Breastfeeding

WITH SUCCESS
TABLE OF CONTENTS
Chapter 1
The Value of Breastfeeding . . . . . . . . . . . . . . . . 1
For the Baby: Breastfeeding and Breast Milk . . . . 1
For the Mother: Breastfeeding. . . . . . . . . . . . . . . . 1
For Fathers, Mothers, and Families: Diet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
For the Environment . . . . . . . . . . . . . . . . . . . . . . . . 2
A Perfect Match . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Chapter 2
Getting Breastfeeding Started. . . . . . . . . . . . . . 3
Getting to Know Your Baby . . . . . . . . . . . . . . . . . . 3
Breastfeed Early. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Breastfeed Often. . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Breastfeed Well . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Your Breastfed Baby at Home . . . . . . . . . . . . . . . . 5
Breastfeeding Holds . . . . . . . . . . . . . . . . . . . . . . . . 6
Latch. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Milk Supply. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
How to Tell Baby Is Getting Enough to Eat. . . . . . 9
Feeding Patterns for Breastfed Babies. . . . . . . . 12
Chapter 3
Breastfeeding Challenges. . . . . . . . . . . . . . . . 15
Breast Engorgement . . . . . . . . . . . . . . . . . . . . . . . 15
When Breastfeeding Hurts . . . . . . . . . . . . . . . . . . 15
Breast Pumps and Pumping . . . . . . . . . . . . . . . . . 18
Introducing a Bottle to Your Breastfed Baby. . . . 21
Congratulations
on the birth of your baby and your decision to breastfeed. Breast milk is considered
the gold standard for all newborns. By breastfeeding you will be giving your baby the
very best nutrition possible.
Chapter 4
Fitting Breastfeeding into Your Lifestyle . . . . . 23
Breastfeeding in Public . . . . . . . . . . . . . . . . . . . . . 23
Leaking Breasts. . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Returning to Work or School . . . . . . . . . . . . . . . . 24
Breastfeeding for the First Year and Beyond . . . 24
Weaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Birth Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Chapter 5
Frequently Asked Questions . . . . . . . . . . . . . . 27
Chapter 6
Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Kaiser Permanente Breastfeeding Clinics and
Lactation Consultants . . . . . . . . . . . . . . . . . . . . 31
Kaiser Permanente Health Education
Departments. . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
La Leche League . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Breast Pumps and Supplies . . . . . . . . . . . . . . . . . 31
Lactation Web Sites . . . . . . . . . . . . . . . . . . . . . . . 31
WIC (Women, Infants and Children). . . . . . . . . . . 32
Recommended Reading . . . . . . . . . . . . . . . . . . . . 32
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
i
CHAPTER 1 The Value of Breastfeeding
Breastfeeding can benefit the baby, the mother, the
father, families, and the environment in many ways.
For the Baby: Breastfeeding and
Breast Milk
Promotes bonding and attachment
Presents food that is always ready to feed at the
right temperature
Provides antibodies to strengthen the immune
system
Provides good cholesterol and other types of
fat in human milk that support the growth of
nerve tissue and brain growth
Promotes visual acuity
Promotes healthy jaw and tooth development
and reduces the risk of cavities
Supports your childs intelligence. (A clinical
study shows infants who were breastfed for the
first 6 months of life test 11 IQ points higher
than formula-fed babies.)
 reastfeeding reduces the risk of infections and
B Produces the naturally soothing hormones
promotes healthy bacteria in the digestive system,
which can result in:
Fewer colds and ear infections
Fewer urinary tract infections
Fewer visits to the babys physician and less
chance of needing hospitalization
A reduction in the possibility for constipation or
diarrhea (less Crohns disease later in life).
Breastfeeding reduces the risk for:
asthma and allergies,
eczema,
obesity in infancy and childhood,
diabetes and high blood pressure,
high cholesterol later in life,
colitis and Crohns disease,
bacterial meningitis,
leukemia and other childhood cancers,
multiple sclerosis and juvenile rheumatoid
arthritis, and
SIDS (Sudden Infant Death Syndrome).
While breastfeeding may not seem the
right choice for every parent, it is the
best choice for every baby.
Amy Spangler, from cover of video,Through Their
Eyes: Breastfeeding, the Gift for Life, 1997
For the Mother: Breastfeeding
Promotes bonding and attachment, calmness,
self-esteem, and confidence in mothering
oxytocin and prolactin (the hormones of
motherly love)
Helps your body recover from pregnancy, labor,
and birth
Helps your uterus contract after birth, lessening
the chance of hemorrhage and anemia
Lowers the risk of breast cancer. The longer you
breastfeed, the lower the risk.
Lowers your chance of ovarian cancer
May protect you against osteoporosis in later
life
May help you lose weight, by burning calories
to make milk (about 500 calories a day).
1
For Fathers, Mothers, and Families: TABLE 1

Breastfeeding How Does Formula Compare to Breast Milk?

Makes for healthier mother and baby, resulting breast milk formula
in up to six times less absenteeism at work water
4 4
Produces less offensive-smelling diapers 4 4 protein
Produces free breast milk. Artificial baby milk/ 4 4 carbohydrates
formula is expensive ($1,500$4,000 for 1 year).
4 4 vitamins
4 4 minerals
For the Environment 4 4 fats
Artificial feeding involves 4 4 lipids
overgrazing of land by cattle; 4 enzymes
use of chemical fertilizers to grow the soy; 4 growth factors
use of valuable environmental resources for 4 hormones
formula production; 4 antiviral
packaging and transportation of the product; 4 antiparasitic
use of water and fuel for mixing the product, 4 antibacterial
heating it, and for cleaning bottles and nipples; 4 anti-allergenic
and
waste disposal of cans, bottles, accessories,
cartons, etc. There are some similarities between formula and
breast milk . . . but where formula ends, breast milk
is still providing!
A Perfect Match
Your breast milk is a perfect match for your breast-
fed baby. It changes as your baby grows. The milk a Cost of Infant Feeding for 1 Year (Estimated)*
mother produces for her preterm baby is different Breastfeeding $300.00
from what she produces when her baby is full term.
Formula
The milk produced during the babys first days is
Powdered $2,135.00
different from the milk that is produced two weeks
later. As the babys needs change, so does the milk. Concentrate (11.5-oz. cans) $2,562.00
Breast milk is the perfect food for your breastfed Ready to feed (32-oz. cans) $3,190.00
baby at all ages and stages.

*Enfamil purchased at Southern California stores in 2007.

The American Academy of Pediatrics recognizes
that breastfeeding is important for optimal infant
and child health and development.Breastfeed-
ing has advantages for infants, mothers, families,
and society. These advantages include health, Babies thrive on
nutritional, immunologic, developmental, psy- exclusive breastfeeding.
chologic, social, economic, and environmental
benefits.
From American Academy of Pediatrics (AAP) Web site
(aap.org/healthtopics/breastfeeding.cfm), March 2009

