Benefits of Breastfeeding
Breastfeeding provides the intimacy, warmth, and emotional gratification that create a special bond between a mother and her baby. Breast milk is far superior to baby formula and cow’s milk. There are over one hundred ingredients contained in breast milk that cannot be duplicated in commercial formulas and does not exist in cow’s milk. These ingredients are dynamic, changing throughout your baby’s development and adjusting to the needs of your baby. Here are more benefits of breastfeeding for mother and baby:

Benefits of Breastfeeding for Baby

• Breast milk is easier to digest than formula
• Mother’s milk protects baby from infection and disease, such as:
     Diaper rash
     Ear infections
     Allergies
     Vomiting and diarrhea
     Meningitis
     Pneumonia and bronchitis
     Bone fractures later in life
• Breast milk cannot be contaminated like cow’s milk or loose it’s potency like formula
• Baby’s mouth, jaws, teeth and palate reach optimum development due to increased effort of suckling from a breast
• Recent studies show that that breastfeeding reduces cavities later on in childhood

Benefits of Breastfeeding for Mom

• Burns calories, helping you lose the fat accumulated during pregnancy
• Reduces the risk of premenopausal breast cancer and lowers the risk of uterine cancer
• Helps the uterus return to its normal size more quickly
• Can postpone the return of your menstrual period for several months
• Reduces the risk of hip fracture after menopause due to improved mineralization in bones after weaning

Breast milk is FREE, does not need preparation, and is in constant supply. The longer you breastfeed, the greater the benefits will be to your baby and you, and the longer these benefits will last. Your milk gives your baby more than just food. It also provides important antibodies to fight off infection and has medical and psychological benefits for both of you. Breastfeeding is the most natural gift that you can give your baby.

How is Breast Milk Produce
Your body naturally starts to prepare for breastfeeding when you become pregnant. During the fourth or fifth month of pregnancy your body is capable of producing milk. This first milk, called colostrum, is packed with all the nutrients that your newborn baby needs. It also contains many substances to protect new babies against infections. Colostrum is thick and yellowish or orangish in color. Your body will produce colostrum for several days after delivery until your mature milk "comes in." The milk then thins, becomes milk-like in color and begins to adjust to the baby’s needs for the rest of the time that you breastfeed. One of the special qualities of human milk is that it changes during the time you nurse your baby to match the changing needs of your growing infant.

During pregnancy, your body increases its production of a hormone called prolactin. This hormone stimulates the cells in your breasts to make milk. The amount of prolactin also increases when you nurse your baby. The size of your breasts is not a factor in how much milk you make; your baby’s nursing controls milk production. In other words, the more you nurse, the more milk your body produces.

Oxytocin is another hormone that increases during pregnancy. This hormone causes tiny muscle cells within the breasts to contract and squeeze milk down the milk ducts toward the nipples. This process, called the let-down reflex, occurs each time you nurse your baby.

Caring for your breasts during pregnancy is easy. Just make sure your bras provide enough support. Since your breasts will get larger, buy nursing bras that allow room for growth. Wash your breasts with warm water only. Soaps, lotions, and alcohol are not necessary, may be irritating, and should not be used. Your obstetrician or family physician should examine your breasts and nipples during pregnancy.

How to Breastfeed
It is best to start breastfeeding within the first hour after birth, if possible. While you are in the hospital you should spend as much time with your baby as possible. "Rooming-in" with your baby during your hospital stay has been shown to help make breastfeeding more successful.

Immediately after delivery, your baby should be placed on your chest or abdomen, skin touching skin. Babies are very alert after they are born, and they are usually hungry, too! Your baby’s first feeding can take place within 30 minutes to an hour after delivery. The protection against infection that human milk provides is important immediately after birth. Your milk will also give the baby nutrients to prevent a low blood sugar level. This early taste of your milk stimulates the baby to nurse better later.

If you had a vaginal delivery, you can nurse in bed or in a chair in the following ways:
1. Lie on your side with your baby facing you.
2. Hold your baby in the cradle position, with the head in the crook of your arm. Firmly support the baby’s back and buttocks, making sure your baby’s entire body is facing your body, not the ceiling.


If you had a Cesarean-section delivery you can nurse your baby in the following ways:
1. Sit up using one or two extra pillows to support your baby and protect your incision. Use a side-sitting or "football" hold.
2. Lie down on your side with your baby facing you.

Just as with learning anything new, it may take several feedings before you and your baby become a skilled nursing team. For some mothers and babies, breastfeeding goes smoothly from the start. For others, it takes a little time and several attempts for mother and baby to adjust. If you need help, ask the nurses while you are still in the hospital, your child’s pediatrician, a lactation consultant, or a breastfeeding support group. The most important keys to successful breastfeeding are proper positioning and correct latch-on.

