Questions and answers on breastfeeding

Advice from Nancy Held, nurse and IBCLC-certified lactation consultant

1. What are the benefits of breastmilk?

Human breast milk is rich in antibodies, which prevents or lessens the effects of many illnesses occurring in babies. Breastfed babies are less likely to develop ear infections, respiratory infections such as pneumonia, childhood diabetes, meningitis, allergies and some childhood cancers. A breastfed baby also has a 30% lower chance dying of SIDS (Sudden Infant Death Syndrome) than if bottle-fed. Research has shown that breastfed babies have higher IQs than formula-fed infants and are less likely to develop learning disabilities. Mothers also reap the health benefits from breastfeeding, including lower risks of pre-menopausal breast cancer, osteoporosis and cervical cancer. Breastfeeding women tend to lose pregnancy weight quickly as they burn more calories than non-breastfeeding women do.

2. What should I do to get ready to breastfeed?

Many women find it helpful to select an area of their home, such as a part of the baby’s nursery or their bedroom, as a "nursing station" for breastfeeding their baby in the first few weeks of life. By establishing a breastfeeding routine, you may find it easier for both you and the baby to settle into a relaxed and comfortable breastfeeding pattern. Privacy can be an essential component of a nursing station, allowing you and your baby a chance to get to know one another. If total privacy is not possible, try to surround yourself only with people who are supportive of breastfeeding. The most important item in a nursing station is a chair or couch to sit on. Choose something comfortable, preferably with a straight back and with arm rests. As your baby grows older and you become comfortable with breastfeeding in many different positions, you may find nighttime feedings work best lying on your side in bed. Another consideration for your nursing station is a nursing pillow. My Brest Friend™ feeding pillow is ideal to use at every feeding since it not only supports your lower back and arms, but it raises the baby up to the level of your breasts for ideal positioning.

Remember, it is important to bring your baby to your breast, not your breast to the baby. The My Brest Friend™ is also just the right firmness to encourage your baby to stay awake for feeding while the adjustable, silent-release strap keeps the pillow in place for the duration of the feeding. Many women also use a footstool or a large telephone book to raise their feet and their lap. Experiment to see what works for you. A small table can also be useful to keep a glass of water readily available at every feeding and to have a radio or CD player nearby to provide relaxing music. Having a phone nearby can help prevent you from getting up during a feeding but you may choose to turn your phone off during feeding times.

3. How do I know my baby is ready to breastfeed?

Crying is actually the last sign of hunger. If you become attune to your newborn’s readiness cues, you can feed your baby in the ideal "quiet alert" state. Hunger cues such as licking movements, sucking motions, the rooting reflex, leg movements (like bicycle riding), and tense, clenched fists are important to recognize and respond to.

4. How do I get started breastfeeding?

Wash your hands before every feeding and after every diaper change. Find a comfortable place to sit, ideally at your nursing station. Unwrap your baby and undo your shirt and bra, allowing your baby to be skin to skin with you. Begin the feeding with the breast you ended the last feeding on. You may want to attach a safety pin to your bra strap to remind yourself which side to start with at the next feeding. There are several common positions for breastfeeding your baby. Correctly positioning your baby can help ensure that your baby is obtaining lots of milk at the feeding and can also minimize sore nipples. The most common breastfeeding position is the cradle hold, but the cross-cradle hold and football positions are excellent alternatives that you may find to be easier and more comfortable. Experiment and alternate your positions throughout the day until you discover what works best for you and your baby.

5. How long should I feed at each breast?

As you watch your baby breastfeed, you will notice he may slow down his sucking and possibly even fall asleep on the first breast after about 20 minutes. It is more important to watch your baby than to watch the clock! When you feel that he has finished the first breast, gently remove him from the breast, burp him, and position and latch him onto your other breast. Allow your baby to breastfeed for as long as he wishes on the second breast, then burp at the end of the feeding.

6. How often should I breastfeed my baby?

Newborns should breastfeed 8 to 12 times in 24 hours. Since breastmilk is easy for babies to digest, they need to eat every 2-3 hours around the clock with possibly one 4-hour stretch (hopefully at night!). Most health care providers recommend that you wake up a baby who is less than 2 weeks old if they are sleeping longer than 3 hours. Since a newborn’s stomach is only the size of a walnut, small, frequent feedings are essential for a good weight gain.