2
CHAPTER 2 Getting Breastfeeding Started
Getting to Know Your Baby
Attachment and Bonding at Birth
Skin-to-skin care, which is holding the baby dressed
only in a diaper on the mothers (or fathers) bare
chest shortly after birth, benefits the newborn by
reducing the stress related to labor and birth. Babies
held skin-to-skin cry less, breastfeed better, and
create stronger attachments with parents. After your
baby is born, your childbirth team will place your
baby on your chest and will give you time alone to
get to know each other. This is a special time for
bonding and attachment. You may wish to quickly
introduce your baby to friends and family. After that,
they will be asked to allow you time alone with your
baby for this special time shortly after birth.
Another benefit of skin-to-skin contact is that within
about one hour after birth, most babies will begin
searching for the breast without any help. Given the
opportunity to explore the mothers chest, they will
move to the breast and often will latch on to the
breast perfectly on their own.
Note: If the mother cannot hold her baby skin-to-
skin during the first hour after birth, it is helpful for
the father (or other significant member of the babys
life) to hold the baby skin-to-skin. This will help the
babys body temperature regulate faster, help stabi-
lize the babys blood sugar, and get the process of
bonding started between baby and father.
A newborn baby has only three demands.
They are warmth in the arms of its mother, food from
her breast, and security in the knowledge of her
presence. Breastfeeding satisfies all three.
Grantly Dick-Read (18901959)
Expert on natural childbirth movement.
Breastfeed Early
Breastfeeding ideally begins during the first one or
two hours after birth. Babies held skin-to-skin will
often move themselves toward the breast and latch,
many times with little or no assistance. When babies
are allowed to breastfeed early, they tend to breast-
feed better. Breastfeeding early and often helps
mother to make more milk, sooner.
Colostrumnewborn milk
At the first feedings, your baby may breastfeed
actively or your baby may prefer just to lick your
nipple and nuzzle your breast. Both are normal and
perfectly okay. The milk your baby gets from these
early feedings is called colostrum and is very im-
portant for the babys immune system. Colostrum is
the first milk for the baby; it is a rich, thick, yellowish
milk. Your baby only needs small amounts of colos-
trum at this time. If baby doesnt latch on right away,
ask your nurse to show you how to hand express
drops that you can put on the babys tongue. Your
baby will enjoy the sweet taste of your first milk. See
pages 19 and 28 for more information on colostrum.
3
Breastfeed Often
Newborn babies feed very frequently. Sometimes
they like to eat every hour, other times they will
sleep for 3 hours. For the first few days, some babies
are sleepy and need to be encouraged to wake up to
feed. After the first few days, most babies will begin
to wake on their own for feedings when they are
hungry. After the milk supply is established, many
babies may begin to stretch out their feedings a bit.
Frequent feeding is good for your baby and good
for your milk supply. Frequent breastfeeding:
Establishes and increases milk supply.
Eases the transition from colostrum feedings to
mature milk, preventing or reducing engorge-
ment.
Prevents too much infant weight loss during the
first days after birth. Some weight loss is normal
for all babies.
Reduces the incidence of jaundice in the new-
born caused from inadequate milk intake.
Hunger Cues
Watch your baby for signs of hunger instead of
watching the clock. Remember, crying is a late sign
of hunger.
Early signs of hunger, or feeding, cues are:
licking or smacking their lips;
opening and closing their mouth;
sucking on their tongues, hands, blankets, your
neck;
searching with their mouth for something to
suck on; and
putting their fingers or hands in their mouth.
Think of your babys feeding cues this way:
Opening and closing mouth, licking lips. Baby is
saying, mmmmm, a little milk right now would
be nice.
Sucking on hands, blankets, fingers, etc. Baby is
saying, Im getting hungry; please feed me.
Crying. Baby is saying, Im really hungry. My
tummy hurts; you need to feed me NOW!
4
Most babies should have at least 8 feedings in 24
hours, but as many as 1214 feedings is common
during the early weeks.
Breastfeed Well
When a baby is breastfeeding well, you will notice
long sucks with frequent swallows. By day 3, you
should notice a lot of swallowing at the beginning of
the feeding with swallows decreasing in frequency
as the feeding progresses. Allow your baby to feed
for as long as he or she wants. If your baby is actively
sucking and you are hearing swallowing, allow the
baby to finish. This may take 10 to 30 minutes, de-
pending on the feeding and the baby.
When your baby finishes the first breast, place your
baby on your chest and give the baby a chance to
burp. When the baby is ready, he or she will begin to
search for the breast again. During the early days, it
is a good idea to encourage your baby to feed from
both breasts. When babies get a little older, some
babies are satisfied after feeding on one breast,
while other babies like both breasts, and even both
breasts twice. Let your baby breastfeed until content
and satisfied.
Nursing is a meditative activity. No matter how
rushed or busy you are, try to slow down, spend
time with your baby and enjoy special time feeding
your baby. Be still, relax, and recuperate. Your body
knows this. That is why you feel so relaxed while you
are breastfeeding. Your glands release special hor-
mones that help you rest and relax during feedings.
Some of my best ideas come to me
while Im nursing my baby.
Joyce Willaford
At first, some women fight this process. They may feel
that nursing restricts them. They may feel that their
time breastfeeding is wasted and see themselves
as unproductive. Yet, if you can learn to quiet your
mind and calm your body, you will find that the time

Tips for Mothers Helpers
New mothers benefit from support and tive activity, breastfeeding helps your creative and
assistance from family and friends. During the
early weeks, the babys father, grandparents,
family members, and friends all play a key
role in helping the new family to be strong
and healthy. By mothering the new mother,
family will help her grow in her new role and
recuperate faster and resume normal activi-
ties when she is ready. Some of the things
family and friends can do to help in the early
days after the baby is born are:
Protect the new familys privacy. Too
many visitors can exhaust new parents,
making it difficult to meet the needs of
the new baby 24 hours a day.
Be positive and supportive of the new
mothers desire to give her baby the
very best.
Prepare snacks and meals for the family.
Shop, do laundry, dishes, and cleaning.
Take toddlers to the park, older children
to school, or just stay at their home to
provide support and assistance.
Hold the baby while the new mother
naps, showers, or enjoys some one-on-
one time with other children.
Be creative. You can find lots of ways to
support the new mother and her baby
as they establish breastfeeding.
Note: Often new mothers are encouraged
to pump their breasts to provide bottles of
breast milk to the baby while they sleep. This
is not recommended during the early weeks
as it can interfere with the establishment of
breastfeeding. Help the mother rest when
the baby is sleeping during the day, and the
nights will be easier to manage for everyone.
spent breastfeeding is not wasted. The tranquility
will help replenish your strength. Like any medita-
inspirational thoughts flow. The endless chatter of
your mind quiets, making room for your best ideas
to emerge.
Your Breastfed Baby at Home
Feeding Station
Many mothers find it helpful to create a special
place where they breastfeed. Choose a place where
you will be comfortable for many feedings a day. A
comfortable chair, couch, or your bed can all work.
Many mothers enjoy a foot stool to put their feet
on when sitting on a chair or couch. Gather all the
items you will want to have within reach: pillows,
something to drink, a snack, diapers, baby wipes,
telephone, channel changer, and anything else you
might need to be comfortable.
Get the baby. Remember, newborn babies feed
frequently (8, 10, 12 times in 24 hours). During the
early days, have lots of skin-to-skin contact with your
baby. Your body temperature will go up or down as
needed to keep your baby at just the right tempera-
ture. Drape a blanket over you and your baby if you
or the baby feel chilly or the room is cool. Babies
who are too warm during feeding tend to fall asleep
before they finish eating.
Position mother and baby for comfort
Get comfortable.
Get the baby organizedawake and ready to
feed.
Tummy to tummy, with shoulders and hips
supported at mothers body.
Babys ear, shoulder, and hip should be in a
straight line.
Baby should be at breast level. Use pillows,
if needed, to support your arms so you can
support the baby. The babys nose should be
opposite the mothers nipple when positioned
correctly.
5
Breastfeeding Holds
Here are some positions in which you can hold your
baby while breastfeeding. You can choose the one(s) Cradle hold
that make you and your baby feel most comfortable.
No matter which one you choose, make sure your
babys mouth is near your nipple and he or she
doesnt have to turn his or her head to breastfeed.
For most positions, your baby should be on his or
her side with his or her whole body facing yours.
This helps the baby to properly latch on to the
nipple. Try using pillows under your arms, elbows,
neck, or back, or under the baby for support.

Cross cradle or This position is a commonly used position

transitional that is comfortable for most mothers. Hold
hold your baby with his or her head on your fore-
arm and the whole body facing yours.

Side-lying position

This position is good for mothers just learning

to breastfeed in the early days or weeks of
the babys life, for premature babies, or for
babies who are having problems latching on.
Hold your baby along the opposite arm from
the breast you are using. Support the babys
head with the palm of your hand at the base
of his or her neck.
This position allows the mother to rest while
the baby nurses. It is useful for mothers who
Used with permission. womenshealth.gov.
had a cesarean birth (C-section). Lie on your
side with your baby facing you. Pull the baby
close and guide his or her mouth to your nipple.

6
 The mothers nipple should be deep in the
babys mouth, resting just in front of the begin-
ning of the soft palate; usually about 111/2
inches of nipple and areola are in the babys
mouth. (You can feel how far back this is in your
mouth by running your tongue along the roof
Clutch or of your mouth until you feel it turn from hard to
football hold soft.) If you feel the babys gums moving on the
nipple, the nipple is not far enough back.
The babys chin and cheeks should be touch-
ing the breast. The nose should be near the
breast but not pushing into the breast.

This position is good for mothers with large

breasts, inverted nipples, or who had a cesarean
birth. Hold your baby at your side, lying on
his or her back, with his or her head at the
level of your nipple. Support the babys head
with the palm of your hand at the base of his
or her head.

Latch
A good latch is important for the baby to be able to
get lots of milk from the mothers breasts. A good
latch also makes breastfeeding comfortable for the A deep latch feels better for the mother and
mother. When latching the baby, be sure the baby allows the baby to get milk out more easily.
takes enough of the nipple and areola into the
Here are other ways to describe how the babys
mouth.
mouth is latched onto the nipple:
The mothers nipple should be placed just
Use your hand to shape the breast to fit your
below the babys nose. Gently touch the babys
babys mouth.
lips with your nipple. This will stimulate baby
to open wide, commonly called the rooting Nose to Chin, Roll It In. The baby needs to
reflex. open her mouth wide to get the nipple deep
in her mouth and her lips back around your
When the baby opens wide, the mother can
areola. Lightly rub your nipple from her nose to
hug the baby close by pressing the babys chin
chin then roll it in when her mouth is open very
into her breast. This will help the baby to latch
wide. Do not allow her to nibble her way
deeply.
onto your nipple.

