Breastfeeding

Breastfeeding is one of the best ways to ensure your baby's health and development. It's a convenient, cost-effective, natural way to feed your baby.
Breastfeeding is widely recommended as the best way of feeding infants by leading health organizations, including, among others, the:
American Academy of Pediatrics
American Academy of Family Physicians
American College of Obstetricians and Gynecologists
American Dietetic Association
American College of Nurse-Midwives
U.S. Department of Health and Human Services, Office on Women's Health
Healthy mothers should consider breastfeeding exclusively (no formula) for the first six months of life and ideally continue until the baby is one year old or beyond. Ideally, solid foods should only be introduced after six months of age.
While most new mothers breastfeed in the weeks following delivery (called the early postpartum period), only one in three continues to nurse when her baby reaches six months of age. The likelihood of breastfeeding is even lower among African-American women, as well as women with lower levels of education.
Initiatives to educate new mothers and their partners, health care professionals and employers about the clear, long-lasting health benefits of breastfeeding for both mom and baby are ongoing. Changes to routine maternity unit practices, including "rooming in" policies, which allow mom and baby to stay together in the hospital, are increasingly common and help support mothers who wish to breastfeed. Healthy People 2010, a national prevention initiative to improve the health of all Americans, set forth goals to increase breastfeeding rates.
Healthy People 2010 Goals
2010 Target
In early postpartum
75%
At six months
50%
At one year
25%
Health Benefits for Mom and Baby
There are compelling reasons to breastfeed—and both you and your baby benefit.For Your Baby...
Breast milk provides just the right balance of nutrients for optimal growth and development.
Breast milk has antibodies that help protect your baby from common childhood illnesses and infections, such as bacterial meningitis, diarrhea, painful ear infections and certain lung infections. This natural immunity—or ability to fight off infection—means breast-fed babies have fewer:
Illnesses (less severe and shorter)
Visits to the pediatrician
Hospitalizations
Research shows that breastfeeding also reduces newborns' and infants' risk for developing chronic diseases, such as celiac disease, inflammatory bowel disease, allergies, asthma and some childhood cancers.
Breastfed babies are at lower risk for sudden infant death syndrome (SIDS), the leading cause of death among infants one month to one year old.
Breast milk may offer protection against overweight/obesity years later in childhood and possibly adulthood, too. At one year of age, breastfed babies have significantly less fat than those who are fed formula.
For You...
Breastfeeding releases a hormone called oxytocin that helps the uterus return to its normal size and reduces post-delivery bleeding.
It also burns extra calories (up to 500 calories per day), making it easier for you to shed those pregnancy pounds.
Breastfeeding can deepen the emotional bond between you and your baby. Such physical contact helps your baby feel secure and warm and eases his/her transition from the womb.
Breastfeeding may guard against postpartum depression.
Nursing can delay the return of regular periods, although you still need to use birth control.
There is growing evidence that certain cancers (breast, uterine and ovarian cancer) occur less often in women who breastfed. A recent study found that breastfeeding may protect women at increased risk of breast cancer due to delayed childbirth.
Breastfeeding may also reduce the risk of osteoporosis.
Breastfeeding saves time and money. There are no bottles to sterilize or formula to mix or warm. In fact, families save an estimated $1,000 on health care costs in the first year because breastfed babies are healthier and tend not to need as many visits to the pediatrician.
How the Breast Produces Milk
Milk production is a normal physiologic response to the childbearing experience. New studies shed light on milk delivery, the composition of milk and the anatomy of the lactating breast. This information can help new moms better understand their bodies and how they respond to breastfeeding.
After pregnancy, your breasts produce colostrum—a thick, yellowish fluid—that helps your newborn's digestive system grow and function. Colostrum, often called "first milk" or "supermilk," is rich in nutrients and infection fighting antibodies. While you may wonder whether you're producing enough colostrum or milk for your baby in these first few days, keep in mind your baby's stomach is only the size of a marble. Your mature milk supply typically "comes in" two to four days after giving birth.
When you put your baby to your breast, your milk doesn't automatically start to flow. Your body responds to your baby's suckling patterns, which occur in two phases.
Non-nutritive phase: when the baby is first put to breast and starts suckling in a fast, light rhythm to stimulate the milk-ejection reflex. This reflex is also known as the let-down reflex. It is the "trigger" that starts your milk flowing and often doesn't occur for a minute or so after the baby starts suckling (timing varies with each mom). This can be stimulated by your baby's cry or if you are overdue for a feeding. When your milk lets down, you may feel a tingling or tightening sensation as it fills your breast.
