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“Nothing you do for children is ever wasted.” - Garrison Keillor

Breastfeeding FAQs

Q: Why is breastfeeding good?

Answer

Breastfeeding is good for babies, mothers, businesses and the environment.

Breastfeeding is good for babies because:

  • Human milk is complete. You don’t need to feed a baby anything else.
  • Human milk has what babies need to grow and develop.
  • Breastfeeding helps a baby know its mother and be emotionally healthy.
  • Human milk protects babies from many common and serious illnesses, such as ear infections.
  • Breastfed babies are less likely to get some long-lasting illnesses, such as diabetes.
  • Breastfed babies are less likely to have allergies.
  • Feeding only breastmilk may protect babies from Sudden Infant Death Syndrome, or SIDS.
  • Human milk is very important for babies who are born early or who are born too small.

Breastfeeding is good for mothers because:

  • Breastfeeding helps mothers recover from giving birth.
  • Breastfeeding helps mothers return to their previous weight faster than mothers who bottle-feed their babies.
  • Breastfeeding can help to delay another pregnancy.
  • Breastfeeding may help mothers avoid long-lasting illnesses, such as breast cancer, heart disease and diabetes.
  • Breastfeeding helps mothers feel good about having a baby.

Breastfeeding is good for everybody because:

  • Breastfeeding saves money.
  • Breastfeeding at work helps businesses.
  • Breastfeeding is good for nature.

Breastfeeding is best!
Women with some illnesses like HIV/AIDS should not breastfeed. They can spread HIV/AIDS to their baby through breastmilk.

Q: How long does it take to breastfeed my baby? How do I know when to switch breasts when feeding my baby?

Answer

Feed your baby for at least ten minutes on each breast, when first starting to breastfeed. Some babies may feed longer. Babies will let you know when they are finished. You should finish one breast before switching to the other. The quality of the milk changes during feedings. Breast milk is higher in sugar (lactose) and protein at the beginning of the feeding and higher in fat at the end. This is the fat that babies need to grow. Start on the breast you finished up on at the last feeding. Try to breastfeed evenly on each side, although your baby may prefer one side over the other and nurse longer. It is important to feed on both sides for stimulation of milk production.

Q: How long into a child’s life should I breastfeed?

Answer

The American Academy of Pediatrics recommends that you give your baby only breastmilk until he or she is six months old [this means no water, juice, other milk (such as cow’s milk) or formula. Most experts recommend that you continue to breastfeed for the first year of your baby’s life, or for as long as is desired by you and your baby.

Q: How can I increase my milk supply?

Answer

You can make all the milk your baby needs. Breastfeed whenever your baby seems hungry or needs comfort. As your baby breastfeeds, your body gets the message to make more milk. The more your baby breastfeeds, the more milk your body makes.

If your milk supply decreases, it is possible to build it up again. Breastfeed more often when you are with your baby or pump more often (every 1 to 2 hours) until your milk supply increases.

Try to pump every 3 hours when you are away from your baby. This will help keep a good milk supply.

Q: How do I express and save my breastmilk?

Answer

Your breastmilk is the best milk for your baby. If you can’t be with your baby, you can express your breastmilk by using your hand or a breast pump.

How do I help my milk flow?

Your milk flows naturally when your baby is breastfeeding. Try these ideas to help your milk flow:

  • Relax and think about your baby.
  • Put warm, wet cloths on your breasts for several minutes.
  • Massage your breasts in a circular motion.

What are some tips that may help me express my milk?

How do I express milk using my hand?

Place your fingers and thumb about 1 inch behind the nipple. Press back toward your chest; then roll your thumb and fingers toward the nipple. Collect your milk in a clean container. Move your hand around your breast and continue to drain milk from all parts of your breast. Continue until the flow of milk slows down then repeat on the other breast. Express from both breasts 1 or 2 more times. This will take about 20-30 minutes.

    • Allow enough time so you won’t feel rushed.
    • Wash your hands well with soap and water.
    • Find a quiet, comfortable place.
    • If you are using a breast pump, follow the pump manufacturer’s directions.
    • Milk expression should never be painful. If it is, you should stop and get help. The amount of milk you will get each time depends on your milk supply, the type of pump you are using and how relaxed you are. Your baby is able to remove milk from your breasts better than hand expression or pumping.
  • How do I express milk using a breast pump?
    • Wash your hands well with soap and water.
    • Follow the directions that come with each pump.
    • Express for 5-10 minutes or until the flow of milk slows down. Rest for 3-5 minutes, then repeat once or twice.
    • Express each breast until the flow of milk slows down and the breast softens.
    • Wash the pump after each use in hot, soapy water and rinse well.