7
 Lips Open. The babys lips need to be open
wide like a yawn. If your babys upper lip seems
to be tucked in and pulling on the nipple, pull
up on her top lip a little to flare her upper lip
out. If her bottom lip is tucked in and pulling
in on the nipple, pull down on her chin. If this
doesnt work right away, stop and reposition
the baby.
Breaking Suction. Place a clean finger inside
the babys mouth (between the gums) and
slide your nipple out, or with your finger in the
babys mouth press down on the lower gum to
break suction before taking the baby off your
breast. Do not get into a tug of war over
your nipple with the baby.
If the latch hurts, break suction and try again.
Note: In the early weeks and months, as your baby is
learning to breastfeed, avoid artificial nipples. When
your baby has established a good pattern of breast-
feeding and is ready to learn a new skill (about 36
weeks), offering an occasional bottle of breast milk
or a pacifier should not interfere with suckling at the
breast or milk production.
Tips for Mothers Helpers
During the early days many mothers need help
with positioning the baby at their breast and
latching on. You can:
Ask if there is anything you can do to help.
Make sure the mother has drinks and
snacks while she is feeding the baby.
Breastfeeding mothers get very thirsty calories than the foremilk. This will help baby feel
during feedings and often get hungry too.
If the mother looks to be in pain, offer
suggestions for relief if you know of any or
offer to make an appointment with a lacta-
tion consultant if there is no improvement
after a day or two. Phone numbers for
lactation consultants are listed in Chapter 6.
8
For more information about positioning and latch-on,
refer to these Web sites:
ameda.com. Latch-on video.
breastfeeding.com
drjacknewman.com. Many good video clips on
baby-led latching as well as guided latching
using the cross cradle hold.
kellymom.com
biologicalnurturing.com
Milk Supply
Establishing a good milk supply occurs during the
first 23 weeks of breastfeeding. Newborn babies
breastfeed often, usually 8, 10, 12 or more times in
24 hours. Babies should be allowed to feed whenever
they show early feeding cues. Dont wait until the
baby cries to feed. Crying means your baby is very,
very hungry.
Feed your baby on the first breast for as long as the
baby is actively sucking with swallows. Watch the
baby for signs that show that the baby is ready to
change sides (falling asleep, no longer swallowing,
coming off the breast and going back on repeatedly).
Gently compressing your breast and/or stimulating
the baby to suck if sleepy may help the baby do a
better job of finishing to feed.
Allow the baby to finish the first breast. This is
important because the baby gets the first milk, called
foremilk, and the later milk, called hind milk. The hind
milk is important because it contains more fat and
fuller and is needed for growth and development.
Give the baby a chance to burp. Offer the second
breast if the baby still appears hungry.
Once the milk supply is established (after the first
week) some babies only feed from one breast per
feeding. If the baby has been gaining weight; is having
at least 6 wet diapers and 23 loose, yellow stools
every day; and is not interested in feeding from the
second breast, it is okay.
Always start on the opposite breast at each feeding.
If your baby starts one feeding on the right breast,
the next feeding should start on the left breast.
Questions About Breastfeeding:
Are you concerned that breastfeeding
may be a problem for you?
Are you concerned that your nipples
are too small, too flat, too big, or not
acceptable for breastfeeding?
Have you had breast surgery and are
worried it may affect your ability to
breastfeed?
Do you have a medical condition that
may affect your breastfeeding?
If you have concerns about your ability to be
able to breastfeed for any reason, discuss
your concerns with your physician or midwife.
Call your lactation consultant before your
baby is born to discuss your concerns.
feeding, with gradual slowing after 510
minutes. Some babies will be finished on the
breast at this time. Others may respond to
a renewed flow at the breast and will begin
sucking again. Baby will usually spend 1030
minutes on each breast.
 ote: After a few months, babies get more
N
efficient and spend a shorter amount of time at
the breast.
Breasts feel full and heavy before baby feeds
and softer after baby finishes feeding.
Some mothers, especially in the early months,
may feel a sensation of the milk ejection reflex,
or the milk letting down. This can range from
a warm or tingling sensation to a tightening in
the breast. Other moms may not feel this at all.
If you dont feel it, watch your babys behavior to
see that swallows are happening regularly.
Milk may drip from one breast while the baby
feeds on the other breast.
Babys urine and stool output increases from day
1 to 5.
Average weight gain of 1 ounce per day after
day 5. All babies lose a little weight the first 35
days of life.
Baby should be happy and content after most
feedings.

How to Tell Baby Is Getting Enough

to Eat
To tell if your baby is getting enough milk, watch for
these signs:
Baby is sucking with swallows.
- Birth to day 3Bursts of sucking 620 sucks or
more, followed by a pause. Baby will not swal-
low with every suck. After resting for a minute or
so, the baby will start another burst of sucking.
Baby will usually feed for 1030 minutes on
each breast.
- Day 3 and beyondContinues bursts of 620
sucks, followed by a pause. Baby should begin
swallowing every 13 sucks. There will be
frequent swallows at the beginning of the

9
Use this chart during the first week of feeding. Circle the time you begin each breastfeeding. Check off a
circle for each wet diaper and each bowel movement.

Babies need to breastfeed frequently, at least 8 times every 24 hours. The number of wet diapers and stools
will increase over the first week. At first the stools will be black, tarry, and sticky. By about day 3, the stools will
become less sticky and will be green or brown. By day 5, the stool should turn to a mustard yellow color and be
liquid and seedy.

TABLE 2
Breastfeeding Log

Day 1 goals: 812 feedings, 1 wet diaper, 1 bowel movement

Feedings: a.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

Supplements:

Feedings: p.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

wet diaper: m

bowel movement: m

Day 2 goals: 812 feedings, 2 wet diapers, 2 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

Supplements:

Feedings: p.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

wet diapers: m m

bowel movements: m m

Day 3 goals: 812 feedings, 3 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

Supplements:

Feedings: p.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

wet diapers: m m m

bowel movements: m m m

10
 Day 4 goals: 812 feedings, 4 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

Supplements:

Feedings: p.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

wet diapers: m m m m

bowel movements: m m m

Day 5 goals: 812 feedings, 56 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

Supplements:

Feedings: p.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

wet diapers: m m m m m m

bowel movements: m m m

Day 6 goals: 812 feedings, 68 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

Supplements:

Feedings: p.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

wet diapers: m m m m m m m m

bowel movements: m m m

Day 7 goals: 812 feedings, 68 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

Supplements:

Feedings: p.m. 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

wet diapers: m m m m m m m m

bowel movements: m m m

11
Night Feedings Some babies fall asleep after only a few minutes of
Babies feed frequently during the night. During the feeding. If your baby is falling asleep at the breast
first 12 weeks, babies often feed more during the during the first week without feeding for very long or
night than they do during the day. It is very important swallowing very much, try these tips for waking your
that new parents rest whenever their baby sleeps baby to finish feeding:
so that the night feedings will be more manageable 1. Start doing breast massage and compressions.
and less difficult. This stage passes as the baby gets
Gently squeeze your breast and hold until you
older. You can try to wake baby more often during
hear swallows then release the breast. Repeat
the day to help the baby transition to better night
as needed watching your baby for increased
sleeping, but this will be a gradual change over the
first days and weeks. interest in feeding and increased swallowing.
2. Dress your baby in a diaper only during feed-
ings. Add a light blanket as needed over the
Sleepy Babies
baby if she wakes and is actively sucking with
Many babies are sleepy in the first few days after swallowing.
birth. You want to be sure that your baby feeds at
least 8 times in 24 hours. Therefore, if your baby 3. Stretch the babys arms slowly up toward the
sleeps more than 3 hours, gently wake your baby up head and down again.
to feed. Watch for early signs of hunger (for exam- 4. Rub your babys feet, head, and/or back to
ple, licking the lips, putting hands and fingers to the stimulate him.
mouth, moving arms and legs to get your attention).
A sleeping baby with rapid eye movement under
the eyelids is a sign that he or she may be starting to If none of this works, try to wake baby again in an
get hungry. hour or so. If the baby skips more than two feedings,
express your milk manually or with a breast pump
and feed your baby using a dropper, soft cup, or a
Tips to wake a sleepy baby:
bottle. Try breastfeeding again at the next feeding.
1. Undress baby down to just a diaper before
feeding time.
Contact a lactation consultant or your babys physician
2. Hold the baby close (skin-to-skin) with the
if this behavior continues for more than two feed-
babys head on your chest, tummy on your
ings in a row, you notice a decrease in urine output,
tummy, or heart to heart.
or the problem lasts for more than one day.
3. Gently massage the babys back, arms, and legs.
4. Stroke your babys cheeks, lips, and mouth
with your finger.
5. Change the babys diaper. Feeding Patterns for Breastfed
6. Talk or sing to your baby.
Babies
One Breast per Feeding or Both
7. Walk your fingers up and down the babys back.
Babies all have their own unique pattern of feeding.
8. Hand express your milk onto your babys lips
Some babies like to feed from one breast per feeding.
to taste and smell.
Other babies like to feed from one breast, wait 10
9. Tickle your babys chin. minutes, and then feed from the other breast. Still
10. With the baby sitting in your lap, gently lean other babies like to feed from one breast then the
the baby back and then bring the baby to a other breast, then back to the first breast, three sides
sitting position. Do this several times. per feeding. Some babies eat a lot during the morning,

