Breastfeeding Questions and Answers

Breastfeeding must begin after childbirth. Your body will not continue to make milk if your baby is not nursing or if you are not pumping. Nursing immediately after delivery when your baby is wide awake is the best way to begin. It is also a quiet and special time for you. Be sure to tell your nurse and partner that you want to begin nursing your baby as soon after the birth as possible. Your baby will want and need close skin-to-skin contact for warmth and comfort. A full-term newborn has a sucking reflex that will enable her or him to feed right away.

Each baby’s suck/swallow pattern is unique. Initially, when beginning breastfeeding right after birth, your baby may take quick, brief sucks until colostrum is tasted. Following that, the suck/swallow pattern is more rhythmic. When you first begin a feeding you want to see about six to ten rhythmic sucks to each swallow followed by a pause. You will feel a gentle pull on the breast with each suck if you have positioned the baby correctly. Multiple sucks encourage your milk to let down. Once the milk is flowing, your baby will swallow more frequently with fewer pauses.

The following are signals from your baby that will alert you that he or she is hungry:

• Open eyes
• Baby starts to wake (eyes flutter and hands move)
• Baby starts to squirm or move
• Sucking movements of the baby’s mouth
• Attempts to suck on fingers or fist
• Rooting (turning toward anything the baby’s face comes in contact with)
• Tongue thrusting

A baby does not have to cry to show readiness for feeding. Crying is a late hunger sign. It is much easier to nurse a baby who is calm and just beginning to show hunger than a baby who has been waiting so long for food that she or he is upset and crying. Just like you, your baby learns best when not distracted by discomfort or frustration.

Newborns typically lose from five to seven percent of their birth weight during the first few days after birth. Breast milk contains 20 calories per ounce, and it has the perfect balance of fat and protein needed for your baby to gain weight. Your baby will regain his or her initial weight loss in one to two weeks if you are feeding 10 to 12 times every 24-hour period. Also, keep track of wet and soiled diapers. These provide a good indicator of how much your baby has eaten. In the first one to two days after birth, your baby may have only one to two wet diapers and one bowel movement per day. By the time your baby is four days old, you should notice:

• Audible swallowing while breastfeeding.
• A sense of fullness in your breast before feeding.
• A "let down" milk release that may feel like a tightening or tingle in the breast. This may happen only in one breast.
• Your breast will be softer after a feeding than before you started.
• Milk may leak from one breast while the baby is feeding from the other.

By the time your baby is four days old, she/he should have:

• At least six to eight wet diapers every 24 hours.
• Light yellow urine (not dark, tea-colored urine). If you use disposable diapers and are unsure if the diaper is wet, place a tissue in the diaper.
• 10 to 12 feedings in 24 hours.
• Contentment after feeding.
• At least one or two soft, yellow, seedy stools every 24 hours. The stools may not be completely yellow, but you should notice a change from dark meconium to lighter milk stools. The baby may stool with most feedings. Call your pediatrician or family physician if your four days or older infant has less than six wet diapers in 24 hours.

You can try burping your baby when he/she slows down during a feeding. Hold your baby upright against your chest with her/his head at your shoulder and give the baby gentle pats or circular rubs on the back.

Alternatively, you can hold your baby in sitting position on your lap for a burp, with one hand patting and the other supporting the belly and jaw. Babies may not burp after every feeding.

It is difficult to nurse modestly at first when you and your baby are still beginners. Within a couple of weeks, you will be able to get into position and get a good latch-on quickly and easily. When you are comfortable doing this at home, try practicing discreet nursing in front of a full-length mirror. Sit down comfortably, lift or unlatch your bra with your shirt still covering you, and get your baby in position. Next lift your shirt, or unbutton your shirt from the bottom, or move your breast through the opening of your nursing shirt. Then quickly latch your baby on and bring the edge of your shirt back down toward the baby’s cheek. Check the mirror to see if you are covered enough for your comfort. You can also practice in front of a friend or partner.

Once settled, the passing stranger will probably think you are just holding a sleeping baby. If you are out in public and would like more privacy than a bench affords, you can use a dressing room at a store, a restaurant table facing a wall, or a special nursing room that some facilities provide. Don’t feel that you need to go to a restroom to nurse. You wouldn’t eat in a restroom, and your baby shouldn’t have to either.

Frequent breastfeeding does not spoil babies. Babies who are breastfed on demand have healthy growth patterns and form healthy attachments. Feeding on demand helps babies grow properly and it teaches babies their first lesson about relationships: they can safely rely on their mothers to take care of their needs for food and comfort.

It is common and normal for newborns to sleep a lot. However, babies need to breastfeed often and for a long enough period of time. Encourage your baby to nurse every one to three hours during the day. Once your baby is nursing well, has regained birth weight and has helped you establish a good milk supply, you can allow the baby to sleep for longer stretches at night. There are various techniques to wake a sleepy baby and keep her or him interested in nursing.

