Breastfeeding Info A to Z
This information is on topics of interest to parents of breastfed children. It is general in nature and may not be pertinent to your family’s lifestyle. It is not intended to be advise, medical or otherwise. If you have a serious breastfeeding problem or concern, please talk directly to a La Leche League Leader which will provide you with support, encouragement, and evidence-based information. LLLI does not engage in the practice of medicine; please consult a health care professional on any medical issue.
Breastfeeding an Adopted Baby
It is possible to establish milk production for an adopted baby, even if you have never been pregnant or given birth. The amount of milk you may produce depends on many factors.
Most mothers are able to produce at least a little milk. You might be able to induce lactation (start to produce milk), and then build up your milk supply by putting your baby to your breast often and/ or expressing.
Drinking Alcohol and Breastfeeding
Breastfeeding mothers often receive conflicting advice about whether alcohol consumption can have an effect on their baby. While women are often warned not to consume alcohol during pregnancy due to evidence that it could cause damage to an unborn child, the risks of consuming alcohol while breastfeeding are not as well defined.
La Leche League’s The Womanly Art Of Breastfeeding (p. 328) says: “The effects of alcohol on the breastfeeding baby are directly related to the amount the mother ingests. When the breastfeeding mother drinks occasionally or limits her consumption to one drink or less per day, the amount of alcohol her baby receives has not been proven to be harmful.”
If consumed in large amounts alcohol can cause drowsiness, deep sleep, weakness, and abnormal weight gain in the infant, and the possibility of decreased milk-ejection reflex in the mother. Mothers who have been drinking should not bed-share with their babies as their natural reflexes will be affected.
Food Allergies and Breastfeeding
Babies are more likely to develop allergies if there’s a history of eczema, asthma, hay fever or food allergies in the family. If your baby has a family history of these conditions, breastfeeding your baby exclusively for the first six months will help to lower their risk.
Substances in human milk coat your baby’s intestines, which prevents microscopic food particles from “leaking” through into your baby’s bloodstream. If they do pass into the blood (something that is more frequent in an artificially fed baby), these food particles may be treated as foreign substances by his white blood cells, which attack them, and can cause painful allergic reactions such as diarrhea, sore bottoms, runny noses and eyes, rashes and eczema, or a crying, sleepless baby.
How can I tell if my baby is getting enough milk?
It is quite common to wonder if your baby is truly drinking enough milk at the breast. It’s nearly impossible to measure the milk, because it can’t be seen. So, how do you tell if baby is getting enough?
For the first few days, your breasts will be making colostrum for your baby. This first milk is thick and sticky but very nutritious and important for baby’s immune system. Your baby will likely feed often, 8-12 or more times in each 24 hour period. This frequent nursing in the early days helps to signal your breasts to make plenty of milk for your baby.
After about two to four days, your milk will “come in” and become plentiful. Your baby will continue to nurse often and start to gain weight.
My Baby is having Surgery
If your baby needs to have surgery they will be given a general anaesthetic to ensure they are unconscious and free of pain during the operation or procedure. Anaesthetists are specialist doctors who give the anaesthetic and look after the health of your child during surgery, and then continue to support them with pain relief afterwards.
Usually, before having a general anesthetic, your baby won’t be allowed anything to eat or drink. Anesthesia will make your baby relaxed and sleepy and stops their body’s reflexes working temporarily. If your baby’s stomach has food or drink in it, there’s a risk of vomiting, or regurgitation (bringing up food into their throat). If this happens, the regurgitated food could spill into your baby’s lungs and affect their breathing.
Why Carry Your Baby in a Carrier or Sling?
Carrying your baby in a carrier or sling is a lovely way to meet needs for warmth and closeness, and is not just for mothers. All parents can nurture their babies in this way; your baby’s carer may also find it an invaluable tool while you are working or studying.
- Babies carried in slings are calmer and cry less. In most cultures, where babies are held almost constantly, they are typically in a quiet alert state and rarely cry for more than brief periods.
- Slings provide a gentle way of transitioning babies from the calm environment of the womb to that of the outside world. Babies in carriers continue to be rocked by their mothers’ movements and to hear their mothers’ heartbeats or learn a new caring adult’s rhythms. This helps babies to regulate their own systems.
My newborn has never really gotten the hang of nursing. How can I get him back to the breast?
There are many reasons why a newborn may be reluctant to nurse. If your newborn is not latching on to the breast, is too sleepy to take his first feed or needs medical attention, you can ask your health care team to show you how to hand express and give your colostrum by teaspoon or syringe. Your baby may sleep for a few hours after this first feed – feel free to cuddle him and wake him if you want to feed. He may feed four to five more times in the first 24 hours.
You can begin expressing colostrum within the first few hours after birth. You may be comfortable using hand-expression or you may prefer to use a pump.
Non-hormonal methods of contraception are compatible with breastfeeding though no method is 100% effective against pregnancy regardless of whether you are breastfeeding or not. Examples include:
- Barrier methods (condom, diaphragm, cervical cap, sponge )
- Non-hormonal IUD (coil)
- LAM (Lactational Amenorrhea Method)
- Natural Family Planning
Some hormonal methods of contraception may affect milk supply especially in the early months after birth. Examples include:
- Contraceptive pill, including combination and progesterone only
- Contraceptive implants, injections and patches
- Hormonal IUD (coil)
- Vaginal ring
WHAT SHOULD I DO IF MY BABY BITES ME?
A baby may bite during a nursing session for many different reasons – distraction, teething, cold or ear infection (it’s hard for your baby to swallow while breastfeeding with a blocked nose). Once it has happened, it may cause you to be tense or fearful at the next feeding. Here are some thoughts that may help you based on questions that arise at this time:
MY BABY BIT ME! DOES THIS MEAN I HAVE TO WEAN?
Weaning is rarely the answer when a baby bites. It is important to identify the cause and work to correct it.
FEEDING BREASTMILK FROM A BOTTLE
When the nursing parent is away from baby or cannot nurse at the breast or chest, it is important that the baby will take breastmilk by another method. These tips assume that the baby is being fed expressed breastmilk. If this is not available, ask the baby’s health care provider for advice.
The Womanly Art of Breastfeeding, the La Leche Leage guide for nursing parents, suggests that the introduction of a bottle wait until the baby is three to four weeks old and nursing well, in order to lessen the risk of nipple confusion. You may want to try once or twice per day to introduce the bottle, using a couple of “tricks” that experienced working/breastfeeding mothers have tried.
During pregnancy and when your milk first comes in, you may find your breasts are enlarged. The support of a well-fitting bra can be most welcome. Let comfort be your guide: it is important to avoid a bra that is too tight, a bra that puts too much pressure on your breasts may result in sore breasts due to plugged ducts.
Some mothers chose to wear a specially designed nursing bra. Others chose to wear the styles they have used before pregnancy.
Bras with under-wiring, or other firm structure, can contribute to blocked ducts and even mastitis so are best avoided in the early months.
Many mothers find that it’s comfortable to wear a bra fairly often during the first 2-6 weeks of breastfeeding. Many moms experience engorgement, and very heavy breasts as their milk is coming in and becoming established. Also, extra body fluid and blood collects in the breast area to help them get ready for breastfeeding. During that time, wearing a well-fitting bra more often during the day or night might be helpful to give extra support so your breasts don’t become sore in any way. After that time of engorgement, or if you’re more comfortable without a bra, there is no reason why you can’t take it off whenever you want to for sleeping, or during the day. It’s totally up to you and your comfort. If you usually go braless, you do not need to wear one during breastfeeding.
Will I ever have sex after baby?
I am so tired, all I can think about is sleep.
I have been holding the baby all day; I am touched out.
I am in awe of my body, and I feel empowered.
Many parents report changes in their sexual lives while breastfeeding. Physical changes in our bodies during the post-partum period and lactation, lack of sleep, and the demands of caring for young children all contribute to a shifting sense of self, including our experiences of ourselves as sexual beings. Whatever you are experiencing, from increased desire, to no desire at all, and everything in between, others have been there before you. Discussing your experiences with others, such as at a La Leche League meeting, can be a reassuring way to feel that you are not alone.
Will caffeine affect my baby?
You might be wondering if your morning cup of coffee or tea may have an effect on your baby. The news is good: breastfed babies generally do not suffer ill effects from mother’s moderate caffeine consumption. However, you may want to take the following into consideration:
Is my baby more likely than others to react to caffeine?
Babies who are under six months or have other health issues may be more likely to show symptoms (Hale 2017).
What symptoms might my baby have?
A baby who is showing signs of caffeine intake may be unusually irritable, fussy, or wakeful. They may have a harder time staying asleep (Mohrbacher 2010).
My Breastfed Toddler’s Skin has Turned Orange / Yellow! Is it my Milk?