12
nap well in the afternoon, and then feed a lot during
the evening hours. Other babies like to feed infre-
quently in the morning then eat all afternoon.
Feeding patterns change over time. What your baby
is doing this month may be very different next month
and the month after. Follow your babys lead. Feed
your baby when hungry, and keep an eye on the
number of diaper changes you are doing. Weight
checks will also help reassure you that your baby is
getting enough to eat.
Cluster Feedings
Babies feed frequently for lots of reasons. Cluster
feeding is common in the early weeks for most
babies. Once or twice a day, your baby may want to
feed from both breasts two or three times in a row,
or have 23 feedings in a very short period of time.
This is normal and is the babys way of getting the
milk at the end of the feeding that has more fat and
calories. Consider this as dessert for your baby. After
a cluster of frequent feedings, most babies will sleep
their longest stretch of the day.
Growth Spurts
When babies are getting ready to have a growth
spurt, they need more milk. The baby increases your
milk supply by breastfeeding frequently for a day or
two and then going back to a more normal routine.
Frequent breastfeeding increases milk production.
It does not mean your milk has dried up or that
your milk is inadequate in any way. Your babys first
growth spurt may occur when he or she is about 1. Put warm, moist towels on your breasts for 1015
6 days old, again at about 23 weeks, then occur minutes before feedings. This can stimulate your
every several weeks over the first year or so. Just
relax and enjoy these days, knowing that your body
will take care of the babys needs. If you become
concerned, count the babys diapers. If there are lots
of diaper changes, your baby is getting plenty to eat.
If you feel your milk supply is low, try these steps to
increase production.
How to tell if youre making enough milk
for your baby
If you are worried you are not making enough
milk for your baby, use this checklist:
o K
 eep your baby close and feed whenever
the baby shows signs of hunger.
o C
 ount diapers. After day 5, look for 6 (or
more) heavy wet diapers every 24 hours
and 3 or more loose yellow stools. Some
babies may have a bowel movement with
every feeding. This is okay too.
o Look
 at your baby. Is the baby getting
bigger? Are the clothes getting tighter? Is
the baby gaining weight? If so, your baby
is getting enough milk.
o Is the baby content after most feedings?
All babies have some fussy times; this is
normal, but the baby should be content
most of the time.
o Is the baby having a growth spurt? These
usually last only 12 days when the baby
feeds often.
o H
 ave you been very busy lately, missing
feedings at times? Sometimes a fussy
baby is telling the mother to slow down
and spend a little more time cuddling
and breastfeeding and enjoying him or
her.
milk to begin flowing; it is often referred to as
let-down.
2. Feed your baby at least every 23 hours, day and
night. If your baby seems hungry more often,
breastfeed more often to meet your babys needs.
3. Latch the baby deeply so that the babys mouth is
open wide covering the nipple and 1 inch or more
of areola.
13
4. Listen for the baby to swallow frequently.
5. Drink enough fluids, at least 1 glass of water every
time you feed the baby and more if you are still
thirsty.
6. Feed yourself. If you are not very hungry, try to
snack several times a day. Fresh fruit, whole-grain
crackers, and nuts all make good healthy snacks.
7. Rest. The demands of taking care of a new baby
are high. Try to nap in the morning and afternoon
when the baby is sleeping during the early weeks
after birth and whenever you can as the baby gets
older.
14
8. Pump after or between feedings for 1020 min-
utes for extra stimulation.
Visualize lots of milk flowing, while massaging
your breasts before you begin and again half-
way through the pumping session.
Try to relax. Avoid staring at the bottles and
getting stressed at the milk flow. This only
inhibits the process. Relax, read, watch TV, or
visit with a friend while pumping.
If you have tried all of these suggestions for
23 days and still feel your milk supply is too
low, call your lactation consultant to discuss
other possible causes and solutions.
CHAPTER 3 Breastfeeding Challenges
Breast Engorgement
For the first week after the birth of your baby your
body is going through many changes. One of these
changes is the beginning of breast milk produc-
tion. Two to five days after birth many women notice
breast fullness, while others experience breast
engorgement.
Difference Between Breast Fullness and Breast
Engorgement
Breast fullness is related to the beginning of milk
production. We usually refer to it as saying, the milk
has come in. Breast fullness rarely causes a baby to
have difficulty latching-on and breastfeeding. When
the infant has finished feeding, the breast usually
feels softer, lighter, and more comfortable.
Breast engorgement is when the breasts are hard
to the touch, swollen, and painful. While the breast
is hard and swollen, the infant may have difficulty
latching and cannot drain the milk from the breast
well. Some mothers get a slight fever (below 100F)
for a short period of time.
To prevent engorgement, breastfeed early, breastfeed
often, breastfeed well, and breastfeed exclusively.
How to Treat Breast Engorgement
1. Breastfeed frequently, at least every 23 hours. Do
not limit your babys time at the breast.
2. Avoid the use of pacifiers, bottles of formula, or
water (unless recommended by your babys physi-
cian).
3. If your breasts are not leaking, you may use warm,
moist compresses on your breasts for 5 minutes
before each feeding. Massaging your breasts will
also help drain the milk better.
4. Warm showers are helpful as well. While in the
shower, massage your breasts to help soften
them.
5. If the baby is unable to latch, unable to soften
the breast when feeding, or has less than 5 wet
diapers in 24 hours, you will need to express your
milk manually (use your hand to massage the
breast to remove the milk; see pages 2021 for
more information) or use an electric breast pump.
Use the milk you express to feed your baby.
6. If your breasts are still hard after breastfeeding
or expressing your milk, apply ice compresses
to your breasts for 1015 minutes. This will help
reduce the engorgement further. (Bags of frozen
peas work well.) Make sure you have a cloth layer
between your breasts and the ice packs.
7. Ibuprofen or acetaminophen may help reduce the
pain. Ibuprofen may help reduce the swelling. You
may continue to breastfeed while taking these
medications.
8. If there is no improvement after 2448 hours,
contact your lactation consultant for advice. If you
get a fever above 101F, notice redness or warmth
in one area, or feel ill, it could mean you have an
infection. If a lactation consultant is not available,
you should see your primary care physician or go
to Urgent Care.
When Breastfeeding Hurts
Sore Nipples
If breastfeeding is painful and hurts, this could
mean that there is something wrong. Blisters, scabs,
cracks, or bleeding are not normal when breastfeed-
ing and are signs that there is a problem. Read the
following information and see a lactation consultant
right away.
15
Early Days of Breastfeeding
Many women experience some nipple tenderness
during the early days of breastfeeding. This is usually
a sign that baby is not latching correctly. Review
the information in Chapter 2 on the correct latch,
look at the videos on the Internet, and ask for help.
If you dont get relief, call a lactation consultant in
your area and schedule an appointment; a lactation
consultation can help.
Pain Management
To treat your pain until you can get help, follow
these steps:
Begin each feeding on the least sore breast. If
both breasts are sore, put a warm, wet wash-
cloth on the breast and use gentle massage
(going from the chest wall toward the nipple) to
start the flow of milk.
If necessary, breastfeed more often (every 12
hours) and for shorter periods of time (1015
minutes or until the breast is soft).
Express a small amount of milk or colostrum
onto the sore area after the feeding. Air-dry
your nipples after feedings.
Pure lanolin cream can help protect nipple tissue.
Do not use vitamin E or other creams or oils.
Gel pads can provide relief and protection. They
can be cooled and, like lanolin, will keep your
nipples moist. Gel pads are available where
breastfeeding supplies are sold. See Chapter 6.
Avoid soap on nipples when breastfeeding, just
rinse with water during your daily shower.
If breastfeeding is too painful, pump your breasts
every 23 hours for about 1520 minutes on each
breast, or longer if the milk is still flowing. An elec-
tric breast pump is the easiest, most effective pump
for this use. See Chapter 6 for pump resources at
your medical center. You can feed your expressed
milk to your baby until your nipples heal and you
can see a lactation consultant for help. Dont quit
breastfeeding because it hurts; get help.
16
Sore nipples after pain-free breastfeeding for
1 week or more
Sore nipples can occur after the first week for several
reasons. The first thing to check is the latch, to make
sure it continues to be correct. Thrush (a fungal
infection many babies get in their mouths that may
require medication), teething, or a new pregnancy
can also affect your nipples. If your nipples become
sore, call your lactation consultant. She will help you
discover the cause so that you can create a plan to
solve the problem as quickly as possible and get you
back to pain-free breastfeeding again.
Sore Breasts
Your breasts can be sore for a number of reasons.
Engorgement, plugged ducts, and mastitis (breast
infection). If you are having breast pain, try the sug-
gestions given below. If the pain is severe or you
have no relief within 24 hours, contact your lactation
consultant or health care professional.
Plugged milk ducts
When a milk duct is not draining well, it can become
blocked or plugged. It often feels like a lump or pea
under the skin or it may be a red, firm, and tender
area near the nipple.
Causes
- missed feedings,
- the babys first sleeping through the night,
- wearing an underwire bra, a bra that is too
tight, or not properly fitted, and
- doing too much in one day or feeling stressed.
Treatment
- Breastfeed the baby often, starting with the
sore side first.
- Position the babys nose toward the plugged
duct while breastfeeding and change positions
often.
- Apply warm, moist compresses 56 times a day
for 1015 minutes just before breastfeeding.
 - Massage the breast just in front of the tender
area to help the milk to begin flowing. Once
there is milk flow, use some deep pressure
massage just behind the tender area while
feeding, working fingers toward the nipple to
help move the plugged milk toward the nipple
and out.
- Drink extra fluids and eat healthy foods.
- Wear a soft bra that doesnt dig into the breast
or dont wear a bra.
Prevention
- Pump your breasts to keep them soft if you
miss a feeding or your baby sleeps all night
and you are uncomfortably full.
- Try not to overdo it. You are still recovering
from giving birth.
Most plugged milk ducts are released within 2448
hours. If there is no improvement or if you begin
running a fever over 101F or you feel sick as if you
are coming down with the flu, see your health care
professional or go to Urgent Care for treatment.
Mastitis
Mastitis is an infection of your breast tissues, not
your milk supply. It is safe and important to continue
breastfeeding.
Mastitis may follow a plugged milk duct or may
appear suddenly with no warning. Symptoms are the
same as the flu: fever, chills, and body aches. Also,
there is usually a red, swollen, hot, painful area on
the breast. Usually it is only on one side.
Causes
- cracked or otherwise damaged nipples,
- infrequent and/or ineffective breastfeeding,
- overtired mother, and
- untreated plugged milk duct.
Treatment
- Heat. Apply warm moist compresses and place
them on your breasts for 1015 minutes before
feeding or pumping. (Fill a clean, disposable
diaper with warm tap water and place it over
your breast. It can be used over and over
again.)
- Rest. Go to bed. Take the baby with you. Make
sure to drink a lot of fluids and eat healthy
foods. This is very important or the condition
may get worse. If you have other children at
home, arrange for someone to care for them
while you recover.
- Breastfeed often to keep your breasts soft.
If your baby cannot, or will not, breastfeed
enough, use a breast pump to keep your
breast well drained.
- If your symptoms are severe or last for more
than 24 hours, call for a same-day appoint-
ment with your primary care physician or go to
Urgent Care. You may need to take antibiotics.
If so, take them for the full 10-day course and
continue to breastfeed.
- Pain relief. The anti-inflammatory medicine
Ibuprofen can relieve your pain. You do not
need a prescription. Follow the instructions or
follow your physicians instructions.
Prevention
- Latch well. A good latch solves most breast-
feeding problems.
- Breastfeed often.
- Rest as much as possible, especially the first
6 weeks.
- Treat plugged milk ducts right away.
- Continue breastfeeding.
17
TABLE 3
Choosing the Right Pump

