Breastfeeding 101

Just starting out?  Visit this link and this link for a wonderful introduction to how to nurse.  Here is another terrific informational website (Kellymom Parenting/Breastfeeding). The best way to prepare for nursing is to watch it being done to learn the correct way to latch and hold.  Bring a nursing pillow to the hospital to help with positioning (try MyBrestFriend.)

  1. Why is “Breast Best”? Evidence suggests that breastfeeding decreases risks for many diseases in infants and mothers. In general, these benefits appear to be dose-related to the amount of breastmilk provided to the infant. Breastfeeding has been associated with a reduction in the risk for acute otits media, gastroenteritis, respiratory tract infections, atopic dermatitis (Eczema), childhood leukemia, inflammatory bowel disease and sudden infant death syndrome. Breastfeeding also offers a protective effect with later obesity. In mothers, a history of lactation has been associated with a reduced risk for type 2 diabetes and breast and ovarian cancers.
  1. My newborn seems hungry all the time- can I just top her off with formula after a feed? Infants love to suck, so their desire to nurse may not be from hunger.  Infants initially should nurse at least 8 times over 24 hours- these feeds may not be every 3 hours, but clustered (as often as every hour at first) with a longer stretch at other times (allow the longer sleeps at night, try to waken every 3 hours during the day.)   Look for signs of a good milk supply- a stool per day of life up to DOL 4, then a minimum of 4 per day; 10-12 feedings per 24 hour period, breasts feeling full before and soft after a feed; baby nursing at least 10 minutes a feed. Unless instructed to do so, supplementing more than 2X in 24 hrs can affect your milk supply. If you are still not sure if your milk production is adequate, bring your infant in for a weight check- the best way to determine she is getting enough to eat.
  1. My breasts no longer feel full, am I making enough milk? Usually by 6 weeks to 2 months, the mother’s body has learned how much milk to produce. Around this time you may start losing the sensation of “fullness” before a feed, and your infant may only nurse for 5 minutes at a time. Full, wet diapers, a satisfied infant and steady weight gain are the best measures of adequate supply. Your infant may also develop very infrequent stools between 4 and 8 weeks of age. This is a normal pattern, and as long as your baby’s stools remain soft or loose there is no reason to worry (even if your child only stools once a week!)
  1. Why does my nursing infant need vitamin D? Vitamin D deficiency is being linked to many illnesses. Infants can develop Rickets (weakened bones.) The AAP recommends 400 IU per day for all nursing infants. Breastmilk can be deficient in Vitamin D even if the mother is taking standard vitamins. We recommend that all breastfed infants be supplemented with 400 IU of Vitamin D (D-Visol, or Just D) daily until the are getting more than 16 ounces a day of formula or vitamin D fortified milk.  Alternatively, evidence suggests that if mothers take approximately 6000 (six thousand) IU per day of vitamin D, they can forgo the infant’s supplement.
  1. What can I do about these sore nipples? Nipple tenderness at the beginning of a feeding may be normal in the first few days of breastfeeding. Soreness that is more intense or continues for a longer time indicates that some adjustments with feeding need to be made. The most common cause of sore nipples is improper positioning of the infant at the breast, resulting in improper latch. Encourage your infant to open her mouth wide by tickling the lips with your finger or nipple. Pull the infant in close by supporting the back (rather than the back of the head) so that the chin dives into the breast and the nose is touching the breast at the nipple. The infant can also be encouraged to latch on with some expressed breast milk on the nipple. The nipple should be round when it goes into the infant’s mouth, and should not be discolored or white/pale when it comes out.

Sore nipples should be air-dried after a feeding, then covered with a pure lanolin ointment (Lansinoh) which will help cracks heal without scabbing or crusting. Persistent sore or cracked nipples need to be seen by a physician. Very painful nursing during this time can be replaced by pumping and bottle feeding until the nipple heals.