Most likely, your toddler is experiencing carotenemia, a condition most often found in babies and toddlers, where skin, especially parts that tend to sweat a lot, becomes tinged with orange. It is most visible in babies and toddlers with light complexions. The condition is caused by ingesting a large amount of carotene, a nutrient most often found in human milk, carrots, squash, sweet potato, pumpkin, spinach, beans, egg yolks, corn and yams. Note that most of the foods listed fall into the “yellow vegetable” category. Cooking, mashing, or pureeing foods increases absorption of carotene (Leung, Alexander. Carotenemia. Advances in Pediatrics. 34: 223-248. 1987). Human milk is also full of carotene, and can even become yellowish or orange if a mother eats a diet high in the foods listed above.
Breastfeeding after Cesarean Birth
Breastfeeding after cesarean birth is an important way for you and baby to get to know each other. It can also help heal any feelings of sadness or disappointment if birth did not go as planned. Breastfeeding can give you the satisfaction of knowing that you are giving your newborn the very best—something no one else can do—even though you are recovering from major surgery.
Whether you give birth vaginally or by cesarean surgery, family, friends, or a La Leche League Leader can be of great assistance and support when you are beginning the breastfeeding experience.
Usually when it is recommended that a breastfeeding mother eliminate dairy produce from her diet, it is because of a problem that may be caused by the protein it contains, not because of lactose intolerance. Human milk is full of lactose, and nature has made certain that babies and toddlers can digest it. Large protein molecules from cow’s milk can pass into human milk fairly intact and it is these particles that can bother a sensitive baby. If your baby has Cow’s milk protein intolerance (CMPI) he might have colic-like symptoms, and be wheezy, vomit, have diarrhea (including bloody diarrhea), constipation, a rash, eczema and/or a blocked nose.
If you suspect your baby is sensitive to the cow’s milk protein in your diet you can remove dairy products and see if it makes a difference. It can take up to 21 days for all traces of cow’s milk protein to leave your system so it’s best to wait for two to three weeks to evaluate the results. Some babies will react well if you remove visible dairy products such as milk, yoghurt, cheese, cream and ice-cream; others will not show any improvement unless you remove every trace of cow’s milk protein from your diet so you may need to read the labels of all the food you eat and eliminate hidden sources.
Human milk comes in a variety of colors. If you pump your milk you may see lots of variation in color: whereas formula milk always looks the same, the composition and appearance of human milk changes throughout the day, and even throughout a pumping session or feed.
Breastmilk may be white, yellow, clear or have a blue tint to it. Ingredients in many foods and beverages that you might ingest can also tinge your milk in a variety of ways. The following are possible variations:
- Diets high in pureed or mashed yellow-orange vegetables (yams, squash, carrots etc) lead to high levels of carotene in milk, which can turn it yellow or orange. Carotene is completely harmless to babies – read our post on *link* carotenemia.
- Food dyes used in carbonated sodas, fruit drinks, and gelatin desserts have been associated with milk that is pink or pinkish orange.
- Greenish milk has been linked to consuming green- colored sports beverages, seaweed, herbs, or large amounts of green vegetables (such as spinach).
WHAT IS COLOSTRUM?
Colostrum is the earliest breastmilk produced, beginning in mid-pregnancy (12-18 weeks) and is continually produced for the first few days after baby’s birth. It is thick, sticky, concentrated milk and is usually yellow, clear or white, although it could be other colors as well. It is made up of immune factors, protein, sugar, and fats.
PRENATAL/ANTENATAL EXPRESSION OF COLOSTRUM
During the first trimester of pregnancy, the breasts begin producing colostrum in small amounts.
Sometimes colostrum ‘leaks’ onto the person’s bra or other clothing; others do not experience any outward signs that the breasts are preparing for lactation even as the pregnancy progresses. The fluid could be thin or thick, and is usually yellow-ish because of beta-carotene, one of the protective components of milk. At the time of the baby’s birth, more colostrum is being produced by the breasts than the baby will need. However, some fear that the baby ‘won’t get enough’ or that the ‘milk won’t come in,’ and want to express colostrum before the baby is born. According to research, the breasts make 10-100 ml of colostrum per day, averaging about 30 ml or an ounce per day – more than the baby needs.
IS MY BREASTFED BABY CONSTIPATED?
The amount and frequency of a breastfed baby’s wet diapers and bowel movements can be valuable indicators of his well-being. However, there is a wide range of normal in infant stooling patterns.
The correct definition of constipation is when a baby experiences hard, dry, infrequent bowel movements that are difficult and painful to pass. Breastfed babies rarely have these types of bowel movements while exclusively nursing.
CONCERNED ABOUT ENVIRONMENTAL CONTAMINANTS? YOUR MILK IS STILL BEST FOR YOUR BABY
Every year, reports in news media describe environmental contamination events or the presence of lead, mercury, Persistent Organic Pollutants (POPs), or other things in our water, food, air, and ground. These media stories often raise concerns in nursing parents about the safety of their milk. Families’ fears of possibly doing their babies harm by nursing them may contribute to unnecessary early weaning (Geraghty, Khoury, Morrow, & Lanphear, 2008), particularly if they lack good support and information about the ways in which human milk and nursing outweigh and mitigate any risks due to contaminants (Hatcher, 1982). Early weaning itself can be harmful for both parent and baby.
HUMAN MILK IS THE NATURAL FOOD FOR YOUR BABY, UNIQUELY MEETING YOUR BABY’S CHANGING NEEDS
Public health organizations around the world affirm the importance, safety, and value of human milk for the human baby. The World Health Organization (WHO), which conducts periodic reviews of the research published on contaminants and human milk, states definitively, “The benefits of breastfeeding far outweigh the toxicological disadvantages that are associated with certain POPs” (van den Berg et al., 2017, p. 94). Indeed, Nickerson states, “WHO recommends breastfeeding in all but extreme circumstances” (qtd. p. 31). In its position statement supporting breastfeeding, the American Academy of Family Physicians (AAFP) concurs, explaining that certain components of human milk act to increase the infant’s elimination of some toxins and to protect the infant’s developing brain, central nervous system, and body as a whole (2018; see also Mead, 2008).
DO YOU FEEL WORRIED ABOUT HOW TO HANDLE CRITICISM ABOUT BREASTFEEDING? LA LECHE LEAGUE IS HERE TO HELP.
Many parents worry about criticism they may face while breastfeeding their baby. Some parents worry about criticism from their own friends, family members, or in-laws. Some parents worry about criticism from strangers when breastfeeding in public. Most parents have been criticized in their life at some point and can remember how this felt in the past. Criticism often leads to problems in relationships and can even be destructive to relationships if on a frequent basis. Past experiences with criticism makes it normal to desire to avoid criticism, however you cannot control what other people say to you, but you can control how you respond to criticism.
The most important parts of responding to criticism often lie in your tone of voice, your facial expression, and your body language. You may need to practice saying your responses in a mirror to ensure that you appear confident and non-threatening. Also, be sure that you take a deep, relaxing breath filling your lungs and brain with oxygen before you respond.
Breastfeeding is the most natural and normal way of feeding and nurturing your baby, and is highly valued in many cultures. Many mothers also find that although they feel proud of nursing their baby, they feel concerned about how to do this in a public place without drawing unwanted attention to themselves.
Being modest doesn’t have to keep you and your baby at home (or hidden in the restrooms). It’s easy to breastfeed discreetly in public if you wear the right clothes. A loose-fitting shirt or top that lifts or can be unbuttoned from the waist will let you feed your baby without exposing your breast, because the baby will cover the nipple and lower breast. You can also buy special nursing blouses, dresses, or shirts, with hidden slits and panels, or modify your existing clothes. If you wear a nursing bra, it’s easiest to breastfeed discreetly if the bra can be pulled up or unfastened and re-fastened with one hand. Layering of clothes can often be helpful so that you can use the “one up, one down” method and lift your outer layer up and pull down a vest underneath. This is good for warmth too.
Can I donate blood while I am breastfeeding?
The American Red Cross accepts nursing mothers, they say ” Persons who are pregnant are not eligible to donate. Wait 6 weeks after giving birth.”
Dr. Jack Newman is a member of La Leche League International’s Health Advisory Council, he says any otherwise eligible mother who is not anaemic can donate blood.
The Canadian Blood Service does not allow breastfeeding mothers to donate blood in the first six months postpartum.
Whether to donate blood is a personal decision.. La Leche league recommends that you consult your health care professional and/ or the blood donor programme in your country and make an informed choice.
Brand new baby? Tight, full breast? Baby having trouble latching on? You probably have “first week engorgement.” And there may be some simple solutions.
Mothers have come to see engorgement as the natural follow-up to birth. But it’s more often a natural follow-up to modern expectations of age-old biology. In a nutshell, babies and breasts expect a lot more cuddling and nursing than many new mothers expect.
You’ve been making milk since your first trimester. Maybe you leaked, maybe you didn’t. But that first milk – colostrum – was there. Colostrum is thick and yellowish and sluggish and more salty than sweet, but it’s full of antibodies and protein. Call it “practice milk” for your newborn. It coats your baby’s stomach and intestines with antibodies. It fuels but it doesn’t flood.