Q: How do I know if I am making enough milk for my baby? How do I know if my baby is getting enough milk?

Answer

Making milk is easy when you know how and when to breastfeed. Remember the following key words: supply and demand. The more your baby breastfeeds and removes milk from your breast (demand), the more breast milk you will make (supply).

Signs to watch for in the first few weeks

  • Your baby is breastfeeding every 1-1/2 to 3 hours, or 8 to 12 times in 24 hours.
  • Your baby is having frequent dirty and wet diapers. The number of dirty diapers should increase from day 2 after birth to day 5. After day 5, most babies will have 4-5 dirty diapers and 6-8 wet diapers each day.
  • Your baby ends the feedings, after at least 10 minutes of swallowing and comes off your breast contented.
  • Your breasts feel full before feeding and soft after feeding.
  • Breastfeeding your baby is comfortable.
  • Your baby is back up to his or her birth weight by 7-14 days and is gaining 1/2 ounce to 1 ounce per day.

Call a breastfeeding specialist or your health care provider if any of the above statements is not true.

Growth spurts

Suddenly, your baby is eating all the time! This is called a growth spurt. Breastfeeding more often is your baby’s way of building your milk supply to meet his new growth needs. You may notice growth spurts when your baby is:

  • 7-10 days old
  • 3 weeks old
  • 6 weeks old
  • 3 months old
  • 6 months old

Your body will adjust to your baby’s needs by making more milk when you breastfeed more often.

Increasing your milk supply

Breastfeeding more often than usual will help you make more milk. Add 2 or more extra feedings a day for 3 to 4 days. Massaging your breasts before and during feedings or pumping will also help. If you are away from your baby, pumping more often will help to increase your milk supply.

You can do it! You can make enough milk for your baby!

Q: What might be causing sore nipples? What can I do for sore nipples?

Answer

A possible cause of sore nipples is the way you hold your baby on your breast. Make sure that you are getting your baby on and off your breast correctly. Make sure that your nipple is pointed up when you put your baby to your breast. You can do this by making a “C” with your fingers around your nipple and making sure that your baby latches on firmly, getting the nipple and the outer area in the mouth.

When your baby is finished eating, gently break the baby’s suction by placing the tip of your little finger in the corner of your baby’s mouth. Quickly pulling your baby off your breast and breaking the suction can hurt your nipple.

Q: Can I breastfeed and go to work or school?

Answer

Many mothers continue to breastfeed their babies after returning to work or school. It takes a little planning, but the benefits are worth it! Breastfeeding can calm you after a busy day! Consider the following:

  • Work fewer hours, if possible.
  • Find a caregiver close to work or school, and go there for breaks to breastfeed your baby or have the caregiver bring your baby to you to be fed.
  • Pump your milk and save it for the caregiver to feed your baby.
  • Ask your employer about a place to pump and if you can adjust your break times for pumping.

Helpful hints

  • Before returning to work or school, begin to express or pump your milk a few times a day. Collect milk whenever your breasts feel extra full. You can build up a supply of frozen breastmilk this way.
  • Begin practicing with a bottle 2 weeks before you return to work or school. Most babies accept the bottle better from someone other than their mothers. Someone else can offer your baby 1 to 2 ounces of breastmilk from a bottle once a day.
  • Breastfeed before you leave your baby and when you pick up your baby.
  • Ask your caregiver to avoid feeding your baby if you will arrive in the next hour. Your baby will be hungry and ready to breastfeed when you arrive.

Scheduling feedings

  • Breastfeed before you leave your baby and when you pick up your baby.
  • Ask your caregiver to avoid feeding your baby if you will arrive in the next hour. Your baby will be hungry and ready to breastfeed when you arrive.
  • Pump 1 to 3 times during the day. If your baby is less than 3 months old, express milk at least every 3 hours. Try to follow your baby’s usual feeding schedule.
  • Breastfeed on your days off and avoid bottle feeding.

Managing your milk supply

  • You can make all the milk your baby needs. Breastfeed whenever your baby seems hungry or needs comfort. As your baby breastfeeds, your body gets the message to make more milk. The more your baby breastfeeds, the more milk your body makes.
  • If your milk supply decreases, it is possible to build it up again. Breastfeed more often when you are with your baby or pump more often (every 1 to 2 hours) until your milk supply increases.
  • Try to pump every 3 hours when you are away from your baby. This will help keep a good milk supply.