Small electric, Double pump, Hospital

Manual
If you plan to battery-operated electric grade electric
pump
pump (to purchase) pump (rental)
Pump for the occasional supplemental bottle 4 4
Pump at least once per day 4 4
Return to work 4
Increase milk supply 4 4
Establish milk supply (baby is not latching) 4
Baby in NICU (premature or sick baby) 4

Breast Pumps and Pumping

A good pump should be able to relieve breasts
Here are several resources for breast pumps: of some milk and of stimulating production.
Many Kaiser Permanente facilities have breast It should be clean, contamination free, easy to
pumps available for rent and/or purchase. See use and not cause pain or discomfort.
Chapter 6 for pump options at your medical Ruth Lawrence, MD
From her book, Breastfeeding: A Guide for the
center.
Medical Profession
You can call Medela at (800) TELL-YOU
(1-800-835-5968) or visit their Web site at
medela.com or Ameda at (866) 99-AMEDA effectively. Most women switch over to breastfeed-
(1-866-992-6332) or visit their Web site at ing once the problems are resolved. Be sure to
ameda.com for a breast pump dealer located stay in contact with your lactation consultant so she
near you. can guide you through the process of moving from
Recommended hand pumps for purchase: pumping to breastfeeding. Some reasons you may
Ameda, Medela, and Avent ISIS (avent.com). need to pump for a while are that the:

Recommended electric pumps for purchase:
Ameda, Medela, and Lansinoh (lansinoh.com).
Battery-operated and small electric pumps
are not as efficient as the large electric breast
pumps available for rent.
If you are unsure about what pump to use, ask your
lactation consultant at your local medical center.
Using a Breast Pump to Start Your Milk Supply
Many women need to use a breast pump to establish
a milk supply until the baby is able to breastfeed
baby is not able to maintain latch and breast-
feed well,
baby has an anatomical problem preventing
effective breastfeeding,
baby is in the NICU because he has special
needs, or
mothers nipples are too large for baby to take
them into his or her mouth.
Even though your baby cannot breastfeed right
away, you can begin the important task of giving the

18
best food possible to your baby by removing milk
from your breasts by using an electric breast pump.
After your babys birth, your hormones that control
milk making are at high levels. If the milk stays in the
breast too long, the hormone levels drop and milk
production stops. By using an electric breast pump
on a regular basis (810 times a day), you will help to
keep the lactation hormones high for milk production.
Your nurse or lactation consultant will help you to
get pumping started while you are in the hospital
and will help guide you in the steps needed for you
to continue pumping once you are home from the
hospital. As your milk production increases and your
baby is able to drink the milk you have pumped, the
lactation consultants will help you and baby learn to
breastfeed.
To prepare to express/pump your milk, follow these
steps:
If you are expressing milk for a premature baby
or for a baby who is sick, your physician may
have recommended you store milk in sterile
containers. For the well baby, clean bottles or
milk storage bags can be used.
Apply warm, moist heat to your breasts for about
510 minutes before expressing milk to help
your milk ducts relax and the milk to let-down
and flow better. Follow this with 12 minutes of
breast massage. (Once you are used to ex-
pressing your milk and you have a good flow of
milk, you can skip this step.)
Set the pressure on your pump to minimum
pressure. Turn the pressure up to your comfort
level. To find your comfort level, turn the suction
up to the point where it hurts, then turn it down
slightly. Pumping should not hurt. If it hurts, turn
it down a little more.
Follow this procedure for pumping:
If your baby is in the NICU, begin pumping
within 2 hours after birth, if possible.
If your baby cannot latch on after several attempts,
begin pumping to provide breast milk for your
baby until an effective latch has been achieved.
Pump frequently; 810 pumping sessions in 24
hours will help you establish a good milk supply.
Try to space your pumping sessions throughout
the day with at least one pumping session at
night.
Pump your breasts for about 15 minutes, both
at the same time or one at a time, or until no
milk flows for 2 minutes. Pump no more than
30 minutes at a time. If you are pumping one
breast at a time, it may be helpful to change
sides, back and forth, whenever your milk flow
slows.
Hand expression is often very effective during
the first days after giving birth. Ask your nurse
to teach you how to hand express and if little
milk is flowing at the beginning, try alternat-
ing between hand expression and pumping to
increase the milk flow.
During the first 2 days after birth, you have
colostrum. Colostrum is the first milk, or new-
born milk. It is concentrated and has the right
amount of nutrients and immune factors for
your baby. Do not be alarmed if there are only
small amounts; this is normal. Every drop is
important for your baby.
Milk volume will increase when your baby is
about 35 days old. Pump even when there is
little or no milk coming, as this stimulation will
help your milk supply later and will prevent
engorgement from occurring.
Mothers have found the following tips helpful to
increase milk flow when pumping:
- Apply warm, moist heat to the breasts for
510 minutes. It can help relax milk ducts and
encourage the milk to letdown.
- Gently massage the breast for a minute or so
before beginning to pump and whenever your
milk flow slows.
- Relax. Pumping is a learned behavior and
takes practice. The milk will come.
19
TABLE 4
Breast Milk Storage Guidelines

