Breastfeeding & Bottle Feeding | Breastfeeding |
To or Not to
About Breastfeeding / Nursing
Breastfeeding is something that mothers have been doing for years so it must be fairly easy? You simply put your baby close to your breast, she latches on successfully and drinks happily, right? Well, it doesn’t always work that easily, especially your first time. But with practice breastfeeding can be a very enjoyable process for both you and your baby. This article provides additional information about breastfeeding. Please refer below.
What’s in Breast Milk?
As discussed in “To or Not to” breast milk “contains antibodies that can protect infants from bacterial and viral infections,” (CDC) the iron in breast is in a form easy for babies to absorb and the “chemicals in breast milk may be important for optimal brain development [DHA and ARA]” (Spock 242).
The one thing breast milk does NOT supply is sufficient vitamin D. According to American Academy of Pediatrics, (“AAP”), “[a]ll breastfed infants should receive 200 IU of oral vitamin D drops daily beginning during the first 2 months of life and continuing until the daily consumption of vitamin D-fortified formula or milk is 500mL [16.9 ounces]” (“Breastfeeding”). My daughter's pediatrician recommended giving 400 IU of vitamin D daily. I plan to start giving my baby girl Enfamil Poly-Vi-Sol Without Iron drops when she is close to 1 month old.
It will take a few days for your mature milk to "'come in' some time between the second and sixth day after you give birth" (LLL, "My"). Initially your baby will receive colostrum, "which will provide him with all the nourishment he needs, plus antibodies and other immune properties to protect him from illness" (LLL, "My"). It will be important to have your baby be on your breast a lot even though your "mature milk" is not in to not only help her learn how to breastfeed but also to help your body know to start to produce breast milk. Note: As stated it is normal for it to take a few days to get your true supply of milk in. With my first baby the nurse was acting like we had to give my son a bottle since he wasn't getting milk right away but it is typical to not have mature milk the first few days.
Once your milk does come in, if you pump you will notice that the breast milk will separate into different parts. According to Hogg, the different layers you see is also how it is delivered to your baby,
Quencher (first five to ten minutes): This is more like skim milk…satisfies Baby’s thirst. It’s rich in oxytocin....[and] also has the highest concentration of lactose.
Foremilk (starts five to eight minutes into the feed): More like the consistency of regular milk, foremilk has a high protein content, which is good for bones and brain development.
Hind milk (starts fifteen or eighteen minutes into the feed): This is thick and creamy, and it’s where all the goody-goody fat is – the “dessert” that helps your baby put on weight (106).
Due to the different layers of milk, most research now suggests to make sure you let your baby finish drinking from one breast before switching to the other to make sure the baby gets all three types of milk, quencher, foremilk, and hind milk. . “If you switch sides after the first ten minutes, at best your baby is only starting to get foremilk and never gets to the hind milk. Even worse, this switching eventually sends a message to your body that it’s not necessary to produce hind milk” (Hogg 106). The article by Vickers on the La Leche League also documents this same information.
If the baby is only getting the quencher or foremilk and not the hind milk then the baby may have one of two problems 1)Always hungry or 2)Spitting up as too much lactose or milk sugar was consumed. The mother may also have overactive let-down if both breasts are continually used in each feeding and one breast isn’t allowed to empty (Vickers).
It’s also important to note that the consistency of your breast milk may change throughout the day. Breast milk is richest in fat in the morning (after a good night’s sleep), so you may want to save the morning pumped milk to give to the baby before bed to help the baby sleep longer (Hogg 117). In addition breast milk “contains a natural sleep-inducing protein that…puts baby into a restful slumber….[t]he “hormones induced by sucking tranquilize mother” (Sears 123).