  1. Do I have a plugged duct or mastitis? A plugged duct can be a firm, tender swelling in the breast that typically improves with heat, pumping and deep massage (this can be painful, but when done during nursing can effectively relieve the swelling.) Mastitis, or an infected milk duct, is associated with fever, flu-like illness, and often redness. These infections need antibiotics and occasionally drainage, so be sure to contact your physician if you experience persistent pain, swelling, redness or fever.
  1. What medications are safe to take when nursing? Acetaminophen and Ibuprofen are safe to take when nursing, as are most over-the-counter cold medications. Products containing pseudoephedrine, diphenhydramine and other antihistamines, however, may cause a temporary decrease in milk supply. Most pain medication given after delivery is safe, although rarely some babies become overly sedated if the mother uses opiods. All prescription medications should be cleared with a physician prior to using. One resource to consult is TOXNET.
  1. Can I drink alcohol while nursing? Alcohol such as a glass of wine or beer occasionally is fine. You should nurse first, then have the drink and wait at least 2 hours before nursing again. If you drink enough to feel particularly effected, you should then pump and dump the milk within the next 8 hours as alcohol can get from the bloodstream into the breast milk.
  1. How long can I store pumped milk? Remember the rule of threes- three hours at room temperature, three days in the refrigerator, and three months in the freezer. A deep freezer that is not frequently opened will keep milk for up to six months. Store the milk in the back, labelled with time and date, not in the warmer door area. Mothers returning to work may want to try pumping first thing in the morning when the milk supply is greatest. 
  1. Some mothers find that their refrigerated or frozen milk begins to smell or taste soapy or sour soon after it is stored. Lipase in the milk is an enzyme that may begin to break down the milk fat soon after the milk is expressed. Most babies do not mind the change in taste, and it is safe to use. To be sure that your baby accepts frozen milk, try a bottle of it prior to accumulating a lot that might need to be thrown out if too soapy tasting. Scalding the milk prior to freezing can eliminate this soapy taste.
  1. My baby fusses and spits after feedings, should I eliminate foods from my diet? Food allergies caused by proteins in breast milk are uncommon. Mild fussing or spitting after feeds is not uncommon, and most often related to mild reflux due to a baby’s loose esophageal junction. This is normal, and resolves over time. If your child’s irritability and discomfort seem to be worsening talk to us before strictly limiting your diet. Typical symptoms of food intolerance include extended periods of irritability after feeds, frequent spitting and arching after feeds, rash, hives, eczema, wheezing, persistent congestion, ear infections, vomiting, diarrhea (green stools with excess mucous or blood.) We may ask you to eliminate dairy from your diet for at least 2 weeks, which requires stringent label reading.

Breastfeeding hints:

  1. Growth spurts frequently occur around 10 days, 3 weeks, 6 weeks and 3 months and infants may show hunger and more frequent feedings for 24-48 hour periods until mother’s milk increases. They may also cluster feed in the evenings to “tank up” for the night before sleeping a longer period of time. You may feel temporarily “empty” and frustrated, but the increased feedings will quickly stimulate your breasts to produce more milk.
  2. If an infant is having a hard time settling to sleep after a feeding, have the father or other caretaker hold him so they can no longer smell the breastmilk. This avoids the “should I sleep or should I feed” phenomenon.
  3. Infants between 4 and 8 weeks may start stooling only every 4-7 days. This is normal as long as the stool consistency remains soft or loose. Breast fed babies are rarely if ever constipated (firm, hard stools.)
  4. Infants may pull away when feeding due to a vigorous let-down; try nursing in a semi-reclined position.
  5. Some women overproduce milk, leading the infant to fill up on the watery foremilk instead of creamier hindmilk. Such infants may be fussier, gassy, and have looser, green stools. Avoid pumping if you think you are producing an excess of milk. You can also “mash up” your breasts prior to nursing to help loosen fat droplets in the ducts for a more uniformly creamy milk.
  6. Around 4 months of age many infants become more distractable, leading to incomplete and thus more frequent feedings. Try feeding in a quiet, dark corner with no other stimulation, and do not allow feedings more than every 3 hours to encourage a hungrier infant.
  7. Around 6-9 months of age your infant may start biting. If the biting occurs in the beginning the infant may not be hungry, and if at the end he may be full. If your infant bites, quickly remove him from the breast and lay him down briefly- he will not like this.
  8. Weaning should ideally take place over a period of time. Drop a feeding every few days, and offer a bottle or sippy cup in its place. Use distraction as much as possible along with more fitted clothing to discourage “easy access” for older infants/toddlers.

