recommend an analgesic to relieve the pain.

If you feel a large, hard area on your breast that is very tender and red, there may be a breast abscess—a collection of fluid and pus. These are rare but will require antibiotic treatment and possibly a procedure to drain the abscess.

Additional treatments for mastitis may include:

• Take a hot shower or apply warm compresses before breastfeeding to help increase circulation to the affected area.
• Apply cold compresses between feedings.
• You may need to take an anti-inflammatory such as ibuprofen, but be sure you talk to your health care provider before taking any over-the-counter pain medication.

Thrush

Thrush, or yeast infection, is also less common than other breastfeeding complications. A yeast infection at the nipple may be suspected if you suddenly get sore nipples after several weeks of successful, pain-free nursing; the pain occurs when your baby is latching. Other signs include pink, flaky, shiny, itchy or cracked nipples. If you experience shooting pains deep in the breast during or after feedings, the yeast may have gotten into the ductal tissue of the breast.

Consult your health care professional if you experience these symptoms. Both you and your baby may need treatment with antifungal medication.

In most cases, you can, and should, continue nursing through breastfeeding problems, even an infection. Emptying your breasts frequently can often reduce inflammation and relieve the problem.

Prevention

Breastfeeding is a unique experience for each woman and her baby. You may or may not experience the same (or any) breastfeeding symptoms a friend or your mother had. Many difficulties associated with breastfeeding can be minimized. The benefits of staying committed, whenever possible, to breastfeeding always pay off.

Here are a few tips to further explain why breastfeeding is valuable to you and your baby's health now and in the future, as well as how to prevent complications.

• Breastfeeding offers a wide range of health benefits and reduces the risk of certain illnesses for both mom and baby.
  • Breast milk has antibodies that bolster you baby's natural immunity to fight common childhood infections, including diarrhea, ear infections, respiratory infections and bacterial meningitis. It can also lower the risk of some chronic illness (e.g., juvenile diabetes, some childhood cancers, irritable bowel syndrome/colitis, overweight and obesity). Because breastfed babies tend to be healthier, they have fewer:
    • Illnesses (less severe and shorter)
    • Sick care visits
    • Hospitalizations
  • Breastfeeding helps moms recover from pregnancy and childbirth and can reduce the likelihood of certain cancers (e.g., breast, ovarian) and osteoporosis.

• Before starting to breastfeed, talk with your health care provider about any prescription or over-the-counter medications or herbs you are taking, just in case these can pass into your milk and harm your baby.
• Limit alcohol and caffeine, which can easily pass into your milk. Your baby does not have the enzyme to break down alcohol and keep it from reaching toxic levels, so you need to be especially careful about alcohol. The effect of alcohol is related to the amount you consume and, in general, should be limited to one serving (or less) of beer or wine. If you are going to consume alcohol, time feedings so they occur two hours later, so the alcohol is no longer in your system. If you are feeling drunk effects of the alcohol, the level in your system is too high, and you should avoid feeding baby while you are feeling these effects.
• Avoid certain kinds of fish and shellfish that contain high levels of mercury. These include shark, swordfish, king mackerel and tilefish. You can safely eat up to 12 ounces (two servings) per week of fish low in mercury, which include shrimp, canned light tuna, salmon, pollock, cod, and catfish.
• Get plenty of rest and eat a well-balanced diet. As a new mom, you are probably feeling overly tired and may not be eating as well as you should be. This can lower your resistance to illness, making breast infections more likely.

