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Breastfeeding

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1. Is my body ready to breastfeed?

Your body has been preparing to breastfeed throughout your entire pregnancy. In the fourth month of pregnancy, your breasts started producing colostrum, the first milk for your baby.

Colostrum is a thick milk that is clear and colorless or yellowish. It is high in protein and antibodies that protect your baby from infections, which is exactly what your baby needs in the first few days.

Colostrum also helps your baby pass the dark, tarry stools he will have in the first day or two. This reduces his chance of jaundice. Nurse your baby often in the first few days so he’ll get plenty of colostrum.

Colostrum is a miracle food!

2. How do I know when my baby is hungry?

Your baby will tell you when he is hungry by showing
feeding cues. Watch your baby closely so you can feed
him when he shows early hunger cues. It will be easier
to feed him if he is not fussy and crying.

His early feeding cues include:

- Sucking on his tongue, lips, hands, or fingers while asleep
- Moving his arms and hands toward his mouth
- Restless movements while asleep
- Rapid eye movements under his eyelids
- Opening his mouth when his lips are touched
- “Rooting” or searching for your nipple
- Making small sounds

Late hunger cues include:

- Crying
- Fussiness

view Hunger Cues

3. How should I hold my baby when I feed him?

It is important that the baby is positioned and attached to the breast in a way that allows him to get all the milk he can. This will also help prevent sore nipples.

Whatever feeding position you use, here are some general suggestions that will help you both have a good experience:

- Try to nurse him in a dimly lit and quiet room.
- Make sure you are comfortable before you position him.
- Use pillows to raise your baby to breast level.
- Make sure your baby’s ear, shoulder, and hip are in a straight line. Your baby should not
have to turn his head to nurse.

To view breastfeeding positions click on the following link: Breastfeeding positions

4. What is Laid-back breastfeeding?

Laid-back breastfeeding is when you use your baby's natural instincts to latch on and breastfeed. By lying back, you also let gravity help your baby snuggle into your body and breastfeed.

Laid-back breastfeeding is more than a position to "follow". It is a way to bond with your baby and get breastfeeding off to a natural start.

So recline, relax and breastfeed! Laid-back breastfeeding

5. My breasts feel too full. Do I have too much milk?

When your baby is 2 to 5 days old, your milk will become watery and bluish-white in color, like skim milk, and taste very sweet. Your breasts will also feel fuller and heavier. Your body is making an abundance of milk because it doesn't know if you have five babies to feed or just one. When this happens, it is very important to nurse your baby frequently to keep your breasts from becoming too full or engorged. By the second week your breasts should not feel this way because they have adjusted to what baby is drinking and will continue to make milk as he is removing it.

If your breasts become too full, take a warm shower or place a warm, wet towel over your breasts and nipples for a few minutes before each feeding. Gently massage your breasts toward your nipples. Hand express or gently pump your breasts to get the milk flowing. The idea is to soften your breasts so your baby can latch on.

Ice packs can be used between feeds to keep the swelling down.

See engorgement and plugged ducts for more information. View Hand Expression

6. How can I tell if my baby is getting enough to eat?

When breastfeeding your baby you should see his jaws moving in a steady rhythm and hear or see him swallowing milk after every 2-3 sucks. At the end of a feeding, your breast should feel softer and lighter. You may also see milk pooling in his mouth. These are good signs that your baby is getting milk. Ways to know he's getting enough from birth to 6 weeks: ~~~Birth to 6 Weeks~~~ WEIGHT GAIN: If baby is gaining well on mom’s milk alone, then baby is getting enough. A 5-7% weight loss during the first 3-4 days after birth is normal. Baby should regain birth weight by 10-14 days. By day 5, average weight gain is 2/3-1 ounces per day (5-7 ounces/week). If these goals are not met, call your lactation consultant. WET DIAPERS: 6+ wet diapers per day (by day 6). Expect one wet diaper on day one, increasing to 6+ by day 6. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 mL) of water into a clean diaper (if baby wets more often, then the amount of urine per diaper may be less). Urine should be pale and mild smelling. DIRTY DIAPERS: 3 – 5+ dirty diapers per day (by day 6). Stools should be yellow and seedy (no meconium) by day 5 and the size of a US quarter (2.5 centimeters) or larger. The normal stool of a breastfed baby is usually bright yellow and very loose (soft to watery, may be seedy or curdy). At 6 weeks some babies switch to less frequent but large bowel movements. More on infant stooling click on link below OTHER POSITIVE SIGNS: After a feeding, mom’s breast feels softer and baby seems reasonably content. Baby is alert, active and meeting developmental milestones.

breasfed baby stool

7. How do I know my baby is full?

At the beginning of a feeding, your milk will be watery to satisfy your baby’s thirst. At the end of a feeding, your milk will be rich and creamy, which satisfies your baby’s hunger. Allow your baby to nurse as long as he wants.

