Breastfeeding

Breastfeeding or bottle feeding your newborn baby is a personal decision. If you choose to breastfeed, it will be helpful if you are in a supportive environment and have resources to assist you with questions you may have or breastfeeding problems that may develop. The following breastfeeding tips may also be helpful:

• Consider attending a series of La Leche League meetings or reading La Leche League's book on breastfeeding (The Womanly Art of Breastfeeding) before the birth of your baby.
• Ask other breastfeeding mothers for advice.
• Join a supportive network including other like-minded mothers to help with the commitments of this style of feeding.
• If you are undecided at birth time, consider a one-month trial. It is easier to go from breastfeeding to bottle-feeding than the reverse.
• The first month of breastfeeding is the most difficult, so if you get through that period, the rest will be easier.

• The ideal food for human infants is human milk. Human milk contains all the right ingredients - protein, carbohydrates, fats, vitamins, minerals, and water - in just the right balance. No formula can make that claim. Infant formula manufacturers attempt to artificially duplicate human milk. Formula feeding is a practice that is relatively recent - about 60 years - compared to the beginning of humankind (not to mention all other mammals) relying on breast milk.
• Formula does not contain the disease-fighting factors or the digestive enzymes that breast milk has. The nutrients in formula are more difficult for a baby to digest and absorb than the nutrients in human milk, requiring the baby to handle excess waste. Some formulas may have a less than optimal composition by containing too much salt and/or not enough cholesterol, fats, lactose, zinc, and iron, among other nutrients.
• Some infants fed a cow's milk-based formula may develop allergies to the proteins in the cow's milk. Infants who are allergic to cow's milk often are also allergic to "hypoallergenic" (non-allergy-causing) soy formulas.
• During the early months, a formula-fed baby may develop signs of allergy to or intolerance of a particular formula. These signs may include the following:
  • Bouts of crying after feeding
  • Vomiting after most feedings
  • Persistent diarrhea or constipation
  • Colic with a distended tense painful abdomen after feeding
  • Generally irritable behavior
  • A red, rough sandpaper-like rash especially around the face or anus or in both places
  • Frequent colds and ear infections
  • Red itchy rash especially in the folds of the elbow and knee joints
    • These signs, or the baby's preference, may lead you through a series of different formulas, often each more expensive than the last.
    • Formula-fed infants may be exposed to a variety of environmental substances used during the preparation of the formula or carried as a minor contaminant from which breastfed infants are protected.
    • The protein in formula (cow's milk or soy-based) may be too large for infants to digest and may lead to stomach discomfort and intolerance to formula.

With rare exceptions, breast milk is the preferred feeding for infants and confers unique benefits.

Breastfed babies (for at least six months) may be at reduced risk for many acute and chronic diseases, including gastrointestinal tract infection (like diarrhea), irritable bowel syndrome, respiratory tract infections (like a cold), urinary tract infections, otitis media (ear infections), and allergic reactions (like atopic dermatitis and asthma). Breastfeeding also has been shown to reduce pain in infants undergoing painful procedures.

Exclusive breastfeeding has been shown to help infants recover faster from major illnesses such as pneumonia, with shorter hospital stays and decreased need of antibiotic changes than formula-fed babies.

The effect of breastfeeding in protecting against infection is well established. Infants who were fully breastfed for six months or more seem to have higher mental development when compared with infants who were never breastfed. Some studies show that the effects of breastfeeding may carry over and also protect young children and adolescents from becoming overweight, having elevated cholesterol levels, and developing diabetes or prediabetes. Either exclusive breastfeeding for four months or breastfeeding with some formula supplementation for six months reduces risk of being overweight. Breastfeeding may also impact adult health. In some studies, breastfed infants were more likely to have good cholesterol levels and normal weight as adults than those who were not breastfed.