Some women experience problems when breastfeeding, such as sore or cracked nipples, engorgement or blocked milk ducts, especially during the first four weeks. There are preventive steps you can take to limit their occurrence and reduce the likelihood of breast infections that may develop as a result. See the Treatment section for descriptions of some common breastfeeding problems and how to prevent them and treat them if necessary

Facts to Know

1. Breastfeeding is the best way to feed babies and is highly recommended. The American Academy of Pediatrics (AAP) and other leading health organizations strongly recommend exclusive breastfeeding (with no formula or solid foods) for the baby's first six months of life. Breastfeeding should ideally continue through the first year of life or beyond.
2. Breast milk is preferred for all infants, including premature and sick newborns, with few exceptions, according to the AAP. Human milk is rich in nutrients and easier to digest.
3. Breastfed infants are healthier. They have fewer deaths during the first year and experience fewer and shorter illnesses than formula-fed babies.
4. The health benefits add up. The longer you breastfeed, the greater the health benefits for you and your baby.
5. Supply will meet demand. Many mothers worry about whether their babies are getting enough milk. Your milk supply will respond to your baby's needs—the more your baby suckles, the more milk will be produced.
6. Breastfeed early. Try breastfeeding within the first hour of giving birth. This is an important time to bond with your baby and learn breastfeeding techniques from a lactation consultant or nurse on staff.
7. Some new mothers experience difficulties breastfeeding. In fact, many mothers report problems during the first few weeks, such as sore nipples, breast pain or swelling. If problems persist, talk with your health care provider or ask to be referred to a lactation consultant. The good news is that most of these problems can be resolved with patience, practice or treatment.
8. Working mothers can and should continue breastfeeding. More and more new mothers are returning to work and plan to continue breastfeeding. Make sure to speak with your employer or human resources manager before returning so you can discuss the logistics of pumping at work. Find out if there is a private room you can use and how you will fit pumping breaks into your schedule. Know your rights. Many states have laws that require employers to set up a space for you and/or allow unpaid or paid time to accommodate pumping breaks.
9. In some cases, breastfeeding is not recommended. For example, mothers with certain health conditions can pass illnesses on to the baby through breast milk. These include:
   
   • Human immunodeficiency virus (HIV)
   • T-cell leukemia virus type 1
   • Active, untreated tuberculosis
   
   Mothers who use illicit drugs, drink excessive amounts of alcohol or are taking prescribed chemotherapy or radiation therapies for cancer also should not breastfeed their babies. If you have a herpes lesion (sore) on your breast, you should not breastfeed.
   
   Women who have had breast reduction surgery or breast implants may not be able to breastfeed because of the impact these surgeries can have on milk production.
10. Breastfeeding has economic benefits. Mothers of breastfed babies tend to have fewer missed work days and shorter absences because breastfed babies are better able to fight off infection and are sick less often. Companies incur fewer insurance claims for infant illnesses. Breastfeeding saves families money because it's a lot less expensive than formula.

Questions to Ask

Review the following Questions to Ask about breastfeeding so you're prepared to discuss this important health issue with your health care professional.

1. Can you recommend a lactation consultant? Are there support programs for new mothers available through your practice or the hospital?
2. How often should I breastfeed? How will I know whether my baby is getting enough milk?
3. When should I introduce a bottle?
4. How can I prevent sore nipples?
5. Can I continue breastfeeding my baby if my breasts are sore or if I have a cold or the flu?
6. Are there specific foods I should eat or avoid eating while breastfeeding? What about alcohol or caffeine?
7. Are there any over-the-counter or prescription medications that I should stop taking?
8. I've heard that I can't get pregnant if I'm breastfeeding. Is this true?
9. What should I look for in a breast pump?
10. How often should I pump when I go back to work?
11. Can I exercise while breastfeeding? How will this impact my milk supply?
12. How can I minimize leakage from my breast?

