Common Questions about Breastfeeding Breastfeeding may be a new experience for you, therefore we have compiled a list of frequently asked questions about breastfeeding to help you better prepare for this skill. If you need more information or have additional questions, please do not hesitate to ask your nurse, obstetric care provider, or pediatric care provider. Will my baby show any cues that she or he is hungry? Yes. Hunger signs may include awakening, fluttering eyes, lip smacking noises, bringing hands to the mouth, thrusting his or her tongue, rooting, or trying to suck. How often should I feed my baby? By three to four days old, your baby should feed eight to 12 times in 24 hours or on demand. Some babies will feed every one and a half to two hours; others feed every three to four hours. How long should I breastfeed during each feeding? Initially, your baby may actively suck for only five to 10 minutes. After the first few days, breastfeed at least 10 minutes or longer until your breast feels softer and your baby seems content. This will allow for the baby to get the richer hindmilk. Sometimes your baby may breastfeed on only one breast. If this happens, start on the opposite breast at the next feeding. When will my breast milk come in? Roughly two to five days after giving birth, your breasts will begin to fill with milk - feeling firmer and warmer. As your milk changes from colostrum (thin, initial breast milk) to a transitional milk, its color will change from yellow to light yellow or whitish yellow. Your mature milk, which comes in about two weeks after the birth of your baby, will also be thin and may have a bluish-white color. What does breastfeeding feel like? Once you position the baby directly facing your chest and place the nipple/areola in the baby’s mouth, she or he will latch onto the nipple and areola. If you have positioned your baby correctly, with each suck you will feel pulling, tugging, and/or pressure on the breast. Breastfeeding should not hurt. What is a normal feeding pattern? Babies suck in bursts and every baby has his or her own unique style and rhythm. You want to feel about six to 10 rhythmic sucks followed by an audible swallow, then a pause. Your baby’s suck and swallow pattern will slow as she or he swallows the richer milk at the end of each feeding. How do I know if my baby is getting enough? As your milk supply increases within two to five days after the birth, you should notice: · a sense of fullness in your breast before feeding; · that your baby is swallowing while breastfeeding; · that your breasts are softer after a feeding; · a tightening or tingling in the breast as your milk “lets down” or releases (you may also feel relaxed and sleepy); · possible leaking from one breast while the baby is feeding from the other; · possible uterine cramps the first few weeks while breastfeeding. In the first 24 hours after your baby’s birth, he or she should have one wet diaper and one with stool (bowel movement). By day two, he or she should have two wet diapers and one to two stools. By day three, he or she should have three wet diapers and one to three stools, and by day four, he or she should have four wet diapers and one to four stools. When your milk supply has increased or by six days of age, your baby should have: · eight to 12 feedings in 24 hours; · at least six to eight wet diapers every 24 hours. Urine will be pale yellow, not dark tea-colored. Hint: If you use disposable diapers and are unsure if the diaper is wet, place a tissue in the diaper; · At least two to three soft, yellow, seedy stools every 24 hours. During the first weeks the baby may have a bowel movement with most feedings; · Quiet, contented periods after breastfeeding. My baby is a week old and seems to want to breastfeed all of the time! Is this normal? This is normal due to “growth spurts,” which are predictable periods when the breastfed baby will want to feed more frequently than before. Growth spurts occur at two to three weeks, six weeks, three months and six months. This frequent feeding may last for 24-72 hours. During these times, it is important to feed your baby on demand - as much as she or he wants. Breastfeeding on demand will meet your baby’s needs; water or formula supplements are not necessary. As your baby feeds more frequently, your body will respond by producing more milk. When growth spurts end, your baby will want to feed less often. Will breastfeeding help me lose weight? Women who choose to breastfeed may find it easier to lose weight because their bodies burn 200-300 calories of stored fat each day to provide the energy needed to breastfeed during the first three months. If you decide to breastfeed, you can expect to lose weight gradually if you maintain a healthy, well-balanced diet. Starting a reduced-calorie diet while breastfeeding is not recommended-it can impact your ability to produce milk and deprive you of much-needed energy. (Remember, 30 percent of the weight you gain during pregnancy is the result of fluid accumulation; you will most likely lose that weight over time regardless of your calorie intake.) How much should I eat while I am breastfeeding? While breastfeeding, you should consume at least 1,800 calories each day, which is the minimum amount you will need to produce an adequate supply of milk and meet your nutritional needs. As a rule, it is recommended that you consume 300-500 calories more than you would if you were not breastfeeding. Be sure to maintain a well-balanced diet that includes protein, carbohydrates, fruits and vegetables. What should I do if my baby seems sleepy and does not regularly awaken for feedings ...loses interest easily ... does not vigorously breastfeed? Watch for cues that your baby is hungry as described on the previous page, especially the eyes fluttering. This rapid eye movement indicates that the baby is in a light sleep state and may awaken more easily to breastfeed. During the day, be alert to your baby’s feeding cues or wake your baby every two and a half to three hours to encourage at least eight to 12 feedings in 24 hours. Try waking your baby by unwrapping blankets, stimulating rooting by stroking the baby’s mouth or encouraging baby to suck on a clean finger before bringing your baby to your breast. It may be helpful to change your baby’s diaper or try burping your baby. At night, it is not necessary to awaken your baby - unless your pediatric care provider recommends