• Milk has biologic specificity, meaning that every species of animal who breastfeeds their babies makes a milk that is unique for the young of that species.
• The amounts of nutrients change to match your baby's rapidly changing needs.
• The fat content increases during a feeding so that the baby gets the right amount of fat. Human milk contains the right kinds of fats along with an enzyme (lipase) that helps digest the fat.
• Cholesterol is high in human milk, lower in cow's milk, and very low in formulas. Cholesterol promotes brain growth and provides basic components of hormones, vitamin D, and intestinal bile.
• Milk (cow's, formula, and human) contains two main proteins: whey and casein. Whey is easier for humans to digest and is found in higher concentrations in human milk.
• At around 6 months of age, the baby's intestines mature and become less open to proteins that may harm the body as allergenic proteins (allergens). Giving only human milk until the intestines mature is the best way to keep potentially allergy-causing proteins out of baby's blood.
• Human milk includes helpful proteins not naturally found in milk made by cows or companies.
• Human milk is fresh and contains more lactose (sugar) than cow's milk. Formulas add sucrose or glucose (other types of sugars).
• Vitamins and minerals have a higher bioavailability in human milk. In other words, the body uses most of what is in the milk. There is very little waste.
• The germs in the baby's environment, to which the mother has been exposed, cause the mother to produce antibodies to that germ, which are passed on to the breastfeeding infant.
• Breastfeeding relaxes mother and baby.
• Women who breastfeed have a lower incidence of breast cancer.
• Women who breastfeed have benefits to their health even later in life. Some studies show that women who breastfed their infants longer than six months were less likely to develop high blood pressure, diabetes, high cholesterol, and heart disease.
• Women who have a family history of breast cancer have a lower risk of getting breast cancer before menopause if they breastfeed.
• Breastfeeding is less expensive.
• Women who breastfeed lose the weight that they gained during pregnancy faster than women who do not breastfeed.
• Type1 diabetes and breastfeeding: If you have a family history of type1 diabetes, breastfeeding may help reduce your child's risk of developing type 1 diabetes. Because babies can digest human milk proteins better than intact cow or soy milk proteins they are less likely to develop an autoimmune response which can trigger the gene to cause diabetes. Those "foreign" proteins can cause an immune response which can lead to the destruction of insulin-producing cells.
• An ongoing study called TRIGR (Trial to Reduce IDDM in the Genetically at Risk) will determine if delaying the exposure to those intact food proteins will reduce the chances of developing type 1 diabetes. Results will be available in the year 2017.

• There is really no physical preparation that is necessary for breastfeeding. Education about the benefits and practice of breastfeeding is the best preparation. Contrary to some popular beliefs, it is not necessary to "toughen up" or prepare the nipples in advance for breastfeeding. Some techniques of stimulating the nipples may actually be harmful.
• Sometimes women prepare for breastfeeding by exposing the nipples to air for a certain amount of time each day; while this has not been shown to be medically useful, it is likely not harmful either.
• Take a breastfeeding class. Your hospital may offer breastfeeding classes as part of the childbirth class. These classes can put you in touch with a lactation specialist who may later be your personal breastfeeding consultant.
• Join your local La Leche League or other breastfeeding support group. Call 800-LA LECHE to find your local leader.
• Talk with supportive friends who encourage your feeding choices.
• Learn proper positioning and latch-on techniques.
• During pregnancy, establish good vitamin D stores for both you and the baby. A mother with adequate nutrition gives her infant two months' worth of vitamin D after delivery.
  • Take your prenatal vitamin. However, since prenatal vitamins have only 400 IU of vitamin D, try to do some of the following things:
  • Drink milk or eat other sources of dairy: three to four servings per day during pregnancy, especially in the second and third trimester.
  • Spend at least 15-20 minutes per day outside with arms and legs exposed to the sunlight without sunscreen (we activate our stored vitamin D through the sun).

Do your homework on the hospital policies on infant care and feeding. Look for Baby Friendly accreditation of the associated maternity hospital. Research indicates that women who do not receive training and/or assistance with breastfeeding while in the hospital have more than two times greater odds of not initiating breastfeeding.

