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Chapter 1 Chapter 4
The Value of Breastfeeding . . . . . . . . . . . . . . . . 1 Fitting Breastfeeding into Your Lifestyle . . . . . 23
For the Baby: Breastfeeding and Breast Milk . . . . 1 Breastfeeding in Public . . . . . . . . . . . . . . . . . . . . . 23
For the Mother: Breastfeeding. . . . . . . . . . . . . . . . 1 Leaking Breasts. . . . . . . . . . . . . . . . . . . . . . . . . . . 23
For Fathers, Mothers, and Families: Diet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
For the Environment . . . . . . . . . . . . . . . . . . . . . . . . 2 Returning to Work or School . . . . . . . . . . . . . . . . 24
A Perfect Match . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Breastfeeding for the First Year and Beyond . . . 24
Weaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Chapter 2 Birth Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Getting Breastfeeding Started. . . . . . . . . . . . . . 3
Getting to Know Your Baby . . . . . . . . . . . . . . . . . . 3 Chapter 5
Breastfeed Early. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Frequently Asked Questions . . . . . . . . . . . . . . 27
Breastfeed Often. . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Breastfeed Well . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Chapter 6
Your Breastfed Baby at Home . . . . . . . . . . . . . . . . 5 Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Breastfeeding Holds . . . . . . . . . . . . . . . . . . . . . . . . 6 Kaiser Permanente Breastfeeding Clinics and
Latch. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Lactation Consultants . . . . . . . . . . . . . . . . . . . . 31
Milk Supply. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Kaiser Permanente Health Education
How to Tell Baby Is Getting Enough to Eat. . . . . . 9 Departments. . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Feeding Patterns for Breastfed Babies. . . . . . . . 12 La Leche League . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Breast Pumps and Supplies . . . . . . . . . . . . . . . . . 31
Chapter 3 Lactation Web Sites . . . . . . . . . . . . . . . . . . . . . . . 31
Breastfeeding Challenges. . . . . . . . . . . . . . . . 15 WIC (Women, Infants and Children). . . . . . . . . . . 32
Breast Engorgement . . . . . . . . . . . . . . . . . . . . . . . 15 Recommended Reading . . . . . . . . . . . . . . . . . . . . 32
When Breastfeeding Hurts . . . . . . . . . . . . . . . . . . 15
Breast Pumps and Pumping . . . . . . . . . . . . . . . . . 18 Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Introducing a Bottle to Your Breastfed Baby. . . . 21

on the birth of your baby and your decision to breastfeed. Breast milk is considered
the gold standard for all newborns. By breastfeeding you will be giving your baby the
very best nutrition possible.

CHAPTER 1 The Value of Breastfeeding

Breastfeeding can benefit the baby, the mother, the obesity in infancy and childhood,
father, families, and the environment in many ways. diabetes and high blood pressure,
high cholesterol later in life,
For the Baby: Breastfeeding and colitis and Crohns disease,
Breast Milk bacterial meningitis,
Promotes bonding and attachment leukemia and other childhood cancers,
Presents food that is always ready to feed at the multiple sclerosis and juvenile rheumatoid
right temperature arthritis, and
Provides antibodies to strengthen the immune SIDS (Sudden Infant Death Syndrome).
Provides good cholesterol and other types of
fat in human milk that support the growth of While breastfeeding may not seem the
nerve tissue and brain growth right choice for every parent, it is the
Promotes visual acuity best choice for every baby.
Promotes healthy jaw and tooth development Amy Spangler, from cover of video,Through Their
and reduces the risk of cavities Eyes: Breastfeeding, the Gift for Life, 1997

Supports your childs intelligence. (A clinical

study shows infants who were breastfed for the
first 6 months of life test 11 IQ points higher For the Mother: Breastfeeding
than formula-fed babies.) Promotes bonding and attachment, calmness,
self-esteem, and confidence in mothering

 reastfeeding reduces the risk of infections and

B Produces the naturally soothing hormones
oxytocin and prolactin (the hormones of
promotes healthy bacteria in the digestive system,
motherly love)
which can result in:
Helps your body recover from pregnancy, labor,
Fewer colds and ear infections
and birth
Fewer urinary tract infections
Helps your uterus contract after birth, lessening
Fewer visits to the babys physician and less the chance of hemorrhage and anemia
chance of needing hospitalization
Lowers the risk of breast cancer. The longer you
A reduction in the possibility for constipation or breastfeed, the lower the risk.
diarrhea (less Crohns disease later in life).
Lowers your chance of ovarian cancer
May protect you against osteoporosis in later
Breastfeeding reduces the risk for: life
asthma and allergies, May help you lose weight, by burning calories
eczema, to make milk (about 500 calories a day).

For Fathers, Mothers, and Families: TABLE 1

Breastfeeding How Does Formula Compare to Breast Milk?

Makes for healthier mother and baby, resulting breast milk formula
in up to six times less absenteeism at work water
4 4
Produces less offensive-smelling diapers 4 4 protein
Produces free breast milk. Artificial baby milk/ 4 4 carbohydrates
formula is expensive ($1,500$4,000 for 1 year).
4 4 vitamins
4 4 minerals
For the Environment 4 4 fats
Artificial feeding involves 4 4 lipids
overgrazing of land by cattle; 4 enzymes
use of chemical fertilizers to grow the soy; 4 growth factors
use of valuable environmental resources for 4 hormones
formula production; 4 antiviral
packaging and transportation of the product; 4 antiparasitic
use of water and fuel for mixing the product, 4 antibacterial
heating it, and for cleaning bottles and nipples; 4 anti-allergenic
waste disposal of cans, bottles, accessories,
cartons, etc. There are some similarities between formula and
breast milk . . . but where formula ends, breast milk
is still providing!
A Perfect Match
Your breast milk is a perfect match for your breast-
fed baby. It changes as your baby grows. The milk a Cost of Infant Feeding for 1 Year (Estimated)*
mother produces for her preterm baby is different Breastfeeding $300.00
from what she produces when her baby is full term.
The milk produced during the babys first days is
Powdered $2,135.00
different from the milk that is produced two weeks
later. As the babys needs change, so does the milk. Concentrate (11.5-oz. cans) $2,562.00
Breast milk is the perfect food for your breastfed Ready to feed (32-oz. cans) $3,190.00
baby at all ages and stages.

*Enfamil purchased at Southern California stores in 2007.

The American Academy of Pediatrics recognizes
that breastfeeding is important for optimal infant
and child health and development.Breastfeed-
ing has advantages for infants, mothers, families,
and society. These advantages include health, Babies thrive on
nutritional, immunologic, developmental, psy- exclusive breastfeeding.
chologic, social, economic, and environmental
From American Academy of Pediatrics (AAP) Web site
(, March 2009

CHAPTER 2 Getting Breastfeeding Started

Getting to Know Your Baby Note: If the mother cannot hold her baby skin-to-
skin during the first hour after birth, it is helpful for
Attachment and Bonding at Birth
the father (or other significant member of the babys
Skin-to-skin care, which is holding the baby dressed life) to hold the baby skin-to-skin. This will help the
only in a diaper on the mothers (or fathers) bare babys body temperature regulate faster, help stabi-
chest shortly after birth, benefits the newborn by lize the babys blood sugar, and get the process of
reducing the stress related to labor and birth. Babies bonding started between baby and father.
held skin-to-skin cry less, breastfeed better, and
create stronger attachments with parents. After your
baby is born, your childbirth team will place your
baby on your chest and will give you time alone to A newborn baby has only three demands.
get to know each other. This is a special time for They are warmth in the arms of its mother, food from
bonding and attachment. You may wish to quickly her breast, and security in the knowledge of her
introduce your baby to friends and family. After that, presence. Breastfeeding satisfies all three.
they will be asked to allow you time alone with your
Grantly Dick-Read (18901959)
baby for this special time shortly after birth. Expert on natural childbirth movement.

Breastfeed Early
Breastfeeding ideally begins during the first one or
two hours after birth. Babies held skin-to-skin will
often move themselves toward the breast and latch,
many times with little or no assistance. When babies
are allowed to breastfeed early, they tend to breast-
feed better. Breastfeeding early and often helps
mother to make more milk, sooner.