Now wait a couple days. Your hormones shift. The blood supply to your breasts increases to start up the milk factory, causing fullness. (If you’ve had IV fluids, that fullness may be more than normal.) Sugar enters your early milk, which pulls water into it. It turns white. From now on, your milk will be sweet and sloshy, and there will be a lot more of it… provided your body gets the message it’s looking for.
Whether you are used to running marathons or want to start some gentle activities to help with your fitness and/ or weight loss goals you might be wondering if your milk supply will be affected by exercise.
It’s worth remembering that women with babies have always worked – the bottom line is that throughout history and in many cultures they couldn’t afford not to. Often this work involved fairly strenuous manual labor and we know these moms continued to breastfeed their babies without problems.
Most people feel better when they get some exercise, and this is certainly good for both mother and baby.
When your new baby arrives, sometimes your older child will feel left out. You can reassure your older child he is still loved, with plenty of hugs and kisses. Remind him or her that they were tiny once, and needed to be held and breastfed a lot. Show them photos and videos of when they were small(er) and tell them stories about what they were like.
Arrange a place on the sofa where you can comfortably feed your baby, and your toddler can snuggle close too. Or put a small chair and table near a comfortable chair, where the toddler can play, while you are breastfeeding.
Reading to your older child, watching TV with them and talking about the game they’re playing can all be done while you sit and feed your baby.
If you use a baby carrier or sling (link) you may be able to breastfeed and move around. If you time walks, or outings to the park or shops, to coincide with a nap for your baby you can give your older child(ren) attention they need. If your children get enough fresh air and exercise they may be more settled with you spending a lot of time sitting down with your baby.
LINKS TO RESOURCES FOR INFANT FEEDING IN EMERGENCIES (MULTILINGUAL)
الرضاعة الطبيعية في حالات الطوارئ
تغذية الرضع في حالات الطوارئ (شبكة التغذية في حالات الطوارئ)
Infant Feeding in Emergencies – information for health and nutrition workers and media in emergency situations (source: Emergency Nutrition Network)
Breastfeeding can have an effect on your fertility, particularly in the early months. While for some mothers this is a benefit, it can also be a source of frustration for those hoping to grow their families.
CAN I GET PREGNANT WHILE I’M NURSING?
The simple answer is that you can get pregnant while nursing.
However, many moms experience a time of delayed fertility during breastfeeding. This is very common and is referred to in many places as the Lactation Amenorrhea Method of contraception.
As described in THE WOMANLY ART OF BREASTFEEDING, the Lactation Amenorrhea Method of using breastfeeding to delay fertility needs all the following to be true:
- Your periods have not returned.
- Your baby is exclusively and frequently fed from your breasts- this is especially important to remember when your little one begins sleeping through the night. It means not just that your baby does not have bottles, but also that they do not use a pacifier, in other words that all of your baby’s sucking needs are met at your breast.
- Your baby is less than 6 months old. If your little one is older and eating solid foods, your chances of ovulating and risk of pregnancy increases. Some moms will find it takes more than six months for their cycles and fertility to return, while other mothers find that their cycles and fertility return earlier than six months. It is also important to mention that after six months, there is a higher chance that you might ovulate and possibly become pregnant before your first postpartum period. If you suspect you are pregnant, you will want to check with your health care professional.
Are there any foods I should avoid while breastfeeding?
One of the concepts La Leche League is founded on is “Good nutrition means eating a well-balanced and varied diet of foods in as close to their natural state as possible.”
You don’t need to eat anything special while you’re breastfeeding. But it’s a good idea for you, just like everyone else, to eat a varied and healthy diet. The food any family chooses will depend on personal preference, climate, culture and finances.
There are no foods you need to avoid while breastfeeding (unless you’re allergic to them of course!).Some strongly flavored foods may change the taste of your milk, and many babies seem to enjoy a variety of breast milk flavors! Often the dominant flavors of your diet – whether soy sauce, chili, garlic or something else – were in your amniotic fluid during pregnancy. Before birth babies swallow amniotic fluid and are accustomed to these flavors before tasting them in your milk.
FAT CONTENT OF MILK
You may have heard people talking about two kinds of milk – foremilk and hindmilk. This suggests that breasts produce two distinct kinds of milk, which is not the case. The milk-making cells in your breasts all produce the same kind of milk.
Foremilk is the milk available when your baby starts feeding, hindmilk is the milk your baby gets at the end of a feed. Foremilk is not necessarily low in fat: fat content of the milk that is removed varies according to how long the milk has been collecting in the ducts and how much of your breast is drained at the time.
As milk is made, fat sticks to the sides of the milk-making cells and the watery part of the milk moves down the ducts toward your nipple, where it mixes with any milk left there from the last feed. The longer the time between feeds, the more diluted the leftover milk becomes. This ‘watery’ milk has a higher lactose content and less fat than the milk stored in the milk-making cells higher up in your breast.
This information is for birth parents with babies born at full term or close to full term and addresses the normal course of breastfeeding.
- How often should I feed my baby in the first 24 hours after birth?
- How often should I breastfeed my baby in the first few days?
- How does nursing frequently prevent my baby from becoming jaundiced or help if he/she does become jaundiced?
- How can I tell whether my baby is getting enough milk from me?
- Should I put my baby on a schedule?
- How will I know when my baby is hungry if I don’t use a schedule?
- How often should I breastfeed my baby in the first weeks?
- How often should I breastfeed my baby in the first six months?
- Do I need to breastfeed my baby at night?
- I’m not sure I’m making enough milk—my baby is fussy! How can I increase my milk supply?
- People say I’m spoiling my baby by nursing her/him too often. How often is right?
- Why does my baby suddenly want to breastfeed constantly?
BREASTFEEDING AFTER GASTRIC BYPASS SURGERY
You can still breastfeed if you have had gastric bypass surgery. You will need to be extra careful about making sure you are getting enough nutrition. Your body will provide any nutrients that are in short supply to your breastmilk first, and then to your body. It is important that you tell your baby’s healthcare provider about your history so that they can watch him carefully for any signs of not getting the proper nutrition.
Gastric bypass surgery is performed to help you lose weight and lower your risk of serious health conditions such as diabetes, high blood pressure, heart disease and stroke. The surgery helps you lose weight by changing how your stomach and small intestine handle the food you eat. After surgery your stomach is smaller and you feel full with less food: this decreases the number of calories that you take in each day and helps you lose weight, but it also affects your body’s ability to absorb some important nutrients.
When your baby is spitting up many times a day and seems very unhappy with feedings, he may have gastroesophageal reflux disease. Although baby will need assessed by his doctor, symptoms include:
- Frequent spitting up, often with pain
- More uncomfortable when sitting than when upright on chest
- Gagging, choking, coughing, burping or frequent hiccuping
- Bad breath
- Uncomfortable when laid down, sleeps poorly
GROWTH OF BREASTFED BABIES
It is common to wonder whether your breastfed baby is growing as he should be, and while diaper output is one good indicator of whether he is getting enough milk, progress on growth charts is also a tangible measure.
The World Health Organization (WHO) issued its most recent Child Growth Standards, using a world-wide sample of over 8,000 children in April of 2006. To view the report and charts, visit their website — the links to the charts are near the bottom of the page.
The new charts will be an invaluable tool for parents and healthcare providers as a way of detecting under-nutrition, overweight and obesity, and other growth and nutrition-related conditions at an early stage in a child’s life. The premise of the study is that the gold standard in infant nutrition is exclusive breastfeeding for the first six months and continued breastfeeding after the introduction of appropriate complementary foods.
Hand expression is a useful technique, and what’s more it’s convenient and free! It’s a handy way to relieve engorged breasts. You can use it to stimulate milk production if you need to increase your supply, and to provide milk for your baby. You can also combine hand expressing with pumping – read more about pumping here: LINK
Hand expression is often used for antenatal expression of colostrum – read more here.
Hand expression is simple to learn and gets easier with practice. Follow these steps:
- Wash your hands.
- You can use any clean container you like to collect your milk, colostrum can be expressed into a small (5ml) container or even onto a teaspoon if you want to feed it to your baby immediately.
- Relax and get comfortable: your milk will flow more easily if you are warm and comfortable.
- Privacy can help: try the breathing exercises you learnt for use during labour; visualise flowing milk.
- It can be easier to get your milk flowing if your baby is nearby – if he is not try thinking about him, or looking at a photo or recording of him.
- Many moms find that keeping a piece of clothing that smells of their baby close-by helps – this may be especially helpful if you’re separated from your baby, for example if your baby is in special care (NICU).
- Take some deep breaths and drop your shoulders.
- Gently massage your breasts with your hands and fingertips to stimulate your milk ejection reflex (MER or ‘let-down’) – this is the key to effective expressing.
- Bending forward with your breasts suspended means gravity can help milk flow.
What is the best way to thaw my milk?