When your milk first comes in you may feel like your breasts are going to burst and they may feel uncomfortable. "This fullness is due to additional blood and fluid traveling to the breasts, preparing them for producing milk, as well as the increased volume of the milk itself" (LLL "My"). Some women only notice a little fullness while others feel like their breasts are extremely full. Make sure you continue to breastfeed to help relieve the engorgement although it may take 12-48 hours for the fullness to subside (LLL "My"). "Intravenous (IV) fluids, or drugs such as pitocin may cause even more retained tissue fluid, which often takes 7-14 days to go away. Avoid long pumping sessions and high vacuum settings on breast pumps to prevent extra swelling of the areola itself" (LLL "My").
The main thing that worked well the first few days for me was to first apply a warm compress before the feeding and then after the feeding to use a cold compress to reduce the swelling and relieve pain. You don't want to use the warm compress too long as it then could increase swelling and inflammation. The main problem I found with the initial engorgement (besides it being uncomfortable) was that my baby was not able to effectively latch on since engorgement "can cause the nipples to flatten, or the dark area around the nipple, the areola, to become hard and swollen" (LLL"My"). One way to help relieve some of this pressure in the areola to allow your baby to latch easier is called reverse pressure softening (RPS). Refer to this link which has an excerpt by Cotterman about how to do RPS. You may need to do RPS for a week until your baby can latch on well again. My lactation consultant said I could temporarily use a plastic nipple shield to help my baby latch. This worked really well for me. The nipple shield also works well if your let down is too fast as the shield will slow down the milk and help keep the milk from spraying into your baby's mouth.
After the first couple of days, the main engorgement should be relieved and if you continue to breastfeed and allow your baby to finish the first breast before switching sides this should help your breasts not become engorged. If you go several hours without feeding your baby your breasts may become engorged again. The first couple of weeks I would pump for a few minutes after feeding my baby to relieve engorgement. I didn't want to pump too long as I didn't want my body to continue to produce an overabundance of milk; I would pump just long enough (few minutes) to help relieve some of the engorgement.
What is let-down? The let-down reflex “is a hormonally driven process that gets the milk from the upper portions of the breast through the ducts to the sinuses beneath the areola, out the nipple and finally into a baby’s waiting mouth” (Vickers). But how do you know if your breasts have let-down and the baby is getting breast milk? “THE BREASTFEEDING ANSWER BOOK goes on to say that the ‘most reliable sign of the let-down is a change in the baby’s sucking and swallowing pattern from quick sucks with occasional swallowing to long, slow sucks with regular swallowing or gulping’….Some women barely feel any let-downs, while others experience a tingly sensation in the breast every time the milk lets down” (Vickers).
Some women may have either fast or slow let-down. If you have an “overactive let-down, milk is ejected forcefully from the breast and in great quantity.” If this occurs, the baby may swallow air since she is trying to keep up with the fast let-down and may also consume too much foremilk in proportion to hind milk, both of which may contribute to the baby getting a stomachache “from the combination of filling the tummy too fast, swallowing air to keep up with the let-down and the laxative effect of a large quantity of lactose (milk sugar) (Jozwiak).
One recommendation to counter fast let-down is to not switch sides, while breastfeeding. As discussed in “Breastfeeding Tips,” pumping for a brief period of time before feeding the baby may help if you have either 1) fast letdown or 2) slow letdown.
Position & Latch On
It takes practice establishing the best way to hold your baby so both you and your baby are comfortable. The following list is a summary of the tips based on my personal experience in addition to those I read at LLL’s web site:
- Make sure you’re comfortable. Sit in your comfort chair, ideally with your feet supported by a footrest and position the baby in your lap. You may want to use a Boppy Pillow or regular pillows to support the baby.
- Use one of the breastfeeding holds (cross-cradle, football, cradle, or side-lying). Position baby by making sure “he does not have to turn his head to reach your breast. His mouth and nose should be facing your nipple.” This will allow your baby to swallow more effectively.
- “Support your breast.”
- Help baby latch on. My sister-in-law told me how you can rub the baby’s bottom lip (with your nipple or finger) and it usually encourages the baby to open his mouth. It is important to bring the baby to you and not your breast to the baby. (“How”).
