We heartily encourage you to nurse your baby.  Breastfeeding your baby has a multitude of advantages. Breastfeeding can and should be an enjoyable, rewarding and successful experience with many health and emotional benefits for both you and your infant. Several pointers will help you breastfeed effectively.

The Beginning

The first few days the breasts produce a thick yellow liquid, called colostrum. It provides some essential nutrition and antibodies; therefore, it is important to breastfeed from the start.  Giving your baby a lot of time at the breast early on allows him to learn how to breastfeed more efficiently.  Two to four days after delivery, the mother’s milk will come in. Usually the breasts feel very full; frequent feedings can help relieve pressure.

Engorgement

Engorgement is when the milk supply becomes plentiful and the breast becomes very full and painful, usually around 3-4 days after delivery.  To relieve pain, frequent feedings, massaging, using warm packs and taking hot showers will help.  If redness or undue tenderness occurs , contact your obstetrician since this may be a sign of infection.

Frequent Feedings

Your daily nursing patterns will vary but should average 6 -10 times in 24 hours.  Some babies will nurse more frequently and some less.  Allowing your baby to finish one breast before you switch to the 2^nd breast is preferable.  You should hear the baby swallow regularly and your breast should feel softer after nursing.  Some babies will be sleepy during feeding – undress them to just a diaper, change their diaper, or rub their back to help wake them.  The production of breast milk follows the law of supply and demand – the more stimulation to the breast with feeding or pumping, the more milk that is produced.

Latching on and Positioning

The mother and the baby should be comfortable.  Start with the mother in a comfortable chair, back straight, and lap flat. (You can try other positions as you feel comfortable with feedings.)  Use pillows if needed to raise the baby to just below the breast.  The baby’s ear – shoulder – hip should be aligned.  Tickle the baby’s lips lightly to help them open their mouths wide.  Bring the baby to the breast quickly; the nose, cheeks and chin should all be touching the breast. Your breast will not prevent the baby from breathing through his nose.  The baby’s lip should both be flanged outward.  Initially the sucks will be rapid, then the sucking will have a pattern with audible swallows.  Prevent changing the nipple position while the baby is sucking.  To break the sucking, place your finger in the corner of the baby’s mouth and break the seal. Do not pull the baby off.

Nutrition for Mother

To insure a well-balanced diet; select your food from the food pyramid and strive to consume 500 calories more than your pre-nursing intake.  Snacks between meals should be nutritious and not just “filleruppers”.  There should be no strict dieting as this leads to diminished milk production, fatigue, and a malnourished mother.  We also recommend that you continue your prenatal vitamins and iron. See page 51 for vitamin recommendations for your baby.  You should make it a habit to drink a full glass of liquid every time you nurse your baby and whenever you feel thirsty.  You should be drinking about 64-ounces per day.  Nursing mothers need 1200 milligrams of calcium daily but if you do not like or cannot tolerate milk, compensate instead by increasing other fluids and calcium containing orange or apple juice, dairy products and green leafy vegetables.  Viactiv or Caltrate D sold over-the-counter are inexpensive and are well absorbed if you cannot get enough calcium naturally.

Pumping and Introduction of the Bottle

Giving your infant water or formula is not necessary and may interfere with nursing early on.  However, if you are going back to work, getting the baby used to an occasional bottle can be helpful. It is best to wait to offer a bottle until breast feeding is established by 2–4 weeks of age.  One to two bottles a week can be all that is needed to keep the baby familiar and accepting of the bottle.  You can store freshly pumped breast milk for 5-7 days in the back of the refrigerator, or for 3-6 months in the back of your freezer.  To defrost, sit the milk (in bottle or bag) at room temperature for about 1 ½ hours or place in a bowl of warm water.  Do not use the microwave to defrost breast milk. It can heat the milk very unevenly and burn the baby’s mouth. It can also destroy the antibodies the breast milk contains.

Checklist to Know that Breastfeeding is going OK

Your milk should “come in” 2 to 4 days after delivery.  Your baby should appear satisfied after nursing and probably fall asleep once full.  Your newborn should nurse at least 8 times in 24 hours. Time the feedings from the beginning of one nursing to the beginning of the next.  Consistent 4 hour intervals are too long for a newborn.  Your breasts should seem full before feedings and soft after nursing.  You should hear swallowing during nursing.  Your baby should urinate 6 or more times every 24 hours.  Your baby’s bowel movements should look yellow – like cottage cheese and mustard after the first 3-4 days.. If the BM’s are green and dark (meconium), it could mean they are not getting enough milk.  Usually tenderness at the nipples is present only at the beginning of the feedings for the first few days. If the tenderness persists or worsens it probably means your baby’s latch on and positioning is incorrect, get help sooner than later.

Weaning

You and your baby should find the transition from breast to bottle or cup a smooth one.  You may decide to wean at any time that seems convenient for you or you may find that your infant may gradually cut back on his nursing naturally.  Your method should be gradual, allowing several weeks for the new supply and demand to balance off and eventually eliminate nursing.  o You should start the weaning process gradually by replacing one of the feedings with formula from a cup or bottle if your child is less than one year old or whole milk from a cup if your child is older than one year.  Drop the feeding in which your baby seems least interested or the feeding at which your breasts feel least full.  Gradually eliminate other feedings until you are nursing only once daily. In a few more days you should start skipping days between nursings until nursing is eventually eliminated. 

STOOLS Just as every adult establishes their own bowel pattern, your baby will also. Newborns may have a stool with every feeding or only one a day. Older infants may go for 2-3 days without a stool. The first bowel movements are black and sticky.  Within a few days they will turn to a light, yellow green. Breast fed infants will have watery, explosive stools, which have a seedy consistency. Bottle fed infants also have yellow seedy stools but the consistency is thicker. All infants have an occasional green stool.  Grunting and straining are very common during the first several months and are due to the physical process of having a BM.