it or your baby is not feeding eight to 12 times in 24 hours. My baby seems frantic when we begin feedings. What can you suggest? Begin feedings when your baby is first showing early cues. Do not wait until your baby cries or he or she may become too frantic to suck. Use slow, gentle movements and provide a quiet environment. Provide skin-to-skin contact. To decrease the time from “latch” to “let down,” massage your breast for two to four minutes and express a few drops prior to putting baby to breast. If your breasts are very full or engorged, soften your areola by expressing milk so that baby can easily latch on. Change the diaper between breasts or after a feeding. I am a vegetarian. Can I breastfeed my baby? As long as your diet is well balanced and not too restrictive, your breast milk will provide your baby with the necessary nutrients. Many vegetarians have difficulty getting enough protein, calcium, vitamin D and vitamin B-12, so take special care to incorporate foods with these nutrients into your diet. Getting enough vitamin B-12 is particularly challenging for vegetarians because it can only be found in animal products. Good sources include yeast, soymilk, cereal and other soy products that are B-12 fortified. Can I have caffeine while I am nursing? Because caffeine is passed on to babies through breast milk, you should limit the amount of caffeine you consume to one or two eight-ounce servings per day. In addition to helping you stay hydrated and sleep better, avoiding caffeine will prevent the irritability and poor sleep habits that it can cause in babies. The caffeine in your breast milk will reach its highest level one hour after you ingest it - try to time your baby’s feedings so they occur before you drink a caffeinated beverage. Can I drink alcohol? You should abstain from drinking alcohol while you are breastfeeding your baby. Alcohol can be passed on to babies through breast milk and can negatively affect your ability to let down or release milk. Can I exercise if I am breastfeeding my baby? Yes! Make it a point to exercise regularly. In addition to helping you achieve a healthy weight and improve your cardiovascular fitness, exercise stimulates milk production. Be sure to speak with your obstetric care provider before you begin an exercise plan. Are there foods I should avoid eating? Most women who are brestfeeding can eat a wide variety of foods without any problems. However, some babies are more sensitive to certain food proteins, spices, or dairy products. If your baby seems fussy after you have eaten a different type of food, try to avoid that food until your baby’s digestive system has developed a bit more. My nipples have become sore from breastfeeding. Is there anything I can do to treat them? The best way to prevent nipple damage (trauma) is correct positioning and latching at the breast. When you begin to breastfeed, your nipples may become somewhat sore and tender. Expressing colostrum/breastmilk after each feeding and rubbing it into your nipples will soothe and condition them and help with the healing process. Colostrum contains anti-infective properties that will protect your nipples from bacterial growth. Avoid using soap and washing your nipples between feedings. Taking a daily shower is all you need to do. If your nipples become cracked and/or are bleeding, repositioning your baby will prevent further damage. If you need additional help, call your obstetric care provider. What do I do when my breasts get very full? · Shower or apply warm compresses to your breasts, massage them gently and express milk to soften the areola. · Find a comfortable chair, relax and begin breastfeeding. · Make sure your baby is properly positioned and latched well onto your breast. · Feed your baby for at least 10 minutes or until your breast softens and your baby is in a content state. · Gently massage and compress (squeeze) your breasts when your baby pauses between sucking bursts; this will increase the amount of milk your baby takes during the feeding. · Continue to watch your baby for signs of feeding cues or feed your baby at least every two to three hours (eight to 12 feedings in 24 hours). How do I prevent/treat breast engorgement? Two to five days after your baby is born, your milk supply will begin to increase. Some mothers may experience a condition called engorgement where their breasts become very hard, swollen, inflamed and painful. It is important to treat engorgement quickly. Excessive fullness may inhibit the let-down reflex and also flatten your nipples making it difficult to establish a correct latch, which would then contribute to nipple damage and soreness. Prevention: Establish early, frequent feedings. Your baby should be breastfeed eight to 12 times or an average of every 11/2 - 3 hours in a 24-hour period. Avoid supplements of formula or water for three to four weeks unless your pediatric care provider instructs you to do otherwise. (Limit the use of a pacifier.) Use a breast pump to pump your breasts if your baby cannot breastfeed or if he or she misses a feeding. Treatment: · Take pain-relieving medication as directed by your obstetric care provider. · Shower to relax. Gently massage your breasts and hand-express some milk to soften the areola. · Find a comfortable room with minimal distractions. Play soft music and use calming images to decrease stress. · Feed your baby for 15-20 minutes or until the breast softens. Using breast massage and compression during the feeding will enhance milk removal. Offer the second breast. If your baby does not feed on the second side, pump that breast for two to five minutes or until the breast is softer and you are more comfortable. Begin the next feeding on this breast. · Do not go longer than three hours during the day without either breastfeeding your baby or pumping your breasts. If your baby is unable to latch effectively and pumping does not facilitate milk release and breast softening, lie flat on your back, elevate your breasts with towels and apply ice to your breasts to decrease swelling. · Continue cold treatments in between feedings until your milk begins to flow, as well as for your comfort. · Wear a well-fitting, supportive bra without an underwire. Engorgement usually resolves within 24-48 hours. Please contact a lactation consultant or your obstetric care provider if engorgement continues and you are unable to feed your baby at least eight times in 24 hours.