He will signal he is full when he:

- “falls off” your breast, releasing the nipple;
- falls asleep; or
- relaxes his body and opens his fists.

If he stops sucking and does not come off the breast on his own, slide your finger into the corner of his mouth to break the suction. Burp him and offer the other breast. He may nurse again right away or he may take the other side in a few minutes or a few hours.

8. How do I feed my sleepy baby?

Some babies will be very sleepy for the first few days. Wake your baby by completely undressing him except for his diaper.

Gently place him on your chest, against your bare skin. If needed, use a blanket to cover yourself and the baby. Skin-to-skin contact is very comforting to a newborn and will encourage your baby to wake up and nurse.

Keep your baby against your skin and gently stroke or massage his back, arms, hands, and feet. Talk to him in a soothing voice when he opens his eyes. When he begins to “root,” move him to the breast to feed.
Click here for more tips on waking a sleepy baby
Sleepy baby

9. Do I have too little milk?

Sometime between your baby’s first and third week of life, he will unexpectedly want to nurse more often. This often occurs at the same time your breasts naturally soften and feel less full. This does not mean you don’t have enough milk. It means your baby is having his first growth spurt.

When your baby goes through a growth spurt, he will eat almost constantly for one to three days or, sometimes, for up to a week. Your body will naturally respond to the frequent nursing by making more milk. Avoid giving bottles. You will make more milk if you nurse more often.

Growth spurts usually occur around these times:

- 1 to 3 weeks of age
- 6 weeks of age
- 3 months of age

10. Engorgement and Plugged Ducts

A feeling of fullness is normal in the first few weeks. However, if your baby doesn’t remove enough milk from your breasts, they may become uncomfortably full, hard, or warm to the touch. This is called engorgement.

To prevent engorgement:
• Breastfeed on demand, at least 10 times per 24 hours . Every 2 hours or sooner if baby shows
signs of hunger. Don't skip feedings (even at night) If baby is very sleepy: wake baby to nurse
every 2-3 hours, allowing one longer stretch of 4-5 hours at night.
• Avoid pacifiers and bottles during the first few weeks (so that baby effectively sucks to
stimulate your milk production. Artificial nipples can be "confusing.")
• Allow baby to finish the first breast before offering the other side. Switch sides when baby
pulls off or falls asleep. Don’t limit baby’s time at the breast.
• If baby is not nursing well, express your milk regularly and frequently to maintain milk supply
and minimize engorgement.

To treat engorgement:

Before feedings:
• Put a warm wet cloth on your breasts or take a warm shower to help your milk flow.
• Massage your breasts gently.
• Express some milk to soften your breast.

Between feedings:
• Put a cool cloth or an ice pack on your breasts for comfort and to help reduce swelling.

Other treatments for engorgement:

Cabbage Leaves
To use cabbage leaves:

• Green cabbage leaves may be used chilled or at room temperature.
• Wash cabbage leaves and apply to breasts between feedings.
• For engorgement or oversupply: Limit use as cabbage can decrease milk supply. Leave on for
20 minutes, no more than 3 times per day; discontinue use as soon an
engorgement/oversupply begins to subside.
• During the weaning process: Leave the leaves on the breast until they wilt, then apply new
leaves as often as needed for comfort.

Plugged duct/breast infection:
A plugged duct is a sore area on one breast, which is caused by breastmilk not moving through the milk duct. To treat a plugged duct:
• Breastfeed often. Try different positions. Baby’s nose needs to point toward the tender spot on
your breast to help remove the plug. Begin on the sore side first.
• Before a feeding, put a warm wet washcloth on your breast and massage the tender spot.
• Take care of yourself. Rest and eat well!

If you also have flu-like symptoms or have a fever, you may have a breast infection called Mastitis. Contact your doctor, as you may need an antibiotic.

You can and should continue breastfeeding!
Plugged Duct or Mastitis

11. Do I have flat or inverted nipples?

Flat or inverted nipples can sometimes be problems when starting to breastfeed. It is a good idea to know your nipple shape before starting to breastfeed. Compare yourself to these examples.
Flat or Inverted?

12. Sore nipples

Tender nipples at the start of a breastfeeding are normal during the first week or two. But pain, cracks, blisters, and bleeding are not. Your comfort depends on where your nipple lands in baby's mouth. And this depends on how your baby takes the breast, or latches.

Causes of sore nipples:
• Improper latch-on
• Tongue-tie
• Flat or inverted nipples
• Removing baby from the breast without breaking the suction first.
- To take the baby off the breast, put your clean finger in the corner of your baby’s mouth to
break the suction.

Treatment:
• If your nipples are very sore, use ibuprofen or acetaminophen.
• Take a few deep breaths before feeding to relax.
• Before a feeding, ease the soreness by putting ice on your nipples for a few seconds.
• Start the feeding on the less sore nipple.
• Rub a few drops of breastmilk onto your nipple and areola after a feeding. Let nipples air dry.
• Pain that continues during and between feedings, blisters, cracked and bleeding nipples are
not normal. Call a breastfeeding specialist or your doctor for help!

