Please note that something things like, how your breasts feel, behaviour of your baby, frequency of our nursing, the feeling of being let down or the amount you pump is not valid way to determine if your milk supply is enough for your baby. If your baby is having 6 or more wet diapers in a day then your milk supply is just fine.

Following things does not mean that you have a problem with the milk supply If your baby is nursing for longer or increases the frequency. Its often due to a growth spurt. When that happens the milk supply will increase to meet your baby’s requirements. In this period, please don’t offer your baby any supplements, as that would indicate to your body that the baby doesn’t need extra.

If you baby wants to nurse often - breast milk is easy to digest and hence the babies want milk every 1.5 hours to 2 hours. Some babies have a strong need to suck and most babies want constant contact with mother to feel secure.

Your baby is not nursing often - Babies grow older and get better at nursing.

Your baby is fussy - especially towards the evening.

You don’t get enough milk when you pump using a breast pump. The amount of milk you can pump is not an accurate measure of your milk supply. Babies are much more efficient with it.

Potential causes of low supply -

Supplementing - Nursing is on very demand and supply basis. Your body will make the amount of milk that your baby requires. If the baby needs more, body will adjust … vice verse for drop in demand by your baby.

Preference for the bottle - Its easier for the baby to get milk from the bottle and hence some prefer it. Nursing with only one breast per session. If you are trying to increase the milk supply then your baby finish milk from one side and then offer the other side.

Mom’s health - sometime mothers health can lead to reduced or low milk supply like hormonal problem, smoking, anemia amongst other can cause this problem.

Tips to increasing your milk supply - Milk production is essentially works on demand and supply model, hence to increase the supply, you need to extract more milk from the breast and you need to do this often.

Make sure that you baby is nursing efficiently. If all the milk is not removed from the breast then the milk supply will reduce. If the baby is not latched on properly then he/she is probably not extracting the milk efficiently. If you think that the baby is not nursing properly or efficiently then you should use a breast pump to extract the remaining milk so that the milk supply increases. You can even extract milk in between the nursing cycle to increase the milk supply.

Nurse frequently and for as long as the baby is actively taking the feed. We know how difficult that can be because it can take forever. If you baby is having problems with gaining weight then you must nurse every 1.5 hours to 2 hours.

Offer both sides of the breasts. Let baby finish one side and then offer the other one.

Try and avoid pacifiers and bottles if you can.

Take care of yourself. Eat well, sleep well and don’t get stressed. You have a healthy new baby, take care of your little bundle of joy and leave the rest of the work to every one else!

Nutrition facts – am I eating for two?

Breastfeeding women burn about 500 calories a day in milk production and generally need to consume 2,200-2,700 calories a day. Nursing moms who are trying to lose weight should not go below a daily consumption of 1,800 calories. Most women who are nursing find that they lose weight slowly and consistently while eating a normal, healthy diet.

The US department of Agriculture’s Food Guide Pyramid (modified for lactation) suggests there foods daily:

  • Fruits 3 servings (1-2 citrus)
  • Vegetables 3 servings (1-2 leafy)
  • Grains 7 servings (preferably whole grain)
  • Dairy 2-3 servings
  • Protein 6-8 ounces

While these are excellent recommendations for breastfeeding women, as long as you are not undernourished you will produce good quality milk regardless of your diet.

Vegetarianism can be compatible with breastfeeding. Mothers who are on restricted diets, or eat no animal products should talk to a healthcare provider about supplements with vitamins A,D,B6 and B12.

Breastfeeding women also may experience an increase in thirst. Water is the best fluid for your body, but soup, fruit or vegetable juice and milk also provide fluids. Soft drinks, fruit flavored drinks and sweetened iced tea are not good substitutes for water and should be consumed in moderation. Nursing depletes your fluid levels, so try to keep water or another healthy beverage close by while you are feeding your baby.

Positioning

Correct positioning and latch-on are essential to a comfortable, successful breastfeeding experience. Getting assistance from a lactation consultant, nurse or another qualified healthcare provider will go a long way in helping you master the techniques of breastfeeding, while building your confidence.

Cradle hold:

Sit up or in a comfortable chair that supports your back. Keep your knees slightly higher than your hips – use a footstool if necessary.

Use pillow to support your baby at the breast height, lying on his/her side, with the baby’s head comfortable in the bend of your elbow.

After the baby is positioned correctly, hold your breast with four fingers underneath, thump resting slightly on top. Tickle baby’s lips with your nipple and wait for baby to open the mouth wide (like a yawn), bring the baby quickly to your breast. The baby needs to take the nipple and some of the areola into his or her mouth (the areola is the darker skin around the nipple). 

