Breastfeeding

Learn about the benefits and keys to success for giving your baby the ultimate natural food.

During pregnancy, a woman’s body prepares to make milk. Breasts expand, adding an extra one to one-and-a-half pounds on each side. The nipples enlarge and darken in color. The blood vessels in the breast also enlarge and become more visible. After the baby is born and the placenta is delivered, hormonal changes signal the breasts to begin milk production. Each time the infant suckles at the breast or cries, hormones are activated that cause the breasts to release their milk to the baby. This is called the let-down reflex. These hormones also lead to the production of more breast milk. In this way, a mom’s breasts produce milk in response to her infant’s needs. Breastfeeding, also called nursing, is considered the best and most natural way to feed a baby.

Benefits of Breastfeeding

You may have heard that “breast is best.” This refers to the many health benefits associated with breastfeeding. The benefits are so great that the American Medical Association, American Academy of Pediatrics, and World Health Organization recommend that women feed their infants only breast milk for the first four to six months of life. At six months, you may begin to supplement with food, but are encouraged to continue breastfeeding until after your baby’s first birthday.

So, what is so great about breast milk? It is easy on a baby’s tummy. All of its ingredients are easily digested by an infant’s young digestive system. It also provides enzymes, antibodies, and other factors that boost immunity. In fact, babies who are breastfed are less likely to develop ear infections, diarrhea, inflammatory bowel disease , respiratory infections, meningitis, allergies, asthma , sudden infant death syndrome , iron-deficiency anemia , and diabetes later in life. Breastfed babies may also have better mental development. There is even research to suggest that people who were breastfed are less likely to become obese.

Babies who are fed infant formulas are more likely to have infections. They are also more likely to be admitted to the hospital than babies who are fed breast milk. In addition, both mom and baby benefit from the bonding that occurs with skin to skin contact during breastfeeding.

Benefits for Mom, Too

Women who breastfeed return to their pre-pregnancy weight quicker than moms who don’t breastfeed. Nursing burns about 500 calories per day. The amount of calories is more than that burned during pregnancy, which demands an extra 300 calories daily. Breastfeeding also stimulates the uterus to contract back to its normal size, and reduces bleeding. There are long-term benefits as well. The risks of breast , uterine , and ovarian cancers , as well as hip fractures and osteoporosis are lower among women who breastfeed their babies.

Financially speaking, breast milk is free. The cost of formula and supplies can add up to $1,000 per year. Preparing formula also takes time which is precious in those early days. Breast milk is always available and requires no preparation. Formula, on the other hand, needs to be bought, made, put into bottles, warmed up, and properly stored.

Steps for Successful Breastfeeding

Think of breastfeeding as a skill that needs to be learned and practiced. During pregnancy, take a class or read books on this new skill. To get off to a good start, follow these guidelines:

Nurse early and often . Begin feeding your baby shortly after birth, ideally within the first hour. (Your nurse or care provider will help you and your baby.) Each day, feed every one to three hours, except during one longer sleeping stretch. During the first 24 hours, your baby should nurse at least five minutes on each breast at each feeding. Alternate which breast you begin feeding on. Gradually increase to 15 minutes on each side. The first milk produced is called colostrum. This is a thick yellow/gold liquid that is rich in protein and antibodies. It gives your baby’s immune system a quick boost. Within a few days, your mature milk comes in.
Feed from both breasts at each feeding . If you don’t feed from each breast, you may get a plugged milk duct.
Breastfeed on demand . Breast milk is more easily and quickly digested than formula. Your baby will need to eat more often than a baby who takes formula. Your baby will likely want to eat every two to four hours. Watch your baby for hunger signals such as: being more alert or active; rooting (turning his or her head in search of a nipple); and mouthing (putting hands in his or her mouth and/or making a sucking motion with the mouth). Crying is a late sign of hunger.
Find a comfortable position for you and baby . There are four main positions. Try each to find what works for you. It is also a good idea to vary the positions.
1. Cradle hold—sit with your arm bent across your lap. The baby’s head rests in your elbow and her or his body along your forearm and lap. The baby’s chest should be against your skin so he or she does not have to turn his or her head to reach the nipple.
2. Cross-cradle hold—sit with your arm bent across your lap. This time, the baby’s head is in your hand and his or her body extends toward your elbow. This is helpful in learning to get the baby latched on, as you can control his or her head better.
3. Football hold—sit with your arm bent alongside your body. The baby’s head rests in your hand, with his or her head facing your breast and his or her body extended along your forearm next to your body. This position is more comfortable if you have engorged breasts, sore nipples, or plugged ducts. It is also good after a c-section, because the baby is not resting on your sensitive stomach. If you are able to multitask, this is a good position for nursing twins.
4. Lying down—lie on your side with the baby on his or her side facing you. Put the baby’s face to your breast and ensure she can breathe through her nose. Use pillows for support. This is a good position for night feedings or if you have had a c-section.
Breastfeeding Positions