Colostrumnewborn milk
At the first feedings, your baby may breastfeed
actively or your baby may prefer just to lick your
nipple and nuzzle your breast. Both are normal and
perfectly okay. The milk your baby gets from these
early feedings is called colostrum and is very im-
portant for the babys immune system. Colostrum is
the first milk for the baby; it is a rich, thick, yellowish
Another benefit of skin-to-skin contact is that within
milk. Your baby only needs small amounts of colos-
about one hour after birth, most babies will begin
trum at this time. If baby doesnt latch on right away,
searching for the breast without any help. Given the
ask your nurse to show you how to hand express
opportunity to explore the mothers chest, they will
drops that you can put on the babys tongue. Your
move to the breast and often will latch on to the
baby will enjoy the sweet taste of your first milk. See
breast perfectly on their own.
pages 19 and 28 for more information on colostrum.

Breastfeed Often Most babies should have at least 8 feedings in 24
hours, but as many as 1214 feedings is common
Newborn babies feed very frequently. Sometimes
during the early weeks.
they like to eat every hour, other times they will
sleep for 3 hours. For the first few days, some babies
are sleepy and need to be encouraged to wake up to
feed. After the first few days, most babies will begin
to wake on their own for feedings when they are Breastfeed Well
hungry. After the milk supply is established, many When a baby is breastfeeding well, you will notice
babies may begin to stretch out their feedings a bit. long sucks with frequent swallows. By day 3, you
should notice a lot of swallowing at the beginning of
the feeding with swallows decreasing in frequency
Frequent feeding is good for your baby and good
as the feeding progresses. Allow your baby to feed
for your milk supply. Frequent breastfeeding:
for as long as he or she wants. If your baby is actively
Establishes and increases milk supply. sucking and you are hearing swallowing, allow the
Eases the transition from colostrum feedings to baby to finish. This may take 10 to 30 minutes, de-
mature milk, preventing or reducing engorge- pending on the feeding and the baby.
Prevents too much infant weight loss during the When your baby finishes the first breast, place your
first days after birth. Some weight loss is normal baby on your chest and give the baby a chance to
for all babies. burp. When the baby is ready, he or she will begin to
Reduces the incidence of jaundice in the new- search for the breast again. During the early days, it
born caused from inadequate milk intake. is a good idea to encourage your baby to feed from
both breasts. When babies get a little older, some
babies are satisfied after feeding on one breast,
Hunger Cues while other babies like both breasts, and even both
Watch your baby for signs of hunger instead of breasts twice. Let your baby breastfeed until content
watching the clock. Remember, crying is a late sign and satisfied.
of hunger.
Early signs of hunger, or feeding, cues are: Nursing is a meditative activity. No matter how
licking or smacking their lips; rushed or busy you are, try to slow down, spend
time with your baby and enjoy special time feeding
opening and closing their mouth;
your baby. Be still, relax, and recuperate. Your body
sucking on their tongues, hands, blankets, your knows this. That is why you feel so relaxed while you
neck; are breastfeeding. Your glands release special hor-
searching with their mouth for something to mones that help you rest and relax during feedings.
suck on; and
putting their fingers or hands in their mouth.
Some of my best ideas come to me
Think of your babys feeding cues this way: while Im nursing my baby.
Opening and closing mouth, licking lips. Baby is Joyce Willaford
saying, mmmmm, a little milk right now would
be nice.
At first, some women fight this process. They may feel
Sucking on hands, blankets, fingers, etc. Baby is
that nursing restricts them. They may feel that their
saying, Im getting hungry; please feed me.
time breastfeeding is wasted and see themselves
Crying. Baby is saying, Im really hungry. My as unproductive. Yet, if you can learn to quiet your
tummy hurts; you need to feed me NOW! mind and calm your body, you will find that the time

spent breastfeeding is not wasted. The tranquility
Tips for Mothers Helpers will help replenish your strength. Like any medita-
New mothers benefit from support and tive activity, breastfeeding helps your creative and
assistance from family and friends. During the inspirational thoughts flow. The endless chatter of
early weeks, the babys father, grandparents, your mind quiets, making room for your best ideas
family members, and friends all play a key to emerge.
role in helping the new family to be strong
and healthy. By mothering the new mother,
family will help her grow in her new role and
recuperate faster and resume normal activi- Your Breastfed Baby at Home
ties when she is ready. Some of the things Feeding Station
family and friends can do to help in the early Many mothers find it helpful to create a special
days after the baby is born are: place where they breastfeed. Choose a place where
Protect the new familys privacy. Too you will be comfortable for many feedings a day. A
many visitors can exhaust new parents, comfortable chair, couch, or your bed can all work.
making it difficult to meet the needs of Many mothers enjoy a foot stool to put their feet
the new baby 24 hours a day. on when sitting on a chair or couch. Gather all the
Be positive and supportive of the new items you will want to have within reach: pillows,
mothers desire to give her baby the something to drink, a snack, diapers, baby wipes,
very best. telephone, channel changer, and anything else you
might need to be comfortable.
Prepare snacks and meals for the family.
Shop, do laundry, dishes, and cleaning. Get the baby. Remember, newborn babies feed
Take toddlers to the park, older children frequently (8, 10, 12 times in 24 hours). During the
to school, or just stay at their home to early days, have lots of skin-to-skin contact with your
provide support and assistance. baby. Your body temperature will go up or down as
needed to keep your baby at just the right tempera-
Hold the baby while the new mother
ture. Drape a blanket over you and your baby if you
naps, showers, or enjoys some one-on-
or the baby feel chilly or the room is cool. Babies
one time with other children.
who are too warm during feeding tend to fall asleep
Be creative. You can find lots of ways to before they finish eating.
support the new mother and her baby
as they establish breastfeeding. Position mother and baby for comfort
Get comfortable.
Note: Often new mothers are encouraged Get the baby organizedawake and ready to
to pump their breasts to provide bottles of feed.
breast milk to the baby while they sleep. This Tummy to tummy, with shoulders and hips
is not recommended during the early weeks supported at mothers body.
as it can interfere with the establishment of
Babys ear, shoulder, and hip should be in a
breastfeeding. Help the mother rest when
straight line.
the baby is sleeping during the day, and the
nights will be easier to manage for everyone. Baby should be at breast level. Use pillows,
if needed, to support your arms so you can
support the baby. The babys nose should be
opposite the mothers nipple when positioned

Breastfeeding Holds
Here are some positions in which you can hold your
baby while breastfeeding. You can choose the one(s) Cradle hold
that make you and your baby feel most comfortable.
No matter which one you choose, make sure your
babys mouth is near your nipple and he or she
doesnt have to turn his or her head to breastfeed.
For most positions, your baby should be on his or
her side with his or her whole body facing yours.
This helps the baby to properly latch on to the
nipple. Try using pillows under your arms, elbows,
neck, or back, or under the baby for support.

Cross cradle or This position is a commonly used position

transitional that is comfortable for most mothers. Hold
hold your baby with his or her head on your fore-
arm and the whole body facing yours.

Side-lying position

This position is good for mothers just learning

to breastfeed in the early days or weeks of
the babys life, for premature babies, or for
babies who are having problems latching on.
Hold your baby along the opposite arm from
the breast you are using. Support the babys
head with the palm of your hand at the base
of his or her neck.
This position allows the mother to rest while
the baby nurses. It is useful for mothers who
Used with permission.
had a cesarean birth (C-section). Lie on your
side with your baby facing you. Pull the baby
close and guide his or her mouth to your nipple.

The mothers nipple should be deep in the
babys mouth, resting just in front of the begin-
ning of the soft palate; usually about 111/2
inches of nipple and areola are in the babys
mouth. (You can feel how far back this is in your
mouth by running your tongue along the roof
Clutch or of your mouth until you feel it turn from hard to
football hold soft.) If you feel the babys gums moving on the
nipple, the nipple is not far enough back.
The babys chin and cheeks should be touch-
ing the breast. The nose should be near the
breast but not pushing into the breast.

This position is good for mothers with large

breasts, inverted nipples, or who had a cesarean
birth. Hold your baby at your side, lying on
his or her back, with his or her head at the
level of your nipple. Support the babys head
with the palm of your hand at the base of his
or her head.