Latch-on
Touching your breast to the center of your baby’s lips stimulates your baby to open his mouth widely. This is called the "rooting reflex". As this occurs, pull your baby to the nipple and areola. Keep in mind that when a baby is correctly positioned, or "latched-on," your nipple and much of the areola are pulled fully into the baby’s mouth. Your baby’s lips and gums should be around the areola and not only the nipple.

When the baby first nurses there will be a tugging sensation. If your nipples are not sore, breastfeeding should not be painful. If the latch-on hurts, pinches, or produces pain, the latch-on may be incorrect. Break the latch-on by slipping your finger into the corner of your baby’s mouth, reposition, and try again. It can take several tries. Never pull the baby off the breast without releasing the suction.

Correct latch-on is very important. It makes milk flow better, prevents sore nipples, and helps to prevent overly full (engorged) breasts. If your baby is latched-on correctly but you still have pain while breastfeeding, talk with your pediatrician.

Most babies will nurse actively if they are hungry and positioned correctly. For the first few weeks after birth until breastfeeding is well-established, breastfeeding newborns should not be given any supplements (water, sugar water, formula, etc.) unless recommended by your pediatrician. A baby who is breastfeeding regularly and effectively will get all of the water and nutrients she needs.

Let-Down
The signs of let-down are different for each woman. Sometimes when your baby starts to nurse, you may feel a brief prickle, tingle, or even slight pain in your breast. Or, milk may start dripping from the breast that’s not being used. These feelings and milk flow are signs of the let-down reflex. This means your body is making it easier for your baby to nurse.

The let-down reflex occurs every time you breastfeed. The first few times you breastfeed this let-down reflex may take a few minutes. Afterward, let-down will occur much more quickly, usually within a few seconds.

You may feel strong cramping in your uterus when your milk lets-down. The hormone oxytocin, which stimulates milk flow, also causes the muscles of the uterus to contract. Nursing helps your uterus go back to its original size. This cramping is normal and is a sign of successful nursing. The cramping should go away in a week or so.

Establishing a Routine
Breastfed babies tend to feed more often than formula-fed babies, usually 8 to 12 times a day. The main reason for this is that their stomachs empty much more quickly because human milk is so easy to digest.

Initially, your newborn will probably nurse every couple of hours, regardless of whether it’s day or night. By the end of the first month, your baby may start sleeping longer at night. Let your baby feed on demand—that is, whenever he is hungry. Watch for different signals from your baby, rather than the clock to decide when to nurse. When your baby is hungry, he/she may nuzzle against your breast, make sucking motions, put hand to mouth, or cry. Do not to wait until your baby is overly hungry before you breastfeed.

Do not let your baby sleep through feedings until your milk supply has been developed, usually about 2 to 3 weeks. If your baby is not demanding to be fed, wake her if 3 to 4 hours have passed since the last feeding. If this persists, call your pediatrician.

How Long Does Breastfeeding Take?
While some infants nurse for only 10 minutes on one breast, others to stay much longer. Feedings may depend on your baby’s schedule and the time of day. Some babies may be nursing even though they appear to be sleeping. If your baby has fallen asleep at your breast, or if you need to stop a feeding before your baby is finished, gently break the suction with your finger. Do this by slipping a finger into your baby’s mouth while he or she is still latched-on. Never pull the baby off the breast without releasing the suction.

When you breastfeed, alternate between which breast you offer first. (You may want to keep a safety pin or short ribbon on your bra strap to help you remember on which breast your baby last nursed.) While you should try to breastfeed evenly on both sides, your baby may prefer one side to the other and nurse much longer on one side. When this happens, the breast adapts its milk production to your baby’s feedings. Remember, your baby’s feedings control how much milk your breasts produce. It is important to nurse with both sides so that each breast gets stimulation over the course of a day.

Each baby has a particular style of eating, some slower, some faster. Learning your own baby’s eating patterns makes it easier to determine when she is hungry, when she has had enough, how often she needs to eat, and how much time she needs for feedings.

Is Baby Getting Enough Milk?
There are several ways you can tell whether your baby is getting enough milk. One is by the number of wet diapers he has in a day. Make sure he has at least six wet diapers per day with pale yellow urine, beginning around the third or fourth day of life. During the first week of life, your infant should have at least two stools per day. From about 1 to 4 weeks old these should increase to at least 5 per day. As your baby gets older, bowel movements may occur less often, and may even skip a number of days.

Your baby’s feeding patterns are an important sign that he/she is feeding enough. A newborn may nurse every 1.5 to 3 hours around the clock. If your baby sleeps for stretches of longer than 4 hours in the first 2 weeks, wake him for a feeding. Listen for gulping sounds to know that your baby is actually swallowing the milk and not just sucking. Also look for slow, steady jaw movement.