7. How do I know my baby is getting enough to eat?

Hearing your baby swallow during every feeding (a breathy ?ah? sound), noting that he seems content after feedings and that your breasts feel softer after the feedings are all good signs that your baby is getting enough milk. Another excellent way of determining how much your baby is taking in is to keep track of your baby’s diapers. Frequent feedings lead to frequent wet and stooled diapers. By the time your baby is 5 days old, your baby should be wetting at least 6- 8 diapers and his stools should change from dark green/black color to bright yellow/mustard color. If you are not seeing these diaper changes, contact your health care provider immediately. Most pediatric health care providers schedule office visits to see you and your baby within a few days of your release from the hospital to weigh your baby, see how things are going, and answer any questions you may have. It is normal for babies to lose up to 7-10% of their birthweight in the first week but most babies will return to their birthweight by two weeks of age. After two weeks, a weight gain of about one ounce a day assures you that your baby is getting lots of wonderful breastmilk and is thriving.

8. How can I allevaite shoulder and neck stress when I breastfeed?

Poor posture is a major factor in breastfeeding related muscle fatigue. My Brest Friend has an adjustable back support and arm rests to help you maintain ideal posture and baby positioning.

9. My baby falls asleep during feeding. How can I keep him awake?

When babies are too warm or comfortable, they tend to fall asleep. Try dressing baby lightly and position him/her on a firm pillow. My Brest Friend is designed with a firm, flat top to help keep baby awake and focused during feeding. Stroke your baby's feet, back and head to remind him to eat.

10. I don’t feel comfortable when I’m feeding. Any suggestions ?

Try setting up a nursing station where you regularly feed. I suggest using a foot stool to elevate your lap, a bottle of water to rehydrate you as you feed and the My Brest Friend™ pillow to provide consistent, proper positioning. Place the pillow securely around your waist. This should minimize shifting and movement that leads to discomfort and sore nipples.

11. How will I know if my baby is well-latched?

If you can hear slow and rhythmic swallows and the feeding is comfortable for you, your baby is well latched. You can also notice a well-latched baby’s ears moving during a feeding due to the strong action of his jaws working effectively to draw the milk from the breast. If your baby has incorrectly latched onto your nipple, you will probably be uncomfortable and your baby will be sucking quickly and not making any swallowing sounds. He will also most likely be fussy since he will be unable to obtain the milk he wants and needs. Carefully remove him from your breast and try latching-on again.

12. What causes soreness and what can I do to alleviate it?

IIt is not uncommon for a new mother to experience sore nipples, especially during the first week or two. However, cracked, bleeding, painful nipples are not to be expected and signal a need for help from a lactation consultant, breastfeeding counselor or health care provider. Poor positioning and latch-on of the baby at the breast are the primary causes of sore nipples. Starting the feeding in a correct position can help prevent or minimize sore nipples.

Consider starting the feedings on the least sore side first, since babies tend to be the most vigorous on the first breast. In the first few weeks, it may be helpful to feed sitting up using the most common feeding position, cradle hold. Use of a firm nursing pillow such as My Brest Friend™ can help bring the baby up to the level of the breast. Many women also raise their feet on a footstool or phonebook to help raise their knees. The baby should lie on his side, tummy to tummy, with his body in a straight line. Support your breast with your thumb on top and remaining fingers underneath, away from the areola. Encourage your baby to open his mouth by tickling your nipple on the baby’s lower lip. When your baby opens his mouth wide, bring him onto the breast quickly, helping him take as much of the areola as possible. It may be necessary to repeat this process several times until the baby is positioned correctly.

When removing your baby from your breast, insert a clean finger in the baby’s mouth between his jaws to help break the suction. Expressing a few drops of breastmilk onto sore nipples or applying a small amount of modified lanolin may help provide some comfort and aid the healing process. Also, avoid using bra pads with plastic linings as they can irritate sore nipples. Consider alternating your feeding positions to include cross-cradle, the football hold or side lying. If you fail to notice any improvement in soreness after 24-48 hours, contact a lactation professional or your health care provider for more assistance.