A good latch is important for the baby to be able to
get lots of milk from the mothers breasts. A good
latch also makes breastfeeding comfortable for the A deep latch feels better for the mother and
mother. When latching the baby, be sure the baby allows the baby to get milk out more easily.
takes enough of the nipple and areola into the
Here are other ways to describe how the babys
mouth is latched onto the nipple:
The mothers nipple should be placed just
Use your hand to shape the breast to fit your
below the babys nose. Gently touch the babys
babys mouth.
lips with your nipple. This will stimulate baby
to open wide, commonly called the rooting Nose to Chin, Roll It In. The baby needs to
reflex. open her mouth wide to get the nipple deep
in her mouth and her lips back around your
When the baby opens wide, the mother can
areola. Lightly rub your nipple from her nose to
hug the baby close by pressing the babys chin
chin then roll it in when her mouth is open very
into her breast. This will help the baby to latch
wide. Do not allow her to nibble her way
onto your nipple.

Lips Open. The babys lips need to be open For more information about positioning and latch-on,
wide like a yawn. If your babys upper lip seems refer to these Web sites:
to be tucked in and pulling on the nipple, pull Latch-on video.
up on her top lip a little to flare her upper lip
out. If her bottom lip is tucked in and pulling Many good video clips on
in on the nipple, pull down on her chin. If this
baby-led latching as well as guided latching
doesnt work right away, stop and reposition
using the cross cradle hold.
the baby.
Breaking Suction. Place a clean finger inside
the babys mouth (between the gums) and
slide your nipple out, or with your finger in the
babys mouth press down on the lower gum to
break suction before taking the baby off your
breast. Do not get into a tug of war over Milk Supply
your nipple with the baby. Establishing a good milk supply occurs during the
first 23 weeks of breastfeeding. Newborn babies
If the latch hurts, break suction and try again.
breastfeed often, usually 8, 10, 12 or more times in
24 hours. Babies should be allowed to feed whenever
Note: In the early weeks and months, as your baby is they show early feeding cues. Dont wait until the
learning to breastfeed, avoid artificial nipples. When baby cries to feed. Crying means your baby is very,
very hungry.
your baby has established a good pattern of breast-
feeding and is ready to learn a new skill (about 36
weeks), offering an occasional bottle of breast milk Feed your baby on the first breast for as long as the
or a pacifier should not interfere with suckling at the baby is actively sucking with swallows. Watch the
breast or milk production. baby for signs that show that the baby is ready to
change sides (falling asleep, no longer swallowing,
coming off the breast and going back on repeatedly).
Gently compressing your breast and/or stimulating
Tips for Mothers Helpers the baby to suck if sleepy may help the baby do a
During the early days many mothers need help better job of finishing to feed.
with positioning the baby at their breast and
latching on. You can:
Allow the baby to finish the first breast. This is
Ask if there is anything you can do to help. important because the baby gets the first milk, called
Make sure the mother has drinks and foremilk, and the later milk, called hind milk. The hind
snacks while she is feeding the baby. milk is important because it contains more fat and
Breastfeeding mothers get very thirsty calories than the foremilk. This will help baby feel
during feedings and often get hungry too. fuller and is needed for growth and development.

If the mother looks to be in pain, offer

suggestions for relief if you know of any or Give the baby a chance to burp. Offer the second
offer to make an appointment with a lacta- breast if the baby still appears hungry.
tion consultant if there is no improvement
after a day or two. Phone numbers for Once the milk supply is established (after the first
lactation consultants are listed in Chapter 6. week) some babies only feed from one breast per
feeding. If the baby has been gaining weight; is having

at least 6 wet diapers and 23 loose, yellow stools feeding, with gradual slowing after 510
every day; and is not interested in feeding from the minutes. Some babies will be finished on the
second breast, it is okay. breast at this time. Others may respond to
a renewed flow at the breast and will begin
sucking again. Baby will usually spend 1030
Always start on the opposite breast at each feeding. minutes on each breast.
If your baby starts one feeding on the right breast,
the next feeding should start on the left breast.  ote: After a few months, babies get more
efficient and spend a shorter amount of time at
the breast.
Breasts feel full and heavy before baby feeds
Questions About Breastfeeding: and softer after baby finishes feeding.
Are you concerned that breastfeeding
Some mothers, especially in the early months,
may be a problem for you?
may feel a sensation of the milk ejection reflex,
Are you concerned that your nipples or the milk letting down. This can range from
are too small, too flat, too big, or not a warm or tingling sensation to a tightening in
acceptable for breastfeeding? the breast. Other moms may not feel this at all.
If you dont feel it, watch your babys behavior to
Have you had breast surgery and are
see that swallows are happening regularly.
worried it may affect your ability to
breastfeed? Milk may drip from one breast while the baby
feeds on the other breast.
Do you have a medical condition that
Babys urine and stool output increases from day
may affect your breastfeeding?
1 to 5.
If you have concerns about your ability to be
Average weight gain of 1 ounce per day after
able to breastfeed for any reason, discuss
day 5. All babies lose a little weight the first 35
your concerns with your physician or midwife.
days of life.
Call your lactation consultant before your Baby should be happy and content after most
baby is born to discuss your concerns. feedings.

How to Tell Baby Is Getting Enough

to Eat
To tell if your baby is getting enough milk, watch for
these signs:
Baby is sucking with swallows.
- Birth to day 3Bursts of sucking 620 sucks or
more, followed by a pause. Baby will not swal-
low with every suck. After resting for a minute or
so, the baby will start another burst of sucking.
Baby will usually feed for 1030 minutes on
each breast.
- Day 3 and beyondContinues bursts of 620
sucks, followed by a pause. Baby should begin
swallowing every 13 sucks. There will be
frequent swallows at the beginning of the

Use this chart during the first week of feeding. Circle the time you begin each breastfeeding. Check off a
circle for each wet diaper and each bowel movement.

Babies need to breastfeed frequently, at least 8 times every 24 hours. The number of wet diapers and stools
will increase over the first week. At first the stools will be black, tarry, and sticky. By about day 3, the stools will
become less sticky and will be green or brown. By day 5, the stool should turn to a mustard yellow color and be
liquid and seedy.

Breastfeeding Log

Day 1 goals: 812 feedings, 1 wet diaper, 1 bowel movement

Feedings: a.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2


Feedings: p.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

wet diaper: m

bowel movement: m

Day 2 goals: 812 feedings, 2 wet diapers, 2 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2


Feedings: p.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

wet diapers: m m

bowel movements: m m

Day 3 goals: 812 feedings, 3 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2


Feedings: p.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

wet diapers: m m m

bowel movements: m m m

Day 4 goals: 812 feedings, 4 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2


Feedings: p.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

wet diapers: m m m m

bowel movements: m m m

Day 5 goals: 812 feedings, 56 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2


Feedings: p.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

wet diapers: m m m m m m

bowel movements: m m m

Day 6 goals: 812 feedings, 68 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2


Feedings: p.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

wet diapers: m m m m m m m m

bowel movements: m m m

Day 7 goals: 812 feedings, 68 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2


Feedings: p.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

wet diapers: m m m m m m m m

bowel movements: m m m

Night Feedings Some babies fall asleep after only a few minutes of
Babies feed frequently during the night. During the feeding. If your baby is falling asleep at the breast
first 12 weeks, babies often feed more during the during the first week without feeding for very long or
night than they do during the day. It is very important swallowing very much, try these tips for waking your
that new parents rest whenever their baby sleeps baby to finish feeding:
so that the night feedings will be more manageable 1. Start doing breast massage and compressions.
and less difficult. This stage passes as the baby gets
Gently squeeze your breast and hold until you
older. You can try to wake baby more often during
hear swallows then release the breast. Repeat
the day to help the baby transition to better night
as needed watching your baby for increased
sleeping, but this will be a gradual change over the
first days and weeks. interest in feeding and increased swallowing.
2. Dress your baby in a diaper only during feed-
ings. Add a light blanket as needed over the
Sleepy Babies
baby if she wakes and is actively sucking with
Many babies are sleepy in the first few days after swallowing.
birth. You want to be sure that your baby feeds at
least 8 times in 24 hours. Therefore, if your baby 3. Stretch the babys arms slowly up toward the
sleeps more than 3 hours, gently wake your baby up head and down again.
to feed. Watch for early signs of hunger (for exam- 4. Rub your babys feet, head, and/or back to
ple, licking the lips, putting hands and fingers to the stimulate him.
mouth, moving arms and legs to get your attention).
A sleeping baby with rapid eye movement under
the eyelids is a sign that he or she may be starting to If none of this works, try to wake baby again in an
get hungry. hour or so. If the baby skips more than two feedings,
express your milk manually or with a breast pump
and feed your baby using a dropper, soft cup, or a
Tips to wake a sleepy baby:
bottle. Try breastfeeding again at the next feeding.
1. Undress baby down to just a diaper before
feeding time.
Contact a lactation consultant or your babys physician
2. Hold the baby close (skin-to-skin) with the
if this behavior continues for more than two feed-
babys head on your chest, tummy on your
ings in a row, you notice a decrease in urine output,
tummy, or heart to heart.
or the problem lasts for more than one day.
3. Gently massage the babys back, arms, and legs.
4. Stroke your babys cheeks, lips, and mouth
with your finger.
5. Change the babys diaper. Feeding Patterns for Breastfed
6. Talk or sing to your baby.
One Breast per Feeding or Both
7. Walk your fingers up and down the babys back.
Babies all have their own unique pattern of feeding.
8. Hand express your milk onto your babys lips
Some babies like to feed from one breast per feeding.
to taste and smell.
Other babies like to feed from one breast, wait 10
9. Tickle your babys chin. minutes, and then feed from the other breast. Still
10. With the baby sitting in your lap, gently lean other babies like to feed from one breast then the
the baby back and then bring the baby to a other breast, then back to the first breast, three sides
sitting position. Do this several times. per feeding. Some babies eat a lot during the morning,