You can use regular pillows or buy a support pillow like a Boppy Pillow, to help support your baby and get her level to your nipple. Initially you may even need to ask for assistance from your spouse to help arrange your baby and provide words of encouragement.
A few of the common breastfeeding holds as described by the LLL in "How do I position my baby to breastfeed?" are:
- Cross-Cradle Position
- Football Position
- Cradle Position
- Side-Lying Position
The cross-cradle position is one of the common holds during the first couple weeks as it gives you more control to help guide your baby. In this hold if you are breastfeeding on your left side your left hand supports your left breast in a "U" hold and you support your baby with your right arm and guide your baby into your left breast with your right hand.
The football hold is another easy hold to do when you are learning to breastfeed and is good if you had a C-Section as it keeps the baby away from the incision. This hold was also recommended to me by my lactation consultant since she knew I had a preschooler at home. In this position you support your baby's head in your hand along side the breast. Your baby is laying on her side on your side which allows your other side to be available to your older child. The first week home from the hospital I would use this hold and sit on our family room sofa and my 2 1/2 year old would sit next to me and rest his head on my lap opposite from the side I was breastfeeding.
The cradle position is similar to the cross-cradle except if you are breastfeeding on your left side then you support your baby with your left arm and support your breast with your right hand.
The side-lying position allows you to breastfeed in bed. Please refer to the LLL web site article for more information on each hold along with a descriptive picture.
It also takes practice to have the baby latch on correctly. You will need to help support your breast and guide it into your baby's mouth in order to help her latch on. You do not want to push your baby's head onto your breast since her natural reflex will be to flex backward; rather use your hand to help direct her into your breast by "pushing" with the palm of your hand between your baby's shoulder blades. Make sure you wait until your baby's mouth is open wide before helping her latch. You will also want to make sure your baby's body is in line, head, neck, and back i.e. do not twist your baby's head to line up with your breast instead move the entire baby toward you.
If the baby doesn’t latch correctly, she may not be able to drink properly and or it may be very painful for mom and may cause mom to develop cracked nipples. You may have heard about the problem of sore nipples when breastfeeding. In general, the main solution to prevent sore nipples or (cracked nipples) is to make sure the baby latches on correctly.
How Often & How Long
This is definitely going to vary baby to baby. Not only is there the baby differential, but mommy impacts this one as well since not all women produce and distribute breast milk the same. Most research advises against watching the clock while breastfeeding. Although, I definitely agree that ultimately you have to feed your baby according to your baby’s needs and you shouldn’t be concerned about timing the feeding; I feel it is also nice to have a rough idea of the “norm” times for breastfeeding.
With my son I definitely watched the clock and tracked how long he would eat and with my daughter after the first week I rarely kept track of the time. Part of this dealt with how I felt when breastfeeding my son compared to my daughter. My son never breastfed well and I supplemented a lot with the bottle and so I would try to determine if he ate enough while breastfeeding to determine if I needed to also give him a bottle. With my daughter, she primarily only breastfed and breastfed really well so I didn't have to be concerned with the amount of time she was breastfeeding I knew she was getting a lot of breast milk.
According to the AAP web site, “[s]ome newborns feed as often as every 1.5 hours, while other feed about every 3 hours. Breastfed newborns will feed 8-12 or more times per 24 hours….” It is also recommended to wake your baby if “3-4 hours have passed since the last feeding” (“FAQs”). My son ate extremely well as a newborn and we never had to wake him to feed him. With my daughter we did wake her the first two weeks since she originally lost 10% of her birth weight. Our daughter's pediatrician said the first couple weeks it is good to make sure they are eating every couple of hours to make sure they don't get dehydrated and to make sure they are eating enough for the entire day.
As discussed above, allow your baby to fully finish on one breast before switching to the other.
For more information on how long and how often to feed the baby, please refer to the “How Much” article which discusses the average time on each breast, the average amount a baby drinks, and the number of times the baby breastfeeds during a 24 hour period. The article also discusses other signs a breastfeeding baby is drinking enough.