Q: Can I give breastmilk without breastfeeding?

Answer

You can give breastmilk to your baby if you choose not to breastfeed. You can use pumped breastmilk to feed your baby. If your baby is premature, you can pump and store your breastmilk until your baby is ready to breastfeed. It does take more patience, time and supplies to pump, store and feed breastmilk, but the benefits to you and your baby are many.

Start a pumping schedule right after your baby is born to build your milk supply. Newborn babies usually nurse often, 10-12 times or more in 24 hours. Pumping at least 8-12 times a day will stimulate your breasts to establish an adequate milk supply.

For best pumping results, use a hospital-grade electric pump with a double collection kit. Pumping time is usually 10-15 minutes with this type of pump. Click here to learn more about expressing and saving your breastmilk. Your pumping schedule should closely follow your baby’s feeding schedule. This will help your milk supply to increase to meet your baby’s needs as he grows.

Q: Is there a special diet I should follow while I am breastfeeding?

Answer

The healthy diet recommended during your pregnancy is still good for you to follow while you are breastfeeding. Some of the fat that was stored in your body during pregnancy will provide energy needed by your body to make milk. Eat nutritious foods and avoid eating large amounts of food.

You may need to eat and drink often while you are producing milk. Between meals, eat a snack if you are hungry. Eating small meals more often may also be helpful. Meals and snacks should be as nutritious as possible. Choose a variety of foods from all the food groups. Continue to take your prenatal vitamin supplement. Drink when you are thirsty. Try drinking a glass of water or a nutritious beverage every time you feed your baby.

Q: Can I take herbal dietary supplements while I am breastfeeding?

Answer

Be careful about taking herbal dietary supplements while breastfeeding. While most herbs may be safe in small amounts, they are not regulated by the U.S. Food and Drug Administration and their safety cannot be guaranteed. Product labels may list only some of the ingredients included. Labels may not include herbs such as ginkgo, ginseng, kava and valerian, which can cause harmful side effects if taken in large quantities over time. Many herbs found in teas are safe for breastfeeding mothers. Herbal supplements made by companies which label their products thoroughly and accurately, so that consumers know exactly what they are getting, should be safe to use. Choose teas that do not have potent herbal ingredients. Orange, cinnamon, lemon and raspberry teas are good choices. When in doubt, when you are breastfeeding, avoid all herbal supplements or talk to your health care provider about the safety of these products.

Q: Can I take fenugreek while I am breastfeeding?

Answer

Fenugreek is an herbal dietary supplement breastfeeding mothers may use to increase the amount of milk they make. Be cautious when using it, since it may be dangerous. It may cause:

  • Worsening asthma symptoms.
  • Allergic reactions including stuffy nose, wheezing, facial swelling and shock.
  • Allergic reactions in those allergic to soybeans, peanuts and green peas.
  • Low blood sugar if taken in large amounts.
  • Diarrhea, gas and increased sweating.

Use caution with fenugreek if you are at risk for bleeding. If you are breastfeeding, consult your health care provider before taking this supplement.

Q: When do I have to decide if I want to breastfeed my baby?

Answer

There is no absolute time when you have to make this decision. However, most mothers decide how they will feed their baby during pregnancy. While you are preparing for your new baby, you can learn more about breastfeeding, get your questions answered, perhaps even correct inaccurate information that you might have heard.

When you start to feel your baby’s movements, you will probably start to make plans for care, including how you will feed your baby. Your baby’s father and other family members need to be included in these plans so that they can support breastfeeding!

Six building blocks that help make breastfeeding successful:

  • You want to breastfeed for a long time.
  • You are very committed to breastfeeding.
  • You and your family strongly support breastfeeding.
  • You have a positive attitude and are looking forward to breastfeeding your baby.
  • You are able to start breastfeeding shortly after birth.
  • You and your family avoid supplemental feedings of water or formula.

Q: Can I breastfeed and supplement with formula?

Answer

The simple answer to this question is “Yes!” But, there are a few things to think about. First of all, what is the reason that you want to supplement with formula? Will you be returning to work or school soon? Are you planning on weaning from the breast soon? Do you feel that you are not making enough milk for your baby? How you answer one or more of these questions may influence whether or not you should breastfeed and supplement with formula.