nap well in the afternoon, and then feed a lot during
the evening hours. Other babies like to feed infre- How to tell if youre making enough milk
quently in the morning then eat all afternoon. for your baby
If you are worried you are not making enough
milk for your baby, use this checklist:
Feeding patterns change over time. What your baby
is doing this month may be very different next month o K
 eep your baby close and feed whenever
and the month after. Follow your babys lead. Feed the baby shows signs of hunger.
your baby when hungry, and keep an eye on the o C
 ount diapers. After day 5, look for 6 (or
number of diaper changes you are doing. Weight more) heavy wet diapers every 24 hours
checks will also help reassure you that your baby is and 3 or more loose yellow stools. Some
getting enough to eat. babies may have a bowel movement with
every feeding. This is okay too.
Cluster Feedings o Look
 at your baby. Is the baby getting
Babies feed frequently for lots of reasons. Cluster bigger? Are the clothes getting tighter? Is
feeding is common in the early weeks for most the baby gaining weight? If so, your baby
babies. Once or twice a day, your baby may want to is getting enough milk.
feed from both breasts two or three times in a row, o Is the baby content after most feedings?
or have 23 feedings in a very short period of time. All babies have some fussy times; this is
This is normal and is the babys way of getting the normal, but the baby should be content
milk at the end of the feeding that has more fat and most of the time.
calories. Consider this as dessert for your baby. After o Is the baby having a growth spurt? These
a cluster of frequent feedings, most babies will sleep usually last only 12 days when the baby
their longest stretch of the day. feeds often.
o H
 ave you been very busy lately, missing
Growth Spurts feedings at times? Sometimes a fussy
When babies are getting ready to have a growth baby is telling the mother to slow down
spurt, they need more milk. The baby increases your and spend a little more time cuddling
milk supply by breastfeeding frequently for a day or and breastfeeding and enjoying him or
two and then going back to a more normal routine. her.
Frequent breastfeeding increases milk production.
It does not mean your milk has dried up or that
your milk is inadequate in any way. Your babys first
growth spurt may occur when he or she is about 1. Put warm, moist towels on your breasts for 1015
6 days old, again at about 23 weeks, then occur minutes before feedings. This can stimulate your
every several weeks over the first year or so. Just milk to begin flowing; it is often referred to as
relax and enjoy these days, knowing that your body let-down.
will take care of the babys needs. If you become 2. Feed your baby at least every 23 hours, day and
concerned, count the babys diapers. If there are lots night. If your baby seems hungry more often,
of diaper changes, your baby is getting plenty to eat. breastfeed more often to meet your babys needs.
3. Latch the baby deeply so that the babys mouth is
If you feel your milk supply is low, try these steps to open wide covering the nipple and 1 inch or more
increase production. of areola.

4. Listen for the baby to swallow frequently. 8. Pump after or between feedings for 1020 min-
5. Drink enough fluids, at least 1 glass of water every utes for extra stimulation.
time you feed the baby and more if you are still Visualize lots of milk flowing, while massaging
thirsty. your breasts before you begin and again half-
6. Feed yourself. If you are not very hungry, try to way through the pumping session.
snack several times a day. Fresh fruit, whole-grain Try to relax. Avoid staring at the bottles and
crackers, and nuts all make good healthy snacks. getting stressed at the milk flow. This only
7. Rest. The demands of taking care of a new baby inhibits the process. Relax, read, watch TV, or
are high. Try to nap in the morning and afternoon visit with a friend while pumping.
when the baby is sleeping during the early weeks If you have tried all of these suggestions for
after birth and whenever you can as the baby gets 23 days and still feel your milk supply is too
older. low, call your lactation consultant to discuss
other possible causes and solutions.

CHAPTER 3 Breastfeeding Challenges

Breast Engorgement 4. Warm showers are helpful as well. While in the

shower, massage your breasts to help soften
For the first week after the birth of your baby your
body is going through many changes. One of these
changes is the beginning of breast milk produc- 5. If the baby is unable to latch, unable to soften
tion. Two to five days after birth many women notice the breast when feeding, or has less than 5 wet
breast fullness, while others experience breast diapers in 24 hours, you will need to express your
engorgement. milk manually (use your hand to massage the
breast to remove the milk; see pages 2021 for
more information) or use an electric breast pump.
Difference Between Breast Fullness and Breast Use the milk you express to feed your baby.
6. If your breasts are still hard after breastfeeding
Breast fullness is related to the beginning of milk or expressing your milk, apply ice compresses
production. We usually refer to it as saying, the milk to your breasts for 1015 minutes. This will help
has come in. Breast fullness rarely causes a baby to reduce the engorgement further. (Bags of frozen
have difficulty latching-on and breastfeeding. When peas work well.) Make sure you have a cloth layer
the infant has finished feeding, the breast usually between your breasts and the ice packs.
feels softer, lighter, and more comfortable.
7. Ibuprofen or acetaminophen may help reduce the
pain. Ibuprofen may help reduce the swelling. You
Breast engorgement is when the breasts are hard may continue to breastfeed while taking these
to the touch, swollen, and painful. While the breast medications.
is hard and swollen, the infant may have difficulty 8. If there is no improvement after 2448 hours,
latching and cannot drain the milk from the breast contact your lactation consultant for advice. If you
well. Some mothers get a slight fever (below 100F) get a fever above 101F, notice redness or warmth
for a short period of time. in one area, or feel ill, it could mean you have an
infection. If a lactation consultant is not available,
To prevent engorgement, breastfeed early, breastfeed you should see your primary care physician or go
often, breastfeed well, and breastfeed exclusively. to Urgent Care.

How to Treat Breast Engorgement

1. Breastfeed frequently, at least every 23 hours. Do When Breastfeeding Hurts
not limit your babys time at the breast. Sore Nipples
2. Avoid the use of pacifiers, bottles of formula, or If breastfeeding is painful and hurts, this could
water (unless recommended by your babys physi- mean that there is something wrong. Blisters, scabs,
cian). cracks, or bleeding are not normal when breastfeed-
3. If your breasts are not leaking, you may use warm, ing and are signs that there is a problem. Read the
moist compresses on your breasts for 5 minutes following information and see a lactation consultant
before each feeding. Massaging your breasts will right away.
also help drain the milk better.