Nutritive phase: after let-down occurs and your baby switches to a slower, deeper suck. This nutritive phase is when the baby actually drinks your breast milk.
Anatomy of the Lactating Breast
Used with permission by Medela, Inc.
New research using ultrasound imaging reveals a number of key differences from the previously held understanding of the anatomy of the breast. These findings can help mothers understand how their infants obtain milk and provide insights for physicians and women considering breast augmentation or reduction surgery.
Key findings include:
The average number of milk ducts (4-18) per breast is less then previously believed (15-20).
An absence of lactiferous sinuses, which were previously believed to contain a significant amount of milk
Fat and glandular tissue overlap more than originally believed.
The absence of lactiferous sinuses changes our understanding of the way in which the breast produces and delivers milk. For example, it's thought that the lack of lactiferous sinuses is a reason why little milk is able to be expressed prior to milk ejection. Much more study needs to be done to further understand milk delivery.
The number of milk ducts also has implications for breast augmentation surgeons, since the loss of only a few ducts could seriously compromise a woman's ability to breastfeed. The overlapping of fat and glandular tissue also suggests that it is very difficult to remove only fatty tissue from the breast. For more information about the anatomy of the breast, visit www.medela.com
Overcoming Breastfeeding Challenges
Breastfeeding is a natural and rewarding process; however, some women have trouble during the early stages of nursing. In fact, more than one in three moms report one or more complications within the first few weeks. The good news is that most of these problems can be resolved with patience, practice or treatment, so don't be discouraged.
Don't be discouraged if you experience sore nipples, engorged breasts, mastitis or thrush. The severity of these symptoms can vary, but they all are treatable and often avoidable.
Sore nipples may develop as you start to breastfeed. Mild nipple tenderness is common. Seek the advice of a lactation professional if your nipples are cracked or bleeding as these are often signs that your infant may not be latching properly onto your breast.
Engorgement happens when your breasts are overly full due to missed feedings or poor or inadequate feeding by your baby. There are some simple steps you can take to ease engorgement. If your baby is not latching on well, use a pump to reduce engorgement and help your milk flow. Use cool compresses in between feedings to reduce swelling.
Plugged milk ducts can reduce the flow of milk from one or more sections of the breast. If untreated, this often leads to infection. To help alleviate the situation take a warm shower and massage the breast. If it continues, seek the advice of a lactation consultant.
Mastitis, or breast infection, is not a common occurrence, but typically happens when bacteria from your baby's body or from your body invade your milk duct through a crack in the skin. If you have an infection, your breast will feel tender, and you may also have flu-like symptoms, including chills, high fever or fatigue. Your health care professional may need to prescribe an antibiotic.
Yeast infection, or thrush, is suspected if you experience deep, shooting breast pain after you've been successfully breastfeeding for a while. This condition is relatively rare. Consult your health care professional if you experience these symptoms. Both mom and baby will need treatment with antifungal medication, if this condition develops.
Breastfeeding shouldn't hurt. Contact your health care professional if your breasts remain tender or sore, or if you have flu-like symptoms that may indicate an infection. In most cases, you can continue breastfeeding. Emptying your breasts frequently by breastfeeding or pumping can often reduce inflammation and relieve the problem.
Finding Extra Support
Your health care professional may suggest that you work with a lactation consultant (also called a lactation counselor) who can review breastfeeding techniques and help you address any problems that you may have while nursing. Many hospitals and health centers have lactation consultants on staff, so make sure to ask your obstetrician or primary care provider if you think you need extra support. New mother support groups and encouragement from your partner, family, friends and your employer are also important.
When Not to Breastfeed
Despite the clear benefits of breastfeeding, there are circumstances when breastfeeding is not in the best interest of the baby. A woman should not breastfeed if her infant is diagnosed with galactosemia (a rare metabolic disorder) or if she has certain health conditions that can be passed to her baby through breast milk, including:
Human immunodeficiency virus (HIV)
T-cell leukemia virus type 1
Active, untreated tuberculosis
Mothers who use illicit drugs, drink excessive amounts of alcohol or are taking prescribed chemotherapy or radiation therapies for cancer also should not breastfeed their babies. If you have a herpes lesion (sore) on your breast, you should not breastfeed.
