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Breastfeeding Basics

An important reason for considering breastfeeding is the benefits for your baby. That's because breast milk contains the perfect balance of nutrients that will help your baby fight common childhood diseases and recover quickly from illnesses.

Some babies nurse naturally from the breast right away; others need a little help from Mom. The information on the following pages should be helpful, but if you need more advice and support, talk to your doctor or the nurses where you delivered your baby about helping you find a lactation specialist in your area.

Latching On

The different ways of putting baby to the breast:

Learning to breastfeed takes time and practice for both you and your baby. Of course, the first step to success is to have a comfortable position and a good latch-on...need a few tips?

Three easy steps to latching on:

Start by positioning baby's face and body so she's facing you, with her head at the level of your breast.

Then:

• Gently lift and support your breast with your fingers below and your thumb on top of the breast, well away from the areola (the dark area around your nipple).
• Gently stroke her lower lips with your nipple until she opens her mouth very wide.
• Quickly pull her onto your breast so that her nose, cheeks and chin are all slightly touching your breast. If her nostrils are blocked, pull her bottom upward and closer to you, so her head will move back slightly.

Since your baby sucks more efficiently on the first breast she uses, you should alternate the side she starts nursing on from feeding to feeding.

How to check for proper position:

If you can imagine being able to draw a straight line from her ear to her shoulder to her hip, your baby will be latched on correctly.

How to remove your baby from your breast:

When you need to remove your baby from your breast, it is important to first break the suction. To do this, gently slip one of your fingers into the corner of her mouth before removing her from your breast.

Options for Positioning Your Baby

How you hold your baby can determine how comfortable it is for you and how effective it is for your baby to nurse. Review these breastfeeding positions now and your back will thank you later.

The "cradle" hold:

• Sit in a comfortable chair with support for your arms and back. (Don't lean over your baby.)
• Place your baby across your stomach with his face and knees close in, facing your body.
• His head should be in the bend of your elbow, with his mouth in front of your nipple.
• Tuck his lower arm around your waist, out of the way.

The "cross-cradle" hold:

• Hold your baby across your body in the arm opposite the breast from which he will be feeding. His position will be the same as in the "cradle" hold, but you will use the other arm to hold him.
• He should be at the level of your breast, with his whole body turned towards you.

The "football" or "clutch" hold:

• Place pillows at your side to support your elbow and your baby's bottom.
• Tuck him into the side of your waist, cradled under your arm.
• Place his head in the palm of your hand at the level of your breast.
• Support the base of his head between your thumb and forefinger.

Lying down to breastfeed:

• Lie on your side. Use one pillow to support your head and neck, and another along your back.
• You may want to put a small, rolled blanket behind your baby's back.
• Lay your baby next to you so that his mouth is opposite your nipple. When he opens his mouth wide, he is ready to latch on.
• After the feeding, place the baby back in his crib. This is the safest place for him to sleep if you're feeding this way at night.

Your position may change over time:

Even if one position does the trick at first, you may find that adding some variation will help you from straining your back. And remember, as your baby grows, the old tried-and-true football clutch may stop doing the trick. Many moms find that different positions work better for older babies than for newborns.

How Often and How Long to Breastfeed

Most doctors recommend feeding your newborn baby 8 to 12 times in every 24-hour period. Generally, feedings last for 10 to 60 minutes. Paying attention for signs from your baby will help you determine how long a feeding will last. Since your newborn's stomach is very small and breast milk is easily digested, the milk obtained from a feeding will empty from the stomach in about one to two hours. Frequent feedings are very important to ensure a good milk supply and support your baby's healthy weight gain.

Is Your Baby Getting Enough Breast Milk?

In the beginning, you'll know that your newborn is getting enough if, after about day four, she no longer passes meconium (thick, black or dark-green stools) and begins to pass yellow, seedy, runny stools three or more times a day. During the first month she is wetting six to eight diapers and having at least two bowel movements a day. Once your milk supply is established, she should gain about 2/3 ounce a day during her first three months. Between three and six months, her weight gain will taper off to about 1/2 ounce a day.

Signs Your Baby is Getting Enough Breast Milk

• She is sleeping for a couple of hours right after feeding.
• She is breastfeeding every two to three hours - at least eight times in a 24-hour period.
• She usually breastfeeds for 10 minutes or more and no longer than 60 minutes. (Let your baby, and not the clock, determine how long feeding lasts.)
• You can hear a rhythm of suck/pause/suck during feedings.
• Your baby usually breastfeeds at both breasts.
• Your breasts feel full before a feeding and softer afterward.
• She appears satisfied and no longer hungry after feedings.

How do You Know When Your Baby is Hungry?

As your baby gets older, she may give you signs that she is ready to be fed. She may lick and smack with her lips and tongue, make sucking motions, clench her fists and put her hand to her mouth, flex her arms and legs or nuzzle against your breast. And of course, she may cry, too.

If you think your baby is not getting enough breast milk, check with your health care professional.

Charting the Course

Patterns commonly seen in breastfed infants:

INDICATOR	AGE	DESCRIPTION
URINE OUTPUT	3-4 days	Pale yellow color to clear (NOT deep yellow or orange)
	5-7 days	6 wet diapers or more
STOOLS	1-2 days	Thick, tarry and black color
	3-4 days	Greenish-yellow color
	5 days	Yellow color (NOT white or clay-colored) with watery, seedy or mustard-like texture
	By 5-7 days	3-4 stools/day
	1 month & older	Number of stools may vary (can be several stools/day, 1 every 3-4 days or 1/week)
WEIGHT GAIN	0-6 months	4-8 ounces/week
	7-12 months	3-6 ounces/week
BREASTFEEDING PATTERN	0-1 month	8-12 feedings/24 hours
	1-2 months	7-10 feedings/24 hours

Content Provided by Similac

Breastfeeding Questions & Answers

[Adapted from The Nursing Mother's Companion, by Kathleen Huggins. Copyright © 2005, used by permission of The Harvard Common Press.]