Early Days of Breastfeeding Sore nipples after pain-free breastfeeding for
Many women experience some nipple tenderness 1 week or more
during the early days of breastfeeding. This is usually Sore nipples can occur after the first week for several
a sign that baby is not latching correctly. Review reasons. The first thing to check is the latch, to make
the information in Chapter 2 on the correct latch, sure it continues to be correct. Thrush (a fungal
look at the videos on the Internet, and ask for help. infection many babies get in their mouths that may
If you dont get relief, call a lactation consultant in require medication), teething, or a new pregnancy
your area and schedule an appointment; a lactation can also affect your nipples. If your nipples become
consultation can help. sore, call your lactation consultant. She will help you
discover the cause so that you can create a plan to
solve the problem as quickly as possible and get you
Pain Management back to pain-free breastfeeding again.
To treat your pain until you can get help, follow
these steps:
Sore Breasts
Begin each feeding on the least sore breast. If
Your breasts can be sore for a number of reasons.
both breasts are sore, put a warm, wet wash-
Engorgement, plugged ducts, and mastitis (breast
cloth on the breast and use gentle massage
infection). If you are having breast pain, try the sug-
(going from the chest wall toward the nipple) to
gestions given below. If the pain is severe or you
start the flow of milk.
have no relief within 24 hours, contact your lactation
If necessary, breastfeed more often (every 12 consultant or health care professional.
hours) and for shorter periods of time (1015
minutes or until the breast is soft).
Plugged milk ducts
Express a small amount of milk or colostrum
onto the sore area after the feeding. Air-dry When a milk duct is not draining well, it can become
your nipples after feedings. blocked or plugged. It often feels like a lump or pea
under the skin or it may be a red, firm, and tender
Pure lanolin cream can help protect nipple tissue.
area near the nipple.
Do not use vitamin E or other creams or oils.
Gel pads can provide relief and protection. They
can be cooled and, like lanolin, will keep your - missed feedings,
nipples moist. Gel pads are available where - the babys first sleeping through the night,
breastfeeding supplies are sold. See Chapter 6. - wearing an underwire bra, a bra that is too
Avoid soap on nipples when breastfeeding, just tight, or not properly fitted, and
rinse with water during your daily shower. - doing too much in one day or feeling stressed.
If breastfeeding is too painful, pump your breasts - Breastfeed the baby often, starting with the
every 23 hours for about 1520 minutes on each sore side first.
breast, or longer if the milk is still flowing. An elec-
- Position the babys nose toward the plugged
tric breast pump is the easiest, most effective pump
duct while breastfeeding and change positions
for this use. See Chapter 6 for pump resources at
your medical center. You can feed your expressed
milk to your baby until your nipples heal and you - Apply warm, moist compresses 56 times a day
can see a lactation consultant for help. Dont quit for 1015 minutes just before breastfeeding.
breastfeeding because it hurts; get help.

- Massage the breast just in front of the tender Treatment
area to help the milk to begin flowing. Once - Heat. Apply warm moist compresses and place
there is milk flow, use some deep pressure them on your breasts for 1015 minutes before
massage just behind the tender area while feeding or pumping. (Fill a clean, disposable
feeding, working fingers toward the nipple to diaper with warm tap water and place it over
help move the plugged milk toward the nipple your breast. It can be used over and over
and out. again.)
- Drink extra fluids and eat healthy foods. - Rest. Go to bed. Take the baby with you. Make
- Wear a soft bra that doesnt dig into the breast sure to drink a lot of fluids and eat healthy
or dont wear a bra. foods. This is very important or the condition
Prevention may get worse. If you have other children at
home, arrange for someone to care for them
- Pump your breasts to keep them soft if you
while you recover.
miss a feeding or your baby sleeps all night
and you are uncomfortably full. - Breastfeed often to keep your breasts soft.
If your baby cannot, or will not, breastfeed
- Try not to overdo it. You are still recovering
enough, use a breast pump to keep your
from giving birth.
breast well drained.
- If your symptoms are severe or last for more
Most plugged milk ducts are released within 2448 than 24 hours, call for a same-day appoint-
hours. If there is no improvement or if you begin ment with your primary care physician or go to
running a fever over 101F or you feel sick as if you Urgent Care. You may need to take antibiotics.
are coming down with the flu, see your health care If so, take them for the full 10-day course and
professional or go to Urgent Care for treatment. continue to breastfeed.
- Pain relief. The anti-inflammatory medicine
Mastitis Ibuprofen can relieve your pain. You do not
need a prescription. Follow the instructions or
Mastitis is an infection of your breast tissues, not
follow your physicians instructions.
your milk supply. It is safe and important to continue
breastfeeding. Prevention
- Latch well. A good latch solves most breast-
feeding problems.
Mastitis may follow a plugged milk duct or may
appear suddenly with no warning. Symptoms are the - Breastfeed often.
same as the flu: fever, chills, and body aches. Also, - Rest as much as possible, especially the first
there is usually a red, swollen, hot, painful area on 6 weeks.
the breast. Usually it is only on one side.
- Treat plugged milk ducts right away.
- Continue breastfeeding.
- cracked or otherwise damaged nipples,
- infrequent and/or ineffective breastfeeding,
- overtired mother, and
- untreated plugged milk duct.

Choosing the Right Pump

Small electric, Double pump, Hospital

If you plan to battery-operated electric grade electric
pump (to purchase) pump (rental)
Pump for the occasional supplemental bottle 4 4
Pump at least once per day 4 4
Return to work 4
Increase milk supply 4 4
Establish milk supply (baby is not latching) 4
Baby in NICU (premature or sick baby) 4

Breast Pumps and Pumping

A good pump should be able to relieve breasts
Here are several resources for breast pumps: of some milk and of stimulating production.
Many Kaiser Permanente facilities have breast It should be clean, contamination free, easy to
pumps available for rent and/or purchase. See use and not cause pain or discomfort.
Chapter 6 for pump options at your medical Ruth Lawrence, MD
From her book, Breastfeeding: A Guide for the
Medical Profession
You can call Medela at (800) TELL-YOU
(1-800-835-5968) or visit their Web site at or Ameda at (866) 99-AMEDA effectively. Most women switch over to breastfeed-
(1-866-992-6332) or visit their Web site at ing once the problems are resolved. Be sure to for a breast pump dealer located stay in contact with your lactation consultant so she
near you. can guide you through the process of moving from
Recommended hand pumps for purchase: pumping to breastfeeding. Some reasons you may
Ameda, Medela, and Avent ISIS ( need to pump for a while are that the:

Recommended electric pumps for purchase: baby is not able to maintain latch and breast-
Ameda, Medela, and Lansinoh ( feed well,
Battery-operated and small electric pumps baby has an anatomical problem preventing
are not as efficient as the large electric breast effective breastfeeding,
pumps available for rent. baby is in the NICU because he has special
If you are unsure about what pump to use, ask your needs, or
lactation consultant at your local medical center. mothers nipples are too large for baby to take
them into his or her mouth.
Using a Breast Pump to Start Your Milk Supply
Many women need to use a breast pump to establish Even though your baby cannot breastfeed right
a milk supply until the baby is able to breastfeed away, you can begin the important task of giving the

best food possible to your baby by removing milk If your baby cannot latch on after several attempts,
from your breasts by using an electric breast pump. begin pumping to provide breast milk for your
After your babys birth, your hormones that control baby until an effective latch has been achieved.
milk making are at high levels. If the milk stays in the Pump frequently; 810 pumping sessions in 24
breast too long, the hormone levels drop and milk hours will help you establish a good milk supply.
production stops. By using an electric breast pump Try to space your pumping sessions throughout
on a regular basis (810 times a day), you will help to the day with at least one pumping session at
keep the lactation hormones high for milk production. night.
Pump your breasts for about 15 minutes, both
Your nurse or lactation consultant will help you to at the same time or one at a time, or until no
get pumping started while you are in the hospital milk flows for 2 minutes. Pump no more than
and will help guide you in the steps needed for you 30 minutes at a time. If you are pumping one
to continue pumping once you are home from the breast at a time, it may be helpful to change
hospital. As your milk production increases and your sides, back and forth, whenever your milk flow
baby is able to drink the milk you have pumped, the slows.
lactation consultants will help you and baby learn to Hand expression is often very effective during
breastfeed. the first days after giving birth. Ask your nurse
to teach you how to hand express and if little
To prepare to express/pump your milk, follow these milk is flowing at the beginning, try alternat-
steps: ing between hand expression and pumping to
increase the milk flow.
If you are expressing milk for a premature baby
or for a baby who is sick, your physician may During the first 2 days after birth, you have
have recommended you store milk in sterile colostrum. Colostrum is the first milk, or new-
containers. For the well baby, clean bottles or born milk. It is concentrated and has the right
milk storage bags can be used. amount of nutrients and immune factors for
your baby. Do not be alarmed if there are only
Apply warm, moist heat to your breasts for about
small amounts; this is normal. Every drop is
510 minutes before expressing milk to help
important for your baby.
your milk ducts relax and the milk to let-down
and flow better. Follow this with 12 minutes of Milk volume will increase when your baby is
breast massage. (Once you are used to ex- about 35 days old. Pump even when there is
pressing your milk and you have a good flow of little or no milk coming, as this stimulation will
milk, you can skip this step.) help your milk supply later and will prevent
engorgement from occurring.
Set the pressure on your pump to minimum
pressure. Turn the pressure up to your comfort Mothers have found the following tips helpful to
level. To find your comfort level, turn the suction increase milk flow when pumping:
up to the point where it hurts, then turn it down - Apply warm, moist heat to the breasts for
slightly. Pumping should not hurt. If it hurts, turn 510 minutes. It can help relax milk ducts and
it down a little more. encourage the milk to letdown.
- Gently massage the breast for a minute or so
Follow this procedure for pumping: before beginning to pump and whenever your
milk flow slows.
If your baby is in the NICU, begin pumping
within 2 hours after birth, if possible. - Relax. Pumping is a learned behavior and
takes practice. The milk will come.