How old is your baby? Introducing a supplemental formula feeding in the early weeks following the birth of your baby can bring a quick end to breastfeeding. Remember the law of supply and demand. The more you nurse, the more milk you will make. If you start introducing supplemental formula bottles in the early weeks following birth, your milk supply may be reduced, because baby is not sucking at your breast, telling your body to make more milk. This may not be what you had wanted. Also, in the early weeks following delivery, baby can be easily confused by the difference in nipples. Baby will suck from the bottle differently than he will suck from your breast. Some babies will prefer the bottle nipple over the breast nipple, because they do not need to work as hard to get what they want. The milk is right there for immediate satisfaction! The good news is that most babies will get past this nipple confusion by 3 to 4 weeks of age. After that age, if you introduce a bottle now and then, baby will take both the breast and the bottle.

If you will be returning to work or school soon, the good news is that you do not need to quickly end your breastfeeding experience. You may continue to breastfeed when you are home with your baby, and another caretaker may feed formula to your baby when you are at work or school. Another option you may want to consider is pumping your breastmilk and storing it in the refrigerator or freezer for later use. Did you know that the bottle is not the only way of offering an alternative feeding? Depending on the age of your baby, supplemental breastmilk or formula can be offered with a spoon or cup.

Only you can decide what is best for you and your baby! Whether it is one day, one week, one month or one year, any length of breastfeeding is good! If supplementing with formula will help you extend your breastfeeding experience, go for it!

Q: Can I take prescribed or over-the-counter medications when I am breastfeeding?

Answer

Some prescription medications are okay to use when breastfeeding while others should be used with caution. If you are thinking about taking an over-the-counter medication, make sure to read the package labeling about its safety for pregnant and breastfeeding women. Talk to your health care provider before taking any medications while breastfeeding.

Q: Can I breastfeed in public?

Answer

Breastfeeding is the natural way to feed your baby. If you are away from home and need to feed your baby you can do this easily and hardly be noticed. Wisconsin and other states have laws protecting mothers who breastfeed in public.

Tips for breastfeeding while away from home:

  • Wear loose-fitting tops that you can raise up. The top can then rest around the baby’s head so your breast will not be seen. For a top with buttons, unbutton from the bottom just enough so the baby can be put to the breast.
  • To screen more, drape a blanket, sweater or jacket over your shoulder and the baby.
  • Wear a nursing bra that you can access your breast with one hand.

Q: Can I breastfeed after a C-section?

Answer

For some mothers and babies, breastfeeding may get off to a slower start because of a C-section. There is no reason that you can’t nurse your baby successfully even though you may have to overcome some additional challenges after a C-section, whether it is planned or unplanned. No matter how you deliver your baby, breastfeeding early and often offers many health advantages for both you and your baby.

Before your anesthetic wears off, there will be a period of time of pain-free, more comfortable nursing during your baby’s first feedings at the breast. When the baby is sucking on your breast, your uterus contracts more quickly and helps in your healing. Your baby’s sucking urge is strongest in the first couple hours after birth and can help to bring in your milk sooner.

You might have to try different holding positions with your baby while you heal. It is sometimes difficult to find a comfortable breastfeeding position that doesn’t put pressure on your incision. With the help of a nurse, midwife or lactation consultant, you will be able to figure out the easiest and most comfortable breastfeeding position for you. If all positions you try are painful, you can try pumping. The good news is that for many women, it is possible to breastfeed right after a C-section!

Pain medications are routinely given to mothers after a C-section. The amount of medication passed through the milk to your baby in his first few days of life will be very small. At most, your baby may be a bit sleepy. One of the benefits of pain medication is that it can help you relax and be comfortable enough to breastfeed.

If you know you will be delivering by C-section before the birth, you will be able to make some choices in advance that will help you have a successful breastfeeding experience. Check with your hospital on their policies regarding breastfeeding, rooming in and availability of electric breast pumps. Discuss with your health care provider any questions or concerns you have about breastfeeding after your C-section, including choices in anesthesia and pain medications.

A C-section may make you apprehensive, but it should not rob you of the loving experience of breastfeeding. You and your baby may have to be more patient and persistent, but the rewards will be worth it and your extra efforts will pay off!

Q: What do I do if I am not making milk or do not believe that I am making enough milk?

Answer

There is nothing magical about making enough milk to satisfy your baby’s needs. Milk in your breast is produced by “supply and demand.” The more your baby nurses effectively, the more milk there will be. Allowing milk to accumulate in your breast and not offering your baby the breast often (at least every 2-3 hours) signals your body to make less milk.

