Breastfeeding Basics

Do I have enough milk? Is it normal for my nipples to hurt? Can I have a glass of wine? Every new nursing mom has questions. We're here to help, with answers to the 10 most common.


1. How do I know if my baby is getting enough milk? "Watch and listen to your baby's sucking and swallowing patterns," says Nancy Erickson, R.N., I.B.C.L.C., a spokeswoman for the International Lactation Consultant Association. A baby who is getting enough milk takes long, drawing sucks, and her swallowing is audible. "The pattern should be rhythmic, with some pauses between sucking bursts," she adds. "When the baby isn't getting much milk, her sucks are short and choppy." Another way to gauge whether your baby's intake is adequate is to monitor her diapers: She should have at least six to eight wet diapers a day, with an average of two or more bowel movements.

2. How often should I nurse my baby? Every baby is different, but in general, a newborn up to about 3 months of age should nurse between eight and 12 times a day. But rather than keeping a tally or trying to get your baby on a schedule, the most important thing you can do is pay attention to her signals and feed her whenever she seems hungry. "Babies give hunger cues, including rooting, opening the mouth, turning the head and making fussing noises," says Margot Mann, I.B.C.L.C., director of the Riverdale Lactation Center in New York City. "Crying is the cue of last resort."

3. Is it normal to feel pain during breastfeeding? "Some women do feel tenderness or discomfort when the baby latches on," says Corky Harvey, R.N., a lactation consultant and co-owner of The Pump Station, a breastfeeding-support center in Santa Monica, Calif. "But it shouldn't last for more than 20 seconds." Shooting pain, she adds, is a sign that something isn't right. If you experience such pain, it probably means that your baby isn't latched on properly and is sucking only on the nipple, rather than the nipple plus at least 1 inch of the areola. (See next question for tips on getting a good latch.)

4. How can I get my baby to latch on correctly? "As long as your baby has taken your entire nipple and a large portion of the areola into her mouth and her lower lip is flanged out, she's latched on properly," Mann says. Following are tips for ensuring a proper latch: > Get comfortable. Consider using a rolled-up blanket or towel to prop your baby up so you don't have to lean over her. Or try using a specially designed breastfeeding pillow, such as the Boppy or My Brest Friend. > Position your baby so she is lying on her side, her belly tight against yours. > Support your baby's head and neck by placing one hand behind her neck; your thumb should be near her ear, your middle finger on her jaw.

> Hold your baby so that your nipple is about level with her nose. Brush her lips with your nipple until she opens her mouth wide, then quickly place her mouth on your breast. Don't stretch your breast out to reach her. > Once she begins to suck, check to make sure you can see her tongue between her lower lip and your breast. (If you can't, she may be sucking her tongue along with your nipple.) If necessary, use your finger to break the suction, remove her from your breast and try again.

5. When will my baby sleep through the night? Every baby is different. That said, some breastfed babies sleep through the night—meaning for about six hours—by 3 months of age; others don't until about 9 months. Until then, Mann suggests sleeping with the baby and nursing from the side-lying position, allowing yourself to fall back asleep while you breastfeed. If you take precautions to protect your baby from suffocation (remove padding such as a feather bed or wool mattress pad, make sure your comforter doesn't cover the baby, don't push your bed against a wall, etc.), your baby can safely nurse while you sleep.

6. Will it harm my baby if I have a glass of wine or beer? "Most authorities say an occasional glass of beer or wine is OK," Harvey says. "But the earlier in your baby's life you drink alcohol, the greater the potential risk." (One study suggests that the breastfed babies of mothers who have one or two alcoholic beverages a day score lower on tests of motor skills at age 1 than the babies of moms who don't drink.) "We don't want to make life so miserable for breastfeeding moms that they don't want to nurse," Harvey adds. "If you want to have a drink on occasion, then have one, but try to limit your intake to one drink every other day," she says. Other experts advise that breastfeeding women who choose to drink do so slowly and on a full stomach, and that they forgo nursing for several hours after having an alcoholic beverage. Still others recommend that nursing women "pump and dump" their breast milk two hours after drinking.

7. How do I know if my baby is nursing because she's hungry or needs comforting? You may not know the difference, and it shouldn't matter. "Sucking is one of a newborn's highest needs," Harvey says. Furthermore, sucking for comfort rather than for hunger can actually help you succeed. "Sucking triggers milk production," she explains, "so during the early weeks and months, it's important to let your baby suckle as often as she wants." You may notice that your baby's nursing demands wax and wane. That's because when she's going through a growth spurt, she will need to nurse more often, which in turn increases your milk supply.

8. Do I need to change my diet while I'm breastfeeding? "You should follow the same basic guidelines and precautions that you did when you were pregnant," Mann says. In other words, make sure you're eating a healthy, well-rounded diet and drinking plenty of fluids—at least eight 8-ounce glasses a day. You may discover that eating certain foods seems to upset your baby's tummy, but there is no evidence that you should make drastic changes, she says. The Environmental Protection Agency does advise that nursing mothers not eat shark, tilefish, swordfish and king mackerel because these fish may contain dangerous levels of mercury. You can safely eat 12 ounces per week of other fish, such as tuna, salmon and shellfish. (For more guidelines, visit opacom/hottopics/mercury/backgrounder.html.)

9. I want to give my baby a pacifier, but I don't want to torpedo my breastfeeding. What's the real deal with nipple confusion? Early in the newborn period, the baby is learning how to breastfeed, and sucking from a plastic nipple—whether a pacifier or a bottle—is very different from sucking at the breast. It's therefore best to wait awhile before giving your baby a pacifier or a bottle. "Babies don't come with labels that tell us which ones will be at risk for early weaning or breastfeeding problems if given an artificial nipple," Erickson says. "That's why we say that across the board, it's better to wait to introduce a pacifier or bottle until a baby is 4 to 6 weeks old and is breastfeeding well."

10. If I give my baby an occasional bottle of formula, will she not want to nurse? As long as you wait until your baby is about 6 weeks old, giving your baby formula occasionally probably won't affect her willingness to breastfeed or take breast milk from a bottle. But giving your baby bottles of pumped breast milk rather than formula will increase her ability to fight off certain diseases. "The baby's gut is an open structure, like a honeycomb, until about 5 months of age," Harvey explains. "Breast milk creates good bacteria that help close up the open walls of the intestines, in turn preventing the large molecules of some harmful bacteria and viruses from passing through."