Never attempt latch-on with baby’s mouth half open. The baby’s nose and chin should touch the breast. Avoid pushing on the back of baby’s head; instead, bring his or her whole body towards you. Don’t lean forward for the baby. If there are more than a few moments of discomfort, or if suction is concentrated only at the nipple, break the suction with your finger and try to position and latch-on again. Don’t get discouraged if several tries are necessary. This is normal part of nursing process.

Football hold:

A good choice if your breasts are very large, or you’ve had a cesarean delivery.

Sit up, putting pillow at your side to support your arm.

Lay baby on his/her back, supporting the back of the head with your hand and the body with your forearm. Position the baby’s feet so that they are tucked under your arm and the knees are directly under your armpit.

Bring the baby’s mouth to your nipple. Hold your breast with four fingers underneath, thumb resting lightly on top. Stroke your baby’s lower lip with your nipple. When he/she opens wide like a yawn, bring the baby quickly to your breast.

Side-lying position:

Allows you to lie down while breastfeeding. Lying comfortably on your side, place a supportive pillow firmly behind your back. Position another pillow between your legs, with your flexed upper knee resting on a pillow.

Place the baby next to you, tummy-to-tummy so that his or her mouth is even with your nipple. Support your breast with the opposite hand to assist with the latch-on. Stroke your baby’s upper lip with your nipple. When he/she opens wide like a yawn, bring the baby quickly to your breast.

Latching-on

If your nipple is the first one your baby ever uses, learning to breastfeed will be easier and more natural for both of you. Proper latch-on techniques ensure that breastfeeding does not become painful and that your baby can get enough to eat.

Be sure your baby’s body is facing you, with his/her nose directly facing your nipple and almost touching the breast.

Support your breast with your free hand and stroke your baby’s lips with your nipple until he/she opens their mouth very wide, almost as if yawning.

Never attempt latch-on with baby’s mouth partially open as this can lead to: Sore nipples from improper positioning Inadequate emptying of the breast Non-nutritive suck patterns from baby’s suck reflex not being stimulated properly.

When your baby’s mouth is wide open, bring the baby quickly to your breast. The baby’s mouth should cover approximately 1-1.5 inches of the nipple, areola and breast tissues. If not, gently insert your finger into the corner of the baby’s mouth to break the suction, and try again.

You should not have to hold your breast back from the baby’s nose. If you baby is properly positioned at the breast, his/her breathing will not be obstructed. If you press on your breast in an effort to help the baby breathe, it can lead to plugged milk ducts and improper latch.

Don’t get discouraged, as the last-on takes practice for both you and your baby. If you feel you are having difficulty achieving proper positioning and latch-on, contact your doctor or a lactation consultant to assist you.

Adjusting after a cesarean delivery

A cesarean delivery may require some special care during the early weeks postpartum because of the discomfort associated with the incision site. Your physician can prescribe over the counter or prescription medication that is safe to take while breastfeeding. With proper use your prescribed pain medications, this discomfort can be reduced. Controlling this pain not only helps your recovery, it can also aid in more effective breastfeeding.

Uncontrolled pain can hinder your milk ejection reflex (let-down). When breast feeding after cesarean delivery, many mothers find the side-lying position or football hold most comfortable. When nursing in the cradle hold position, put a pillow on your lap so that the baby is above the level of your incision. For added comfort when you are sitting up on a chair, try putting your feet up on the footstool to take the pressure off your incision and lower abdomen. Twins or multiple births Nature is generous and initially most women will have a milk supply that is sufficient to feed twins or triplets. Provided that the babies feed well, there will continue to be enough milk for all.

Start by feeding each baby individually during the early days so that the common early problems can be resolved efficiently. Then you can continue to feed them separately or you may prefer to feed them simultaneously. Feeding schedules Within a few weeks, each baby will develop a unique feeding schedule.

Keep in mind that your baby may go through periods when he or she is not very hungry, as well as growth spurts when it seems that all your baby wants to do is eat. How often to feed A new baby needs to nurse at least 8-12 times every 24 hours. Usually this works out to a feeding schedule of once every one to three hours (timed from start of one feeding session to the start of the next).

Some babies like to group several feedings into only a few hours (cluster feeds), followed by a nap. To breastfeed successfully, it’s important to nurse whenever your baby is hungry. How long on each side Nurse the baby on the first breast until he or she drops suckling and swallowing, even when you massage the breast. Then nurse on the other side if he/she is willing. Nursing on just one breast per feeding is fine if your baby is satisfied. Let the baby decide when the feeding is over; he/she will let go and probably fall asleep.