© 2011 Nucleus Medical Media, Inc.
Make sure the baby is properly latched on . This means that the baby has both the nipple and the areola (colored area around the nipple) in his mouth. If the baby sucks on only the nipple, you will have pain and the baby will not get enough milk. Here are some tips for latching on:
1. Hold your baby in a comfortable position. With your free hand, cup your breast with your fingers underneath and your thumb on top. This is called a C-hold. Or, try the U-hold, where your fingers are on one side of the breast and your thumb on the other. Support your breast in this way for the first six weeks of breastfeeding.
2. Bring your baby close to your breast. Stroke her cheek with your finger or brush her bottom lip with your nipple. These motions stimulate the baby’s rooting reflex, which causes her to turn her head and open her mouth.
3. When your baby opens his mouth, put your nipple and areola far into the mouth, while pulling his body towards you. If the baby does not have a good grasp on both the areola and nipple, try again. Press your finger on the corner of the baby’s mouth to break the suction and move him off the nipple.
4. Check that the baby is able to breathe through her nose. If the breast is blocking the nose, push down on your breast next to her nose to allow breathing room.
Take care of mom. To meet the demands of breastfeeding, sleep when your baby sleeps, drink a glass of water while you are nursing, and eat a well-balanced diet. Limit caffeine to 300 mg per day (1-3 cups of coffee). Minimize intake of alcoholic drinks. If you have a drink, wait at least two hours to breastfeed. Avoid drugs including nicotine. Check with your doctor about any prescription drugs that you take.
Talk to your doctor before taking prescription and over-the-counter medicine, as well as herbs and supplements. Some medicines can pass through the breast milk to your baby and may not be safe. Drugs can also interfere with how much milk you produce.

Concerns About Breastfeeding

Like pregnancy and delivery, each woman’s experience with breastfeeding is different. Common concerns and difficulties include worry that your baby is not eating enough, planning for times away from your baby, sore nipples, and breast engorgement.

Is Your Baby Getting Enough?

Instead of measuring the ounces going in, as you would with a baby drinking formula, breastfeeding moms count what is coming out. In the first few days of life, your baby will have one to three wet diapers per day. From day four on, your baby should have five to six wet diapers and one to three dirty diapers every 24 hours. In addition, your pediatrician will weigh and measure your baby regularly. All babies lose weight after they are born. This occurs for a very brief period. Normal weight gain is 3-7 ounces per week. A breastfed baby should be back at birth weight by two weeks.

What If I Go Back to Work?

Many women continue breastfeeding when they return to work. You can pump your milk and store it for your baby’s caretaker to feed when you are away. Many employers will provide a clean, private place for you to pump during the work day. If you have difficulty pumping enough to store, another option is to supplement with formula. You can breastfeed the times you are with your baby and use formula for times you are not there. You should still pump your breasts during the work day to relieve the pressure and maintain your milk supply.

If possible, wait two to three weeks before giving your baby a bottle. Because it is easier for a baby to get milk from a bottle than from your breast, she may develop a preference for the bottle. Also, your milk supply will decrease if you do not feed often. Allow at least two to three weeks to establish your milk supply before making changes.

The longer you are able to breastfeed your baby, the better. But also remember that any length of time is beneficial to your baby, even if it’s only a few weeks.

How Do I Pump and Store Breast Milk?

You can rent or buy a breast pump to help express your milk. Manual pumps cost about $50 and electrical pumps can cost $200 or more. The pricier versions include a carrying case and an insulated section for storing milk. Many hospitals have pumps for rent so ask your care providers when you deliver your baby.

Once pumped, breast milk can be stored in sterile glass or plastic containers in a refrigerator for up to 72 hours. In the freezer, it will keep for 6 months (if you have a deep freezer, milk will stay good for 12 months). Thaw frozen milk in the refrigerator or under lukewarm running water. Do not leave breast milk at room temperature for a long time, expose it to very hot water, or put it in the microwave. Once thawed, milk can stay in the refrigerator for 24 hours. It cannot be refrozen.