Is breast and nipple size or shape a factor in nursing?

No. Size and shape have no bearing on successful breastfeeding.

Do flat or inverted nipples interfere with breastfeeding?

No. Nipple shape and size varies from woman to woman, and this does not commonly affect one's ability to breast feed. By the end of pregnancy, 90 to 95% of all women have nipples that protrude, even if they began with flat nipples or inverted nipples (a rare case where nipples look like a slit or fold). An inverted nipple can be detected as follows: Gently pinch the base of your nipple with your thumb and finger. If the nipple shrinks back, it is inverted. Regardless of the type of nipple you have, your baby will most likely draw your nipple out by nursing.

Lactation consultants are available to help your baby latch-on to your nipple in the beginning. Many women visit with lactation consultants before their baby is born.

Is there some type of nipple preparation that I can do now?

No. Physical and hormonal changes brought-about by pregnancy and birthing will naturally prepare your breasts for your baby. Attempting to "prepare" nipples by pulling on them (or rubbing them with a rough towel) is ineffective, and may only increase the chance of premature contractions.

Should I try and save my colostrum now, before I deliver?

No. Colostrum is really early milk, and is to become your baby's milk after birth. If you wish, rub it into your nipples and areola, or rinse it away with plain water.

About Breast-Milk

As you collect & consider the facts about breastfeeding, it is important to note that the American Academy of Pediatrics, World Health Organization and the U.S. Surgeon General, recommend that babies breast feed for a minimum of 1 to 2 years. In addition to nutritional advantages, much has been written about the emotional and psychological advantages of nursing one's own baby.

Here are some points to consider:

Breastfeeding...

• is easy to learn with the help of your nursing staff or lactation consultant.
• is part of the natural motherhood process, literally helping the uterus return to its pre-pregnancy state more quickly, while reducing the bleeding time after birth.
• can help protect you against breast and ovarian cancer.
• releases hormones that help you relax and enjoy your baby.
• reduces a baby's risk of food allergies, and initial research suggests that breastfeeding may have a long-term positive effect on your baby's immune system.
• provides growth hormones to your baby including those that produce brain, respiratory and digestive maturity, that cannot be reproduced in formula.
• allows you to give nourishment and nurse your baby at any time, without the assistance of a pump.

Breastfeeding Videos

Breast-Milk...

• has nutrients that are not found in any formula.
• is key in helping your baby remain healthy.
• is all the food your baby needs for the first 6 months.
• helps boost your baby's immune system.
• is simpler than purchasing, mixing and remembering to stay supplied with formula.

Just as your body provides exactly what your baby needs to grow inside your uterus, your body prepares the perfect food for your baby after birth. Your breast-milk will be just right, even if your baby is born prematurely. Your milk continues to change to fit your baby's needs as she grows and develops.

Sore Nipples

If your nipples become sore try these suggestions:

• Nurse on the less sore side first (your baby will nurse more vigorously on the first breast offered).
• Use deep breathing, soft music, or other relaxation techniques before and during breastfeeding.
• Express a little milk before nursing to stimulate the milk to let down (if let-down has already occurred, your baby won't have to nurse as vigorously).
• Massage your breasts while nursing to help stimulate milk flow.
• Use bras and bra pads that do not have a plastic lining.
• Change bra pads often to keep nipples dry.
• If your nipples become dry or cracked, use a little USP-modified lanolin on them to form a moisture barrier.
• Wear multiple-holed breast shields between feedings (this lets the air circulate around your nipples and protects nipples from rubbing on fabric).
• It is not normal to have blisters, cracking, bleeding and pain that continues during or between feedings. Consult your health care provider or a lactation consultant.

Gradual Weaning

Weaning gradually is best for both you and your baby. It allows you to slowly decrease your milk production without experiencing fullness or discomfort.

Start by skipping one daily feeding and substituting formula or milk. This should be discussed with your baby's health care provider. Choose the feeding in which your baby is least interested. Wait 1 to 3 days until you are not producing as much milk at that feeding and then choose a second feeding to eliminate. To minimize engorgement, choose the feeding 1 or 2 hours after the one you've already stopped. Continue this process until your baby is only nursing once a day.

After a few days of once-a-day feedings, start skipping days between breastfeedings until you eventually stop nursing altogether. By this time, you'll be producing very little milk, and your baby should give up the last feeding easily. Gradual weaning also gives your baby time to adjust to drinking from a bottle or a cup.

Partial Weaning

Partial weaning allows you to eliminate certain feedings but keep breastfeeding at other times. For example, you may decide to nurse in the morning and at night and give your baby formula at other times. One advantage of this method is that if you decide later to return to full breastfeeding, you'll be able to do so.

Abrupt Weaning

This is difficult for both you and your baby, however sometimes circumstances dictate sudden weaning. You'll probably become engorged with unexpressed breast milk. If you'll be returning to breastfeeding, try to pump or express your milk at regular feeding times until you can resume feeding.

Weaning begins when your baby begins to get other sources of nourishment; such as solid foods and cereals. As your baby grows, you will see changes in behavior such as reaching for foods, testing, and gumming them. Weaning can be accomplished by the baby and the mother adjusting breastfeeding and allowing more solids.

Gradually weaning your baby from breastfeeding will reduce breast engorgement for you and anxiety for your baby. This process naturally begins when you introduce other foods to your baby at about 6 months. The process of weaning can last a few weeks to more than a year.