Women who have had breast reduction surgery or breast implants may not be able to breastfeed because of the impact these surgeries can have on milk production. However, each woman's breast anatomy and breast surgery is unique. Discuss any concerns you may have about your ability to breastfeed or complications you may experience breastfeeding with a lactation consultant.
10 Hints for Ensuring Success
1. Start early. Learn as much as you can about breastfeeding before your baby is born so you'll feel prepared. Try to breastfeed your baby soon after giving birth (within the first hour). Newborns sleep a lot, so you'll have to wake him/her every couple of hours for a feeding. Ask to keep your baby in your hospital room (called "rooming in"). Mother-infant rooming in is becoming more accepted as hospitals try to support early breastfeeding.
2. Review nursing techniques with a lactation consultant or nurse. Learn how to position your baby so he/she is properly latched on to your breast. This will improve your confidence when you return home.
3. Nurse frequently (8-12 times in 24 hours) and anytime your baby seems hungry. Your milk supply responds to your baby's demand—the more the baby suckles, the more milk will be produced. Many health care providers recommend breastfeeding on demand rather than according to a predetermined schedule. Watch for early signs of hunger, which include:
Increased alertness or activity
Mouthing or putting hands to mouth
Rooting (moving his/her head in search of your nipple)
Be aware that crying is a late sign of hunger. Try to feed your baby before he/she becomes overly hungry and starts to cry. Offer both breasts during feedings. Usually breastfeeding takes 10 to 20 minutes for each breast. However, from time to time your baby may become full after feeding on just one breast. If this is the case, remember to pump the breast that remains full to avoid engorgement or discomfort.
4. Know how much milk is enough. Many nursing mothers worry about whether their baby is getting enough nourishment. An easy way to gauge whether your baby is getting enough milk is to pay attention to the number of wet, dirty diapers (six to eight wet diapers and three to four yellow, seedy bowel movements by day five are good signs). Keep in mind it's normal for babies to lose some weight (7 to 10 percent of birth weight) within the first week.
If you are still concerned about whether your baby is getting enough milk, seek the advice of a health care professional or lactation consultant.
5. Choose a comfortable position. Breastfeeding is very personal. There are a number of ways to hold your baby while breastfeeding. See what feels most comfortable for you and your baby. (See the American Academy of Family Physicians (AAFP) Web site for more information.)
Cradle position: Place your baby's head in the crook of your arm. Support his/her back and bottom with your arm and hand.
Cross cradle position: Hold your baby with the opposite arm from the breast you are using. Support baby's head with the palm of your hand at the base of his/her neck.
Clutch/football position: Tuck your baby under your arm like a football with his or her head resting on your hand. Support your baby's body with your forearm.
Side-lying: Lie on your side with your baby facing you. Use pillows to prop up your head and shoulders.
No matter which feeding position you use, make sure your baby's whole body is turned toward your breast, not just his/her head. Your baby should have your entire nipple and most of the areola (dark skin around the nipple) well into his/her mouth.
6. Breastfeeding shouldn't hurt. If you feel pain or discomfort, your baby is probably not latched on properly. Gently place your finger into your baby's mouth to break the suction and try again. You may want to position a pillow just below your breasts or under your arm to support yourself and ensure the baby is at the same level as your nipple. Contact your health care professional if the pain continues or if you notice flu-like symptoms.
7. Take care of yourself. Get plenty of rest and eat well-balanced meals to regain energy.
8. Ask about medications. Talk with your health care providers about any prescription medications or over-the-counter drugs you are taking just in case these may be harmful to your baby.
9. Refrain from giving your baby other liquids or formula during his/her first six months.
10. Delay introducing bottle nipples or pacifiers to let your baby develop a good sucking pattern and become familiar with feeding from your breast. If you plan to return to work, try introducing a bottle filled with your breast milk during week four to six, after breastfeeding is well established.
Returning to Work: Breastfeeding Tips for Working Moms
The transition back to work after maternity leave can be emotional. You're probably asking yourself lots of questions: Can I overcome the guilt of leaving my baby? Will I be able to juggle motherhood and work? How can I continue breastfeeding? Like any transition, some of these issues may take some time to work through. But, fortunately, where continuing to provide your baby with breast milk is concerned, breast pumps offer working mothers the flexibility to maintain their milk supply and continue nursing, which helps you stay connected to your baby even when you're away.