Will My Nipples Be Sore?

Breastfeeding should not hurt. For the first week to ten days, you may have some tenderness at the beginning of a feeding. If this pain is severe, lasts throughout the feeding, or persists for more than a week, talk with your doctor or a lactation consultant. Sore nipples are most likely due to poor latching on. Steps to prevent or minimize nipple soreness include the following:

Ensure that your baby is positioned correctly and latched on. Try the football or cross-cradle holds for more control of your baby’s head.
Babies suck harder at the beginning of a feeding, so begin on the less sore nipple. As soon as the soreness resolves, return to alternating the starting side.
If one nipple is extremely sore, try feeding for a shorter time (10 minutes), but more often.
Keep your nipples dry. After a feeding, air dry or pat your nipples dry. Then apply a thin coat of lanolin cream.
If your skin is cracked, keep your nipples covered with a soothing emollient. Try lanolin cream, breast shells, or gel pads.
If the pain prevents you from nursing, use a pump to express your milk. Pumping is gentler on your nipples, allows you to feed your baby breast milk, and maintains your milk supply. Pump for two to three days to allow your nipples to heal.
Watch for signs of a breast infection. Call your doctor immediately if you have chills, fever, headache, flu-like symptoms, or pain or redness in your breast.
Call your doctor if you have blisters, cracking, bleeding, or pain that continues during or between feedings.

What Is Breast Engorgement?

Breast engorgement normally occurs around the second to fifth day after birth. This is when breasts produce large amounts of mature milk to replace colostrum. Your breasts will feel heavy, firm, and tender. Your breasts will feel more comfortable as your baby feeds and your milk supply gets in synch with your baby’s needs, . But if your baby does not remove enough milk from your breasts, your breasts may feel hard, painful, and hot. The best way to resolve engorgement is to keep feeding. Breastfeed every two to three hours. If you miss a feeding, pump your breast. Avoid giving your baby formula for the first three to four weeks. Do not give your baby water unless your doctor advises you to.

Use Your Resources

Breastfeeding is a great way to get your baby’s life off to a healthful start. Take advantage of breastfeeding classes, lactation consultants, support groups, and other people who can help make breastfeeding a wonderful experience for you and your new baby.

RESOURCES

International Lactation Consultant Association http://www.ilca.org

La Leche League International http://www.lalecheleague.org

CANADIAN RESOURCES

AboutKidsHealth http://www.aboutkidshealth.ca/

Women's Health Matters http://www.womenshealthmatters.ca/

References

Breastfeeding. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated December 18, 2012. Accessed December 26, 2012.

Breastfeeding. Womenshealth.gov website. Available at: http://www.womenshealth.gov/breastfeeding/index.html . Updated August 1, 2010. Accessed December 26, 2012.

Breastfeeding: helpful hints for you. Am Fam Physician . 2000;61(7):2103-2014. Available at: http://www.aafp.org/afp/20000401/2103ph.html . Accessed December 26, 2012.

Breastfeeding vs. formula feeding. Nemours Foundation website. Available at: http://www.kidshealth.org/parent/food/infants/breast%5Fbottle%5Ffeeding.html . Updated January 2012. Accessed December 26, 2012.

Feeding your newborn. Nemours Foundation website. Available at: http://www.kidshealth.org/parent/food/infants/feednewborn.html . Updated September 2011. Accessed December 26, 2012.

Tips for breastfeeding success. Am Fam Physician . 2001;64(6):991-992. Available at: http://www.aafp.org/afp/20010915/991ph.html . Accessed December 26, 2012.

10/9/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Barclay AR, Russell RK, Wilson ML, Gilmour WH, Satsangi J, Wilson DC. Systematic review: the role of breastfeeding in the development of pediatric inflammatory bowel disease. J Pediatr. 2009;155(3):421-426.

10/21/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Guxens M, Mendez MA, Moltó-Puigmartí C, et al. Breastfeeding, long-chain polyunsaturated Fatty acids in colostrum, and infant mental development. Pediatrics. 2011;128(4):e880-889.

Revision Information

Reviewer: Andrea Chisholm, MD
Review Date: 11/2012 -
Update Date: 11/26/2012 -

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