Talking softly to the baby, loosening or removing blankets or holding the baby in a standing position will help awaken him or her. Other ways to help the baby awaken include changing the baby’s diaper, gently rubbing the baby’s feet or hands or giving the baby a bath.

If your baby starts to fall asleep while nursing, try burping the baby between sides, gently massage the baby’s limbs or switch breasts. You can also try compressing your breast gently and releasing. Breast compression and release can increase the milk flow, which encourages the baby to continue sucking.

Yes, you can. However, we recommend you be evaluated by a lactation consultant.

Yes, you can. Many mothers fully breastfeed twins and triplets (multiples). Multiples can be born early and often are small. These factors can make early breastfeeding more challenging. Learn as much as you can about breastfeeding before your babies are born. Plan for extra help around the house. A home visit from a professional lactation consultant can help you learn comfortable nursing positions and how to tell if your babies are feeding and growing well.

Yes, breast milk is the perfect food for babies no matter what the color. Normal breast milk can be bluish, skim-milk-like, yellowish, or have other tints, depending on the foods and vitamins you eat. Colostrum, the "first milk", often has a yellow color.

It is best to wait until the baby is three to six weeks old before introducing the bottle. This allows enough time for breastfeeding to be established. You can hand-express or pump milk for your baby, and then ask a partner or friend to offer the bottle to the baby while you are away. You may have to try several different kinds of bottles and nipples before you find one your baby likes. Some babies eat from bottles on the first try. Others need a number of attempts before they will drink from a bottle.

It is helpful to choose a pediatrician or family doctor for your baby while you are still pregnant. You can call the doctor’s office to ask questions over the phone. Ideally, you can interview the doctor in person during a prenatal appointment. To see if the doctor is supportive of breastfeeding you can ask the following questions:

• What is your perspective on breastfeeding?
• What do you do if a mother is having difficulty breastfeeding?
• Do you have a lactation consultant in the office or do you refer to a particular lactation consultant or breastfeeding support group in the community?
• Do you recommend a feeding schedule or do you recommend feeding on demand? (Nursing on demand is best for young babies.)
• Do you suggest a specific age that is the right age to stop breastfeeding? (There is no one age that is right for all children. The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months, breastfeeding supplemented by solid foods for the next six months, then continued breastfeeding for as long as the mother and baby wish.)
• Do you have any breastfed children?

Babies do need to eat frequently through the day and night in their first few months of life. Night nursing in the early months also helps encourage a good milk supply. Eventually, babies are able to sleep for longer periods at night. Babies are often able to do this between four and six months of age, though it is normal for a baby to sleep through the night earlier or later than this age range. The medical definition of sleeping through the night for a baby is sleeping a five-hour stretch.

Babies have growth spurts and need to feed more frequently at these times. The first growth spurt usually occurs around 7 to 14 days, followed by spurts at four to six weeks, three months, and six months. These growth spurts last one to three days. During this period, increased sucking will boost your milk supply to provide for your growing baby.

During a growth spurt, your baby is asking your body to make more milk. Your body can do this best if you allow your baby to nurse as often is she/he wishes. The amount of milk in your breasts during a growth spurt is still enough to support your baby’s needs until the milk supply increases. Giving the baby formula or water during this time can interfere with your baby’s efforts to increase your milk supply. After the growth spurt, your baby’s feeding pattern will return to normal.

• Very few foods that you eat will bother your baby. Most babies have gassy and fussy times during the day no matter what their mother eats. This is also common among bottle-fed babies. Gassiness and fussiness are conditions most likely related to the development of your baby’s digestive and nervous systems.
• In rare instances, large quantities of a particular food such as a quart or more of orange juice or a large amount of a particular fruit have been associated with diarrhea and colicky symptoms in some babies.
• Some mothers report that their babies seem gassy after they have had broccoli, cabbage, or beans. Most babies are not bothered by these foods.
• If you suspect that milk or some other food is causing colicky symptoms in your infant, eliminate that food from your diet for 48 hours and see if the symptoms disappear. If the food did bother your infant, you should see an improvement within 48 hours.
• Families with a history of egg, peanut or milk allergies may choose to eliminate these foods from the mother’s diet.
• You can continue to take your prenatal tablet or multivitamin while you are breastfeeding. It is recommended that all women who could become pregnant take 0.4 mg (400 mcg) of folic acid daily to reduce the possibility of the developing baby having a neural tube defect.
• Use your weight to decide if you need to have more calories while breastfeeding. You will have a significant weight loss in the first three to four weeks after birth. You can then eat enough nutritious foods to maintain that weight or safely lose one to two pounds a week until you reach your desired weight. Losing more than two pounds a week could cause fatigue and reduce your quantity of milk production. There is a wide variation in the pattern of weight loss or gain during breastfeeding. Usually women notice a weight loss after three months of exclusive breastfeeding.
• If a mother consumes caffeine or chocolate, less than one percent will appear in her milk. It is fine to have a cup or two of coffee, a cola, tea, or small amount of chocolate while breastfeeding.
• Some foods such as garlic, onions and mint have been found to change the odor and flavor of breast milk. Researchers studying garlic in breast milk found peak levels in the milk two hours after the mother ate garlic. When the garlic levels were high, babies suckled more vigorously and took in more milk. These researchers speculate that we teach breastfeeding babies about family food preferences by exposing them to a variety of flavors in the breast milk.
• Years ago, women were encouraged to drink beer to make more milk. We now know that beer does not increase milk supply. In fact, alcohol can interfere with the letdown reflex and will be present in breast milk. Alcohol is not good for babies and should be avoided. The same researchers who studied garlic in breastfeeding mothers found that when a mother had even one drink, her infant suckled less vigorously and consumed less milk during a feeding.
• When a breastfeeding mother smokes, nicotine will be in her milk. Nicotine can decrease milk supply and cause colicky symptoms in the baby. It is important that babies not be exposed to cigarette smoke from anyone who smokes. Exposure to cigarette smoke has been associated with increased incidence of respiratory illness, ear infections, and sudden infant death syndrome (SIDS).