A 2007 survey of working mothers conducted by the National Women's Health Resource Center and Medela about breastfeeding in the workplace found:
The top three reasons why working mothers decide to continue breastfeeding include:
The health benefits for the baby
The emotional bond between mom and baby
It is the most natural way to feed the baby
Although one in three women stopped breastfeeding less than seven weeks after returning to work, many more continued to breastfeed and stopped between six and 12 months.
Older moms were more likely to take longer maternity leaves.
Working moms find it difficult to continue breastfeeding upon returning to work if their employer does not provide a supportive environment.
Younger moms and African-American moms said they were not able to pump as often as they would have liked.
Women surveyed reported that the top three things employers could do to make pumping at work easier, include:
Providing a physical environment (private office with lockable door, clean environment, fridge/freezer)
Having or establishing a corporate policy on breastfeeding (written policy supportive of breastfeeding in the workplace)
Offering flexible scheduling to accommodate pumping breaks
Here are some tips to help ensure success for your goal to continue breastfeeding when you return to work:
Take as much time away from the workplace as possible. Studies show that women who take longer maternity leaves are more likely to continue breastfeeding once back at work. And the longer babies are breastfed, the greater the health benefits for mom and baby.
The Family Medical Leave Act provides 12 weeks of unpaid time for the birth and care of a newborn for certain employees. Visit the U.S. Department of Labor for more information, www.dol.gov.
Plan in advance. Before returning to work, talk with your employer or human resources department about your needs and plans to continue breastfeeding.
Ask if there is a private, clean room set aside for mothers to pump. If not, suggest an office or conference room. Your employer should create a supportive environment for you to continue breastfeeding.
Discuss how pumping breaks (20 minutes every three to four hours) will fit into your schedule.
Educate your employer about the benefits of breastfeeding. This includes fewer missed work days and shorter absences because breast-fed babies are better able to fight off infection and are sick less often.
Breastfeed your baby as soon as you get home. This is a special time to bond and helps you maintain your milk supply. Ask your caregiver not to feed your baby during the last hour of the workday, so your baby will take your breast when you return home.
What You'll Need
A breast pump (double electric pumps, which allow you to empty both breasts at the same time, are more effective than hand pumps for expressing milk.) Also, look for a pump that fits your work environment. Most leading electric pumps offer a battery option which may give you greater flexibility.)
An insulated bag with cold packs or access to a refrigerator (most pumps come with a cooler pack)
Bottles or bags to collect and store your milk
Labels to mark the date
Breast pads to protect your clothes and conceal leakage (you may want to keep an extra shirt at work just in case)
Picture of your baby
A support system. Don't try to do everything yourself. Let your partner, family and friends help out. Seek out other working mothers who can offer you support.
It's important to continue breastfeeding for as long as you can and ideally until your baby is one year old and beyond.
Using a breast pump
Breast pumps are designed to help:
Provide your baby with the health and nutritional advantages of breast milk while you're away.
Empty the milk in your breast, which can guard against engorgement, blocked milk ducts and infection.
Stimulate your milk production.
If possible, you should pump every three hours that you are away from your baby. Make sure to clean the breast pump parts between uses.
Both hand and battery-operated pumps are available. Electric pumps simulate your baby's sucking more effectively and are faster than hand pumps. Many pumps come with discreet carrying cases. The cost ranges from $35 to $350. Not all pumps are created equal. Be sure to research which brands and models provide the best performance, reliability and comfort. Also take into consideration the demands of your daily schedule. Many hospitals and clinics rent breast pumps, so you may want to ask your health care provider or a lactation counselor about these and which models would best fit your needs.
A word about milk storage
After pumping, refrigerate, freeze or store your milk in a cooler.
Any container used to store milk should be clean and sterile. Glass containers, polypropylene plastic bottles (slightly cloudier, flexible plastic indicated with recycling #5) and storage bags are all good choices.
Always label and note the date on the storage bag or container. Always use oldest dated milk first.
The following are some guidelines for freshly expressed breast milk storage:
At room temperature (66-72°F) for up to four hours
In a refrigerator (32-39°F) for five to seven days
In a cooler with freezer ice packs (59°F) for 24 hours
In a self-contained freezer unit for three to four months
In a deep-freezer (0°F) for six to 12 months
Breast milk should be thawed slowly under warm running water and not in the microwave, which can reduce its nutrition.
Once the milk has been thawed it should not be refrozen.