Nursing Know-How

Breastfeeding can be difficult for some women in the first few weeks, but it gets easier and more natural with time.

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Whether you’ve already had your baby or are still pregnant, successful breastfeeding requires preparation and knowledge. Lactation consultants Corky Harvey and Wendy Haldeman answer questions to help you get it right.

[Q] My sister-in-law put her newborn on a nursing schedule, rather than breastfeeding on demand. It seemed like a bad idea to me at the time, but her baby seems to have taken to the schedule, and now her life seems so much less chaotic than mine. I'm thinking of trying it with my second baby. Is it a good idea? [A] This type of scheduling can work as long as you have a plentiful milk supply and a baby who does fine with scheduling. But if you have any issues with your baby not gaining weight properly, or if you have a high-need baby, then scheduling is not for you.

If you do opt for scheduling, wait until the baby is at least 2 to 3 weeks old and is gaining adequate weight. Be prepared, though: You'll need to do frequent weight checks with your pediatrician to ensure that the baby continues to gain adequately. If his weight begins to drop at all, you'll need to start feeding on demand.

Above all, remember that babies need to be held a lot--it's an essential part of their growth and development. Research is also clear that newborn breastfed babies need to feed eight to 12 times in 24 hours depending on your milk supply--if your baby needs 12 feedings and doesn't get them, he may lose weight. (Some women have so much milk that they can nurse eight times a day and the baby will gain weight sufficiently; others need to nurse 12 times a day to ensure adequate gain.)

The bottom line: Scheduling works for some babies but not others. If you want to try it, stay flexible, keep a close eye on your baby's weight and level of contentment, hold him often, and give him lots of love and attention. And if you decide not to try scheduling, don't give it a second thought.

[Q] My husband and I are going to a wedding in a few weeks, and I'd like to have a cocktail or two. How long do I need to wait after drinking before nursing my baby? [A] Many factors affect how your body metabolizes alcohol--including the type and amount of alcohol you drink, the time between drinks, your body weight and how much food, if any, you eat while drinking. As such, it's hard to be definitive about exactly how long you need to wait before nursing your baby.

That said, in general, alcohol is metabolized at the rate of about 1 ounce per hour, so if you have one drink, you should be able to nurse your baby about one hour later. If you have two drinks in an hour, you'll probably need to wait at least two hours. But a better guideline is this: As long as you are feeling any effects from the alcohol, even if you are just a bit tipsy or giddy, don't put your baby to the breast. Instead, "pump and dump" your milk until you're not feeling any effects. And never put your baby in bed with you if you've been drinking.

[Q] My friend nursed her baby for 16 months and now has very saggy breasts. Will the same thing happen to me if I breastfeed? [A] Probably not. Some women do have "involution" of the breasts after nursing, but a very small percentage of these cases are caused by breastfeeding itself. The more likely causes include age, gravity, pregnancy, lack of proper support and large breast size.

If you do find yourself a bit saggy after nursing, you'll be happy to know that the majority of women in this situation "perk up" over time as fat tissue regenerates in their breasts. Wearing a well-fitting, supportive bra during pregnancy and nursing can help.

[Q] How do I know if I need to see a lactation consultant? [A] There are several reasons you might need to see a lactation consultant: • You have sore, cracked nipples and/or dread nursing • You think the baby isn't getting enough milk • The baby cries nonstop for three to five hours; is constantly fussy; or never seems to sleep or rest • The baby seems discontent after many feedings or he sleeps all the time • Filling of your breasts (engorgement) doesn't happen by the fifth day post-birth • You are severely engorged or the baby doesn't latch on • The baby has fewer than three yellow, loose stools daily by day six • The baby hasn't regained his birth weight by 2 weeks of age • You have any other breastfeeding concerns

If you need help finding a lactation consultant, contact the International Lactation Consultant Association at 919-861-5577; www.ilca.org.

[Q] Should I modify my diet to keep my baby from getting gassy? [A] We recommend the wait-and-see approach: Don't alter your diet unless your baby seems absolutely miserable and you suspect a food you've eaten may be the cause. If you do decide to change your diet, try removing one or two foods at a time, wait a few days and see if the baby seems better. If not, add the foods back in. We also encourage moms to eat everything in moderation--instead of three bowls of strawberries, try one. If you do suspect that a food is causing your baby distress, consider eliminating the following items from your diet, which some experts suspect can cause gas in breastfed babies: • Cruciferous vegetables--particularly broccoli, cabbage and Brussels sprouts • Garlic and onions • Highly acidic foods such as tomatoes • Highly spiced foods

Also keep in mind that if your baby is sensitive to a particular food, he may not be bothered by it long-term; what bothers him at 2 weeks of age may not bother him at 2 months. Now for a caveat: If you or your husband has food allergies or they run in your family, you should steer clear of those foods while nursing. P.S.: You can safely eat sushi, soft cheeses and other foods that were verboten during pregnancy. But do still pay attention to mercury levels in fish.