Milk can be thawed several ways. Slow, gentle thawing is best to protect and preserve the healthy qualities of the milk. One excellent way is to allow it to thaw overnight in the refrigerator. This method preserves the most fat content of the milk. Another is to warm some water, remove it from the burner or microwave and set the bottle in the warm water to thaw. Be sure the heated water is warm, not hot. Human milk can also be thawed by rotating the container under running warm water. Some caregivers thaw human milk in a waterless bottle warmer. Once thawed, it should be used within 24 hours.
Hypoplasia/Insufficient Glandular Tissue (IGT)
Mothers who struggle with milk production hear advice like this from well-meaning friends and family members (and sometimes, from breastfeeding supporters who should know better). While the vast majority of milk production problems can be remedied by addressing issues of breastfeeding management, there are some for whom making enough milk to sustain their babies is difficult or impossible. Called “primary lactation failure”, this condition occurs when a mother’s body does not make an adequate amount of milk for her baby, even when everything else is in order (including but not limited to: latching and positioning, breastfeeding frequency and exclusivity, mother and baby being kept together, baby’s oral anatomy is fine with no tongue-tie or cleft palate).
Breastfeeding is the biological norm.
The Womanly Art of Breastfeeding *link* explains that “there is almost nothing you can do for your child in his whole life that will affect him both emotionally and physically as profoundly as breastfeeding.” Human milk provides the specific nutrients that babies need to grow, both in size and maturity. Your milk is made to order for your baby. Research points to the significant value to infants, mothers, families and the environment from breastfeeding.
IMPORTANCE FOR BABY
The Womanly Art of Breastfeeding documents the benefits of breastfeeding such as the antibodies in it to protect the baby from illness. Breastfed babies have a decreased likelihood for allergies and dental caries. They also benefit from appropriate jaw, teeth and speech development as well as overall facial development. This means that people who were artificially fed may experience more trips to doctors and dentists.1
La Leche League International encourages all families to recognize the importance of breastfeeding in providing immunological protection to the breastfed child. Most often, babies who are being nursed remain healthy even when their parents or other family members fall ill with an infectious illness, because they benefit from the antibodies provided in the lactating parent’s milk. Lactating parents who are infected or immunized with an appropriate vaccine during the antenatal period will produce sufficient quantities of specific secretory IgA antibodies in their milk to protect their nursing infants against infection from the influenza virus. Following good hygiene practices will also help reduce transfer of the virus.
The Centers for Disease Control (CDC) recently re-released an older report suggesting that breastfeeding should be temporarily discontinued and the lactating parent and baby separated when the parent exhibits flu symptoms. Members of La Leche League International’s Health Advisory Council have responded to concerns about the current applicability of the guidance offered. It is important to recognize that the report, originally developed during the 2009 H1N1 pandemic and updated in 2011, was based on concerns for newborns in labor, delivery, recovery, and postpartum hospital settings when their mothers have or are suspected of having influenza.
Remember that babies BREASTfeed, not NIPPLEfeed. As long as your baby can take a good portion of your breast into their mouth (baby’s mouth and gums should bypass the nipple entirely and latch on to the areola), most types of flat or inverted nipples will not cause problems with breastfeeding. Some types of nipples are more difficult for a baby to latch on to at first, but in most cases, careful attention to latch and positioning, along with a little patience, will ensure that you and your baby get off to a good start with breastfeeding.
How can I tell if my nipples are flat or inverted?
Just looking at the breast often won’t tell you the answer. Instead, you can determine whether or not your nipples are flat or inverted by doing a “pinch” test. Gently compress your areola (the dark area around the nipple) about an inch behind your nipple. If the nipple does not become erect, then it is considered to be flat. If the nipple retracts, or becomes concave, it is considered to be inverted. It should be noted, too, that true inverted or flat nipples will not become erect when stimulated or exposed to cold. If the nipple becomes erect during the “pinch” test, it is not truly inverted and does not need any special treatment.
During the first week of life, more than half of all newborns have jaundice. Usually, jaundice is a normal part of adjusting to life outside the womb, but occasionally it may be a sign of serious health problems. Sometimes, the treatment of jaundice is challenging for mothers and babies.
WHAT CAUSES JAUNDICE?
After birth, the infant no longer needs the extra red blood cells that transport oxygen in utero. During the first days after birth, the excess red blood cells break down producing the yellow pigment bilirubin. The liver processes (conjugates) bilirubin into a form transported to the intestines and from there, carried out of the body in the stool. However, a newborn baby’s liver may not be able to process bilirubin efficiently and the newborn’s gut easily absorbs unconjugated bilirubin, so bilirubin levels increase in blood circulation. The excess is deposited in the skin, muscles, and mucous membranes of the body.
How long should I breastfeed?
You can breastfeed for as long as you and your baby want to.
One of the concepts La Leche League is founded on is that “Ideally the breastfeeding relationship will continue until the baby outgrows the need.”
The World Health Organization and UNICEF recommend that babies be breastfed for at least two years.
“Review of evidence has shown that, on a population basis, exclusive breastfeeding for six months is the optimal way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding up two years of age or beyond.” 1
As solids are introduced, usually around the middle of the first year, your baby will begin to shift his primary source of nutrition from your milk to other foods.
LUMP IN BREAST
Finding a lump in your breast is scary! Fortunately, most lumps in a lactating mother’s breasts are either milk-filled glands or an inflammation, such as a blocked duct or mastitis. If the lump is tender, it is probably mastitis. Check out this page for information on treating mastitis.
If the lump does not go away after a week of careful treatment for a blocked duct/ mastitis or if you are experiencing sudden flu-like symptoms or a high fever, or are at all concerned, contact your healthcare provider. If you notice red streaks on your breasts seek medical attention as they are a sign of infection that, left untreated, can develop into sepsis, a life threatening complication of an infection.
Having a sore breast can be a painful and alarming experience and can occur when the milk flow in your breast is blocked. Your breast may feel tender, there may or may not be redness or a hard spot or sore lump in your breast. Treat any engorgement promptly to avoid developing blocked ducts or mastitis.
Whether you have a sore breast, a plugged duct or a breast infection, the initial care is similar: nurse frequently, rest and apply heat to the tender area.
Milk flows through a duct system in your breasts. Sometimes an area of the ducts becomes blocked and milk stops flowing well. A section of your breast may or may not be red. If you have a plugged duct, your breast will usually be tender though the pain will be localised. If the blockage is not treated, the area may become infected.
One of the most common questions that mothers ask their health care providers is- “Can I safely take medication while breastfeeding?” Sometimes mothers are told that they cannot continue breastfeeding while taking a certain medication. Some are told to wean, or to “pump and dump” for a certain number of days.
According to Dr. Thomas Hale, author of Medications and Mother’s Milk 2017, “most drugs do not enter milk in levels that are hazardous to a breastfed infant.” However, it is important to check reliable sources for up-to-date research-based information.
Many health care providers rely on the package insert of the medication that they are prescribing. The package insert almost always cautions against prescribing the medication to pregnant or lactating mothers. However, there are many reliable resources for finding more accurate answers.
MENSTRUATION AND BREASTFEEDING
Human beings have known for centuries that breastfeeding affects fertility, and this has been borne out in recent studies. The individual variations are, however, great. In general, the more often a baby is breastfed, the younger the baby is, and the less nutrition he gets from other sources, the later the mother’s periods will resume.
The range of “normal”, though, is enormous. Some women resume their menstrual cycles soon after giving birth, while others do not resume menstruating until the baby is weaned (which can be months or years later, depending on how long the baby is nursed). This depends on how sensitive the mother’s body is, and how frequently the baby nurses. Also, some women have a non-ovulatory period before 6 months postpartum, but do not menstruate again for many months.
Whether you are someone who produces more milk than your baby needs, or you’re someone who is unable to produce as much as you’d like for your baby or cannot nurse your baby for other reasons, you may have considered milk donation or milk sharing. Either way, you should be aware of some potential risks. Research has shown that the “perceived risks and benefits of feeding milk from another mother may not align with actual risks and benefits”[i][ii]. However, milk sharing and donation are perceived differently in different cultures around the world; what one country and culture sees as potentially risky may be a long-standing and widely accepted tradition in another country and culture. Hence, we are not here to make any judgment about these practices. Instead, we simply hope to offer information that will allow you to make an informed decision that is right for you, your baby, your family, and your location.
As per our milk donation policy, La Leche League International cannot facilitate milk sharing. You may be wondering why. You can read our policy at the end of this post.
MILK ISSUES: SOAPY, METALLIC, SOUR, OR SPOILED MILK?
Being able to pump and store one’s own milk has been an enormous benefit for many who go back to work after their babies arrive. However, for a small group of people, this boon comes with an extra challenge: changes in the aroma and possibly the taste of their milk after it has been stored for a while.
Some people describe a “soapy” smell or taste in their milk after storage; others say it is a “metallic” or “fishy” or “rancid” odor. Some detect a “sour” or “spoiled” odor or taste. Accompanying these changes are concerns that the milk is no longer good for the baby. In addition, while sometimes the baby doesn’t seem to care and drinks a bottle of the expressed milk readily, other times the baby refuses to drink the milk. And sometimes, if it is actually spoiled, it isn’t good for the baby. Let’s figure out what’s happening.