Key Q&A

Lifestyle Tips

• Similar to when you were pregnant, it's important that you lead a healthy lifestyle. Make the right choices for you and your baby:
  • Get plenty of rest. As a new mom, you're probably feeling overly tired. This can lower your resistance to illness and may make breast infections more likely.
  • Eat a well-balanced diet with plenty of calcium. Try to eat lots of fruits and vegetables, whole-grain cereals and breads, meats or beans, and milk and dairy foods like cheese. Nursing burns extra calories—about 500 more each day—so make sure you are eating enough and drink plenty of fluids. Best food choices for calcium are: milk, cheese, yogurt, broccoli, sesame seeds, tofu and kale. If you don't think you're getting enough calcium (about five servings a day), talk with your health care provider about supplements.
  • Steer clear of fish and shellfish high in mercury—shark, swordfish, king mackerel and tilefish. You can eat 12 ounces per week (two servings) of fish and shellfish low in mercury, such as shrimp, canned light tuna, salmon, pollock, clams, haddock, trout and catfish. Check with your health care professional about specific guidance with regard to eating fish and shellfish.
  • Limit alcohol and caffeine, which can get into your milk.
  • Ask your health care provider about any prescription medications, over-the-counter drugs or herbs you are taking, just in case these may be harmful to your baby.
  • Pay attention to any reactions your baby has to your milk.
• Problems are common during the beginning stages of nursing. Although it's a natural process, breastfeeding is also an art. Take your time and try not to get discouraged or overly stressed, which may make it worse. Ask for help if you need it. Lactation consultants can offer encouragement and help you overcome difficulties. You may also want to find out about new mom support groups. Talk openly with your partner and family about how they can be supportive of your efforts to breastfeed.

Health Benefits

Health Benefits for Mom and Baby

There are compelling reasons to breastfeed—and both you and your baby benefit.

For Your Baby …

Breast milk provides just the right balance of nutrients for optimal growth and development. Your body constantly changes the content of breast milk, making the perfect milk for baby. Milk changes its nutritional content both day to day and as baby grows to meet your baby's needs. This means that milk you produce when your baby is 3 months old differs from what you will produce 6 months later.

• Breast milk provides just the right balance of nutrients for optimal growth and development. Your body constantly changes the content of breast milk, making the perfect milk for baby. Milk changes its nutritional content both day to day and as baby grows to meet your baby's needs. This means that milk you produce when your baby is 3 months old differs from what you will produce six months later.
• Breast milk has antibodies that help protect your baby from common childhood illnesses and infections, such as bacterial meningitis, diarrhea, ear infections and certain respiratory infections. This natural immunity—or ability to fight off infection—means breast-fed babies have fewer:
  • Illnesses (less severe and shorter)
  • Visits to the pediatric provider
  • Hospitalizations
• Research shows that breastfeeding also reduces newborns' and infants' risk for developing chronic diseases, such as celiac disease, inflammatory bowel disease, and some childhood cancers and may reduce the risk for allergies and asthma.
• Breastfed babies are at lower risk for sudden infant death syndrome (SIDS), the leading cause of death among infants one month to one year old.
• Breastfeeding significantly reduces the risk of childhood obesity and may protect against adult obesity
• Breastfed babies may have a lower risk of developing cardiovascular disease in adulthood.
• Breast milk may protect against the development of type 2 diabetes later in life.
• Breast milk may improve language development and other brain functions such as thinking, reasoning or remembering.

For You …

• Breastfeeding releases a hormone called oxytocin that helps the uterus return to its normal size and reduces post-birth bleeding.
• It also burns extra calories (up to 500 calories per day), making it easier for you to shed those pregnancy pounds.
• Breastfeeding can deepen the emotional bond between you and your baby. Such physical contact helps your baby feel secure and warm and eases his/her transition from the womb.
• Nursing can delay the return of regular periods, although you still need to use birth control.
• There is growing evidence that certain cancers (breast, uterine and ovarian cancer) occur less often in women who breastfeed.
• Data from the Nurses' Health Study shows that breastfeeding for a total of two or more years may help prevent coronary artery disease.
• Breastfeeding may also reduce the risk of diabetes, hypertension and osteoporosis.
• Breastfeeding can help prevent post-partum depression

Breastfeeding saves time and money. There are no bottles to sterilize or formula to mix or warm. In fact, families save an estimated $1,000 to $2,000 on formula per year. In addition, mothers who breastfeed pay fewer out-of-pocket health care costs and take fewer sick days because breast-fed babies are healthier and tend not to need as many visits to their pediatric provider.

How the Breast Produces Milk

Milk production is a normal physiologic response to the childbearing experience. New studies shed light on milk delivery, the composition of milk and the anatomy of the lactating breast. This information can help new moms better understand their bodies and how they respond to breastfeeding.