Breast Milk Storage Guidelines

Storage Time Refrigerator Cooler with Room Room

Deep Freeze Refrigerator
for Human Freezer Ice Packs Temperature Temperature
(0F) (39F)
Milk (variable 0F) Frozen (59F) (66F72F) (72F79F)

Up to 12
Fresh 34 months 8 days 24 hours 610 hours 4 hours

Do not Do not
thawed in 48 hours Do not store 4 hours 4 hours
refreeze refreeze

Do not Do not Do not Until feeding Until feeding
warmed, not 4 hours
refreeze refreeze refreeze ends ends

Until feeding Until feeding

Warmed, fed Discard Discard Discard Discard
ends ends

Storage of Breast Milk Thaw frozen milk by placing it in the refrigerator

Be sure to label any bottles of milk that will be stored the night before if you know you will need it the
with the date and time you pumped it as well as next day.
any other information you feel will be important. Place a bottle of frozen milk in a mug of warm
Breast milk stored for a period of time will separate. water and allow it to thaw gradually.
The fatty portion of the milk will float on the top. If the fatty portion of the milk has floated to
The amount of fat will vary depending on when you the top, mix the separated milk back together
pump, how long you pump, and the time of day the before feeding it to the baby by gently swirling
milk was expressed. Shake gently to mix the milk the bottle.
back together before giving it to your baby.

Hand (Manual) Expression of Milk

Preparing Milk for Feeding
Before you begin to express your milk, wash your
Follow these tips to warm milk or thaw frozen milk hands. Use a clean collection container such as a
for feedings: bowl to collect the expressed milk. There are 420
Never heat babys milk in a microwave or on the openings on each nipple, so the milk may spray out
stove. in different directions. A wide mouth container is
Warm milk gently and slowly, placing the bottle helpful.
in a cup or bowl of warm water.

Follow the steps listed on page 19 to prepare your Introducing a Bottle to Your
breasts with warm, moist heat and then massage.
Breastfed Baby
Use your fingertips to stimulate the nipple for a
minute or two as well. Under normal circumstances, it is not advisable to
pump, nor to give your baby a bottle, until your milk
supply is established and your babys first growth
Start out by making a C shape with your hand to spurt has passed. At that time, you may start pump-
support your breast. To do this, place four fingers ing once a day for milk storage. It is recommended
under your breast to support it and place your thumb that your baby be at least three or four weeks old
above the breast. Place your fingers so they are well before introducing a bottle. Many mothers do not
above the nipple and on the areola. introduce a bottle until 2 weeks before they return
to work. Your baby will usually accept a bottle if not
overly hungry and if the bottle is not forced. After
Press your fingers inward toward your chest wall. At
the bottle is introduced, it is recommended that
the same time, use your fingers and thumb to gently
your baby be given a bottle at least twice a week so
squeeze the areola for about 5 seconds and then
that she will continue to accept the bottle.
release the squeeze and inward pressure. Wait a few
seconds and repeat several times. Within seconds,
milk should start dribbling or spraying out. Once the To begin, think about having someone other than
flow of milk slows down, rotate the position of your the breastfeeding mother give the first bottle. It may
fingers. For example, make a U shape with your be helpful for the father or grandparent, etc., to
hand. In this way you are expressing different areas hold the baby in a position other than the familiar
of the breast. breastfeeding position. In fact, it is highly recom-
mended that the mother not even be home. Your
baby senses the mothers presence, can hear and
This process will take practice. Be patient with your-
smell her, and may refuse to accept the bottle.
self as you learn. Try not to pull the nipple.
Instead, take your pump and plan to be away during
your babys feeding time. This gives you a chance to
pump while your baby is learning to accept a bottle.
A good video on manual expression can be
seen at:
The best nipples on a bottle are ones that require
the baby to keep her mouth open wide while suck-
ing. Do not allow your baby to suck only on the
nipple tip.

Typical infant consumption for a feeding is about

1 ounce of milk for every 2 pounds of body weight.
Start by offering the baby 2 ounces. Heat 1 more
ounce if the baby is still hungry. Remember that milk
that has been warmed for a feeding must be thrown
out at the end of the feeding.

CHAPTER 4 Fitting Breastfeeding into Your Lifestyle

Before you know it, your baby will have grown past For most women, leaking becomes less of a prob-
the newborn period and your life will be getting lem after about 6 weeks when the hormones levels
busy as you resume many of the activities you en- adjust to breastfeeding.
joyed before your baby was born. Anticipating your
return to work or school can be stressful for many
mothers. If planned well, you will be able to manage
it all. Diet
There is no need to follow a special diet when you
Breastfeeding in Public are breastfeeding. Follow these simple guidelines to
feel good while you breastfeed:
California state law (Assembly Bill 157) states a
mother may breastfeed her child in any location, Eat a wide variety of foodslots of fresh fruit,
public or private, except the private home or resi- vegetables, whole grains, and an extra serving
dence of another, where the mother and the child of protein.
are otherwise authorized to be present. Drink lots of water. Some juices and caffeinat-
ed beverages are okay, but dont overdo them.

If you need help or tips on how to breastfeed in Eat enough caloriesabout 500 calories extra
public discreetly, ask your lactation consultant or each day to support lactation (usually about
educator for assistance. 2,2002,800 calories per day). A personalized
diet plan while you are breastfeeding can be
found at
You can enter your height, weight, due date/
Leaking Breasts birth date, and activity level to get suggestions
just for you. If you have any special nutritional
Many women find that when their breasts are very needs, be sure to discuss them with your physi-
full or when they are away from the baby and miss cian or lactation consultant.
a feeding, their breasts will leak. Leaking is a signal
your body is giving you that you should try to pump Drinking alcohol in limited amounts is safe when
or breastfeed soon. There are several things you breastfeeding. Remember that the alcohol will
can do to prevent embarrassing wet spots on your filter into your milk, so small amounts taken
clothing. after feedings are usually best.
Human milk varies only slightly from mother
to mother regardless of what you do or do not
Apply direct pressure to your nipple when you
eat. The goal is to eat balanced, healthy, ener-
feel the milk is beginning to flow.
gizing meals so you and your baby can thrive.
Use breast pads. They are available in dispos-
able or reusable cotton pads. Change your
pads frequently.
Avoid letting your breasts get overly full; you Exercise
will leak less. Many mothers are anxious to get back into shape
and want to begin an exercise program right away
after the baby is born. Wait until after your postpar-
tum appointment and approval from your physician

or midwife. When you are ready to start exercising a location, other than a bathroom, for you to express
dont let breastfeeding stop you. Many women walk, your milk. Make arrangements with your employer
run, do yoga, go to the gym, or whatever else they before returning to work to ensure a smooth transi-
enjoy, while they are still breastfeeding. tion back to work.

Returning to Work or School Breastfeeding for the First Year and

When planning to return to work or school, think Beyond
about the following: As the days, weeks, and months pass, you will no-
Return to work mid-week, if possible, for an tice your breastfeeding will change. The American
easier transition. Academy of Pediatrics recommends at least 1 year
of breastfeeding and suggests that you continue for
Get a breast pump before returning to work or
as long as you and the baby enjoy the relationship.
Your milk continues to be nutritious and is a healthy
Locate a clean, private, safe area to pump (this addition to your babys diet for as long as you con-
is required by employer or educational institu- tinue to breastfeed. You will make milk as long as
tions) and store your milk. your baby is drinking the milk.
Having your babys caregiver close to work
is convenient if you plan to visit at lunch to
Begin pumping and storing milk two weeks The American Academy of Pediatrics recom-
before returning to work or school. Begin mends that you breastfeed your baby for at
pumping after the fullest feeds (usually in the least 12 months, and thereafter for as long
morning). as mutually desired. You can breastfeed your
baby for over 1 year.
Someone other than the nursing mother (dads
Surround yourself with supportive family and
are a good choice) can introduce the baby to
the bottle the first time. Place baby in a posi-
tion that is not similar to breastfeeding. Be Attend a support group. Youll be glad you
patient; this is a new experience for your baby. did.
Pack the diaper bag and pump kit the night
before a new work or school day to make your
mornings flow easier.
Under natural circumstances, babies wean gradually.
Plan ahead. Some Kaiser Permanente facilities offer
The weaning process begins when baby starts solid
a Breastfeeding and Returning to Work class. Call
foods at around 6 months of age. Over the coming
your local health education department or your lac-
weeks or months, the baby will gradually increase
tation consultant/educator. See Chapter 6.
the amount of solid foods eaten and decrease
breastfeeding. It can take weeks, months, or years
California Lactation Accommodation Law to completely wean your baby. For a comfortable
weaning, always wean gradually. Never try to drop
Assembly Bill 1025 states that any business shall pro-
more than one breastfeeding a week.
vide an employee with a reasonable break time and

Birth Control
You can get pregnant while breastfeeding. Be sure
to discuss birth control options with your health care
professional. They can guide you in choosing a safe
and effective contraception method to use while you
are breastfeeding.