Is it OK to mix human milk and artificial baby milk (formula)?
Mixing refers to giving your baby your own milk and artificial baby milk in the same container. This is actually a form of supplementation. Supplementation means giving your baby liquid nourishment in addition to breastfeeding. Giving your milk and any supplement separately is advantageous for these two reasons:
- Your baby will receive the immunological benefits of human milk and
- Less will have the chance to be wasted than if the milks were mixed.
Reasons supplementation of a breastfed baby may be necessary include if the nursing parent’s supply is low or if the baby is separated from the parent. However, there are many options in these cases, including the possibility of supplementing with breast milk, donor human milk or formula, so be sure to contact your La Leche League Leader to discuss your particular circumstances.
NATURAL BUT NOT ALWAYS EASY
Many mothers have asked the question ‘if breastfeeding is so natural, why doesn’t it seem to come naturally?’ It’s a good question!
Before your baby arrives, it seems like all you need to do is put your baby to the breast, let him latch on, and away you go. Sometimes it’s not so easy – some babies do go straight to the breast and their mothers never experience any problems. But many of us need some help.
In times gone by, when every mother breastfed and generations of the same family lived close to each other, new parents would have plenty of support. Mothers would mostly likely have seen countless babies being breastfed before having their own, and could turn to their own mother, grandmother, aunt or other member of their community for breastfeeding help. Unfortunately, today many communities have lost that inbuilt support.
La Leche League may be able to fill the gap. Have a look around our website, pick up a copy of The Womanly Art of Breastfeeding, find local support.
The term nipple confusion or nipple preference has been used to describe an infant’s fussiness at breast or frustration when they are having problems switching from a bottle nipple and breast, before breastfeeding is well established. A baby uses a totally different technique to remove milk from the breast than he uses to drink from a bottle. Some babies have difficulty alternating between a bottle and the breast and some do not. There is no way to predict who will have problems breastfeeding after drinking from a bottle. Babies that are born early or babies with a weaker or more uncoordinated suck may be more vulnerable to nipple confusion. Breastfeeding experts disagree to what extent baby’s have difficulty with nipple preference or confusion.
Ways To Avoid Nipple Confusion:
- Wait until breastfeeding is well established and feels like part of your daily routine. Many mothers recommend postponing a bottle at least 4 weeks.
- If baby needs to be supplemented then consider other alternatives like a feeding cup or a supplemental nursing system.
- Inform hospital staff of your wish to not give a pacifier or supplement to baby unless medically indicated.
Nipple piercings have become increasingly popular in recent years and you may be wondering if it safe to breastfeed your baby if you already have pierced nipples. You might be thinking of getting your nipples pierced and wish to continue breastfeeding without interruption.
IS IT SAFE TO BREASTFEED WITH NIPPLE PIERCINGS?
That depends on whether you are breastfeeding with holes from previous piercings or breastfeeding with jewelry still in place. Nipple piercings can impact breastfeeding for both mother and baby. Common concerns for mom may include nerve damage that impacts the milk ejection reflex or scarring that obstructs the milk flow which can, over time, affect milk production. There have been reports of mastitis and abscesses from previous nipple piercings as well. Often the longer the time since the piercings were initially placed and the birth of the baby the better the outcome.
MY BABY IS SUDDENLY REFUSING TO NURSE. DOES THAT MEAN IT’S TIME TO WEAN?
A baby who is truly ready to wean will almost always do so gradually, over a period of weeks or months. If your baby or toddler has been breastfeeding well and suddenly refuses to nurse, it is probably what is called a “nursing strike,” rather than a signal that it’s time to wean. Nursing strikes can be frightening and upsetting to both you and your baby, but they are almost always temporary. Most nursing strikes are over, with the baby back to breastfeeding, within two to four days.
First thing to remember is to feed the baby. The other important thing is to protect your supply.
Nursing strikes happen for many reasons. They are almost always a temporary reaction to an external factor, although sometimes their cause is never determined.
Sometimes a mother may make more milk than her baby needs. Although this may sound like a good problem to have, too much of any good thing can cause challenges – for baby and mother.
WHAT ARE SOME SIGNS OF OVERSUPPLY?
- Baby is restless during the feeding, may cry or pull off and on the breast.
- Baby may cough, choke, splutter, or gulp quickly at the breast, especially with each let-down. See Positioning
- Baby may clamp down at the nipple to try to stop or slow the rapid flow of milk. This may cause sore, creased nipples. See Biting
- Baby may arch or stiffen, often with painful cries.
- Each feeding feels like a struggle or battle.
- Feedings may be short but frequent because baby fills up quickly on air and the lower fat milk from the early part of a feeding and not get to the higher fat that comes further into the feeding.
- Baby may have green, loose, or explosive stools. Some may have signs of blood.(See section on digestion concerns, below)
- Baby may be very gassy and have frequent, large spit ups. See Breastfeeding and Reflux and Breastfeeding and GERD .
- Mother may notice a strong, forceful milk release, also know as Overactive Milk Ejection Reflex (OMER). This can cause coughing or choking. This may also result in excessive leaking from the side where baby is not feeding.
- Mother’s breasts may never feel fully empty and seem to refill very quickly after a feeding.
- Mother may have frequent bouts of plugged ducts or mastitis.
- NOTE: Some mothers may benefit from having their thyroid levels checked as overactive thyroids can contribute to oversupply.
It hurts when my milk “lets down.” What could be causing this and how can I remedy this situation? What if my pain is deep in my breast?
A painful let-down reflex can occasionally happen while your body adjusts to feeding your baby. You may find that using relaxation techniques that were helpful during labor might help you cope with this early discomfort.
Make sure you are using good positioning techniques and are not straining or leaning over your baby as you are breastfeeding your baby. Your back, arms, feet and elbows should be well-supported, and your shoulders and neck muscles relaxed.
Some deep breast twinges during let-down can occur as the milk ducts constrict to force the milk toward the nipple. As your body becomes more used to breastfeeding, these disappear.
Breastfeeding with Sore Nipples
Breastfeeding is a gift only you can give to your baby. It should be a pleasant experience for both of you. A healthy, full-term baby is likely to know instinctively what to do at the breast. In the first three to five days after birth, if you experience nipple soreness beyond a slight tenderness when your baby latches on, it may be a sign that something isn’t right with the baby’s latch, position, or suck. An adjustment to the latch or positioning can help you and your baby to be more comfortable. With proper positioning and latch-on techniques, you can expect little or no nipple soreness. Correcting poor positioning or latch-on can often alleviate sore, cracked nipples and allow healing to begin.
If nipple pain worsens after the early days of breastfeeding your nipple pain may be due to other causes like thrush, bacterial infection, or tongue-tie. Contact a La Leche League Leader for help if you need further assistance to improve your sore nipples.
Note: For clarity, we are referring to baby as “he” and mother as “she.”
THE FIRST WEEK: POSITIONING AND LATCH
Breastfeeding is a gift only you can give your baby. A healthy, full term baby is likely to know instinctively what to do at the breast.
During the early weeks skin-to-skin contact helps your baby be connected to his instinctive breastfeeding skills and helps you and baby enjoy breastfeeding. Each mother discovers what works for her, and what works for one mother may not work for another. Mary Renfrew wrote in Journal of Human Lactation that learning to breastfeed is like mother and baby learning a dance. Use what works in these suggestions and tailor them for you and your baby. Trust that you know what works for you and your baby. You will know when the positioning is ideal for you, when you and your baby are comfortable. When positioning is right for you, your nipples stay healthy and your baby can feed most efficiently. Concern about sore nipples or breastfeeding comfortably is a common reason that mothers contact La Leche League. Improving positioning helps eliminate many cases of sore nipples.
You may have noticed this description is long. Be assured that many mothers have successfully accomplished breastfeeding their babies for centuries and you too will learn how to best position your baby. These suggestions are not meant to tell the mother that if she follows all the steps the position will be “right”. The suggestions are meant to gives you ideas on how you and your baby can learn to breastfeed and enjoy the breastfeeding experience.
Many women experience a roller coaster of emotions after having a baby, from joy and elation to worry and sadness. Mix big feelings with limited sleep and meeting the needs of a new baby, and new parenthood can feel overwhelming at times.
Having a baby is a life-changing experience, and around 85% of women experience some kind of mood disturbance postpartum. Despite being so common, postpartum (postnatal) mood disturbances are not always talked about, leaving some women to feel alone and wondering if they are good enough mothers. Talking openly about your postpartum experiences with others going through the same thing can combat feelings of isolation and shame. Going to a La Leche League meeting is a great place to find other new mothers to share experiences with.
Breastfeeding During Pregnancy
You can breastfeed while pregnant; some mothers go on to nurse both their new baby and their older child after the birth. This is known as ‘tandem nursing’.