Good positioning – not time – prevents soreness. How to tell when your baby is ready to feed Watch for feeding cues, even if you baby is asleep. Try to feed the baby before he/she starts crying. Watch and listen for small sounds, sucking movements of the mouth and tongue, restlessness and increased body movements, especially hand-to-mouth movements. As time passes, your baby will gradually start to reduce the number of feedings per day and may nurse more efficiently than in the beginning weeks, shortening the length of each feeding session.

Remember: the goal is for your baby to have an enjoyable, comfortable meal, so sit back, relax and enjoy your nursing together. Selective breastfeeding Breastfeeding mothers can choose how to fit breastfeeding into their lives. The beauty of breastfeeding is that you can select the “how, when and where” of your breastfeeding experience.

Remember breastfeeding is the best way to feed your baby, and help you to continue the experience for as long as possible, consider these options:

  • Breastfeeding exclusively Combining breastfeeding with feeding expressed breast milk
  • Breast pumping and feeding expressed milk exclusively
  • Breastfeeding when you and your baby are together; and feeding infant formula recommended by your infants physician when apart

Whichever option you choose, it’s the right one if it makes your breastfeeding experience the most comfortable for you and your baby. A lactation consultant can be assist you with designing your unique breastfeeding experience. Premature babies Premature babies have a particular need for breast milk and close contact with their mothers. Sometimes, it is not possible to breastfeed premature babies right away and lactation has to be stimulated and maintained by the breast pump. As your baby improves, the milk you express will be given to him/her through a tiny tube until he/she grows and becomes strong enough to establish breastfeeding.

Try to express as soon as you get up from the night’s sleep and before there are any interruptions. It is very important to express your milk on regular basis – atleast 6-8 times every 24 hours. It is also important to express your milk during the night as your body’s milk production will be boosted by night time expressing sessions. Always make sure you follow professional advice so that the initial difficulties can be overcome.

Returning to work – pumping your breasts

With patience and cooperation from your family, caregiver and employer, it is possible to make breastfeeding and returning to work a winning combination. Using a breast pump is an effective methods for maintaining an adequate milk supply. Both electric and manual pumps are available in retail stores. Planning ahead is one key to combining breastfeeding with your work schedule. A few weeks before returning to work, start incorporating your breast pump in your daily routine. You might find that it saves time to pump one breast while is baby is nursing on the other. Another convenient method is to pump one hour after the baby’s feedings or at skipped night feedings after your baby starts sleeping through the night. Choose the times that work the best for you and your daily rountine, then store the expressed breast milk for when you actually return to work. Selecting a one-hour “window” during which you pump each day, for instance 9 a.m. and 10 a.m. each morning, trains your body to produce a little extra milk at a specific time each day. If you choose this method, pump five or ten minutes on each side during your daily “window”. By the fouth day of pumping, you should be able to collect one to three ounces at each session. If you pump and store three ounces of milk a day for ten days, you will have 30 ounces stored – a generous milk supply for two days of childcare. Expressing more than four to six ounces a day might cause engorgement and discomfort when you finally return to work. The first day back you’ll be dealing with the regular milk supply that your baby takes, plus the extra milk that your body has been producing for the pump. Returning to work on a Wednesday or a Thursday (instead of traditional Monday) will make your adjustment easier.

Returning to work – storing your breast milk

Always use clean storage containers (hard-sided plastic/glass) or freezer milk bags designed to safely store milk and label with the current date. Refrigerate breast milk at 32-39 degrees Fahrenheit or 0-4 degrees Celsius for upto 48 hours. Freeze breast milk as soon as it is expressed for up to 3 months. Do not store in the freezer door as frequent opening and closing causes variations in temperature that are not conducive to long term milk storage. Expressed milk can be kept in a common refrigerator at the work place or in the day care center. The US Centers for Disease control and US Occupational Safety and Health Administration agree that human milk is not among the body fluids that require special handling or storage in a separate container. If milk has been frozen and thawed, it can be refrigerated for up to 24 hours for later use. It should not be refrozen. Thaw or warn breast milk under warm water or in a bottle warmer (never microwave); then shake to mix. Do not bring temperature of the milk to boiling point. Shake before testing the temperature. Shaking will also redistribute the cream with the milk (its normal for stored milk to separate into a cream and milk layer.) Safety tips Never re-feed leftover breast milk. Storing milk in 2-4 ounces amount may reduce waste. When storing, try not to exceed the average amount your new born/infant consumes during each feeding. Transport expressed breast milk in an insulated container with an ice pack. For freezer storage, your freezer should be cold enough to keep the ice cream hard. Chill freshly expressed milk before adding it to previously chilled or frozen milk.