Support Groups
It has been proven that support groups help
mothers to breastfeed longer. Find a sup-
portive group that you enjoy and get to know
other breastfeeding mothers. Here are some
Many Kaiser Permanente facilities have
support groups for new families. Con-
tact your local lactation consultant for
support group information at your local
medical center. See Chapter 6.
WIC (Women, Infants and Children).
Many WIC programs have support
groups for new mothers. Ask your WIC
worker if a support group is available in
your area. See Chapter 6.
La Leche League. La Leche League is
a mother-to-mother information and
support organization for breastfeeding
mothers. Call 1-800-La Leche (1-800-
525-3243) for the La Leche League
group information for your area. See
Chapter 6.
Community centers. Many community
centers offer parent support groups
and new mother groups. Call your local
community center to get information on
what is available in your neighborhood.

CHAPTER 5 Frequently Asked Questions

Q. H
 ow do I know if my baby is getting enough month, your baby should be put on your breast
breast milk since I cant tell how much he is whenever they show signs of hunger, like sucking
drinking? on their hands. After 1 month of age you can in-
A. Look at your baby. Listen and watch for swallows troduce a pacifier but limit its use to times when
during feeding. Expect occasional swallows the you are not available to breastfeed, like in the car
first 12 days with increasing swallowing after or when you are in the shower.
day 3. Track the babys urine and stool output on
the Breastfeeding Log form (Table 2) on pages Q. W
 hy does my baby sleep so well during the
1011 or the chart in Healthy Beginnings, Issue day but stays awake at night?
10 (Postpartum) that you received in the hospital.
A. Babies wake during the night for feedings for
Your baby should be allowed to feed whenever
several months. If your baby is awake more than
he or she shows signs of hunger and for as long
just for feeding, it may be that their sleep cycle is
as the baby desires. Babies should breastfeed
set for being awake at night. During your preg-
812 times in 24 hours. The urine and stool out-
nancy your babys sleep cycle was set by your
put should increase every day until baby is 5 days
activities. If you were active during the daytime
old. After day 5, you should see at least six really
hours, your baby was probably rocked to sleep
wet diapers and at least two large yellow stools
all day. When you went to bed at night, the rock-
every day. After feedings, your baby should be
ing stopped and your baby became more awake
content and sleepy most of the time. If this is not
and alert. Some ways to help your baby to be
the case, call your lactation consultant to discuss
more wakeful during the day and sleep better
your concerns.
at night are to expose your baby to more light
 owever, you should call your pediatrician if
H during the day to help reset the babys internal
your baby appears to have a loss of appetite clock. Keeping your baby close during the night
during feedings, frequent or excessive vomit- may help your baby sleep better as he or she
ing, rectal temperature greater than 100.4F or feels more secure when somebody is close to
axillary temperature greater than 99.4F, marked him or her. Keep the lights low and activity to
behavior changes such an unusual irritability, ex- a minimum during the night to help teach your
cessive sleepiness, general restlessness, or your baby that nighttime is for sleeping.
baby has any difficulty breathing with inhaling or
Q. M
 y baby is so gassy. Did I eat something that
caused this?
Q. M
 y baby wants to suck all the time, even after
A. Probably not. The colostrum the baby is eating
he or she is fed. Should I use a pacifier?
the first few days acts like a laxative to help the
A. Babies are born with a very strong suck instinct. baby pass the sticky first stools, meconium. Some
Sucking feels good to babies. They have been gas is normal for everyone; it is part of the diges-
sucking their fingers and toes since before they tion process. If your baby is gassy, crying, and
were born. Newborns will suck on their hands uncomfortable, call your lactation consultant.
to show you they are hungry, and they will suck She can probably help you to identify possible
to help themselves go to sleep. During the first causes.

Q. Should I give my baby formula, juice, or water? any breast milk and just getting formula. Call your
A. The American Academy of Pediatrics recom- lactation consultant if you are having problems
mends your baby drink only human milk for the with breastfeeding. A baby who is latching well
first 6 months. After 6 months, you can gradu- can feed very quickly and effectively.
ally introduce other foods, water, and a little  fter your breastfeeding is established at about
juice. Your pediatrician will guide you through 1 month, you can begin to pump and store
this process. Breast milk should continue to be breast milk for use when you need to be away
a major part of your babys diet for the first year. from your baby. See Chapter 3 for the section on
Your baby should never need any formula when breast pumps to help you decide what type of
breastfeeding is going well. pump you will need.
 ome medical centers offer a class through
Q. Does breast milk change over time? your local Health Education Department about
Returning to Work for breastfeeding mothers.
A. Yes. Milk changes according to your babys need.
Call your Health Education Department for class
The milk changes as your baby grows, but it also
information. See Chapter 6.
changes during the feeding.
 he milk in the first few days is called colostrum.
Q. W
 hat does it mean that a baby can be nipple
Colostrum is like an energy drink for your baby,
low in fat, high in protein, and easy to digest. It
is the perfect food for your baby to learn how A. Sucking is a natural instinct; breastfeeding is a
to breastfeed. It is sweet and present in small learned skill. Sometimes if a baby gets a bottle
amounts so the baby doesnt get overwhelmed too early, he or she may have difficulty breast-
with too much milk flowing. By about the third feeding. The bottle feels different in the babys
day the milk volume starts to increase. The more mouth and the milk flows differently from the
the baby breastfeeds, the more milk there will bottle than it does from the breast. While some
be. This milk has more water and fat than in the babies can go back and forth from breast to
first two days, but it still has all the good colos- bottle, other babies have difficulty and can get
trum to keep your baby healthy. By the time your quite frustrated. Also, when they do latch to the
baby is about 2 weeks old, the colostrum is gone breast, they may suck incorrectly, making the
and your baby is getting mature milk. nipples very sore. The American Academy of
Pediatrics recommends that you avoid artificial
During the feedings, milk changes too. The milk
bottle or pacifier nipples and only breastfeed
at the beginning of the feeding may appear
for the first month of your babys life. After one
watery. This is because it has a lot of water to
month, babies can usually manage the differ-
quench the babys thirst. The milk toward the
ences better.
end of the feeding is thicker, richer, and has a
higher fat content. This milk helps your baby to
feel full and gain weight. This is why it is im- Q. Why is my baby so fussy?
portant to let baby decide when the feeding is
A. All babies have times during the day when they
finished. In that way, the baby gets just the right
are restless and irritable. There can be many rea-
combination of milks.
sons for a baby to cry and be fussy and irritable.
For some babies, this is worse than others. If your
Q. Is it okay to only pump and bottle-feed my baby is fussy, try holding the baby skin-to-skin
baby breast milk? and just relax. If your baby is crying a lot and
A. This is not recommended on a long-term basis; passing a lot of gas, try burping the baby more
however, it is better than the baby not getting often. If nothing seems to soothe your baby, call

your lactation consultant and she will make other Q. If I get a cold or have a fever, should I still
suggestions that may help. feed my baby?
A. Absolutely. Keep breastfeeding. Before you even
Q. D
 o I have to eat a special diet or avoid certain know you are getting sick, your baby has been
foods while breastfeeding? exposed to your illness. Your body starts pro-
ducing antibodies to fight the illness before you
A. Every culture has different rules about what
have any symptoms. These antibodies pass into
you can and cannot eat when you are breastfeed-
your milk for your baby. By continuing to breast-
ing. You will get lots of advice from well-meaning
feed, you pass these antibodies to your baby to
friends and family about your diet. There is no
help protect him or her.
food that causes every baby to be gassy, get a
rash, or spit up a lot. The best advice is to eat
a variety of foods you enjoy. Enjoy fruits and Q. M
 y family says I cant take any medicines
vegetables, whole grains, protein foods like when Im breastfeeding. Is that true?
meats, eggs, and beans on a regular basis. Try A. Most medications are safe to take when breast-
not to eat the same foods all the time. If you feel feeding. Your lactation consultant has resources
that every time you eat a certain food, your baby on the safety of breastfeeding while taking
reacts badly in any way, please call your lactation medications. If you are concerned about the use
consultant for advice. of any medication you need to take while breast-
feeding, call your lactation consultant for advice.