Family, friends and healthcare professionals may express concern if you are breastfeeding while pregnant. Their concerns might include perceived risk to the health of your unborn baby, and they may also worry about your well being. There is no evidence that breastfeeding during low risk pregnancy leads to increased chance of harm to mother or baby.
Importance of Breastfeeding for a Premature Baby
The simple answer is YES! Babies that are born pre-term have a special need for human milk. If your baby was born earlier than expected, you may be awash in a storm of feelings. Feelings of protectiveness come over you when you see your baby’s tiny body. You may be feeling afraid, angry or guilty. The busy, bustling medical team may be making you feel out of place and question your role as a vital partner in your child’s care.
You are needed, and have a unique gift to provide: your milk. The milk from your breasts is something you alone can provide for your baby. It contains invaluable nutrients and immunities that can make a big difference in the health of your baby and in his development.
Importance of Kangaroo Care and Skin-to-Skin Contact
‘Kangeroo care’ is a practice which is used across the world and has been shown to be extremely beneficial to babies. When your baby is strong enough to come out of the incubator, hold him skin-to-skin on your chest. Skin-to-skin means that your baby will be nestled upright between your breasts. Apart from his diaper/ nappy he will be naked against your skin. You can drape a blanket over you both for warmth. Your warmth, smell, and familiar heartbeat will feel comforting to your baby. He will be soothed and calmed which will aid in his development. He may start to root for your breast and try to nurse for the first time. Fathers and other support people can also hold babies in this way.
Positioning a Pre-Term Baby at the Breast
Perhaps your baby is now strong and mature enough to begin feeding directly at your breast. It may take some time to encourage him to do it correctly.
Many mothers of premature babies find the cross cradle hold very useful for this stage. This technique allows you to get a better view of your baby, and to control your baby’s head.
Pumping Milk for A Premature Baby
If your baby is not strong enough to feed at the breast, you can still give him your milk. Begin to pump as soon after birth as you are able. Frequent pumping, every two to three hours, will mimic the frequency of a newborn’s feeding pattern, and bring in a good milk supply.
It will help if you can use a full-size, hospital-grade pump, with a double-pump kit; many NICUs (Neonatal Intensive Care Units) have these pumps available for use. Ask at your hospital.
Pumping both breasts at once will save you time. Save your colostrum, the first milk. This is the perfect first feed for your baby to have.
There are times when mothers are separated from their child for work or for school. It is important to know that you can still provide milk for your child when you are away and you can maintain your breastfeeding relationship.
HOW OFTEN WILL I HAVE TO PUMP WHEN I GO BACK TO WORK OR SCHOOL (COLLEGE)?
How long you are apart from you baby influences this decision. Ideally, you would pump as often as your baby would nurse. This may not be possible with your work/ school schedule. Most mothers find that pumping every 2-3 hours maintains their milk supply and does not cause them to become uncomfortably full.
For example, if a mother worked an 8 hour work day, she would nurse her child before coming to work, then pump mid-morning, at lunchtime and then mid-afternoon. She would nurse her baby when she returned home.
When you are pumping milk for your baby, it is important to clean your pumping accessories properly, whether at work or at home.
ITEMS TO BRING WITH YOU IN ADDITION TO YOUR PUMP KIT
- Mild, unscented dish soap (washing up liquid).
- Bottle brush.
- Wash basin (many hospitals provide these to their patients); two if you can – one for washing and the other for drying.
One type of breast massage involves using your fingertips to apply gentle pressure to your breast and move your fingers in a circular motion. After a few seconds, you can move your fingers to another spot. Start at the top of your breast and spiral the breast toward the areola using the circular motion. Then switch to the other breast.
Check for Flat or Inverted Nipples
In order for the baby to suck effectively, he will need to draw your nipples far back in his mouth. If you have flat nipples, the baby may have a problem latching. On the other hand many mother have successfully breastfeed with flat or inverted nipples.
A baby spitting up occasionally is usually looked at as “something babies do.” According to the late Dr. Gregory White, husband of the late LLLI Founder, Mary White, “In a healthy baby, spitting up is a laundry problem, not a medical problem.”
A baby may spit up for lots of reasons:
- Baby is not be able to swallow quickly enough when milk ejects forcefully during a feeding, resulting in swallowing excess air.
- Mother has an oversupply of milk that can result in baby taking too much too fast for the stomach to handle. Either can result in additional air swallowed with the large volumes of milk. Read our post on oversupply.
- Less common reasons are:
- Immature muscle control
- Allergy to foods and/or dietary supplements mother may consume
Resuming Breastfeeding After An Interruption
The good news is relactation is possible. It requires time, patience, determination and a cooperative baby! Whether you stopped breastfeeding due a medical procedure, separation from baby, or simply bad advice, many mothers find they can rebuild a milk supply very successfully. Providing human milk for a newly adopted baby is also a relactation opportunity.
Sometimes, relactation produces enough breastmilk to supply all of baby’s needs. Other times, supplementation may still be needed.
Skin-to-skin is a biologically normal practice. It consists of placing an unclothed or diaper-only newborn baby chest-to-chest with mother immediately after delivery and keeping them together for at least the first hour after birth, whether the mother has had a vaginal or cesarean birth and regardless of feeding method planned. This practice is supported by the World Health Organization (WHO), Baby Friendly Hospital Initiative (BFHI), the Academy of Breastfeeding Medicine (ABM), and American Academy of Pediatrics (AAP). This is an important component of family-centered care.
Immediate Skin-to-skin care (SSC) for a minimum of one hour after birth is one of the most effective methods for promoting exclusive breastfeeding. Babies who have early SSC are more likely to be exclusively breastfed at discharge, exclusively breastfed after discharge, and breastfed for longer durations.
Reasons why SSC is important for baby and mother:
• Keeps mother and baby together.
• Promotes bonding between mother and baby.
SHOULD I SLEEP WITH MY BABY?
It can be hard to hard to continue your breastfeeding relationship if you are told you are not safe for your baby for a full third of the day! LLL believes there are many safe sleep options available to parents with infants. Education and accurate information are the keys to unlocking Sweet Sleep solutions!
Safe Sleep for Breastfeeding Babies
Sleeping with our babies is an instinct as old as motherhood itself. Yet today, some authorities say it’s risky. What are the facts?
Sudden Infant Death Syndrome
Sudden Infant Death Syndrome (SIDS), Crib Death, or Cot Death is the unexpected and unexplainable death of a baby. The highest risk is during the first six months. The greatest SIDS risk factors are smoking during your pregnancy and placing your baby face-down for sleep.1 Formula-fed children have double the risk of SIDS.2 Parents who smoke and share a bed with their infant also increase the risk, regardless of where or when the parent smokes. One in five SIDS deaths occurs in daycare.3
Sleep: Safe Surface Checklist
If you are a nonsmoker, sober and unimpaired, a breastfeeding mother, and your baby is healthy and full-term, one his back, lightly dressed, and you both are on a safe surface, the solid research indicates your automatic behaviors and responsiveness as a breastfeeding mother make it practically impossible to roll over on him. Other smoothing risks are simple to deal with and are covered below
SLEEP: TALKING WITH YOUR DOCTOR ABOUT BEDSHARING
Some parents choose not to discuss their sleeping arrangements with medical caregivers, even if asked. If you do choose to, here are some points you may find helpful.
- I really do appreciate your willingness to listen. It’s one of the reason’s we came to you.
- Although the public health campaigns suggest that all bedsharing with babies is dangerous, the research shows that the issue is complex, and not a one-size fits-all.
- Most of the research mixes up SIDS and suffocation. There are ways to make bedsharing safely comparable to a crib’s.
MY NEW BABY WAS BORN WITH SPECIAL NEEDS. CAN I STILL BREASTFEED?
First, congratulations on the birth of your new special baby. Second, congratulations on making the choice to breast feed your new baby. How wonderful that you want to give your baby the gift of your milk. Babies with special needs experience special benefits from breastfeeding beyond the many advantages to typical newborns. Right now, you are probably struggling with conflicting feelings. Like most parents, you are joyful and excited to meet your new baby. At the same time, you may have feelings of disappointment, anger, helplessness, even guilt. Allow yourself time to process these feelings of grief, remember that your baby is a baby first and a baby with special needs second.
Babies born with Down syndrome, cleft lip or palate, cardiac problems, cystic fibrosis, a neurological impairment or other special needs will benefit from human milk even more than other babies. Human milk will boost your baby’s immune system, and is more easily digestible. It offers the perfect nutrition to keep your baby as healthy as possible, and be strong for any surgeries or treatments they may need. The special bond and breastfeeding hormones produced will help to keep you calmer and more in touch with your baby as well.
According to recommendations from the World Health Organization (WHO), the American Academy of Pediatrics (AAP), and the American Public Health Association (APHA), human milk is the only food that healthy, full-term babies need for about the first six months of life. The composition of human milk changes in response to a variety of cues, so that each mother provides milk that meets her own baby’s unique needs. Human milk provides immunity factors for as long as the baby nurses, and many of the health benefits of breastfeeding continue well into childhood and beyond.