Storage Time Refrigerator Cooler with Room Room

Deep Freeze Refrigerator
for Human Freezer Ice Packs Temperature Temperature
(0F) (39F)
Milk (variable 0F) Frozen (59F) (66F72F) (72F79F)

Up to 12
Fresh 34 months 8 days 24 hours 610 hours 4 hours
months

Frozen,
Do not Do not
thawed in 48 hours Do not store 4 hours 4 hours
refreeze refreeze
refrigerator

Thawed,
Do not Do not Do not Until feeding Until feeding
warmed, not 4 hours
refreeze refreeze refreeze ends ends
fed

Until feeding Until feeding

Warmed, fed Discard Discard Discard Discard
ends ends

Storage of Breast Milk Thaw frozen milk by placing it in the refrigerator

Be sure to label any bottles of milk that will be stored
with the date and time you pumped it as well as
any other information you feel will be important.
Breast milk stored for a period of time will separate.
The fatty portion of the milk will float on the top.
The amount of fat will vary depending on when you
pump, how long you pump, and the time of day the
milk was expressed. Shake gently to mix the milk
back together before giving it to your baby.
the night before if you know you will need it the
next day.
Place a bottle of frozen milk in a mug of warm
water and allow it to thaw gradually.
If the fatty portion of the milk has floated to
the top, mix the separated milk back together
before feeding it to the baby by gently swirling
the bottle.

Hand (Manual) Expression of Milk

Preparing Milk for Feeding
Follow these tips to warm milk or thaw frozen milk
for feedings:
Never heat babys milk in a microwave or on the
stove.
Warm milk gently and slowly, placing the bottle
in a cup or bowl of warm water.
Before you begin to express your milk, wash your
hands. Use a clean collection container such as a
bowl to collect the expressed milk. There are 420
openings on each nipple, so the milk may spray out
in different directions. A wide mouth container is
helpful.

20
Follow the steps listed on page 19 to prepare your
breasts with warm, moist heat and then massage.
Use your fingertips to stimulate the nipple for a
minute or two as well.
Start out by making a C shape with your hand to spurt has passed. At that time, you may start pump-
support your breast. To do this, place four fingers
under your breast to support it and place your thumb
above the breast. Place your fingers so they are well
above the nipple and on the areola.
Press your fingers inward toward your chest wall. At
the same time, use your fingers and thumb to gently
squeeze the areola for about 5 seconds and then
release the squeeze and inward pressure. Wait a few
seconds and repeat several times. Within seconds,
milk should start dribbling or spraying out. Once the
flow of milk slows down, rotate the position of your
fingers. For example, make a U shape with your
hand. In this way you are expressing different areas
of the breast.
This process will take practice. Be patient with your-
self as you learn. Try not to pull the nipple.
A good video on manual expression can be
seen at:
http://newborns.stanford.edu/Breastfeeding/
HandExpression.html
Introducing a Bottle to Your
Breastfed Baby
Under normal circumstances, it is not advisable to
pump, nor to give your baby a bottle, until your milk
supply is established and your babys first growth
ing once a day for milk storage. It is recommended
that your baby be at least three or four weeks old
before introducing a bottle. Many mothers do not
introduce a bottle until 2 weeks before they return
to work. Your baby will usually accept a bottle if not
overly hungry and if the bottle is not forced. After
the bottle is introduced, it is recommended that
your baby be given a bottle at least twice a week so
that she will continue to accept the bottle.
To begin, think about having someone other than
the breastfeeding mother give the first bottle. It may
be helpful for the father or grandparent, etc., to
hold the baby in a position other than the familiar
breastfeeding position. In fact, it is highly recom-
mended that the mother not even be home. Your
baby senses the mothers presence, can hear and
smell her, and may refuse to accept the bottle.
Instead, take your pump and plan to be away during
your babys feeding time. This gives you a chance to
pump while your baby is learning to accept a bottle.
The best nipples on a bottle are ones that require
the baby to keep her mouth open wide while suck-
ing. Do not allow your baby to suck only on the
nipple tip.
Typical infant consumption for a feeding is about
1 ounce of milk for every 2 pounds of body weight.
Start by offering the baby 2 ounces. Heat 1 more
ounce if the baby is still hungry. Remember that milk
that has been warmed for a feeding must be thrown
out at the end of the feeding.
21
CHAPTER 4 Fitting Breastfeeding into Your Lifestyle
Before you know it, your baby will have grown past
the newborn period and your life will be getting
busy as you resume many of the activities you en-
joyed before your baby was born. Anticipating your
return to work or school can be stressful for many
mothers. If planned well, you will be able to manage
it all.
Breastfeeding in Public
California state law (Assembly Bill 157) states a
mother may breastfeed her child in any location,
public or private, except the private home or resi-
dence of another, where the mother and the child
are otherwise authorized to be present.
If you need help or tips on how to breastfeed in
public discreetly, ask your lactation consultant or
educator for assistance.
Leaking Breasts
Many women find that when their breasts are very
full or when they are away from the baby and miss
a feeding, their breasts will leak. Leaking is a signal
your body is giving you that you should try to pump
or breastfeed soon. There are several things you
can do to prevent embarrassing wet spots on your
clothing.
Apply direct pressure to your nipple when you
feel the milk is beginning to flow.
Use breast pads. They are available in dispos-
able or reusable cotton pads. Change your
pads frequently.
Avoid letting your breasts get overly full; you
will leak less.
For most women, leaking becomes less of a prob-
lem after about 6 weeks when the hormones levels
adjust to breastfeeding.
Diet
There is no need to follow a special diet when you
are breastfeeding. Follow these simple guidelines to
feel good while you breastfeed:
Eat a wide variety of foodslots of fresh fruit,
vegetables, whole grains, and an extra serving
of protein.
Drink lots of water. Some juices and caffeinat-
ed beverages are okay, but dont overdo them.
Eat enough caloriesabout 500 calories extra
each day to support lactation (usually about
2,2002,800 calories per day). A personalized
diet plan while you are breastfeeding can be
found at www.mypyramid.gov/mypyramidmoms.
You can enter your height, weight, due date/
birth date, and activity level to get suggestions
just for you. If you have any special nutritional
needs, be sure to discuss them with your physi-
cian or lactation consultant.
Drinking alcohol in limited amounts is safe when
breastfeeding. Remember that the alcohol will
filter into your milk, so small amounts taken
after feedings are usually best.
Human milk varies only slightly from mother
to mother regardless of what you do or do not
eat. The goal is to eat balanced, healthy, ener-
gizing meals so you and your baby can thrive.
Exercise
Many mothers are anxious to get back into shape
and want to begin an exercise program right away
after the baby is born. Wait until after your postpar-
tum appointment and approval from your physician
23
or midwife. When you are ready to start exercising
dont let breastfeeding stop you. Many women walk,
run, do yoga, go to the gym, or whatever else they
enjoy, while they are still breastfeeding.
Returning to Work or School
When planning to return to work or school, think
about the following:
Return to work mid-week, if possible, for an
easier transition.
Get a breast pump before returning to work or
school.
Locate a clean, private, safe area to pump (this
is required by employer or educational institu-
tions) and store your milk.
Having your babys caregiver close to work
is convenient if you plan to visit at lunch to
breastfeed.
Begin pumping and storing milk two weeks
before returning to work or school. Begin
pumping after the fullest feeds (usually in the
morning).
Someone other than the nursing mother (dads
are a good choice) can introduce the baby to
the bottle the first time. Place baby in a posi-
tion that is not similar to breastfeeding. Be
patient; this is a new experience for your baby.
Pack the diaper bag and pump kit the night
before a new work or school day to make your
mornings flow easier.
Plan ahead. Some Kaiser Permanente facilities offer
a Breastfeeding and Returning to Work class. Call
your local health education department or your lac-
tation consultant/educator. See Chapter 6.
California Lactation Accommodation Law
Assembly Bill 1025 states that any business shall pro-
vide an employee with a reasonable break time and
24
a location, other than a bathroom, for you to express
your milk. Make arrangements with your employer
before returning to work to ensure a smooth transi-
tion back to work.
Breastfeeding for the First Year and
Beyond
As the days, weeks, and months pass, you will no-
tice your breastfeeding will change. The American
Academy of Pediatrics recommends at least 1 year
of breastfeeding and suggests that you continue for
as long as you and the baby enjoy the relationship.
Your milk continues to be nutritious and is a healthy
addition to your babys diet for as long as you con-
tinue to breastfeed. You will make milk as long as
your baby is drinking the milk.
The American Academy of Pediatrics recom-
mends that you breastfeed your baby for at
least 12 months, and thereafter for as long
as mutually desired. You can breastfeed your
baby for over 1 year.
Surround yourself with supportive family and
friends.
Attend a support group. Youll be glad you
did.
Weaning
Under natural circumstances, babies wean gradually.
The weaning process begins when baby starts solid
foods at around 6 months of age. Over the coming
weeks or months, the baby will gradually increase
the amount of solid foods eaten and decrease
breastfeeding. It can take weeks, months, or years
to completely wean your baby. For a comfortable
weaning, always wean gradually. Never try to drop
more than one breastfeeding a week.
Birth Control
You can get pregnant while breastfeeding. Be sure
to discuss birth control options with your health care
professional. They can guide you in choosing a safe
and effective contraception method to use while you
are breastfeeding.