If it seems that your supply is low and your baby’s needs are not being met, then it is important to figure out what may be interfering with your milk production. Some of the possibilities are:

Supplementing

Even an occasional bottle can impact your milk supply. This causes your baby to wait longer for his next feeding, decreasing the feedings at the breast. Your breasts will then make less milk.

Improper latch-on

Your baby can become confused by the use of an artificial nipple because it encourages a different type of sucking. If your baby is not sucking properly at your breast, the right type of stimulation is not taking place to help you make milk.

Scheduled feedings

Watching the clock and only feeding your baby at certain times can interfere with the “supply and demand” rule. Learn your baby’s hunger cues and offer your breast on demand.

Sleepy baby

If your baby sleeps most of the time and only breastfeeds for short periods, it is important for you to wake him up regularly (at least every 2-3 hours) and put him to your breast.

Shortened feedings

Allowing your baby to come off the breast when he is satisfied will help in assuring an adequate milk supply. On the other hand, a baby who breastfeeds for long intervals and does not seem satisfied may not be sucking correctly. Cutting your baby’s feedings short may prevent your supply from increasing.

Feeding off of one breast per feeding

If you are working on trying to increase your milk supply, feed off of both breasts at each feeding, but do not limit your baby’s sucking time at the first breast.

Drink plenty of liquids and eat a well-balanced diet

Each time you feed your baby, try to have a glass of water or juice.

Get plenty of rest and relaxation

Your milk supply will increase faster if you are relaxed and rested. Take naps with your baby as often as possible. Find activities that relax you -- a warm bath, soft music, a walk or whatever works best for you. Always remember to take a few minutes each day doing something special just for YOU!

Q: Can I go on a weight loss diet while I am breastfeeding?

Answer

The total number of calories you need to maintain the quality and quantity of your breastmilk depends on your activity level, how often you breastfeed your baby and if your baby receives nutrition from other sources, such as formula. Very low calorie diets (1,500 calories or less) may not provide enough of the vitamins and minerals you and your baby need. It is best to aim for 1,800 – 2,200 calories per day and to increase your exercise.

If you are healthy, you can lose about one pound per week while breastfeeding and still provide enough milk to maintain your baby’s growth. Breastfeeding uses calories—you will notice a loss of body fat even without cutting calories. If you are already thin, and you decrease your calories, you may be at risk for low milk production.

Q: Why does my breastmilk look different from the beginning to the end of a feeding?

Answer

Breastmilk is made of two parts: foremilk and hindmilk. Foremilk flows first and looks like skim milk (thin and watery). Hindmilk flows later and looks like buttermilk (thicker and creamier). Sometimes, babies who get too much foremilk and not enough hindmilk are fussy and do not gain enough weight. Hindmilk contains fat and calories important for the rapid growth of your baby. If your baby isn’t gaining enough weight, you should nurse longer at each breast so he will get plenty of the higher fat hindmilk. You may also try nursing at only one breast at each feeding, feeding at both breasts but not limiting your baby at the first breast or starting each feeding at the same breast you ended the last feeding. Massaging your breast near the end of a feeding when your breast is getting soft will also stimulate the release of more hindmilk.

Q: What do I do if I am concerned that my breastfed baby is not gaining enough weight?

Answer

Most newborns lose weight in the first 3-4 days of life. During the first 3-4 days, colostrum is what your baby receives. It is produced in small amounts and is all your baby really needs at this time. After 3-4 days, your milk begins to come in. This is when your baby will begin to gain weight, usually 4-7 ounces per week. Your baby should return to its birth weight by 2 weeks of age.

Here are some encouraging signs that your baby is getting enough milk:

Call your health care provider or a lactation consultant if you are concerned about your baby’s weight gain. Also call if your baby has medical problems or is ill. Discuss a plan for monitoring the weight gain. If, together, you decide that your baby does need to gain more weight, here are some tips to help accomplish this.

  • Talk with your provider about feeding frequency and monitoring weight gain (i.e., bringing baby in for weight checks).
  • Make sure your baby is totally finished on one breast before switching to the other breast. This ensures that your baby will get the higher-in-calorie hindmilk.
  • Pump or hand express for a few minutes before you breastfeed. This takes away some of the foremilk so your baby can take in the higher-in-calorie hindmilk.

Massage your breast in a circular motion before and/or during a feeding.