In summary, eat well while you are breastfeeding. Nurture yourself with good foods that you enjoy. Don’t worry about occasionally skipping a meal or having a cup of coffee or piece of chocolate. Mothers have been breastfeeding successfully for thousands of years in a variety of cultures and their babies have thrived.

This is largely an issue of preference. The American Academy of Pediatrics recommends exclusive breastfeeding (no other food or drink) for six months, continued breastfeeding for at least one year and as long after as desired by mother and baby. The World Health Organization recommends breastfeeding for at least two years and as long after as desired by mother and baby.

With the availability of double-sided electric pumps, it is now easier to accomplish this even if the mother works outside of the home. Breast milk has nutritional and immunological benefits to the baby as long as the she/he nurses. Your milk supply will continue as long as you continue nursing your baby. Babies of any age benefit from the emotional bonding that breastfeeding provides. Weaning at any age should be done gradually in order to make the transition easier on both mother and baby.

Yes. Nursing mothers can become pregnant even while their babies are nursing frequently. If you do not want to become pregnant, be sure to use reliable contraception. Avoid hormonal forms of contraception. They can inhibit milk production in the early months. If you do want to become pregnant while still nursing, your ovulation will resume after your baby is able to space out her or his feedings. This often happens at about six months when the baby has started eating some solid foods.

• Fresh breast milk can be kept at room temperature up to four hours. However, we generally recommend refrigeration as soon as possible. You may store fresh breast milk in the refrigerator for up to five to seven days. If not used during that time, it may be frozen for up to six months in a freezer. Place container in the back of the refrigerator or freezer. Do not store in the door. Breast milk can be stored in the deep freeze at 0° F for up to 12 months.
• Store in a clean glass or plastic container. Plastic disposable bottle bags work well.
• Milk stored in two to four ounce volumes is easier to thaw.
• Label the container with date of collection. Write your baby’s name on the label if it is stored in the nursery or if you will be taking it to daycare.
• Thaw your frozen breast milk in warm water. Never use a microwave oven or boiling water to thaw. Extreme heat can kill the milk’s immune cells and could cause burns in your baby’s mouth. Once thawed, breast milk is good for up to 48 hours in the refrigerator. Do not refreeze.
• Appearance of your mature breast milk is similar to skim milk but may greatly vary in color from yellow to blue. Milk fat does separate after thawing. Shake gently to remix.
• Discard previously frozen breast milk left over in the bottle after feeding or if left at room temperature over two hours.
• If your baby is in the Special Care Nursery, you you may be given other directions about milk collection and storage.
• Call your baby’s physician with questions or concerns.

Yes. There are instances when a woman physically cannot breastfeed such as hormonal and glandular deficiencies or other medical reasons. There are a few infectious diseases that can be transmitted through human milk to a baby, including HIV and untreated tuberculosis. Mothers with HIV are advised not to breastfeed. Similarly, mothers with tuberculosis should not breastfeed until appropriate treatment has been started.

Mothers with hepatitis B can breastfeed their infants if the infant receives the hepatitis B vaccine in the first few days after birth. There is no evidence that hepatitis C is transmitted by breastfeeding. Mothers with chronic hepatitis C are often advised that they can nurse their infants, but they should discuss this with their physician. Other types of infections need to be evaluated by the obstetrician and pediatrician, but nearly all will be found to be safe for breastfeeding.

Infants diagnosed with galactosemia, a rare genetic metabolic disorder in which the body cannot digest the sugar galactose, should not be breastfed.

Talk with your physician or midwife if you are wondering if a medical condition or a medication you are taking would affect your breastfed baby.