Returning to work – pumping at work

When you decide to return to work, remember that nipple stimulation maintains milk production. Plan on pumping at least the same number of times that your baby would normally have nursed. For example, if your baby would have nursed three times during the hours you are gone, then pump at least three times while at work. As your baby gets older and he/she isn’t nursing as often, the frequency of pumping at work will probably decrease as well. Always store breast milk in a refrigerator or freezer after expressing. At work you’ll want to find a quiet, comfortable place where you won’t be interrupted while you pump. If you are having difficulty finding a suitable place, talk to your employer. Plan on also taking extra nursing pads, a spare bra and blouse to work so that they are available if an occasional unwanted let-down occurs. Remember to continue adequate fluid intake while at work. Keep a glass of your favorite healthy drink, such as water or fruit juice, on your desk.

The occasional soft drink or regular coffee is acceptable, although many nursing mothers limit their intake of caffeine, sugar and artificial sweeteners in order to optimize the quality of their milk. Its normal for your milk volume to lower on Friday than on Monday. Don’t get overly concerned. As the week goes on, the busy routine will probably wear on you, causing your milk volume to decrease temporarily. If you spend the weekend nursing frequently and resting up for the next week, you will find that Monday morning your expressed milk volumes will have returned to normal. Problems to watch for During the early weeks of breastfeeding some common problems may arise.

Remember that help is usually only a phone call away. If you experience anything you feel unsure about, contact your healthcare provider or lactation consultant for specific assistance and instructions. When should you call for help Everyone’s experience with breast feeding is unique, and each mother has different questions.

If you have concerns you should always call for help. If your baby is less than a week old, call for help immediately if:

  • He/she is not eagerly nursing at least eight to ten times daily by day three.
  • Your baby doesn’t have daily number of wet and soiled diapers indicated earlier
  • Latch-on is painful
  • You are not sure you hear your baby swallowing regularly throughout the feeding.
  • Your breasts don’t feel full (heavy) with milk by the third or fourth day after delivery.
  • Your baby hasn’t gained weight or is losing weight. Remember, it is normal for your baby to lose a small amount of weight (up to seven to ten percent of birth weight ) during first three days of life.
  • Your baby’s skin or the whites of the eyes appear yellow in color possibly indicating jaundice. All the above signs can signal dehydration or a problem with weight gain. Contact your baby’s healthcare provider immediately!

Weaning

Weaning your baby from the breast is a very personal choice. The current recommendation from the American Academy of Pediatrics is to breastfeed exclusively for the baby’s first six months, and to continue breastfeeding, with the addition of solid food, in your baby’s second six months.

After 12 months, breastfeeding may continue as long as mutually desired by mother and infant. Natural weaning You can encourage your growing child’s independence and gradually substitute activities and foods for breastfeeding when the child seems ready.

Scheduled weaning Sometimes circumstances don’t allow you to continue breastfeeding, and you decide to start a scheduled weaning. Weaning should not be started when your baby is sick or in a growth spurt, or if you are sick, have mastitis, or a plugged duct. If you are pumping, gradually cut back on the amount of milk expressed each day. The best way to let your body and the baby adjust to a scheduled weaning is to drop your baby’s least favorite feeding time.

Substitute infant formula infant formula or solid food, as appropriate, during that time of the day. Continue omitting same feeding each day for the rest of the week. Drop one daily feeding a week until you are down to two or three breastfeeding a day. You and your baby set the pace with this method of weaning and it can be as slow or fast as you choose. Rapid weaning Abrupt weaning can cause considerable discomfort for you and be upsetting to your baby as he/she loses a familiar source of closeness and comfort.

Contact your baby’s pediatrician for a recommendation on what to use as a replacement for breastfeeding, if circumstances necessitate abrupt weaning, wear a firm-fitting sports bra 24 hours a day and apply ice to the breasts for any pain and swelling, engorgement will signal your body to reduce milk production, and within a few days your milk levels will drop significantly.

Contact your healthcare provider immediately about chills, fever or flu-like symptoms that accompany breast engorgement or for advice about taking over-the-counter pain medications.

Commonly asked questions about breastfeeding

Will breastfeeding hurt?