Q: How do I bottlefeed my baby breastmilk?

Answer

At first, your baby will drink about 2-3 ounces of breastmilk at each feeding. This amount will vary based on your baby’s size, activity level, and whether your baby was born early.

It’s usually best to let your baby decide when to feed. That could mean every 2 to 4 hours. If your baby does not want a feeding within 4 hours, gently wake him or her and offer a feeding. As your baby gets older, and your baby’s stomach increases in size, your baby will eat more at a feeding and less often.

BREASTMILK INTAKE GUIDELINES
Age of Infant Recommended Amount Feedings Per Day
Birth-2 weeks 1-2 ounces per feeding 8-12 feedings
2-4 weeks 2-4 ounces per feeding 8 feedings
1-2 months 3-5 ounces per feeding 7 feedings
2-3 months 4-6 ounces per feeding 6 feedings
3-4 months 5-7 ounces per feeding 6 feedings

 

You will know when your baby wants to eat: Your baby will do one or more of the following:

  • Turn head into mom or toward bottle
  • Fuss
  • Make sucking sounds
  • Smack lips/sucks hands, fingers, or fist
  • Cry (However, not all crying means your baby is hungry. Crying between feedings may mean that your baby needs a position change, diaper change, needs to be pacified, or needs to be held.)

Hold your baby in a comfortable position while you are feeding your baby. This is a great time to interact with your baby. Feeding your baby can be a time of pleasure for both of you—it is one more way to learn your baby’s special language. During the early days and weeks, breastfeeding may be one of the few times your baby is awake. Take this time you spend with your baby to get to know him, and for your baby to get to know you.

Always hold your baby and the bottle while feeding. Your baby could burp (spit up) and/or choke if the bottle is propped up.

If you are concerned about how much your baby is eating or your baby’s growth, contact your health care provider.

Q: I am having twins. How do I breastfeed them?

Answer

Women can produce enough milk to exclusively breastfeed their infants for the first six months and longer, whether they have one or more babies. Milk production is based on the law of demand and supply. The more you breastfeed, the more milk you produce. A low milk supply can almost always be corrected by nursing more often. If your babies aren't emptying your breasts, you may need to pump.

Breastfeeding twins will require more organization and more work. However, keep in mind that taking care of twins overall requires more organization and more work. Ideally, you should start breastfeeding as soon as possible after the birth of your twins.

Some twins are born prematurely. Your milk contains just the right amount of nutrients to meet a premature baby’s needs. All the more reason to provide breastmilk for your twins! If the babies are not able to begin breastfeeding right away, you should pump your breasts to initiate milk production. If needed, you can simultaneously breastfeed on one side and pump on the other to keep up your milk supply.

“Tandem feeding” is breastfeeding your babies at the same time. Doing this will save you time. However, before you try to tandem breastfeed, at least one baby should be strong enough to latch on and breastfeed easily. There are several ways that you can position your babies in order to tandem nurse. Look at the pictures below for some positions that might work for you.

Before you leave the hospital, work with your lactation consultant to find a comfortable feeding position for you and your babies. If you find that once you are at home you or your babies are having difficulties with breastfeeding, call your health care provider, lactation consultant, or local chapter of the La Leche League. Get the help you need for you and your babies.

Here are a few more helpful tips about breastfeeding twins:

  • Use lots of pillows or rolled up towels. There are special pillows available that help in positioning twins, or you can make a nursing pillow yourself. Make sure the pillow you purchase is large enough to hold the two babies together. Some of the pillows available in stores are smaller and made for nursing only one baby at a time.
  • It is very common to have one baby who latches on quicker or more easily than the other. Put that baby to the breast first and then you will have ample time to work with settling the other baby who may need a little more coaxing and attention with latching.
  • Alternate feeding each baby from both breasts. This evens out their particular needs and also helps your babies’ eyes get equal exercise and stimulation. If it is too hard to keep track of who was on each breast, alternate breasts every 24 hours, so baby A is fed on the left side on odd numbered days, etc.

Q: Can I breastfeed my premature baby?

Answer

A premature baby is a baby that was born before 37 weeks gestation. Your premature baby’s nutritional needs and feeding skills will vary depending on his/her birthweight and gestational age. Premature babies can be breastfed—even those needing special care.