[Q] I’m six months pregnant and plan to breastfeed, but I keep hearing how hard it is. I’m afraid I won’t be able to do it. Any words of wisdom?[A] It’s true that breastfeeding can be difficult for some women in the first few weeks, though it does get easier and more natural with time. It’s helpful to be prepared: Take a breastfeeding class so you learn the proper techniques, as well as the pitfalls. Also, in case you do have problems, find out where to get support, whether it’s from a friend who has breastfed successfully, a doctor you trust, a certified lactation consultant or a La Leche League support group. Finally, keep in mind that the vast majority of women do nurse their babies successfully.

[Q] I’ve been breastfeeding for two weeks, and my nipples are cracked and bleeding. I’m ready to give up. What can I do?[A] Cracked or bleeding nipples usually indicate an improper latch, so the first step is to make sure your baby is latching on correctly. First, you need to position her correctly: Before putting her on your breast, position her on her side so she is directly facing you, with her belly touching yours. Next, prop up the baby with a pillow, if necessary, and hold her up to your breast; don’t lean over toward her. Now you’re ready to latch her on (see photos): 1) Place your thumb and fingers around the areola. 2) Tilt your baby’s head back slightly and tickle her lips with your nipple until she opens her mouth wide. 3) Help her “scoop” the breast into her mouth by placing her lower jaw on first, well below the nipple. 4) Tilt her head forward, placing her upper jaw deeply on the breast. Make sure she takes the entire nipple and at least 1 1/2 inches of the areola in her mouth. Congratulations! She’s latched on. To help with the discomfort, nurse on your least-sore breast first. When the baby is finished nursing, break the suction by placing your finger in the corner of her mouth before removing her from your breast. After each feeding, soothe and moisturize your nipples by massaging a small amount of breast milk onto your nipples, followed by pure lanolin or nipple cream. Don’t wash your breasts with soap, as it is drying; water is sufficient. If you still have difficulties, call La Leche League for advice at 800-525-3243. Or see a lactation consultant; call 800-835-5968 to find one in your area. Also visit www.pumpstation.com to download a streaming video that shows the deep latch-on technique.

[Q] Some of my friends say that I shouldn’t bother breastfeeding since I will be going back to work shortly after the baby’s birth. What do you think?[A] Even if you breastfeed for just six weeks (and you should take a minimum of six weeks maternity leave after the birth), that’s a huge advantage for your baby. But it’s important to realize that you can continue to breastfeed your baby even after you return to work: It’s a simple matter of nursing in the morning and evening, and pumping your milk while you’re at work (your baby’s caregiver can give the baby your breast milk from a bottle). At least give it a shot; start off breastfeeding and if it isn’t working for you to pump at work, you can slowly wean.

[Q] My friend is taking the antidepressant Zoloft and isn’t sure whether she should nurse her baby. What do you think?[A] Zoloft is safe to take while nursing, although other antidepressants may not be. For specific information, call the University of California, San Diego, Drug Information Service at 900-288-8273.

[Q] My 10-month-old bites me every time she nurses. How can I get her to stop?[A] It’s common for babies of this age to bite, but the good news is that you should be able to fix it within a day or two. This is how: The minute she bites, take her off your breast and say, “No biting!” Don’t say it angrily—just be firm and serious. (And don’t laugh or smile if she grins and giggles.) Keep her off the breast for a good five minutes; doing so will help her associate the fact that she did something wrong with the fact that she can’t eat. Then put her back on the breast; if she does it again, repeat the process. If she keeps doing it, take her off the breast for even longer. And if she bites at the end of a feeding, end the session altogether.

[Q] Where can I find an inexpensive nursing bra?[A] Target, Sears and JCPenney carry a good selection. Also try www.breastisbest.com.

[Q] My mother-in-law is not supportive of my nursing. My 2-month-old son is healthy and growing well, but she constantly nags me to supplement with formula. Any advice?[A] You and your husband need to have a heart-to-heart with her. Tell her that what she is doing is undermining your confidence not only in your feeding choice but in yourself as a mother. Emphasize that the baby is healthy and the pediatrician is pleased with his growth. Also point out that research is irrefutable about breastfeeding being the best feeding choice for your son. Beyond that, you may need to stand tall and say, “This is my parenting style and my feeding choice. I want you to be involved, but that means being supportive of me.”

[Q] I just had my baby and will be returning to work when she's 3 months old. I plan to keep breastfeeding exclusively and pumping my milk; when should I start introducing a bottle? [A] Good for you for planning ahead! Many women make the mistake of not getting their baby used to a bottle before they return to work, only to find that the baby refuses to take a bottle at all. Needless to say, this is not a good situation.