• Within a few minutes after birth, most babies can be introduced to breastfeeding. Relax. Most babies take a few licks, sucks, and pause. Sucking in frequent bursts and pauses is the usual pattern for the first few hours and sometimes even the first few days. The first milk the mother produces, colostrum, is the best food.
• Breastfeeding also helps the uterus contract, which helps stop uterine bleeding.
• Try to room-in with your baby. When you see your baby begin to open its eyes, look around, and put his or her fist into his or her mouth, then it is time to offer your breast.
  • Try to make the nurses understand that you wish to breastfeed and that your baby should not be given sugar water or formula without you and your health-care provider being aware and consenting.
  • You may need to have the nurses actually put a sign on your baby's bed restricting bottle-feeding.
  • Pacifier use does not impact breastfeeding success and does not decrease the duration of breastfeeding after breastfeeding has been established.
  • Breastfeeding should begin within one hour of birth.
  • Breastfeed on demand as often as the child wants.
  • Try latching the baby on at the first signs of hunger. Do not wait until the baby cries, or you will teach the baby to cry to get your attention. The baby will get upset more quickly the longer you take to respond.

Many breastfeeding problems (sore nipples, insufficient milk, or mothers not enjoying breastfeeding) can be resolved with improving basic technique (see Multimedia File 1-5).

Position yourself

• Get comfortable sitting up in a bed, rocking chair, or armchair.
• Place pillows behind your back, on your lap, and under the arm that will be supporting your baby as needed.
• Use a footstool if you are sitting in a chair.
• You can also lie on your side in bed facing your baby with pillows as needed to support your head, back, and upper leg (see Multimedia File 2).

Position your baby

• Start with baby only lightly dressed or even undressed to promote skin-to-skin contact.
• Nestle your baby in your arm in a cradle hold (see Multimedia File 4). This involves cradling the baby with your arm on the same side as the breast being presented. The baby's neck rests in the bend of your elbow, her back along your forearm, and her buttocks in your hand.
• Turn your baby's entire body on its side so he is facing you, tummy to tummy.
• The baby should be straight, not arched backward or turned sideways.
• The baby should not have to turn his head or strain to reach your nipple.
• Raise your baby to the level of your breast by putting a pillow on your lap or by using a footstool, otherwise you may strain your back and arm muscles or cause the baby to pull down on your breast.
• Tuck your baby's lower arm into the pocket between her body and yours below your breast.
• If her upper arm keeps interfering, you can hold it down with the thumb of your hand that is holding the baby.
• If your baby is premature or has trouble latching on, try the clutch hold (see Multimedia File 5).
  • Sitting up in bed or in an armchair, set a pillow at your side, wedge it between you and the arm of the chair, and place your baby on the pillow.
  • Position your baby in close along the same side as the breast you are using and cup the back of the baby's neck in the same hand. Direct the baby's legs upward so that they are resting against the pillows supporting your back.
  • Be sure that baby is not pushing with its feet against the back of the chair or pillow, causing the baby to arch its back. If this happens, position baby bent at the hips with legs and buttocks against the back pillow.
  • Once baby is sucking well, wedge a pillow up against the baby's back to help hold the baby close.

Present your breast

• With your free hand, manually express a few drops to moisten your nipple.
• Cup the breast, supporting the weight of your breast with palm and fingers underneath and thumb on top.
• Keep your hand back toward your chest wall so your fingers stay clear of the areola, away from baby's latch-on site.

Latch-on

• Using your milk-moistened nipple as a tease, gently massage baby's lips, encouraging her to open her mouth wide.
• The moment your baby opens her mouth wide, direct your nipple into the center of the baby's mouth and with a rapid movement pull the baby in very close to you with your arm.
• Your baby's gums should bypass the base of the nipple and take in at least a 1-inch radius of the areola or the nipples will be sore after just one or two feedings. Babies should suck areolas, not nipples (see Multimedia File 1).
• Many babies tighten or purse their lips, especially the lower one.
  • Help your baby open its mouth wider by using the index finger of the hand supporting your breast to press firmly down on your baby's chin as you pull the baby on.
  • You may be able to do this while the baby is latched on by using your index finger to evert (turn out) the baby's lips.
• Make adjustments for the baby's breathing: If your baby's nose seems to be blocked, pull baby's bottom closer to you, change the angle of baby's position slightly, or use your thumb to press gently on your breast to uncover the baby's nose.

Support your breast

• After you have baby correctly latched on, hold your breast throughout the feeding so the weight of your breast does not tire your newborn's mouth.
• Supporting the breast will be less necessary as baby gets older and you will then have a free hand during most of the feeding.

