Breastfeeding
Breastfeeding Advice
- Frequency of Feedings to bring in the milk supply
- Every 1 to 2 hours for the first month (8 or more times/day)
- During the day, wake her up if more than 3 hours have passed since the last feeding
- During the night, wake your baby if more than 4 hours pass without a feeding. After 1 month of age, allow your baby to sleep longer at night
- Length of Feedings to bring in the milk supply
- Offer both breasts with each feeding
- 10 minutes on first breast and up to 15 minutes on second breast if your baby is actively suckling
- Alternate which breast you start on
- Needing to stimulate your baby to take the second breast is normal
- Length of Feedings after milk supply is in (by day 8 at the latest)
- Allow your baby to nurse as long as she wants to on the first breast (up to 20 minutes). (Reason: to get the high-fat, calorie-rich hind milk)
- You can tell your baby has finished the first breast when the sucking slows down and your breast becomes soft. Then offer the 2nd breast if she’s interested.
- Alternate breasts at the start of each feeding.
- Signs of Adequate Milk Supply (ie your baby is receiving enough breast milk)
- 3 or more good-sized, yellow-colored, seedy BMs(bowel movements)/day (EXCEPTION: May not be present while the milk is coming in until day 5 of life) (Caution: infrequent BMs are not normal in breastfed babies until age 6 to 8 weeks)
- 6 or more wet diapers/day. (EXCEPTION: 2 wet diapers/day can be normal while milk is coming in – until day 4 of life) (NOTE: if uncertain about diaper being wet, place tissue in diaper)
- Satisfied (not hungry) after feedings
- Breasts feel full before feedings and soft after feedings. Appropriate let-down reflex
- How to Increase Milk Supply:
- Adequate sleep (extra naps), reduced stress (ask for help), relaxed environment, adequate fluids (1 quart of milk and 1 quart of water per day)(Minimum: One 8 oz. glass of fluid every 4 hours while awake)
- Increase the frequency of nursing and minimize the use of the pacifier
- Pump the breasts for 10 minutes after each feeding (see lactation consultant)
- Supplemental Formula:
- Never routinely supplement with formula before 4 to 6 weeks old (Reason: it will interfere with establishing a good milk supply).
- EXCEPTION: Medical indications include the following:
- The milk is not in (day 2 and 3) AND your baby is very hungry (especially preterms), inadequate number of wet or soiled diapers or the baby is quite jaundiced. (Reason: prevent dehydration)
- Method: give 1 oz. of formula after every other breastfeeding for 1 or 2 days.
- Also see your doctor within 24 hours for a weight check.
- After nursing is well established, give a bottle of pumped breast milk or 2 oz. water once daily. (Reason: so your baby will accept bottle feedings if need to leave with a sitter)
- Until the milk comes in (day 3 or 4), a few need supplemental formula, but not water
- Extra Water:
- Never needed. (Reason: breast milk contains 88% free water)
- Engorgement (swelling and pain) of the breast (most common 48-72 hours after birth)
- Nurse your baby more frequently (avoid the use of pacifiers)
- Express a little milk before nursing your baby
- Compress the areola with your fingers or use a manual pump at the start of each feeding to soften the nipple area. (Reason: for milk release, your baby must be able to latch on to the areola)
- Pump your breasts, whenever they hurt, whenever you must miss a feeding or whenever a feeding doesn’t relieve the pain.
- Localized Engorgement: For localized hard areas or swelling or tenderness due to blocked milk ducts, apply moist heat or take a hot shower and massage the affected area toward the nipple
- Call your doctor if not improved after 24 hours of treatment
- Sore or Cracked Nipples (usually due to friction from improper latching on or areolar grasp).
- Clean with warm water after each feeding (avoid soap which dries out the skin)
- Then coat and lubricate nipple and areola with breast milk for sore nipples
- For cracked nipples, apply 100% lanolin (no prescription) after feedings
- Help your baby latch on to as much of the areola as possible by compressing areola
- Prevent the breast from pulling out of your baby’s mouth by supporting it from below
- Start feedings on the side that is least sore
- Limit feedings to < 10 minutes on the sore side
- Don’t pull your baby off the nipple until she has released her grip. You can break the seal by placing your finger in baby’s mouth between the gums
- Call back if: not improved after 24 hours of treatment
- Mother’s Medicines (it?s best to take your drug at the end of a feeding)
- Most commonly used drugs are safe: e.g. acetaminophen, ibuprofen, penicillins, erythromycin, cephalosporins, stool softeners, antihistamines, cough drops, nose drops, eyedrops, and skin creams. Aspirin and sulfa drugs are safe after 2 weeks old. For all other drugs, call your doctor
- Sick Infants. Do not discontinue breastfeeding for vomiting, spitting up, diarrhea, cough, jaundice, etc. See the appropriate guideline for that symptom. Continue breastfeeding whenever possible
- The Mother is Sick (has an acute illness)
- Continue breastfeeding, even if you have a fever. (Reason: Breast milk carries your antibodies which can protect your baby from the full-blown infection)
- Try to prevent the spread of infection by good hand rinsing, especially after blowing your nose (for colds) or after BMs (for diarrhea).
- Contraindications to breastfeeding are rare: AIDS, Herpes simplex rash (fever blisters) on the nipple/areola, substance abuse and tuberculosis. Talk with your doctor
- Breastfed Stools, Normal
- Breastfed babies pass from 4 stools per day to 1 after each feeding during the first 2 months. The stools are runny, mustard-colored and contain seedy particles
- Normal breastfed stools can even become green or have a water ring around them during the first month
- At 4-8 weeks of age, most breastfed babies change to infrequent BMs. They pass 1 soft BM every 1 to 7 days (Reason: complete absorption)
- Breastfed stools have changed to true diarrhea if:
- They contain blood or mucus
- Develop a bad odor or abruptly increase in number
- Your baby feeds poorly, acts sick, or develops a fever