Increase Milk Supply
It is important to remember that primarily “milk production is based on supply and demand—how much milk the breast makes is determined by how much milk is removed from the breast” (Vickers). Although, some women may produce a ton of milk while others have to work at it. You may not be sure how much milk your producing, so one way to find out is fifteen minutes before you breastfeed, pump your breasts and measure what you are yielding. “Taking into account that a baby can extract at least one ounce more by physically sucking at your breast…” (Hogg 108).
If you don’t feel your producing enough milk then it is usually recommended to allow baby to be placed on each breast at each feeding. Remember as stated above, to let the baby primarily finish feeding on one side so he can receive the hind milk before switching to the other side. In this case you are primarily only switching the baby to the other side to stimulate the breast so it can produce more milk.
I never seemed to have enough milk with my first baby and I definitely had enough with my second baby. I think a lot of it had to do with the fact with my second baby I primarily breastfed. A lot truly depends on supply/demand. The more you breastfeed the more your body will produce.The more you supplement the less your body will produce. So if you really want to exclusively breastfeed and you're not producing enough milk and need to supplement then I would try pumping for a few minutes after each breastfeeding, try to breastfeed as often as you can, and when you need to supplement pump at the same time someone is giving your baby a bottle or pump immediately afterward.
A friend at work mentioned that you produce more milk if you are well rested. Dr. Greene also suggests getting “as much sleep as possible.” This may be why typically you produce less milk at the end of the day when you are more tired. Sleep is very important for many reasons, but that is easier said than done. Also, according to Dr. Greene, drinking more water, at least eight glasses a day, will also increase your milk supply. My friend was advised by others to drink a breastfeeding mom herbal tea to help produce more milk. I would make sure if you decide to drink a special tea to produce more milk that you really know what ingredients are in the tea, just because it is advertised to help breastfeeding moms produce more milk doesn't mean it has ingredients you want to give your baby. I do know several women that used a special herbal tea and liked it. You may want to check out your local La Leche League for more information.
Cracked Nipples and Thrush
If the baby is latched on correctly it will help eliminate problems like cracked nipples. “Nipple tenderness at the beginning of a feeding may be normal in the first two to four days of breastfeeding. Soreness that is more intense or continues for a longer time indicates that some adjustment needs to be made” (LLL, “How”). To help sore nipples you may want to use a warm, moist compress, (unless yeast infection is present) and usually a breast cream can help. If you have severely cracked nipples putting plastic nipple shields on while breastfeeding may enable your nipples to heal. It is generally not recommended to use plastic nipple shields for an extended period of time.
Besides cracked nipples, your nipples could be sore due to a condition called thrush, “which is a yeast infection of the nipples.” Some symptoms of thrush as documented at the following LLL article, “Is Thrush Causing My Sore Nipples?”) are:
- Itchy or burning nipples that appear pink or red, shiny, flaky, and/or have a rash with tiny blisters.
- Cracked nipples
- Shooting pains in the breast during or after feedings.
- Intense nipple or breast pain that is not improved with better latch-on and positioning.
- Deep breast pain.
It is important to treat thrush since it is easily spread and because “it also thrives in warm moist environments such as your baby’s mouth and your nipples” (LLL, “Is Thrush”).
Plugged Ducts and Breast Infections
Some women may get a plugged duct which is what happens “when the milk duct has become inflamed because the milk is unable to flow through easily. You may notice redness, or feel a tender spot or sore lump” (Walters). At my follow-up visit after the birth of my baby, my gynecologist examined me for plugged ducts and she mentioned that if I get pain or feel a lump that generally if you continue nursing the plugged duct will be relieved. I tried to make sure I breastfed or pumped frequently to help prevent a plugged duct.
Some other tips written by Walters are:
- Apply heat.
- Take your bra off as if it is too tight it may be a cause.
- Check baby’s position to make sure he’s breastfeeding properly.
- Nurse frequently on side with plugged duct.