Your milk contains nutrients to help meet your baby’s needs. Providing your milk to your premature baby, either by breastfeeding or by pumping, benefits both of you in many ways. When you pump milk for your baby or breastfeed him, you secrete hormones that enhance the bonding process. Also, your premature baby receiving breastmilk is less likely to develop infections that are common to babies fed breastmilk substitutes and will be protected by the immunities in your milk while his own immature immune system is developing.

Many premature babies are not strong enough to breastfeed, so you may need to begin pumping as soon after the birth as possible. The goal is to pump as frequently as a newborn would eat, every two to three hours. This will help establish a good milk supply. You will want to use a full-size, hospital-grade pump, with a double-pump kit. Many neonatal intensive care units (NICUs) have these available for mothers to use. Research has found that breastfeeding is less stressful than bottle feeding for babies. Let your health care provider know you want to begin breastfeeding your baby as soon as he is ready.

In the beginning, your baby might need to be fed a special liquid through a small tube or needle that is placed in one of his veins (intravenous feeding). As his condition improves, he can be fed your breastmilk through a small tube that is passed through his nose into his stomach (gavage feeding).

Once your baby is strong enough to begin breastfeeding, you will want to work with a lactation specialist or health care provider knowledgeable about breastfeeding premature babies. It may take some learning time--don’t be discouraged. Your milk supply may be low despite regular pumping. Breastmilk (your frozen milk or banked donor milk) or breastmilk substitutes may need to be given with a supplemental feeding device while you are breastfeeding.

Many mothers of premature babies find the cross cradle hold to be very useful for “learning” how to breastfeed. This technique allows you to get a better view of your baby’s face, and to control the baby's head.

Cross Cradle Hold:

  1. Position the baby across your lap, turned in towards you, chest to chest. Use pillows to bring him up to the level of your breast.
  2. If you are offering your right breast, hold the baby's head in your left hand, and support your breast with your right.
  3. Support your breast using the Dancer Hold Position. This position supports your baby's chin in the web [“U”] between your thumb and index finger. This helps your baby maintain a good latch.
    • Support your breast with a C-hold, thumb on top, four fingers underneath.
    • Slide the hand supporting your breast forward, supporting the breast with three rather than four fingers. Your index finger and thumb should now be free in front of your nipple.
    • Bend your index finger slightly so it is gently holding the baby's cheek on one side while the thumb holds the other cheek. The index finger and thumb form a "U" with the baby's chin resting on the bottom of the "U".
  4. Pull your baby close and enjoy! You may need to repeat these steps as you and your baby learn together. Take time to soothe both of you with plenty of skin-to-skin contact.

Resources:
La Leche League International. (2012 update). The Breastfeeding Answer Book. http://www.llli.org/docs/0_babupdate/01babupdatefull.pdf

Riordan,J., & Auerbach, K. (1999). Breastfeeding and human lactation (2nd ed.). Sudbury, MA: Jones & Bartlett Publishers.

Spangler. A. (2000). Breastfeeding: A Parent’s Guide (7th ed.).

Q: When do I need to call my baby’s health care provider?

Answer

Problems can occur during the early weeks when a mother and baby are learning to breastfeed. You can prevent serious problems if you know the early warning signs that your baby may not be getting enough to eat. If your baby is less than 6 weeks of age and any of the following occur, call your baby’s health care provider:

  • Fewer than 3 bowel movements a day during the first 3 days or fewer than 4 bowel movements a day during the next 4 weeks
  • Fewer than 3 wet diapers a day during the first 3 days or fewer than 6 wet diapers a day during the next 4 weeks
  • Fewer than 8 breastfeedings in a 24-hour period
  • No sign of suckling and swallowing when breastfeeding
  • No evidence of any milk in baby’s mouth
  • Your baby is either restless and fussy or listless and sleepy for long periods of time

You may want to arrange weight checks with your baby’s health care provider to make sure that:

  • Your baby has not lost more than 7% of his birth weight
  • Your baby is not below birth weight at 2 weeks of age
  • Your baby is not gaining less than 4-8 ounces each week

Adapted from Spangler. A. (2000). Breastfeeding: A Parent’s Guide (7th ed.).

Q: How will I know when my baby is ready to start solid foods?

Answer

By now, your little one is quite a pro at breastfeeding. Breastmilk or iron fortified formula (as a supplement) is the most important food that you can offer your baby throughout the first year.

Why should I begin solid foods?
There is a role for solid foods in your baby’s diet. Adding infant cereals and pureed foods will not only provide nutrients but will also expose him to flavors and textures and will teach him to master eating skills.