In the first few days of nursing, pain at latch-on is fairly common. If the pain is resolved after you count to 20, you are probably fine. If the pain persists, remove the baby and carefully follow the steps for a good latch-on technique. Breastfeeding you baby should not continue to hurt, and any experienced pain is usually the result of ineffective nursing methods. By learning correct positioning and latch-on techniques at the beginning, you can avoid unnecessary pain and discomfort.

If you still experience nipple pain that lasts more than a few moments of latch-on, contact your healthcare provider. During the learning phase of breastfeeding, there may be cases when more serious pain occurs in the breasts that requires treatment.

How long will it take to breastfeed my baby?

The amount of time it will take to breastfeed depends largely on your baby. Some babies are vigorous nursers, while others take their time. Generally, breastfeeding meals can be take anywhere from 20-40 minutes from beginning to end of the session. The time may decrease as your baby becomes more skilled at nursing. In the meanwhile, try not to concentrate on amount of time your baby takes to eat. Rather, enjoy the special time you have to develop a mother and baby bond that will last a lifetime.

Should I be concerned about spitting up, hiccups and other reactions from my baby while breastfeeding?

Spitting up is a common reaction that infants have during or after feeding, and some just spit up more easily than others. There is usually no need to be concerned when your baby spits up. Unlike formula, breast milk does not smell bad and does not stain clothing or linen. Most babies also hiccup from time to time during feeding. If this happens, you can continue to nurse the baby; the hiccups will stop on their own. However, if you baby repeatedly vomits, especially in a forceful manner, call your pediatrician immediately.

How can the baby’s dad be involved in this process?

The first few weeks while you and your baby are learning to breastfeed can be a very good time for your baby’s father to become involved. He can use this time to participate by smiling, touching, talking to and encouraging the baby during each breastfeeding session. He can also be a great nursing coach to you. In the beginning, it can be difficult to remember all the techniques for latching on and the positioning. You partner can assist you with repositioning and re-latching your baby if needed. After breastfeeding is well established, the baby’s dad can begin to take part in the experience by offering expressed breast milk if your choice is to use an alternative feeding method. Another good way to get your partner involved is to include him in bathing, diaper changing and playing with the baby.

Will medication affect my breast milk?

Illness can often be treated with medications that are safe to take while breastfeeding. Many medications enter breast milk in amounts that are not clinically relevant. Progesterone-only birth control pills considered compatible with breastfeeding. Supplements, teas and herbs used for medicinal purposes (as opposed to seasoning) should be considered as medications. While many medications are considered safe, always check with baby’s healthcare provider or a lactation consultant before taking any medication, supplement or herb.

What about alcohol?

While drinking alcoholic beverages are not encouraged, please contact your healthcare provider for specific guidelines. Is caffeine okay? Coffee, tea, chocolate and many carbonated beverages contain caffeine or similar substances. One or two caffeinated beverages per day consumed by the breastfeeding mother will not usually bother the baby. Chocolate in moderation is also generally not a problem. However, too much caffeine intake may cause an irritable or wakeful infant.

Are there limitations to exercising and dieting while breastfeeding?

It’s usually recommended to wait six weeks after delivery before exercising vigorously. Always consult your healthcare provider before resuming a fitness routine after childbirth. While breastfeeding, you do not need to change your normal exercise routine. For increased confort during your workout, plan to breastfeed or pump just prior to exercising. Try to wear a bra that provides good support to prevent excessive pressure from being applied to your breasts. Especially in the early weeks of breastfeeding, avoid vigorous upper body workouts and routines that cause the breasts to bounce repeatedly. Be sure to drink plenty of fluids to maintain your hydration levels during your workout. For your baby’s comfort and enjoyment, always shower or rinse your breasts after workout. Breastfeeding mothers burn about 500 calories a day making milk and most breastfeeding women lose weight naturally, gradually and steadily without dieting. If planning a diet for weight loss, remember that you need calories for energy and making milk. Be sure your food choices include selections from all the basic food groups. Most reputable weight reduction programs have plans for nursing mothers that are safe. See Nutrition facts – am I eating for two for more diet and nutrition information. Liquid –diet weight loss plans are not recommended while breastfeeding.

Can I combine breastfeeding with alternative feeding methods?

For the most women, it takes three to six weeks of exclusive breastfeeding to establish a good milk supply. Introducing alternative methods before the milk supply is established usually leads to increased reliance on the alternative method and an early end to breastfeeding. Once breastfeeding is well established, most babies adapt nicely to a combination of breast and alternative methods.