If the plugged duct doesn’t clear up it will get infected, which is called mastitis. You may have to take an antibiotic to clear up the infection. “[I]f a mastitis is not treated quickly or correctly” it may turn into a breast abscess. A breast abscess “is a very painful, localized infection containing pus and must be treated immediately” (Walters).
In addition, your breasts may feel different when lactating, but “if you discover a lump that does not go away after a week, even after careful treatment of a plugged duct, you should consider consulting with your doctor” (Walters).
The above information simply is a reminder to make sure you not only take care of your baby but also take care of yourself. Please follow-up with your healthcare professional if you feel anything unusual with your breasts.
Storing Breast Milk
Breast milk can be stored for a short period at room temperature, in the refrigerator, or in the freezer and sources differ on how long you can keep breast milk. Please refer below for guidelines according to the La Leche League International (LLL, "What").
||Amount of Time
||4 (ideal) - 6 hours (acceptable)
||66 to 78°F
||72 hours (ideal) up to 8 days (acceptable)
|24 hours in the refrigerator (do not re-freeze it)
||6 months (ideal) up to 12 months (acceptable)1
||-0.4 to -4°F
1If you do freeze the breast milk, even though according to the LLL you can keep the milk up to 12 months you may not want to keep the milk longer than six months. Your body produces a different type of milk early in the baby’s life versus later so you would not want to give a nine month old baby breast milk you pumped when he was three months old. According to Eiger, “[i]t’s best to use milk soon after collecting it. Ideally, you will not keep it longer than three months.” In addition it is not good to freeze the breast milk for an extended period of time since “long-term freezing alters the chemical composition of the milk” (Eiger 351).
If you have frozen breast milk and you need to give your baby a bottle should you use the fresh milk you pumped that day or use your frozen milk? I liked to do a combination. "Refrigerated milk has more anti-infective properties than frozen milk" (LLL, "What"). Based on that ideally you would want to always use the current refrigerated milk but since your body produces milk differently for a 3 month old baby versus a 6 month old baby eventually you'll want to use the older breast milk as well.
Breast milk may separate into layers, a milk layer and a cream layer when it is stored. As discussed above, there are three different types of breast milk, quencher, foremilk, and hind milk. Simply swirl the milk to re-combine it. It has been found that, "thawed milk may smell or taste soapy" because of the breakdown of milk fats. "The milk is safe and most babies will still drink it" (LLL, "What").
Please refer to the “Storing Breast Milk or Formula" article for more information.
How to Warm the Milk
For bottles made with formula or breast milk from the refrigerator we always warmed the bottles using a bottle warmer. You can also warm the milk by running it under warm water or first heating a pan of water on the stove and then putting the container in the pan. Do not heat the milk directly on the stove. You are not suppose to use a microwave as it "may cause the loss of some of the beneficial properties of the milk" and it "may leave hot spots in the container of milk [or formula]" (LLLI). You do not want to boil the milk.
If the breast milk is frozen, first "thaw in the refrigerator overnight or under cool running water. Gradually increase the temperature of the water to heat the milk to feeding temperature" (LLLI). Both of our babies like to drink the milk warm or at least at room temperature. We always tested the milk on our wrists before giving it to them.
Exercise is definitely good for the body. Trying to find time in the day when you have a little one may not be easy. In addition, if you are breastfeeding you may want to pay attention to when you exercise. According to Eiger, it is best to exercise after you breastfeed the baby. If you do strenuous exercise then your breast milk may taste differently to the baby due to a short-term rise in lactic acid concentration. “Lactic acid levels are less likely to rise after moderate exercise, and in any case are not harmful to infants.” It is also important to drink extra water when exercising since you’ll need to replenish any fluid lost while exercising (150-151).
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---. “Is Thrush Causing My Sore Nipples?” La Leche League International. 19 Nov. 2009
---. "My breasts feel extremely full and uncomfortable. What is happening and what can I do about it?"
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---. "What are the LLLI guidelines for storing my pumped milk?" La Leche League International.
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Last updated: March 2011; November 2010; November 2009