CHAPTER 6 Resources

Kaiser Permanente Breastfeeding Breast Pumps and Supplies

Clinics and Lactation Consultants Contact your local Kaiser Permanente Medical Center.
Anaheim (714) 279-5100 Antelope Valley (661) 533-7600 *
Antelope Valley (661) 533-7600 Bakersfield (661) 869-6438
Bakersfield (661) 869-6438 Baldwin Park (626) 851-5820
Baldwin Park (626) 851-6013 Downey (562) 461-6614
Downey (562) 461-6614 Fontana (909) 427-4560 *
Fontana (909) 427-6234 Irvine/Anaheim (949) 932-2707
Irvine (949) 932-5892 Los Angeles (323) 783-7808 or (323) 783-4345
Los Angeles (323) 783-7808, (323) 783-4345, Panorama City (818) 375-3018
(323) 783-4472
Riverside (951) 353-4475 *
Panorama City (818) 375-3340
San Diego (619) 528-5153
Riverside (866) 883-0119
South Bay (310) 816-5440
San Diego (866) 940-2218
West Los Angeles (323) 857-4065 *
South Bay (310) 517-4300
Woodland Hills (818) 719-4305*
West Los Angeles (323) 857-4121
Woodland Hills (818) 719-2826,
* These Health Stores are open only from Monday to
(818) 719-2255
Friday from 9 a.m. to 5 p.m.

Kaiser Permanente Health Lactation Web Sites

Education Departments
For class information from your local Health
Education Department, call the Healthy Living
Helpline toll-free at 1-866-402-4320.
ameda.comYour Baby Knows How to Latch-on
La Leche League
drjacknewman.comMany good video clips on
latching babies

31 Recommended Reading Eileen Behan, RD. Eat Well, Lose Weight While
lowmilksupply.orgInformation and support for Breastfeeding.
breastfeeding mothers with low milk supply Kathleen Huggins, RN, MS. The Nursing Mothers
bfar.orgFor women who have had breast surgery Companion.
Kathleen Huggins, RN. The Nursing Mothers Guide
to Weaning.
La Leche League International. The Womanly Art of
WIC (Women, Infants and Children)
Nancy Mohrbacher and Kathleen Kendall-Tackett.
WIC is a nutrition program that helps low-income Breastfeeding Made Simple.
pregnant women, new mothers, and young children
Jack Newman, MD. The Ultimate Book of Breast-
under the age of 5 to eat well and stay healthy.
feeding Answers.
Gale Pryor. Nursing Mother, Working Mother.
Amy Spangler, BSN, MN, IBCLC. Amy Spanglers
Breastfeeding: A Parents Guide.

American Academy of Pediatrics (AAP), 2, 24, 28 Holds, 6
Artificial feeding, 2, 28 cradle hold, 6
Attachment and bonding at birth, 3 clutch or football hold, 7
Skin-to-skin contact, 3, 5, 12, 28 cross cradle or transitional hold, 6
side-lying position, 6
Behavior of baby Latch, 7, 14, 16, 19, 28
Fussy, 28 breaking suction, 8
Sleeping problems, 27 lips open, 8
Benefits of breastfeeding, 12 nose to chin, roll it in, 7
Bra, 17 rooting reflex, 7
Breast engorgement, 15, 19 Log, 1011 (Table 2), 27
Breast fullness, 15 Often, 4, 13
Electric breast pump, 15, 16 hunger (feeding) cues, 4, 8
Hand express, 1521 Pain, 8, 1517
How to treat, 15 relief, 17
Infection, 15 acetaminophen, 15
Breast milk changes, 28 antibiotics, 17
Breast milk storage guidelines, 20 (Table 4), 28 ibuprofen, 17
Breast pump, 12, 1720, 24, 28 sore breast, 1617
Choosing the right pump, 18 (Table 3) mastitis, 1617
Electric breast pump, 15, 16, 18, 19 plugged milk ducts, 1617
Hand pumps, 18 sore nipples, 15, 16, 28
Preparing milk for feeding, 20 new pregnancy, 16
Preparing to pump, 19 teething, 16
Procedure, 1920 thrush, 16
Breastfed baby at home, 5 Questions, 9
Feeding station, 5 Supplies
Introducing a bottle, 21, 28 bottles, 19, 20
Breastfeeding breast pads, 23
Benefits of, 12 breast pump, 12, 1720
Challenges, 1521 electric breast pump, 15, 16
breast engorgement, 15 gel pads, 16
breast fullness, 15 lanolin cream, 16
Early, 3, 16 milk storage bags, 19
colostrum, 3, 16 Value of, 12
Fitting into your lifestyle, 2325 Well, 4
birth control, 25 While sick, 29
breastfeeding for the first year and beyond, 24
diet, 23, 29 California state law, 23
exercise, 2324 Assembly Bill 157, 23
in public, 23 Assembly Bill 1025 (California Lactation
leaking breasts, 23 Accommodation Law), 24
returning to work or school, 21, 24 Cesarean birth (C-section), 6, 7
support groups, 25 Colostrum, 3, 16, 19, 27, 28
weaning, 24 Definition, 3, 28

Diet, 23, 29 Neonatal intensive care unit (NICU), 18, 19
Alcohol, 23 Night feedings, 12, 27

Feeding patterns, 1214 Pain management, 16

Cluster feeding, 13 Plugged milk ducts, 1617
Growth spurts, 13, 21 Pump, 5, 19, 21, 28
One breast or both per feeding, 12
Formula, 2 (Table 1), 28 Resources, 3132
Enfamil, 2 Kaiser Permanente, 31
Frequently asked questions, 2729 breastfeeding clinics and lactation consultants,
Gas, 27, 28 breast pumps and supplies, 31
Meconium, 27 health education departments, 31
Lactation Web sites, 31
Hand expressed milk, 12, 1521, 24 La Leche League, 31
Process, 2021 Recommended reading, 32
Hormones, lactation, 1, 4, 19, 23 WIC, 32
Oxytocin, 1
Prolactin, 1 Skin-to-skin contact, 3, 5, 12, 28
Sleep cycle, 27
Infections, 1, 15 Sleepy babies, 12
Mastitis, 1617 Rapid eye movement, 12
Thrush, 16 Tips to wake a sleepy baby, 12
Sucking, 9, 27, 28
Kaiser Permanente Pacifier, 27, 28
Breastfeeding clinics and lactation consultants, 31 Swallows, 9, 12, 27
Breast pumps and supplies, 31 Supplies for breastfeeding, 18
Health education departments, 24, 28 Bottles, 19, 20, 21
Support groups, 25 Breast pads, 23
Breast pump, 18, 28
Lactation consultant, 8, 9, 12, 14, 15, 16, 18, 19, 23, Electric breast pump, 15, 16, 18, 19
24, 25, 27, 28, 29 Gel pads, 16
Latch, 7, 14, 16, 19, 28 Lanolin cream, 16
Breaking suction, 8 Milk storage bags, 19
Lips open, 8 Support groups, 25
Nose to chin, roll it in, 7 Community centers, 25
Rooting reflex, 7 Kaiser Permanente, 25, 31
Low milk supply, 13 La Leche League, 25, 31
WIC, 25, 32
Medications, 29
Midwife, 9, 24 Tips for mothers helpers, 5, 8
Milk ejection reflex, 9
See Milk let-down. Videos, 8, 21, 31
Milk let-down, 9, 14, 19
Milk supply, 8, 1314, 18, 19, 21 Weaning, 24
Foremilk, 8 Web sites, 2, 6, 8, 18, 23, 31
Hind milk, 8
Milk volume, 19, 28

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