Support Groups
It has been proven that support groups help
mothers to breastfeed longer. Find a sup-
portive group that you enjoy and get to know
other breastfeeding mothers. Here are some
ideas:
Many Kaiser Permanente facilities have
support groups for new families. Con-
tact your local lactation consultant for
support group information at your local
medical center. See Chapter 6.
WIC (Women, Infants and Children).
Many WIC programs have support
groups for new mothers. Ask your WIC
worker if a support group is available in
your area. See Chapter 6.
La Leche League. La Leche League is
a mother-to-mother information and
support organization for breastfeeding
mothers. Call 1-800-La Leche (1-800-
525-3243) for the La Leche League
group information for your area. See
Chapter 6.
Community centers. Many community
centers offer parent support groups
and new mother groups. Call your local
community center to get information on
what is available in your neighborhood.

25
CHAPTER 5 Frequently Asked Questions
Q. H
 ow do I know if my baby is getting enough
breast milk since I cant tell how much he is
drinking?
A. Look at your baby. Listen and watch for swallows
during feeding. Expect occasional swallows the
first 12 days with increasing swallowing after
day 3. Track the babys urine and stool output on
the Breastfeeding Log form (Table 2) on pages
1011 or the chart in Healthy Beginnings, Issue
10 (Postpartum) that you received in the hospital.
Your baby should be allowed to feed whenever
he or she shows signs of hunger and for as long
as the baby desires. Babies should breastfeed
812 times in 24 hours. The urine and stool out-
put should increase every day until baby is 5 days
old. After day 5, you should see at least six really
wet diapers and at least two large yellow stools
every day. After feedings, your baby should be
content and sleepy most of the time. If this is not
the case, call your lactation consultant to discuss
your concerns.
 owever, you should call your pediatrician if
H during the day to help reset the babys internal
your baby appears to have a loss of appetite
during feedings, frequent or excessive vomit-
ing, rectal temperature greater than 100.4F or
axillary temperature greater than 99.4F, marked
behavior changes such an unusual irritability, ex-
cessive sleepiness, general restlessness, or your
baby has any difficulty breathing with inhaling or
exhaling.
Q. M
 y baby wants to suck all the time, even after
he or she is fed. Should I use a pacifier?
A. Babies are born with a very strong suck instinct.
Sucking feels good to babies. They have been
sucking their fingers and toes since before they
were born. Newborns will suck on their hands
to show you they are hungry, and they will suck
to help themselves go to sleep. During the first
month, your baby should be put on your breast
whenever they show signs of hunger, like sucking
on their hands. After 1 month of age you can in-
troduce a pacifier but limit its use to times when
you are not available to breastfeed, like in the car
or when you are in the shower.
Q. W
 hy does my baby sleep so well during the
day but stays awake at night?
A. Babies wake during the night for feedings for
several months. If your baby is awake more than
just for feeding, it may be that their sleep cycle is
set for being awake at night. During your preg-
nancy your babys sleep cycle was set by your
activities. If you were active during the daytime
hours, your baby was probably rocked to sleep
all day. When you went to bed at night, the rock-
ing stopped and your baby became more awake
and alert. Some ways to help your baby to be
more wakeful during the day and sleep better
at night are to expose your baby to more light
clock. Keeping your baby close during the night
may help your baby sleep better as he or she
feels more secure when somebody is close to
him or her. Keep the lights low and activity to
a minimum during the night to help teach your
baby that nighttime is for sleeping.
Q. M
 y baby is so gassy. Did I eat something that
caused this?
A. Probably not. The colostrum the baby is eating
the first few days acts like a laxative to help the
baby pass the sticky first stools, meconium. Some
gas is normal for everyone; it is part of the diges-
tion process. If your baby is gassy, crying, and
uncomfortable, call your lactation consultant.
She can probably help you to identify possible
causes.
27
Q. Should I give my baby formula, juice, or water?
A. The American Academy of Pediatrics recom-
mends your baby drink only human milk for the
first 6 months. After 6 months, you can gradu-
ally introduce other foods, water, and a little
juice. Your pediatrician will guide you through
this process. Breast milk should continue to be
a major part of your babys diet for the first year.
Your baby should never need any formula when
breastfeeding is going well.
Q. Does breast milk change over time?
A. Yes. Milk changes according to your babys need.
The milk changes as your baby grows, but it also
changes during the feeding.
 he milk in the first few days is called colostrum.
T
Colostrum is like an energy drink for your baby,
low in fat, high in protein, and easy to digest. It
is the perfect food for your baby to learn how
to breastfeed. It is sweet and present in small
amounts so the baby doesnt get overwhelmed
with too much milk flowing. By about the third
day the milk volume starts to increase. The more
the baby breastfeeds, the more milk there will
be. This milk has more water and fat than in the
first two days, but it still has all the good colos-
trum to keep your baby healthy. By the time your
baby is about 2 weeks old, the colostrum is gone
and your baby is getting mature milk.
During the feedings, milk changes too. The milk
at the beginning of the feeding may appear
watery. This is because it has a lot of water to
quench the babys thirst. The milk toward the
end of the feeding is thicker, richer, and has a
higher fat content. This milk helps your baby to
feel full and gain weight. This is why it is im-
portant to let baby decide when the feeding is
finished. In that way, the baby gets just the right
combination of milks.
Q. Is it okay to only pump and bottle-feed my
baby breast milk?
A. This is not recommended on a long-term basis;
however, it is better than the baby not getting
28
any breast milk and just getting formula. Call your
lactation consultant if you are having problems
with breastfeeding. A baby who is latching well
can feed very quickly and effectively.
 fter your breastfeeding is established at about
A
1 month, you can begin to pump and store
breast milk for use when you need to be away
from your baby. See Chapter 3 for the section on
breast pumps to help you decide what type of
pump you will need.
 ome medical centers offer a class through
S
your local Health Education Department about
Returning to Work for breastfeeding mothers.
Call your Health Education Department for class
information. See Chapter 6.
Q. W
 hat does it mean that a baby can be nipple
confused?
A. Sucking is a natural instinct; breastfeeding is a
learned skill. Sometimes if a baby gets a bottle
too early, he or she may have difficulty breast-
feeding. The bottle feels different in the babys
mouth and the milk flows differently from the
bottle than it does from the breast. While some
babies can go back and forth from breast to
bottle, other babies have difficulty and can get
quite frustrated. Also, when they do latch to the
breast, they may suck incorrectly, making the
nipples very sore. The American Academy of
Pediatrics recommends that you avoid artificial
bottle or pacifier nipples and only breastfeed
for the first month of your babys life. After one
month, babies can usually manage the differ-
ences better.
Q. Why is my baby so fussy?
A. All babies have times during the day when they
are restless and irritable. There can be many rea-
sons for a baby to cry and be fussy and irritable.
For some babies, this is worse than others. If your
baby is fussy, try holding the baby skin-to-skin
and just relax. If your baby is crying a lot and
passing a lot of gas, try burping the baby more
often. If nothing seems to soothe your baby, call
 your lactation consultant and she will make other
suggestions that may help.
Q. D
 o I have to eat a special diet or avoid certain
foods while breastfeeding?
A. Every culture has different rules about what
you can and cannot eat when you are breastfeed-
ing. You will get lots of advice from well-meaning
friends and family about your diet. There is no
food that causes every baby to be gassy, get a
rash, or spit up a lot. The best advice is to eat
a variety of foods you enjoy. Enjoy fruits and
vegetables, whole grains, protein foods like
meats, eggs, and beans on a regular basis. Try
not to eat the same foods all the time. If you feel
that every time you eat a certain food, your baby
reacts badly in any way, please call your lactation
consultant for advice.
Q. If I get a cold or have a fever, should I still
feed my baby?
A. Absolutely. Keep breastfeeding. Before you even
know you are getting sick, your baby has been
exposed to your illness. Your body starts pro-
ducing antibodies to fight the illness before you
have any symptoms. These antibodies pass into
your milk for your baby. By continuing to breast-
feed, you pass these antibodies to your baby to
help protect him or her.
Q. M
 y family says I cant take any medicines
when Im breastfeeding. Is that true?
A. Most medications are safe to take when breast-
feeding. Your lactation consultant has resources
on the safety of breastfeeding while taking
medications. If you are concerned about the use
of any medication you need to take while breast-
feeding, call your lactation consultant for advice.
29
CHAPTER 6 Resources
Kaiser Permanente Breastfeeding
Clinics and Lactation Consultants
Anaheim (714) 279-5100
Antelope Valley (661) 533-7600
Bakersfield (661) 869-6438
Baldwin Park (626) 851-6013
Downey (562) 461-6614
Fontana (909) 427-6234
Irvine (949) 932-5892
Los Angeles (323) 783-7808, (323) 783-4345, Panorama City (818) 375-3018
(323) 783-4472
Panorama City (818) 375-3340
Riverside (866) 883-0119
San Diego (866) 940-2218
South Bay (310) 517-4300
West Los Angeles (323) 857-4121
Woodland Hills (818) 719-2826,
(818) 719-2255
Kaiser Permanente Health
Education Departments
For class information from your local Health
Education Department, call the Healthy Living
Helpline toll-free at 1-866-402-4320.
La Leche League
1-800-525-3243
www.llli.org
www.lalecheleaguescnv.org
Breast Pumps and Supplies
Contact your local Kaiser Permanente Medical Center.
Antelope Valley (661) 533-7600 *
Bakersfield (661) 869-6438
Baldwin Park (626) 851-5820
Downey (562) 461-6614
Fontana (909) 427-4560 *
Irvine/Anaheim (949) 932-2707
Los Angeles (323) 783-7808 or (323) 783-4345
Riverside (951) 353-4475 *
San Diego (619) 528-5153
South Bay (310) 816-5440
West Los Angeles (323) 857-4065 *
Woodland Hills (818) 719-4305*
* These Health Stores are open only from Monday to
Friday from 9 a.m. to 5 p.m.
Lactation Web Sites
kp.org/pregnancy
breastfeedingmadesimple.com
breastfeeding.com
kellymom.com
ameda.comYour Baby Knows How to Latch-on
(video)
drjacknewman.comMany good video clips on
latching babies
motherwear.com/br/bfguide.cfm
medelabreastfeedingus.com
pumpingmoms.org
31
 askdrsears.com
4women.gov
lowmilksupply.orgInformation and support for
breastfeeding mothers with low milk supply
bfar.orgFor women who have had breast surgery
WIC (Women, Infants and Children)
1-888-942-9675
WIC is a nutrition program that helps low-income
pregnant women, new mothers, and young children
under the age of 5 to eat well and stay healthy.
32
Recommended Reading
Eileen Behan, RD. Eat Well, Lose Weight While
Breastfeeding.
Kathleen Huggins, RN, MS. The Nursing Mothers
Companion.
Kathleen Huggins, RN. The Nursing Mothers Guide
to Weaning.
La Leche League International. The Womanly Art of
Breastfeeding.
Nancy Mohrbacher and Kathleen Kendall-Tackett.
Breastfeeding Made Simple.
Jack Newman, MD. The Ultimate Book of Breast-
feeding Answers.
Gale Pryor. Nursing Mother, Working Mother.
Amy Spangler, BSN, MN, IBCLC. Amy Spanglers
Breastfeeding: A Parents Guide.
INDEX
American Academy of Pediatrics (AAP), 2, 24, 28 Holds, 6
Artificial feeding, 2, 28 cradle hold, 6
Attachment and bonding at birth, 3 clutch or football hold, 7
Skin-to-skin contact, 3, 5, 12, 28 cross cradle or transitional hold, 6
side-lying position, 6
Behavior of baby Latch, 7, 14, 16, 19, 28
Fussy, 28 breaking suction, 8
Sleeping problems, 27 lips open, 8
Benefits of breastfeeding, 12 nose to chin, roll it in, 7
Bra, 17 rooting reflex, 7
Breast engorgement, 15, 19 Log, 1011 (Table 2), 27
Breast fullness, 15 Often, 4, 13
Electric breast pump, 15, 16 hunger (feeding) cues, 4, 8
Hand express, 1521 Pain, 8, 1517
How to treat, 15 relief, 17
Infection, 15 acetaminophen, 15
Breast milk changes, 28 antibiotics, 17
Breast milk storage guidelines, 20 (Table 4), 28 ibuprofen, 17
Breast pump, 12, 1720, 24, 28 sore breast, 1617
Choosing the right pump, 18 (Table 3) mastitis, 1617
Electric breast pump, 15, 16, 18, 19 plugged milk ducts, 1617
Hand pumps, 18 sore nipples, 15, 16, 28
Preparing milk for feeding, 20 new pregnancy, 16
Preparing to pump, 19 teething, 16
Procedure, 1920 thrush, 16
Breastfed baby at home, 5 Questions, 9
Feeding station, 5 Supplies
Introducing a bottle, 21, 28 bottles, 19, 20
Breastfeeding breast pads, 23
Benefits of, 12 breast pump, 12, 1720
Challenges, 1521 electric breast pump, 15, 16
breast engorgement, 15 gel pads, 16
breast fullness, 15 lanolin cream, 16
Early, 3, 16 milk storage bags, 19
colostrum, 3, 16 Value of, 12
Fitting into your lifestyle, 2325 Well, 4
birth control, 25 While sick, 29
breastfeeding for the first year and beyond, 24
diet, 23, 29 California state law, 23
exercise, 2324 Assembly Bill 157, 23
in public, 23 Assembly Bill 1025 (California Lactation
leaking breasts, 23 Accommodation Law), 24
returning to work or school, 21, 24 Cesarean birth (C-section), 6, 7
support groups, 25 Colostrum, 3, 16, 19, 27, 28
weaning, 24 Definition, 3, 28