After pregnancy, your breasts produce colostrum—a thick, yellowish fluid—that helps your newborn's digestive system grow and function. Colostrum, often called "first milk" or "immune milk," is rich in nutrients and infection-fighting antibodies. While you may wonder whether you're producing enough colostrum or milk for your baby in these first few days, keep in mind your baby's stomach is only the size of a marble. Because it is so nutrient rich, one teaspoon of colostrum is all your baby needs at a feeding.

Colostrum transitions into mature milk, which increases in volume in the days following birth. This process is referred to as milk "coming in." but in reality, there is breast milk ready for baby in the breast from the moment baby is born.

When you put your baby to your breast, your milk doesn't automatically start to flow. Your body responds to your baby's suckling patterns, which occur in two phases.

• Non-nutritive phase: When the baby is first put to breast and starts suckling in a fast, light rhythm to stimulate the milk-ejection reflex. This reflex is also known as the let-down reflex. It is the "trigger" that starts your milk flowing and often doesn't occur for a minute or so after the baby starts suckling (timing varies with each mom). Let-down can even be stimulated by your baby's cry or if you are overdue for a feeding. When your milk lets down, you may feel a tingling or tightening sensation as it fills your breast. Not all mothers feel let-down, and those who do, do not feel it every time.
• Nutritive phase: After let-down occurs and your baby switches to a slower, deeper suck. This nutritive phase is when the baby actually drinks your breast milk.

The most common reason women stop breastfeeding too early is because they believe (usually incorrectly) that they are not producing enough milk. This leads them to supplement breastfeeding with formula, and what is often only a perceived breast milk insufficiency, turns into a real one. To make the amount of milk that your baby needs—not too much or too little—your breasts must regularly be emptied.

While your body will start making milk as soon as baby is born, your breasts only know how much milk to make by the amount of suckling/stimulation and by how much milk is removed from the breast at each feeding (or pumping or manual expression). To maintain a sufficient milk supply, especially in the first few weeks of breastfeeding, it is necessary for your breasts to receive adequate stimulation (ideally by putting your baby to the breast) and to be emptied of the milk that builds up in response to that suckling. Each breast responds independently to these signals, which makes it possible for some women who have had a breast removed to breastfeed successfully from one breast.

Challenges & Support

Overcoming Breastfeeding Challenges

Breastfeeding is a natural and rewarding process; however, it is a learned process for you and your baby, and many women and babies have trouble during the early stages of nursing. The good news is that most of these problems can be resolved with patience, practice or treatment.

Don't be discouraged if you experience sore nipples, engorged breasts, mastitis or thrush. The severity of these symptoms can vary, but they all are treatable and often avoidable.

• Sore nipples may develop in the first few weeks of breastfeeding. Nipple tenderness, especially at the beginning of a nursing session, is common. Seek the advice of a lactation professional if your nipples are cracked or bleeding or if you still experience tenderness after the first few weeks of nursing because these are signs that your infant may not be properly latching onto your breast.
• Engorgement happens when your breasts are overly full due to missed feedings or poor or inadequate emptying of the breasts. If your baby is not latching on well, use a pump or express milk manually to reduce engorgement and help your milk flow. Click here to see a video about how to manually express milk. The use of heat and massage right before a feeding or pumping session can help. After a feeding, cool compresses can reduce swelling. Red cabbage leaves placed over the breast after and between feedings have been found to help relieve engorgement.
• Plugged milk ducts can reduce the flow of milk from one or more sections of the breast. If untreated, this often leads to infection. Signs of a plugged milk duct include a hard, painful area on the breast. To help alleviate the situation, take a warm shower and massage the breast. If it continues, seek the advice of a lactation consultant.
• Mastitis, or breast infection, is not a common occurrence, but typically happens when bacteria from your baby's body or from your body invade your milk duct through a crack in the skin. If you have an infection, your breast will feel tender, may have redness and streaking and be warm to the touch. You may feel an area that is hard or tender. You may also have flu-like symptoms, including chills, high fever or fatigue. Your health care provider may need to prescribe an antibiotic. It is important to treat mastitis early, so call your health care provider if you have any of these symptoms.
• Yeast infection, or thrush, can occur at the nipple or inside the breast tissue. If the yeast infection is only at the nipple, it may be red, warm and you may experience nipple pain when the baby is latching. A yeast infection in the breast tissue is suspected if you experience deep, shooting breast pain a few minutes after your baby has begun to suckle. This condition is relatively rare. Consult your health care professional if you experience these symptoms. Both mom and baby may need treatment with antifungal medication if you have a yeast infection.