Breaking off:

• To avoid trauma to your nipples, do not pull your nipple from baby's mouth without first breaking the suction by inserting your finger into the corner of baby's mouth, wedging it between the baby's gums.
• Positioning and latch-on skills for breastfeeding are all much easier than they sound once you get the hang of breastfeeding. Observing another mom breastfeeding first will help greatly if you have the opportunity.

• Breast enlargement during pregnancy occurs primarily from the growth of milk-producing glands. Differences in breast size prior to pregnancy are caused more by non-milk-producing fat tissue than by glands. Small-breasted mothers do not produce less milk than do large-breasted mothers.
• The more frequently your infant sucks (correctly), the more milk you produce, until you have both negotiated the proper balance.
  • It is unusual for a mother not to produce enough milk for her baby unless she is not breastfeeding correctly or frequently enough.
  • If your baby is gaining weight properly, then you are probably doing fine.
• Sucking on the breast in the same way as from an artificial nipple is likely to produce sore nipples and a reduced milk supply. This "nipple confusion" is why you should not give bottles to babies during the early weeks when they are still learning to suck properly. If a baby sucks incorrectly on a rubber nipple, the baby still gets rewarded with milk. The baby does not get milk when improperly sucking mother's breast.

Home care

For clogged milk ducts

• You may notice small, red, tender lumps within the breast caused by milk ducts (tubes) that have become clogged (blocked with dried milk or other material).
• The best treatment is to increase flow to open these blocked ducts.
• Increase breastfeeding frequency and offer the affected breast first.
• Pump the breast after breastfeeding if the baby is not emptying the breast.
• Keep pressure off the duct. Make sure your bra is not putting pressure on the duct.
• Do not wean baby at this time, or pain and complications may increase.
• Apply moist heat to the affected area to increase blood flow and healing. (When applying heat, be careful not to burn yourself or the baby. Try 10-20 minute sessions two to four times per day for one to three days. Applying a warm water bottle over a warm, wet washcloth is one method to apply heat.) A warm shower and massaging the area will allow resolution of this problem.
• Sometimes the baby will refuse the affected breast because the milk develops a sour taste. Pump the breast and empty it as well as possible. Continue to offer that breast to the baby until baby breastfeeds again.

For sore nipples

• Expose sore or cracked nipples to the air as much as possible.
• Use a hair dryer on a low setting to dry nipples after breastfeeding.
• Wash only with water, never with soap, alcohol, benzoin, or premoistened towelettes.
• Unmedicated lanolin may help if nipple cracking is severe, but petroleum-based ointments and other cosmetic preparations should not be used.

Medical care

Breast inflammation (mastitis, possibly caused by infection)

• Seek medical care for symptoms or signs of breast infection.
• If you are breastfeeding and experience any of the following, call your health-care provider:
  • Increasing pain in the breast
  • Chills
  • Sweats
  • Fever greater than 101 F
  • Increasing breast tenderness
  • Breast swelling and hardness
  • Redness
• Continue to breastfeed. Breastfeeding helps to empty the breast and prevent clogged milk ducts.
• Rest or get in bed at first sign of infection.
• Breastfeed and pump the affected breast as much as possible.
• Pump the breast to express milk on that side.
• Apply moist heat for 10-20 minutes at a time at least four times per day. Heat increases blood flow to the area, aiding in fighting infection. A warm shower with water on the affected breast may help facilitate healing.
• Watch for additional signs of a localized infection called a breast abscess.
• The baby may not want to breastfeed on the affected side, so pump until the baby accepts the breast again.
• A delay in treating mastitis could lead to a more severe infection and possible breast abscess. If you are experiencing any of the following symptoms, go to a hospital’s emergency department.
  • A localized swelling that generally increases in size
  • Pain
  • Tenderness
  • Possibly warmth and redness if close enough to the skin surface
  • Fever greater than 101 F (may be associated with shaking chills alternating with sweating)
  • Breast abscess (pocket of infection)
• Surgical drainage may be indicated.
• Breastfeeding with the affected breast is generally stopped.
• A breast pump should be used regularly to empty the breast until breastfeeding can be restarted or symptoms could worsen.

The Academy of Breastfeeding Medicine

The International Lactation Consultant's Association

La Leche League

U.S. Food and Drug Administration, Feeding Baby With Breast Milk or Formula