Thrush
Sore nipples may be caused by a condition called thrush, a common yeast infection.
• Your nipples may itch or burn.
• Your baby may have white patches in his mouth or a bright, red diaper rash.
• Your baby may refuse to breastfeed and be fussy.

If you suspect thrush, contact your health care provider for medications for you and your
baby.

You can and should continue breastfeeding!

13. How do I calm my fussy baby?

Babies cry to tell us what they need. Crying can mean they are hungry, tired, cold, hot, sick, scared or bored. Babies tend to cry less when you respond quickly with soothing actions. Here are some ways to calm your baby:
Help...my baby is crying, now what?

14. Calming a Colicky Breastfed Baby

Here are a few suggestions that may help to calm your colicky baby: Colicky Baby

15. Breastmilk Storage and Collection

Many mothers find it convenient or even necessary to collect their breastmilk and store it to be used at a later time. Such is the case for mothers who are returning to work or school or for mothers who may need to be separated from their infants. The guidelines offered below may answer the many questions mothers have about safely storing their breastmilk. Breastmilk storage and collection

16. How should I care for myself after my baby is born?

When you are breastfeeding, you have a higher need for some vitamins and minerals. For a personalized daily food plan click on the link below to get started on your Daily food plan for moms. While you are breastfeeding, your need for fluids increases. You may notice that you are thirstier than before. Drink enough water and other fluids to quench your thirst.

- Forget about housework and try to sleep when the baby sleeps.
- When you are tired, lie down for feedings.
- Eat enough food to satisfy your hunger and have something to drink or eat beside you each time you sit down to nurse.
- Keep meals simple — such as a sandwich, soup, and fruit.
- And limit caffeinated drinks to no more than two a day.
- Check with your doctor before taking any medications.
Daily Food Plan for Moms

17. How do I know when to call my doctor?

You should call your doctor if your baby:

- does not regain his birthweight by 2 weeks of age.
- has fewer than six wet diapers a day by his sixth
day of life.
- has fewer than three stools a day by his third day of life.
- will not wake up to nurse at least eight times a day.
- falls asleep or stops nursing immediately after latch-on.
- baby has signs of oral thrush: a "mother of pearl" look to the saliva or white patches in the
mouth.
- bright red diaper rash that doesn't respond to usual treatments.

You should call your doctor if you:

- feel fever and/or chills and/or generalized aching, as thought you have the flu.
- burning or stabbing pain in the nipple, the breast, or both.
- nipple itching or flaking, redness or shininess, or white spots on the nipple or areola.

18. Vitamin D and Breastfeeding

The American Academy of Pediatrics (AAP) recommends breastfed babies to be supplemented with vitamin D. Breast milk alone does not provide infants with an adequate intake of vitamin D. For further information on what the recommended daily intake of Vitamin D for infants please click on the link below: Vitamin D Supplementation

19. What are my rights as a breastfeeding mother?

Click on the link below for a summary of the Federal and North Carolina laws that protect breastfeeding. Breastfeeding Laws and Regulations

20. Will I spoil my baby if I pick him up when he cries?

No such thing! You can't spoil a newborn baby. Crying is the only way babies can communicate. He may be hungry, wet, need burping, or just need to be held.

If your baby stops crying when you hold him, then that is just what he needs. Remember, your baby was in your womb for 9 months listening to your heart beat and being rocked while you walked. So if you have a baby that needs to be held a lot, you might want to use a carrier or a sling. Your baby can stay close while your hands are free to do other things. He will feel secure and cry less. Many fathers also enjoy wearing their babies!

A baby who is cared for and loved will learn to love and trust as he gets older.

21. What if my family doesn't support breastfeeding?

Unfortunately, many mothers end up having to deal with criticism about their choice to breastfeed at one point or another. Criticism from strangers happens occasionally, but tends to be easier to deal with since you’re unlikely to see those people again. Criticism from family members and others close to you can be much harder to handle.

Always keep in mind that family members and close friends who make negative comments about breastfeeding generally do so because they care for you and your child, even if their comments are uninformed or inappropriate. It may be helpful to have a heart-to-heart talk and try to find out exactly why they feel nursing is a problem – this way you can respond to specific concerns and correct any misinformation.

Some have found humor to be an effective way to hush others. You might come back with something like, “Don’t worry. I don’t think I’ll have to room-in with her when she moves into the dorm at college!”

Some people who will not listen to you will listen to a doctor or other professional. Say that your child’s doctor recommends continued nursing.The American Academy of Pediatrics recommends that “breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired.” The World Health Organization recommends that babies be breastfed for at least two years.

Trust your choice to breastfeed. In time, your family will see that breastfeeding is the best for you and your baby. And if not, that's ok too. You know you gave the best of you to your baby.