Breastfeeding shouldn't hurt. Contact your health care professional if your breasts remain tender or sore, or if you have flu-like symptoms that may indicate an infection. In most cases, you can continue breastfeeding. Emptying your breasts frequently by breastfeeding or pumping can often reduce inflammation and relieve the problem.

Finding Extra Support

Many breastfeeding problems can be caused or made worse when a baby is not latching properly to the breast or when nursing sessions are not happening as frequently or for as long as is needed to empty the breast. Your health care professional may suggest that you work with a lactation consultant (also called a lactation counselor) who can review breastfeeding techniques and help you address any problems that you may have while nursing. Many hospitals and health centers have lactation consultants on staff, so make sure to ask your obstetric or pediatric provider if you think you need extra support. Your insurance company may also be able to help you find a lactation expert. New mother support groups and encouragement from your partner, family, friends and employer are also important.

When Not to Breastfeed

Despite the clear benefits of breastfeeding, there are circumstances when breastfeeding is not in the best interest of the mother or baby. A woman should not breastfeed if her infant is diagnosed with galactosemia (a rare metabolic disorder that babies are usually tested for in the first few days of life) or if she has certain health conditions that can be passed to her baby through breast milk, including:

• Human immunodeficiency virus (HIV)
• T-cell leukemia virus type 1
• Active, untreated tuberculosis

Mothers who use illicit drugs, drink excessive amounts of alcohol or are taking prescribed chemotherapy or radiation therapies for cancer also should not breastfeed. If you have a herpes lesion (sore) on your breast, you should not breastfeed.

Women who have had breast reduction surgery or breast augmentation may not be able to breastfeed because of the impact these surgeries can have on milk ducts and milk production. The loss of only a few ducts can seriously compromise a woman's ability to breastfeed, and the overlapping of fat and glandular tissue make it difficult to remove only fatty tissue during breast reduction.

However, each woman's breast anatomy is unique, as is each breast surgery, so in many instances it is possible for women who have had breast surgery to breastfeed. If you have had breast surgery, work closely with a lactation specialist and your pediatrician to ensure that baby is getting enough milk.

10 Hints for Ensuring Success

In general, it is important to discuss any concerns you may have about your ability to breastfeed or complications you may experience breastfeeding with your care provider or with a lactation consultant. The earlier these concerns are addressed, the more likely it is that you will be able to successfully breastfeed your baby. These tips will also help ensure success:

1. Start early. Learn as much as you can about breastfeeding before your baby is born so you'll feel prepared. Try to breastfeed your baby soon after giving birth (within the first hour). Talk to your prenatal care provider to find out whether the hospital where you plan to give birth supports measures to promote early breastfeeding such as skin-to-skin contact immediately after birth. Newborns sleep a lot, so you may have to wake him/her every couple of hours for a feeding. Ask to keep your baby in your hospital room (called "rooming in"). Mother-infant rooming in is becoming more accepted as hospitals try to support early breastfeeding.
2. Review nursing techniques with a lactation consultant or nurse at the hospital. Learn how to position your baby to properly latch on to your breast. This will improve your confidence when you return home.
3. Nurse frequently (8–12 times in 24 hours) and anytime your baby seems hungry. Your milk supply responds to your baby's demand—the more the baby suckles, the more milk will be produced. Many health care providers recommend breastfeeding on demand rather than according to a predetermined schedule. Watch for early signs of hunger, which include: • Increased alertness or activity
   • Mouthing or putting hands to mouth
   • Rooting (moving his/her head in search of your nipple)
   
