From birth until weaning, nursing moms face different issues as their babies grow. Here's a month-by-month guide.
Even though the first days and weeks of breastfeeding are the most important—it's when your milk supply is established and you and your baby get into the groove of things—many moms focus on this period to the exclusion of all others. But at some point down the road, you're likely to have different concerns and questions. Here's a look at some of the breastfeeding issues you're likely to face through the first year.
Month 1: How can I tell if my baby's getting enough milk? The best way to tell is by monitoring his weight (your pediatrician will watch it closely, especially for the first few weeks) and his stools: They should be dark or green and sticky until about 3 days of age, after which they should be light and mustard colored. But you also need to pay attention to wet diapers: By the third day of breastfeeding, your baby should have at least four wet diapers every day; that number should increase to six to eight by seven days.
Month 2: I'm going back to work soon. How do I handle pumping? By about three or four weeks, you should have begun pumping, both to get your baby accustomed to taking a bottle and so you'll have a healthy amount of breast milk stored in the freezer. You either can rent a hospital-grade pump or buy an electric one. Many working breastfeeding moms recommend a double electric pump because it expresses both breasts at once and therefore cuts down on pumping time. Once you return to work, try to pump as often—and at about the same times—as your baby normally nurses.
Month 3: Can I start taking the birth control pill if I'm nursing? "Yes, but it's best to wait until your milk supply is well established, which is about six to eight weeks after delivery," says Debi Page Ferrarello, R.N., M.S., I.B.C.L.C., director of family education at Pennsylvania Hospital in Philadelphia. "Also opt for a progestin-only 'minipill' because pills containing estrogen can decrease milk supply." Depo-Provera (injections given every three months) is another progestin-only contraceptive that is safe to use while breastfeeding; the manufacturer recommends beginning these injections six weeks postpartum.
Month 5: I've heard that babies who are breastfed usually take longer to sleep through the night. Should my son be doing this yet? First, keep in mind that "sleeping through the night" at this age actually means five or six hours, not eight or nine. Second, every baby is different. Some will start sleeping through at 3 months; others won't until much later. "Babies sleep through the night when they're ready, whether or not they're breastfed," says Jeanette Panchula, R.N., I.B.C.L.C., a senior public health nurse and lactation consultant in Vacaville, Calif. That said, because breast milk is digested so completely and more quickly than formula, some breastfed babies do tend to eat—and therefore wake—more frequently than their formula-fed peers.
Month 6: How and when should I introduce solid foods? "Breast milk is still the most important part of your baby's diet at this age, so you should always nurse right before you offer cereal or other food," says Ferrarello. When you do offer solids, start with rice cereal and gradually add a cooked or mashed fruit or vegetable. (Many pediatricians believe it's fine to start with a fruit or vegetable; check with yours.) Be sure to wait three to five days before introducing a new food to your baby so you can trace the cause of any allergic reaction.
Month 8: I keep getting clogged milk ducts, and they're really painful. What can I do to treat them? "One of the risk factors for clogged ducts is a change in a baby's feeding pattern," Ferrarello says. "Milk 'stasis'—when milk sits in the breast—can cause the ducts to clog, so if your baby is nursing less frequently because he's eating more solids, your breasts can become overly full." The best way to treat clogged ducts is by nursing or pumping often from the affected breast, applying warm compresses and getting plenty of fluids and rest. If you have a fever or flu-like symptoms, see your doctor; you might have mastitis, an infection that may require antibiotics.
Month 9: My baby has several teeth and keeps biting me! How can I make him stop? Ferrarello suggests taking him off the breast as soon as he starts to bite, saying, "No biting!" and keeping him off the breast until the next feeding. You can also make a sad face. Biting—which is nothing more than experimentation—usually happens toward the end of a feeding, Ferrarello adds, so if you can tell that your baby is almost finished nursing, remove him from the breast before he chomps down.
Month 11: My baby is eating more solids. How often should he nurse? "A minimum of four times a day is what we expect," says Corky Harvey, R.N., M.S., I.B.C.L.C., co-owner of The Pump Station in Santa Monica and Hollywood, Calif. "A baby this age should be getting about 16 to 20 ounces of breast milk per day." At the end of the first year, half a baby's calories should be coming from breast milk.
Month 12: Are there reasons to breastfeed for longer than a year? The health benefits don't stop at your baby's first birthday. "As long as your baby is getting breast milk, he's getting all the immunological benefits it provides," Harvey says. But there is another important reason to consider, she adds: "A nursing mother and her infant have a special bond, and there is no reason any woman should be in a hurry to give it up. As long as she and the baby are happy, there is no reason to wean."