Your baby should be steadily gaining weight after the first week of life. During the first week, some infants lose several ounces of weight, but they should be back up to their birth weight by the end of the second week. Your pediatrician’s office will weigh your baby at each visit. Keep in mind that your baby may breastfeed more often during growth spurts.

Another sign that your baby is getting enough milk is that the baby is sleeping well, and looks alert and healthy when awake

The American Academy of Pediatrics and the American Academy of Pediatric Dentistry recommend that breastfed infants (as well as bottle fed infants) not receive fluoride supplements during the first 6 months of life. After 6 months of age, check with your pediatrician to see if you need to give your baby fluoride.

If your baby cannot or will not nurse, or if you are having problems with breastfeeding, it is important that you call your pediatrician as soon as possible. Refusal to breastfeed may be a sign of illness that needs prompt attention.

Why does Baby Hiccup or Spit Up?
Spitting up is a common reaction that infants have during or after feeding, and some spit up more easily than others. There is usually no need to be concerned when your baby spits up.

If your baby does spit up, do the following:

• Try to make each feeding calm, quiet, and leisurely
• Avoid interruptions, sudden noises, bright lights, and other distractions
• Burp your baby at least twice during the feeding
• Hold your baby more upright during feedings
• Put your baby in an upright position right after a feeding
• Do not jostle or play vigorously with your baby right after a feeding

If the baby repeatedly vomits, especially in a forceful manner (shooting out), call your pediatrician right away.

Most babies also hiccup from time to time during feedings. If this happens, you can continue to nurse. Your baby’s hiccups will stop on its own.

Nipples
If your baby is not positioned properly or does not latch-on well when you start breastfeeding, you might end up with cracked or sore nipples. To prevent cracked nipples, position the baby better and be sure the baby’s lips and gums are on the areola and not on the nipple. Also, try to vary your baby’s position at each feeding. Get help from your pediatrician or a lactation consultant.

The best treatments for cracked nipples are dryness, light, and warmth. Do not wear plastic breast shields or plastic-lined nursing pads that hold in moisture. Instead, gently pat your nipples dry then apply human milk or medical grade modified lanolin. Wash your breasts only with water, not soap. Many creams and lotions, which must be removed before nursing, will not help and may actually make the problem worse. If these steps do not solve the problem, consult your doctor for further advice.

Some women have nipples that are inverted. When nipples are inverted, a baby may not be able to grasp the areola properly to get milk. The problem of inverted nipples usually clears up on its own during pregnancy, as breasts get larger. If this does not happen, inverted nipples can be treated late in pregnancy or soon after the baby is born.

Expressing Milk Manually and Storing for Future Use
You can express milk manually with your hands or with a breast pump. Breast pumps are used to ease engorged breasts or to collect milk when you are away from your baby (for example, if you are ill or at work). Pumping enables you to continue to breastfeed by keeping your milk production stimulated. If milk is not emptied from the breast regularly, it sends a message back to your body to stop making milk.

To express milk manually:

• Wash your hands well with soap and water
• Put a clean cup or container under your breast
• Massage the breasts gently toward the nipples
• Place your thumb about 1” back from the tip of the nipple and your first finger opposite
• Press back toward your chest, then gently press the areola between the thumb and finger and release with a rhythmic motion
Your milk should flow or squirt out.

• Transfer the milk into clean covered containers for storage in the refrigerator or freezer for possible later feeding for your baby.
  
• Always label the container and put a date on it.

Some women prefer hand expression because it can be done silently and does not require special equipment. Other women may find it easier and faster to express milk with a breast pump. Pumps are manual, battery-operated, or electric. You can find manual pumps in most pharmacies and baby stores. Do not buy those that look like a bicycle horn, because they cannot be cleaned properly and milk may become contaminated.

Good hand pumps have two cylinders, one inside the other, attached to a rigid funnel-like device that fits over the breast. As you slide the outer cylinder up and down, negative pressure is created over the nipple area. This causes milk to collect in the bottom of the cylinder. This collecting cylinder can be used with a special nipple to feed your baby without transferring the milk. The entire pump can be cleaned in the dishwasher or by hand with soap and hot water.

Some hand pumps have a handle to squeeze that creates a negative pressure and draws the milk into a bottle. These may have a soft, pliable flange that fits around the nipple and areola and produces a milking action while pumping.

For most women, electric pumps stimulate the breast more effectively than manual expression or hand pumps. They are used mainly to keep breastfeeding going when a mother is not able to breastfeed for several days or more. These pumps are easier and more efficient than hand pumps, but they are much more expensive. However, you may be able to save money by renting an electric pump from your hospital or a medical supply store.

When shopping for an electric pump to buy or rent, make sure that it creates a milking action and is not simply a sucking device. Pumps that express milk from both breasts at the same time increase your amount of milk and save time. No matter which type of pump you choose, make sure that all parts of it that come into contact with your skin or milk can be removed and cleaned. Otherwise, the pump will become a breeding ground for bacteria, and the milk will not be safe for your baby.