33
Diet, 23, 29 Neonatal intensive care unit (NICU), 18, 19
Alcohol, 23 Night feedings, 12, 27

Feeding patterns, 1214 Pain management, 16

Cluster feeding, 13 Plugged milk ducts, 1617
Growth spurts, 13, 21 Pump, 5, 19, 21, 28
One breast or both per feeding, 12
Formula, 2 (Table 1), 28 Resources, 3132
Enfamil, 2 Kaiser Permanente, 31
Frequently asked questions, 2729 breastfeeding clinics and lactation consultants,
31
Gas, 27, 28 breast pumps and supplies, 31
Meconium, 27 health education departments, 31
Lactation Web sites, 31
Hand expressed milk, 12, 1521, 24 La Leche League, 31
Process, 2021 Recommended reading, 32
Hormones, lactation, 1, 4, 19, 23 WIC, 32
Oxytocin, 1
Prolactin, 1 Skin-to-skin contact, 3, 5, 12, 28
Sleep cycle, 27
Infections, 1, 15 Sleepy babies, 12
Mastitis, 1617 Rapid eye movement, 12
Thrush, 16 Tips to wake a sleepy baby, 12
Sucking, 9, 27, 28
Kaiser Permanente Pacifier, 27, 28
Breastfeeding clinics and lactation consultants, 31 Swallows, 9, 12, 27
Breast pumps and supplies, 31 Supplies for breastfeeding, 18
Health education departments, 24, 28 Bottles, 19, 20, 21
Support groups, 25 Breast pads, 23
Breast pump, 18, 28
Lactation consultant, 8, 9, 12, 14, 15, 16, 18, 19, 23, Electric breast pump, 15, 16, 18, 19
24, 25, 27, 28, 29 Gel pads, 16
Latch, 7, 14, 16, 19, 28 Lanolin cream, 16
Breaking suction, 8 Milk storage bags, 19
Lips open, 8 Support groups, 25
Nose to chin, roll it in, 7 Community centers, 25
Rooting reflex, 7 Kaiser Permanente, 25, 31
Low milk supply, 13 La Leche League, 25, 31
WIC, 25, 32
Medications, 29
Midwife, 9, 24 Tips for mothers helpers, 5, 8
Milk ejection reflex, 9
See Milk let-down. Videos, 8, 21, 31
Milk let-down, 9, 14, 19
Milk supply, 8, 1314, 18, 19, 21 Weaning, 24
Foremilk, 8 Web sites, 2, 6, 8, 18, 23, 31
Hind milk, 8
Milk volume, 19, 28

34
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