   Be aware that crying is a late sign of hunger. Try to feed your baby before he/she becomes overly hungry and starts to cry. Offer both breasts during feedings. Usually breastfeeding takes 10 to 20 minutes for each breast. However, from time to time your baby may become full after feeding on just one breast. If this is the case, remember to pump the breast that remains full to avoid engorgement or discomfort. Your baby will empty the first breast it nurses at more completely than the second breast, so make sure that you alternate which breast you begin nursing with at each feeding.
4. Know how much milk is enough. Many nursing mothers worry about whether their baby is getting enough nourishment. An easy way to know whether your baby is getting enough milk is to pay attention to the number of wet, dirty diapers. By day five of life, most newborns will have six to eight wet diapers a day and three to four yellow, seedy bowel movements. Keep in mind that it's normal for babies to lose some weight (about 7 percent to 10 percent of birth weight) within the first week. If you are still concerned about whether your baby is getting enough milk, seek the advice of a health care professional or lactation consultant. Also keep in mind that babies are born with a special supply of fat (called brown fat) that only newborns have. This fat is meant to sustain the baby until its mother's milk comes in. Between this fat supply and your colostrum, baby has no need for supplemental feedings. After a few weeks of life, it is common and normal for breastfed babies to have very few bowel movements in a day or to go for several days without a bowel movement. However, your baby should still have frequent wet diapers and be gaining weight. If you are worried about whether your baby is getting enough milk, call your pediatrician.
5. Choose a comfortable position. Breastfeeding is very personal. There are a number of ways to hold your baby while breastfeeding. See what feels most comfortable for you and your baby. (See the American Academy of Family Physicians Web site for more information.) • Cradle position: Place your baby's head in the crook of your arm. Support his/her back and bottom with your arm and hand.
   • Clutch/football position: Tuck your baby under your arm like a football with his or her head resting on your hand. Support your baby's body with your forearm.
   • Side-lying: Lie on your side with your baby facing you. Use pillows to prop up your head and shoulders.
   
   No matter which feeding position you use, make sure your baby's whole body is turned toward your breast, not just his/her head. Your baby should have your entire nipple and most of the areola (dark skin around the nipple) well into his/her mouth.
6. Breastfeeding shouldn't hurt. If you feel pain or discomfort, your baby is probably not latched on properly. A baby who properly latches on should be facing mom with her head slightly tilted back and have a wide-open latch with not just the nipple but some or all of the areola in the mouth, and both lips curled out. You should be able to hear your baby swallowing, but there should not be any sucking or clicking sounds. There may be some discomfort when the baby first latches on, but after the first few moments, there should be no pain. If you suspect your baby is not latched on properly, gently place your finger into your baby's mouth to break the suction and try again. You may want to position a pillow just below your breasts or under your arm to support yourself and ensure the baby is at the same level as your nipple (your baby's nose, not the mouth, should be at the nipple right before latching on). Contact your health care professional if the pain continues or if you notice flu-like symptoms.
7. Take care of yourself. Get plenty of rest and eat well-balanced meals to regain energy. A good rule of thumb to make sure you are taking in enough fluid is to have something to drink each time you nurse. Use your support system to help take care of other children and the house while you focus on recovering from birth and learn to breastfeed. A family member or friend who successfully breastfed can be a great source of support.
8. Ask about medications. Talk with your health care providers about any prescription medications or over-the-counter drugs or herbs you are taking just in case these may be harmful to your baby. If you need to take medications, there are almost always options that are compatible with breastfeeding.
9. Delay giving your baby other liquids or formula until after the first six months. The introduction of any food other than breast milk should be done in consultation with your baby's pediatrician. Try to choose a pediatrician who is supportive of breastfeeding and willing to work with you to make breastfeeding successful.
10. Delay introducing bottle nipples or pacifiers to let your baby develop a good sucking pattern and become familiar with feeding from your breast. If you plan to return to work, try introducing a bottle filled with your breast milk during week three to six (depending on how soon you plan to go back), after breastfeeding is well established.