Speaking of variety, did you know that breastfeeding exposes your baby to a variety of flavors from the foods that you eat, since these flavors are transferred in your breastmilk? This not only teaches your baby early on about the foods that your family enjoys but also helps increase the likelihood that he will accept new foods when he starts eating pureed foods.

When should I begin solid foods?
Generally, you will see signs that your baby is ready to start solids around the middle of the first year. These signs may include:

  • Sits up with support
  • Holds his head steady
  • Reaches for things and can hold them
  • Watches food, waits with an open mouth for food, and then closes mouth over food
  • Takes infant cereal or pureed food from a spoon and swallows it easily

Keep in mind that every baby is an individual; your little one will develop at his own pace. Starting solids is an important step for you and your baby. Don’t let anyone pressure you into starting solid foods before he is developmentally ready. Discuss this issue with your baby’s doctor.

What foods should I start with?
Once you and your baby’s doctor decide it’s a good time to teach your baby about solid foods (The American Academy of Pediatrics recommends at six months of age), start with single-ingredient foods—preferably iron and zinc-fortified infant cereal or pureed meats. Around the middle of the first year, these two nutrients become limited in the diets of solely breastfed babies. This is no reflection on you or the quality of your breastmilk. This is the way Mother Nature intended it to be.

Next comes pureed fruits and vegetables. The order of introduction does not matter. You may want to try some of the traditional favorites first, like carrots, applesauce, or bananas. Did you know that you can make homemade pureed baby foods? Ask your baby’s doctor, nutritionist, or nurse for more information on this topic, including recipes. Introduce solid foods one at a time. Offer just one new food two to four days in a row before starting a new one. This makes it easy to watch for a possible reaction to the food. Once your baby has tried single-ingredient foods, you can move on to mixed varieties. Try mixing a couple of his favorites together or try “combination” jarred baby foods. An easy way to get variety into your baby’s diet is to think color. Let the colors of the rainbow be your guide each day. The more variety, the better!

You have heard the popular expression, “Strive for five!” The same rule also applies to babies. Offer your baby five or more servings of fruits and vegetables every day. How much is a serving? At first, it may only be a teaspoon or less. For older babies, a serving is ¼ cup, or ½ container (3 ½ to 6 ounces), of pureed fruits and veggies. This is a healthy habit that you can begin to teach your baby now.

How long will it take for my baby to get used to a new food?
How many times will it take your baby to get used to a new food? It may take up to 10-15 times before your baby accepts some new foods. Just remember the motto: “If at first you don’t succeed, try, try again.

You know your baby best. These feeding tips are intended only as a guide. They must be adjusted based on your baby’s needs. Be sure to talk to your baby’s doctor about the right time for your little one to begin solid foods.

Remember that this is a big step for the both of you! Relax and enjoy this new developmental milestone!

Q: What is a Certified Lactation Consultant? What is the difference between the various specialists trained to help breastfeeding mothers?

Answer

International Board Certified Lactation Consultant (IBCLC) is the certification granted by the International Board of Lactation Consultant Examiners. It requires continuing education and repeated exam testing to maintain the IBCLC credential. An IBCLC usually has another health care degree in an area such as nursing, medicine, or dietetics. IBCLCs are trained to provide specialized breastfeeding support and clinical lactation management. For a registry of certified lactation consultants, and information on how to become certified as an IBCLC, visit the following site: www.ibcle.org.

The following certifications are geared toward providing basic breastfeeding education and support, rather than the specialized, clinical management provided by an IBCLC.

Certified Lactation Educator (CLE) is granted by UCLA Extension after completion of five days of classroom instruction, written coursework, and community observation. The certificate is a statement of education and does not require continuing education to maintain certification. A CLE can provide basic breastfeeding education and support. For course information visit the following site: http://www.uclaextension.edu/.

Certified Lactation Counselor (CLC) is granted by the Center for Breastfeeding Education after completion of a five-day training that provides comprehensive breastfeeding management with a strong focus on counseling skills. A CLC can provide basic breastfeeding education and support. For course information visit the following site: www.healthychildren.cc.

Certified Breastfeeding Educator (CBE) is granted by Lactation Consultant Services in Oklahoma after completion of a 15-session basic lecture series, clinical role-playing, and an exam. The certification is in effect for five years and a one-day update is required for recertification. A CBE can provide basic breastfeeding education and support. For course information visit the following site: http://lactation-consultant-services.webstarts.com/index.html