Feeding complementary foods to your baby before he is ready is typically messy and inefficient as he will naturally push the food out with his tongue as long as the tongue-reflex is functioning. By waiting for him to be developmentally ready, he becomes an active participant in eating, rather than merely a passive recipient. This helps to put him in charge of how much he eats, teaching him important fullness cues. Starting solid foods before your baby is ready will not increase his sleep at night, is not necessary for larger babies, and does not initially increase calories.
It is essential to properly store your expressed (pumped) milk to maximize its nutritional, immunological and antioxidant qualities. Human milk has anti-bacterial properties that help it to stay fresh and when stored per recommendations, human milk can maintain many of its nutritional qualities making it safe for use. Over time nutrients may break down in expressed milk lowering the quality and as such, it is important to try to give your baby the freshest expressed milk to ensure its rich quality.
Prior to expressing and storing milk ALL mothers should:
- Wash their hands before expressing;
- Use containers that have been washed in hot, soapy water, rinsed and air dried
This information is based on current research and applies to mothers who have healthy, full-term babies. Babies who are preterm/ in NICU/or ill should use more conservative guidelines.
What is the best formula to use?
Because La Leche League Leaders are very interested in infant nutrition, we are often asked about infant formulas or artificial baby milks. However, our area of expertise is breastfeeding, so recommending a specific infant formula is beyond the scope of La Leche League. Please consult with your health care provider.
BREASTFEEDING DURING PREGNANCY AND TANDEM NURSING
Finding out you are pregnant does not mean you must stop breastfeeding your toddler. Many mothers choose to continue breastfeeding throughout pregnancy, while others decide to wean. If you continue breastfeeding through your pregnancy, you may find yourself breastfeeding both an infant and an older sibling. Many mothers have found this arrangement, called “tandem nursing,” is a good way of meeting the needs of both children. Your local LLL Leader can give you more information on breastfeeding while pregnant and/or tandem nursing. The resources below will help you to explore your feelings about breastfeeding both your new baby and your “old” baby, so you can decide what is best for you and your family.
No evidence exists that the use of tanning beds has any effect on human milk or breastfed babies. However some mothers have reported getting burnt nipples and breasts when using tanning beds: this is extremely painful so be sure to cover your nipples and breasts and use caution. If you are offered any vitamins or medications to enhance the tanning process you can check them with your health care provider before taking them.
You do not need to avoid using tanning lotion, or having a spray tan, when you’re breastfeeding. You do however need to take care when applying fake tan (or indeed any cosmetics) when your baby is close, and you need to ensure the fake tan is dry or has been rinsed off before having skin-to-skin contact to avoid accidentally ‘tanning’ your baby.
The active ingredient in most fake tans is DHA, and some self tanners use erythrulose. Both are non toxic: neither substance can absorb beyond the outermost layer of your skin, and so cannot contaminate your breast milk or harm your baby.
In many countries both breastfeeding and tattooing are enjoying a resurgence in popularity.You may be wondering if it safe to breastfeed your baby if you already have a tattoo. You might be thinking of getting a tattoo or having a tattoo removed and wish to continue breastfeeding without interruption.
IS IT SAFE TO GET A TATTOO WHILE BREASTFEEDING?
Tattoos are created by injecting ink into the dermal (second) layer of the skin. Tattooists use a hand-held electric machine that is fitted with solid needles coated in the ink. The needles enter the skin hundreds of times a minute to a depth of up to a few millimeters. The ink that is used in tattoos in the United States is subject to FDA regulation as cosmetics, but none are approved for injection under the skin. Tattoo inks are made from various compounds, including heavy metals such as, cadmium, cobalt and manganese. There are synthetic and vegan brands of ink available. It is generally assumed that ink molecules are too large to pass into breastmilk during the tattoo process. Once injected into the skin the ink is trapped, however it is unknown whether the ink can pass into breastmilk as it slowly breaks down in the body months to years later.
CAN I KEEP BREASTFEEDING ONCE MY BABY BEGINS TEETHING?
Of course! Teething can present some new challenges but breastmilk continues to be the best food for your baby. Sometimes when the teeth are moving under the gums and as they pop through the gums, your baby may be uncomfortable and unhappy. Nursing can come to the rescue and help sooth in those fussy times. The American Academy of Pediatrics (AAP) encourages breastfeeding for at least a year and as long as mother and baby choose to continue. The World Health Organization (WHO) recommends breastfeeding for at least two years. These organizations know that extended nursing provides many benefits for baby and mother and that, with the right approach and techniques, teething can be managed in a way that is mutually acceptable to both mother and baby.
It is important to remember that when the baby is breastfeeding, his tongue extends beyond the bottom gum to draw in the nipple. This helps cushion the nipple from the edges of the new baby teeth. The baby’s lips are flanged (folded out) over the areola and the baby’s gums are compressing on the areola (the dark skin around the nipple), far behind the nipple itself.
Often the greater discomfort for baby is when the teeth are moving under the gums preparing to erupt. The pressure on the gums can be very uncomfortable and clamping down on something firm can feel good.
Breastfeeding and Thyroidism
The thyroid is a gland found in the front of your neck. It secretes hormones that play an important part in lactation by regulating prolactin and oxytocin.
Thyroid disorders impact a woman’s health in a variety of ways. When the thyroid is not functioning correctly, it can impact milk production. There is also connection between thyroid disorders and autoimmune problems. The immune system is suppressed during pregnancy to protect your baby. This is a good thing. You don’t want your body reacting to your growing baby as a foreign invader! Problems with the thyroid can begin before or during pregnancy, in the postpartum period, or later in life. They can also occur along with other medical conditions, which can make diagnosis and treatment more challenging.
IS THRUSH CAUSING MY SORE NIPPLES?
Persistent nipple pain in the early weeks of breastfeeding, or nipple pain that appears after several weeks or months of pain-free nursing, may be caused by thrush, which is a yeast infection of the nipples. Thrush is caused by a yeast fungus, usually Candida albicans. Additional symptoms can include:
- Itchy or burning nipples that appear pink or red, shiny, flaky, and/or have a rash with tiny blisters
- Cracked nipples
- Shooting pains in the breast during or after feedings
- Intense nipple or breast pain that is not improved with better latch-on and positioning
- Deep breast pain
You may be at higher risk for developing thrush if you or your baby has had a recent course of antibiotics, your nipples are cracked or damaged, or you are taking oral contraceptives or steroids (such as for asthma).
- Put baby to the breast to nurse as soon as possible.
- Hold baby skin-to-skin
- Avoid pacifiers
- Correct positioning and latch on are very important for preventing sore nipples.
- Break suction before taking baby off the breast.
- Offer the least sore breast first.
- Use only plain water for washing.
- Gently apply your own milk, ultra pure modified lanolin, or hydrogel pads to speed healing.
- Check with a La Leche League Leader for help.
Smoking and Breastfeeding
There are plenty of reasons to quit smoking, both for you and your baby. You’ve probably heard about lots of them from health care providers, friends, family members, or other sources. But even if you can’t quit smoking, breastfeeding your baby is still the best choice you can make.
Infants of smokers are at increased risk of colic, respiratory infections, and SIDS (Sudden Infant Death Syndrome). But breastfed infants are at lower risk for these diseases compared to artificially fed infants, even when their mothers continue to smoke. And breastfeeding helps to protect babies from the potential risks of environmental smoke.
Breastfeeding your toddler
Toddlers breastfeed for many of the same reasons babies breastfeed: for nutrition, comfort, security, for a way to calm down and for reassurance. Mothers breastfeed their toddlers for many of the same reasons they breastfeed their babies: they recognize their children’s needs, they enjoy the closeness, they want to offer comfort, and they understand the health benefits.
WHAT are TONGUE and LIP TIEs?
Tongue-tie or ankyloglossia is the condition where the lingual frenulum, the band of tissue that attaches the tongue to the floor of the mouth, restricts tongue movement. In tongue-tied infants, the “freedom” of the tongue to move is related to how tight or loose the frenulum is; or, how well the tongue is able to extend and elevate. Many tongue tied infants have difficulties initiating and maintaining a latch. Infants who are unable to latch properly have difficulty effectively transferring milk and therefore may struggle with weight gain. Mothers can experience nipple pain and, due to ineffective suckling, insufficient milk supply.
SUPPORT FOR TRANSGENDER & NON-BINARY PARENTS
La Leche League is an international, nonprofit, nonsectarian organisation.1
LLL supports everyone who wants to breastfeed or chestfeed in reaching their goals.
We at La Leche League International have all nursed our babies. If you want to do the same, whoever you are, whatever your story is, we’re here to help. LLLI is committed to serving everyone inclusive of race, ethnicity, religion, sex, national origin, ancestry, age, marital status, physical or mental ability, socio-economic status, political views, gender identity, sexual orientation, family structure, or other protected status.