Returning to Work: Breastfeeding Tips for Working Moms

The transition back to work after maternity leave can be emotional. You're probably asking yourself lots of questions: Can I overcome the guilt of leaving my baby? Will I be able to juggle motherhood and work? How can I continue breastfeeding? Like any transition, some of these issues may take time to work through. But, fortunately, where continuing to provide your baby with breast milk is concerned, breast pumps offer working mothers the flexibility to maintain their milk supply and continue nursing, which helps you stay connected to your baby even when you're away. Find out what your state laws say about support of breastfeeding women in the workplace. Many states have laws supporting working breastfeeding women.

Here are some tips to help ensure success for your goal to continue breastfeeding when you return to work:

• Take as much time away from the workplace as possible. Studies show that women who take longer maternity leaves are more likely to continue breastfeeding once back at work. And the longer babies are breastfed, the greater the health benefits for mom and baby.
• The Family Medical Leave Act provides 12 weeks of unpaid time for the birth and care of a newborn for certain employees. Visit the U.S. Department of Labor for more information.
• Plan in advance. Before returning to work, talk with your employer or human resources department about your needs and plans to continue breastfeeding.
• Ask if there is a private, clean room set aside for mothers to pump. If not, suggest an office or conference room that can be locked. Your employer should create a supportive environment for you to continue breastfeeding.
• Keeping the lines of communication open with your employer will help make transition back to work easier. Discuss how pumping breaks (20-30 minutes every three to four hours) will fit into your schedule. Sometimes this requires some creative and flexible solutions. Usually women can find a way to be as productive at work as always, even with the needed pumping breaks.
• Educate your employer about the benefits of breastfeeding. This includes fewer missed work days and shorter absences because breast-fed babies are better able to fight off infection and are sick less often.
• Breastfeed your baby as soon as you get home. This is a special time to bond and helps you maintain your milk supply. Ask your caregiver not to feed your baby during the last hour of the workday, so your baby will take your breast when you return home. Many working mothers note that breastfeeding helps them feel less guilty about being a working mother because breastfeeding is the one thing that nobody else can do for their children.

What You'll Need

• A breast pump (double electric pumps, which allow you to empty both breasts at the same time, are more effective than hand pumps for expressing milk). Also, look for a pump that fits your work environment. Most leading electric pumps offer a battery option, which may give you greater flexibility.
• An insulated bag with cold packs or access to a refrigerator (most pumps come with a cooler pack)
• Bottles or bags to collect and store your milk
• Labels or a permanent marker to mark the date
• Breast pads to protect your clothes and conceal leakage (you may want to keep an extra shirt at work just in case)
• Picture of your baby
• A support system. Don't try to do everything yourself. Let your partner, family and friends help out. Seek out other working mothers who can offer you support.

It's important to continue breastfeeding for as long as you can and ideally until your baby is one year old and beyond.

Using a Breast Pump

Breast pumps are designed to help:

• Provide your baby with the health and nutritional advantages of breast milk while you're away.
• Empty the milk in your breast, which can guard against engorgement, blocked milk ducts and infection.
• Stimulate your milk production.

If possible, you should pump every three hours that you are away from your baby. Make sure to clean the breast pump parts between uses.

Both hand and battery-operated pumps are available. Electric pumps simulate your baby's sucking more effectively and are faster than hand pumps. Many pumps come with discreet carrying cases. The cost ranges from about $35 to $350. Be sure to research which brands and models provide the best performance, reliability and comfort. Also take into consideration the demands of your daily schedule. Many hospitals and clinics rent breast pumps, so you may want to ask your health care provider or a lactation counselor about these and which models would best fit your needs.