Since many babies will refuse a bottle if it is introduced too late, we suggest starting when your baby is between 2 and 4 weeks old. Aim to give one bottle two to three times a week so you're not using up your precious supply of breast milk. Also note that the baby may revolt if you try to give her the bottle--it may be better for your partner or other family member to attempt it.

[Q] If I start expressing breast milk to feed my baby from a bottle, will I have enough milk for her when she nurses? [A] Pumping doesn't take milk away from the baby; it makes you produce more. Remember, breastfeeding is a game of supply and demand: If your baby (or the pump) consistently demands more milk, your body will supply more. That said, if you were to pump both breasts completely and then try to feed your baby right afterward, there might not be much milk available. To keep this from happening, pump about a half-hour after the first feeding of the morning, when your milk supply is the highest. The milk you pump can either be frozen for future use (say, when you go back to work) or be refrigerated and then given in a bottle at a later feeding.

Also keep in mind that when you first begin pumping, you may not get as much milk as you'd anticipated. But do it faithfully and your milk supply will increase within a few days.

[Q] How much milk should I have on hand when I go back to work? [A] We recommend storing four 4-ounce bags or bottles for each eight-hour day you'll be working; 20 to 40 bags is optimal. While this may sound like overkill, the reality is that you'll likely go through the milk pretty quickly--babies tend to drink more from a bottle than from the breast because milk flows readily from a bottle. Granted, storing this much milk might sound like a monumental task, but if you pump every day and give a bottle two to three times a week, that leaves you with four to five bags in the freezer every week.

[Q] How long can I store breast milk in the refrigerator? What about in the freezer? [A] Current guidelines state that breast milk can be stored for five to seven days in a refrigerator kept at 32° F to 39° F; three to four months in a standard freezer; and six to 12 months in a "deep-freeze" freezer kept at 0° F. If you're pumping at work and don't have access to a refrigerator, store your milk in a cooler with three ice packs; this will keep your milk fresh for up to 24 hours.

[Q] Sometimes when I pump, my breast milk seems to have a green tinge. What causes this, and is it safe to give the milk to my baby? [A] The color you describe is probably a reflection of what you recently ate --perhaps you had a spinach omelette for breakfast or some asparagus with dinner? Regardless of your milk's picturesque palette, rest assured that it's perfectly safe to feed to your baby. By the way, here are some other color culprits: • Green Gatorade = green milk • Beets = pink • Yams = yellow

[Q] I work in a facility where there is very little privacy for me to pump my breast milk. What can I do? [A] If you live in California, Connecticut, Hawaii, Illinois, Minnesota or Tennessee, your employer by law must provide you the time to pump, as well as a place to do it. If you’re not lucky enough to live in one of these states and no such facilities exist at your workplace, be creative: Use an empty office, your company’s first-aid room, a cubicle with curtains, or even a storage room; try not to use the restroom, as it’s not sanitary. If all else fails, you can pump in your car; just be sure your breast pump is battery-operated or has a power adapter for vehicles. For more information on laws about pumping, visit www.lalecheleague.org/LawMain.html.

[Q] My baby nurses from 8 p.m. to midnight every night. She’s constantly hungry; I’m exhausted. What should I do?[A] Many babies have a three- to four-hour stretch of marathon nursing every day. It’s not necessarily that she’s hungry; she simply may be in a wakeful state when she needs to be with her mother, doing a lot of sucking. It may help to know that this phase won’t last forever; in the meantime, to help with your fatigue, consider taking her to bed with you so you can snooze while she nurses.

[Q] My 4-month-old son is exclusively breastfed. Now that the weather is getting warmer, do I need to give him water to drink? [A] Human milk is 89 percent water, so you don’t need to give him anything but breast milk—if he’s thirsty, he will go to the breast more often. You, on the other hand, do need more water during warm weather, so drink up— a minimum of eight to 10 8-ounce glasses a day, or enough that your urine is nearly clear.

[Q] I keep having bouts of mastitis. Am I doing something wrong, or am I just one of the unlucky ones?[A] The No. 1 reason women get mastitis (inflammation of the breast) is that they produce too much milk, so chances are that rather than doing something wrong, you’re just a good milk producer. There are other things that can contribute to mastitis, however. Pressing on your breast to create an air space for the baby can cause plugging in that area; if you’re doing this, adjust her head a bit instead so she can breathe freely. Underwire or sports bras that don’t fit correctly or that are left on while nursing can also cause plugging, as can erratic feeding schedules, which can lead to the baby not draining the breast well.

[Q] My baby often falls asleep while nursing, and I’m worried that he’s not getting enough milk. Should I let him sleep or try to rouse him to eat more?[A] The breast is very comforting, so many babies fall asleep when nursing. If your baby is growing well and his pediatrician is pleased with his weight gain, you probably don’t need to do anything. If his weight gain seems low, though, you should try to get him to eat more. Gently rub his cheek or lower lip to rouse him; if he’s hungry, he should wake enough to nurse.

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