Breastmilk Storage Guidelines
(Per the Academy of Breastfeeding Medicine )

General Guidelines

  1. Hands must be washed prior to expressing or pumping milk.
  2. Use containers and pumping equipment that have been washed in hot, soapy water and rinsed. If available, cleaning in a dishwasher is acceptable; dishwashers that additionally heat the water may improve cleanliness.
  3. Store in small portions to minimize waste. Most breastfed babies take between 2 and 4 ounces (60–120 mL) of milk when beginning with an bottle. Storing in 2-ounce (60 mL) amounts and offering additional amounts if the baby is still hungry will prevent having to throw away unfinished milk.
  4. Consider storing smaller size portions [1–2 ounces (30–60 mL) each] for unexpected situations. A small amount of milk can keep a baby happy until mom comes to nurse the baby.
  5. Several expressions throughout a day may be combined to get the desired volume in a container. Chill the newly expressed milk for at least 1 hour in the main body of the refrigerator or in a cooler with ice or ice packs, and then add it to previously chilled milk expressed on the same day.
  6. Do not add warm breast milk to frozen milk because it will partially thaw the frozen milk.
  7. Keep milk from one day separate from other days.
  8. Do not fill the container; leave some room at the top because breast milk expands as it freezes.
  9. Label containers clearly with waterproof labels and ink, if possible.
  10. Indicate the date that the milk was expressed and the child’s name (for daycare).
  11. Expect that the milk will separate during storage because it is not homogenized. The cream will rise to the top of the milk and look thicker and whiter. Before feeding, gently swirling the container of milk will mix the cream back through again. Avoid vigorously shaking the milk.
  12. The color of milk may vary from day to day, depending on maternal diet. It may look bluish, yellowish, or brownish. Frozen breast milk may also smell different than fresh breastmilk. There is no reason not to use the milk if the baby accepts it.

Milk Storage Guidelines

  1. The type of freezer in which the milk is kept determines timetables for frozen milk. Generally, store milk toward the back of the freezer, where the temperature is most constant.
  2. Milk stored for the longer durations in the ranges listed below is safe, but there is some evidence that the lipids in the milk undergo degradation resulting in lower quality and a soapy taste.
  3. Chest or upright manual defrost deep freezers that are opened infrequently and maintains ideal temperature (−4°F or −20°C) are best.

Thawing and Rewarming Milk

  1. The oldest milk should be used first.
  2. The baby may drink the milk cool, at room temperature, or warmed.
  3. Thaw milk by placing it in the refrigerator the night before use or gently rewarm it by placing the container under warm running water or in a bowl of warm water.
  4. Do not let the level of water in the bowl or from the tap touch the mouth of the container.
  5. Milk may be kept in the refrigerator for 24 hours after it is thawed.
  6. Never use a microwave oven or stovetop to heat the milk, as these may cause scald spots and will also destroy antibodies.
  7. Swirl the container of milk to mix the cream back in, and distribute the heat evenly. Do not stir the milk.
  8. Milk left in the feeding container after a feeding should be discarded and not used again.

How to avoid a soapy taste in frozen breastmilk :http://kellymom.com/bf/pumpingmoms/milkstorage/lipase-expressedmilk/

What medications are safe to use with breast feeding?
https://pediatricinsider.wordpress.com/2016/02/22/many-medications-are-safe-for-nursing-moms/

http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm

Baby’s stomach size from 1 day to 1 month:
https://babiesfirstlactation.wordpress.com/2013/08/09/the-newborns-stomach/

Plugged ducts and mastitis: symptoms, causes and treatment:
http://kellymom.com/bf/concerns/mother/mastitis/