A Word About Milk Storage

• After pumping, refrigerate, freeze or store your milk in a cooler.
• Any container used to store milk should be clean and sterile. Glass containers and plastic bottles and storage bags that are labeled "bisphenol A (BPA)-free" are good choices.
• Always label and note the date on the storage bag or container. Always use oldest dated milk first.
• The following are some guidelines for freshly expressed breast milk storage from the Centers for Disease Control and Prevention (CDC):
  • At room temperature (up to 77 degrees F) for 6 to 8 hours. Keep containers covered and as cool as possible. Wrapping the container with a cool towel will help keep milk cooler.
  • In an insulated cooler bag (5 to 39 degrees F) for 24 hours. Limit opening the cooler bag and make sure ice is up against the milk to keep it as cold as possible.
  • In a refrigerator (up to 39 degrees F) for up to five days. Store milk in the main body or back of the refrigerator.
  • In a freezer compartment of a refrigerator (up to 5 degrees F) for up to two weeks
  • In a freezer compartment of a refrigerator with separate doors (up to 0 degrees F) unit for three to six months
  • In a deep-freezer (up to -4 degrees F) for six to 12 months
• In all types of freezers, store milk toward the back of the freezer. Milk stored for the later part of the safe ranges is still safe, but some of the lipids may undergo degradation that lowers its quality.
• Breast milk should be thawed slowly under warm running water and not on the stove or in the microwave, which can reduce its nutrition.
• Once the milk has been thawed it should not be refrozen and should be used within 24 hours.

Organizations and Support

For information and support on Breastfeeding, please see the recommended organizations, books and Spanish-language resources listed below.

Academy of Breastfeeding Medicine
Website: https://www.bfmed.org
Address: 140 Huguenot Street, 3rd floor
New Rochelle, NY 10801
Hotline: 1-800-990-4ABM
Phone: 914-740-2115
Email: ABM@bfmed.org

American Academy of Pediatrics
Website: https://www.aap.org
Address: 141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
Phone: 847-434-4000
Email: kidsdocs@aap.org

American College of Obstetricians and Gynecologists (ACOG)
Website: https://www.acog.org
Address: 409 12th Street, SW
P.O. Box 96920
Washington, DC 20090
Phone: 202-638-5577
Email: resources@acog.org

Association of Maternal and Child Health Programs
Website: https://www.amchp.org
Address: 2030 M Street, NW, Suite 350
Washington, DC 20036
Phone: 202-775-0436

Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN)
Website: https://www.awhonn.org
Address: 2000 L Street, NW, Suite 740
Washington, DC 20036
Hotline: 1-800-673-8499
Phone: 202-261-2400
Email: customerservice@awhonn.org

BJC Women and Infants Health Services
Website: https://www.bjc.org
Address: 4444 Forest Park Avenue
St. Louis, MO 63108
Phone: 314-747-WEBB

International Board of Lactation Consultant Examiners
Website: https://www.iblce.org
Address: 6402 Arlington Blvd, Suite 350
Falls Church, VA 22042
Phone: 703-560-7330
Email: iblce@iblce.org

International Lactation Consultant Association (ILCA)
Website: https://www.ilca.org
Address: 1500 Sunday Drive, Suite 102
Raleigh, NC 27607
Phone: 919-861-5577
Email: info@ilca.org

La Leche League International (LLLI)
Website: https://www.llli.org
Address: P.O. Box 4079
Schaumburg, IL 60168
Hotline: 1-800-LALECHE (1-800-525-3243)
Phone: 847-519-7730

Books

Mommy's Little Breastfeeding Book: 101 Tips Your Baby Wants You to Know About Breastfeeding
by Michele Leigh Carnesecca

The Nursing Mother's Companion
by Kathleen Huggins

The Womanly Art of Breastfeeding
by Diane Wiessinger

The Ultimate Breastfeeding Book of Answers: The Most Comprehensive Problem-Solving Guide to Breastfeeding from the Foremost Expert in North America
by Jack Newman M.D., Teresa Pitman

Spanish-language resources

Breastfeeding: The National Women's Health Information Center, U.S. Department of Health Information Center
Website: https://espanol.womenshealth.gov/breastfeeding
Hotline: 1-800-994-9662

Center for Disease Control: Measuring Breastfeeding Support across the US
Website: https://www.cdc.gov/spanish/especialesCDC/LactanciaMaterna/
Address: CDC Info
1600 Clifton Rd
Atlanta, GA 30333
Hotline: 1800-232-4636
Email: cdcinfo@cdc.gov