Trans men, trans women, and non-binary individuals may choose to breastfeed or chestfeed their babies. You do not need to have given birth to breastfeed or chestfeed, as we can also see in the experiences of those nursing adopted babies.
Please note that some of the links in this post will take you to articles or websites where you may notice gendered language.
HOW DO I TRAVEL WITH MY BABY?
Traveling with a baby can be difficult! In many cases, babies travel well. Bringing your baby with you to a special event can be exciting… or nerve-racking!
There are a few things many families have found work when traveling with babies. As always, take what feels right for your family and leave the rest.
FOR A ROAD TRIP:
The car seat – do some research to make sure the car seat you buy for your baby suits your needs. Do you need a car seat that has a base and detachable bucket or would you prefer to have an all-in-one non-detachable seat that will serve as your baby’s seat for several developmental stages? Whichever one you choose, look for one you feel confident installing, removing, and moving around. It is also helpful to be very well acquainted with how the car seat buckles and tightens. Many families find it beneficial to practice how to get their babies into and out of their car seats from the front passenger seats and a seat on the side of the car seat. It can be difficult to take your little one out of the car seat and carry them to you in your seat – especially if it is cold or rainy outside. Practice which seat in your vehicle you are able to nurse in the best and learn how to get your baby out of and back into their car seat from your nursing seat safely. Having an additional adult on hand can help boost your confidence – and help ensure baby’s safety – while you practice.
Many parents have questions about the compatibility of vaccines and breastfeeding. Your healthcare provider can address any questions that come up for you.
VACCINES AND FOR THE BREASTFEEDING PARENT
For parents who may need vaccines during the course of the breastfeeding relationship, questions about which vaccines can be administered while maintaining breastfeeding can arise. According to the American Academy of Pediatrics, “With rare exceptions, maternal immunization does not create any problems for breastfeeding infants[…] “
Organizations such as The Infant Risk Center at Texas Tech University Heath Sciences Center, MotherToBaby, a service of the Organization of Teratology Information Specialists, and The Breastfeeding Network in the United Kingdom can provide information about specific substances and breastfeeding to share with your healthcare provider.
Vitamin D, Your Baby, and You
It is a known fact that human milk is the superior infant food. Human milk is the most complete nutritionally, immunologically, and is the only food designed specifically for your baby. Given that it is expected to be “perfect,” you may be confused about why your baby’s doctor is encouraging you to give your breastfed baby vitamin D supplements.
VITAMINS AND OTHER NUTRITIONAL SUPPLEMENTS FOR BABY
Advertisements, family members and even health professionals often urge mothers to add “something” to baby’s perfect diet of mother’s milk. According to the our comprehensive guidebook, THE WOMANLY ART OF BREASTFEEDING, if a breastfeeding mother is getting an adequate supply of vitamins in her diet, her milk will contain adequate nutrients in the perfect balance for her baby. If your baby is healthy and doing well, there is no need for vitamins, iron, or other supplements in the early months (apart from vitamin D). Furthermore, many mothers have found that vitamin or fluoride supplements may cause fussiness or colic in their infants. By treating each mother and baby as a unique pair, unnecessary supplementation can often be avoided.
Exclusively breastfed babies do not need water supplements – your body makes the perfect milk for your baby, actually changing the composition as he needs more or less water.
Giving water to newborn babies can contribute to jaundice and slow weight gain: water may fill a baby’s tummy and so reduce the amount of colostrum or breastmilk they get. Water supplements may also stop you establishing your milk supply as your baby will ask to breastfeed less.
Even in very hot weather your baby doesn’t need additional water, as long as you respond to his cues to feed he will get all the fluids he needs in your milk. This article from LLL Canada gives more information about breastfeeding and hot weather.
Weaning For Medical Reasons
If your doctor decides you need to take a drug (medicine) for a medical condition, make sure that they know how important it is for you to continue breastfeeding and check to see if a breastfeeding compatible drug can be used. You may not need to wean permanently, or at all. Do your own research, or get a second opinion from another doctor/hospital, if necessary.
Depending on the age of your breastfeeding child, and the frequency with which they breastfeed, certain drugs may have little or no effect on him.
HOW DO I WEAN MY BABY?
Are you feeling ready to wean completely? Sometimes just cutting back on the amount of times you breastfeed will make you feel better, breastfeeding can sometimes be overwhelming. Breastfeeding is a two-way street. If you resent it when you sit down to breastfeed, your child will pick up on this. If your baby is under a year (or older, sometimes), you will have to substitute a bottle feeding for a missed breastfeeding. An older baby may accept a drink from a cup, a nutritious snack, or just a distraction in the form of a game, a toy, or change of scene. Remember, the first supplemental feed, from a bottle, or of solid food, is the beginning of weaning. Weaning does not need to be all or nothing.
If weaning is your decision, it’s best for you and your baby to do it gradually, and with love. If you wean “cold turkey,” your breasts will likely become painfully engorged, and you might develop a breast infection. Your baby will probably fight the switch from your warm, soft breast to a plastic substitute. He might mourn the loss of “his” breasts.
WOULD WEANING MAKE MY LIFE EASIER?
Are you thinking about weaning? Your child may be a few weeks or months old, or may be a breastfeeding toddler. Some mothers decide to continue breastfeeding until the baby outgrows the need. This is called natural weaning or child-led weaning. In modern Western society, this is rather unusual. At a typical LLL meeting, you may find many mothers practice extended or natural weaning. You can review the Toddler Nursing article if this seems right to you.
I WANT TO WEAN
Are you still in the early weeks, and experiencing difficulties with breastfeeding?
Maybe you’d like to breastfeed longer, but feel overwhelmed or are experiencing discomfort?
We are here to help, don’t hesitate to call your local La Leche League Leader if you are having problems! They can help you with any difficulties you may experience. Sometimes just talking to an experienced parent who has “been there,” who understands what you’re going through, can be so helpful. All LLL Leaders have breasted at least one baby, for at least one year.
Were you planning on continuing breastfeeding, but your baby has other ideas? Do you worry baby is trying to wean?
First, make sure it isn’t just a nursing strike.
Common Reasons for an Early Weaning
- Bottles, pacifiers or increased solids. Try cutting down on any of these activities. If your baby is getting bottles at daycare while you are at work, and is over six months old (approximately), it’s probably time to go to the cup for the child’s feeds while away from you. With dummies, reduce use to your baby won’t be meeting his sucking needs, and will be more eager to nurse, when you are together. If you started solids early (before six months), you can always cut back on the size of these meals, gradually, of course. If baby is under 12 months of age, make sure you are offering breast before solids. Your milk supply will build back up, as the baby spends more time at the breast. Remember, your milk is by far the most nutritious food for your baby, for the first year, not to mention the immunological benefits.
HOW CAN I LOSE WEIGHT SAFELY WHILE BREASTFEEDING?
You are not alone in wondering about losing weight. Many women are anxious to return to their pre-pregnancy shape and weight after childbirth. Do try to remember that your pregnancy weight wasn’t gained overnight so it won’t disappear that quickly, either.
While breastfeeding burns about 500-700 calories extra per day to fuel milk making, this may not always contribute to weight loss postpartum – many factors like pre-pregnancy weight, diet, physical activity level, etc will impact weight loss after birth (Institute of Medicine, 2002; Dewey, 1994). On average, exclusively breastfeeding mothers may see a loss of 1-2 pounds a month and over time, breastfeeding moms tend to lose more weight than mothers who do not breastfeed.
WHEN CAN I START LOSING WEIGHT?
It is recommended that you wait at least 6-8 weeks postpartum to start to lose weight, as your body needs this time to recover from childbirth and establish a good milk supply. Many mothers lose weight in the early months by following a well-balanced diet and eating to hunger.
You may choose to continue breastfeeding while working outside the home for many reasons – the best food for your baby, antibodies to protect your baby, great way to reconnect when you return from work, and continuing the special relationship of breastfeeding during your days at home.
- Consider all options for returning to work, including taking the longest maternity leave possible if it is available to you.
- Can you work at part of the time from home?
- It is possible to job share with another employee?
- Is it possible to go part-time? Some mothers find that when they factor in the costs of child care, they can reduce their work hours or delay returning to work for a year or more.
- Can you come back gradually? Some mothers start back just two or three days a week and gradually work up to a full work week.
- Consider flexibility at work.
- Can you leave if your baby needs you during the workday?
- Can your baby be brought to you?
Going back to work and leaving your baby in someone else’s care can be one of the most difficult parts of returning to work. Choosing the right person and right setting takes care. You want to find a setting that will provide the kind of care and attention you would give. You want a setting that respects breastfeeding and your expressed breastmilk. This may take some homework on your part. Visits to the locations you are considering will be important. Here are some things to consider:
IN HOME CARE WITH A FAMILY MEMBER, CLOSE FRIEND, OR NANNY
- This allows your baby to stay in your home, where all is familiar.
- It works best with someone the baby already knows or who is willing to come to your home several times before your return date.