Storing Breast Milk for Future Use:

• Always wash your hands before expressing or handling your milk
• Be sure to use only clean containers to store expressed milk
• Try to use screw cap bottles, hard plastic cups with tight caps or special heavy nursery bags that can be used to feed your baby. Do not use ordinary plastic storage bags or formula bottle bags for storing expressed milk
• Use sealed and chilled milk within 24 hours if possible
• Discard all milk that has been refrigerated more than 72 hours
• Freeze milk if you will not be using it within 24 hours. Frozen milk is good for at least 1 month (3 to 6 months if kept in a 0° freezer). Store it at the back of the freezer and never in the door section
• Make sure to label the milk with the date that you freeze it
• Use the oldest milk first
• Freeze 2 to 4 ounces of milk at a time, because that is the average amount of a single feeding. However, you may want some smaller amounts for some occasions.
  
• Do not add fresh milk to already frozen milk in a storage container
• Do not re-freeze your milk
• Do not save milk from used bottle for use at another feeding

You may thaw milk in the refrigerator or you can thaw it more quickly by swirling it in a bowl of warm water. Do not use microwave ovens to heat bottles because they do not heat them evenly. Uneven heating can easily scald your baby or damage the milk. Bottles can also explode if left in the microwave too long. Excess heat can destroy important proteins and vitamins in the milk. Milk thawed in the refrigerator must be used within 24 hours.

How Long to Breastfeed
The World Health Organization (WHO) and many other experts encourage you to continue breastfeeding for as long as possible. Human milk provides the best nutrition for your baby. Breastfeeding for one year or even longer is desirable.

Mother’s Diet and Medication Use During Breastfeeding Mother’s Diet
Sometimes breastfeeding babies react to certain foods that their mothers eat. You might notice that after eating spicy or "gassy" foods, your baby cries or fusses. With food reactions, symptoms are usually short-lived, lasting less than 24 hours. If your baby gets symptoms every time you eat a certain type of food, stop eating that particular item.

In rare instances, your breastfed infant may be allergic to the cow’s milk in your diet. Symptoms can appear anywhere from a few minutes to a few hours after she breastfeeds and may include: diarrhea, rash, fussiness, and gas. To tell whether your baby is allergic, you need to cut out all dairy products from your diet for 2 weeks. Then one by one, return each dairy product to your diet to see whether your baby has a reaction after nursing.

Try to avoid caffeine or at least reduce your intake while you are breastfeeding. Caffeine tends to build up in babies’ systems because their bodies cannot get rid of it easily. A morning cup of coffee is not likely to harm your baby, but too much caffeine can cause problems such as poor sleeping, nervousness, irritability, and poor feeding. Try using decaffeinated coffee and tea and avoid colas and other carbonated drinks that have added caffeine.

Mother’s Medication Use Talk to your obstetrician and pediatrician to make sure any medications that you are taking will not harm your baby when they pass through your milk. Most medications are not a cause for concern, but get approval for all medications, including non-prescription drugs. Also, take the medication just after you nurse rather than just before.

While you are nursing, avoid drinking alcohol because it can pass through your milk to your baby. If you choose to drink alcohol, drink it just after you nurse rather than just before.

Breast Engorgement
Engorgement occurs when your breasts become too full with milk. A little engorgement is normal, but excessive engorgement can be uncomfortable or painful.

If your breasts do become engorged, try the following:
Express some milk before you breastfeed, either manually or with a breast pump.
Soak a cloth in warm water and put it on your breasts or take a warm shower before feeding your baby. For severe engorgement, warmth may not help. In this case, you may want to use cold compresses as you express milk. Ice packs used between feedings can relieve your discomfort and reduce swelling.

Feed your baby in more than one position. Try sitting up, then lying down.
Gently massage your breasts from under the arm and down toward the nipple. This will help reduce soreness and ease milk flow.

It is important to keep breastfeeding. Engorgement is a temporary condition and will be most quickly relieved by effective milk removal. Once the engorgement passes, your breasts will become soft again. This is normal and is exactly what should happen.

Mastitis
Mastitis is an infection of the breast that occurs when a milk duct gets blocked and bacteria infect a portion of the breast. Mastitis causes swelling, burning, redness, and pain. This usually occurs in just one breast and may also cause a nursing mother to feel feverish and ill. If you have any of these symptoms, talk to your doctor immediately. Lots of rest, warm compresses, antibiotics, breast support, and continued breastfeeding are all that are usually needed.

You should not stop breastfeeding while you have mastitis since the infection will not spread to your milk. It is important to keep the milk flowing in the infected breast. If it is too painful to have your baby nurse on the infected breast, open up both sides of your bra and let the milk flow from that breast onto a towel or absorbent cloth. This relieves the pressure as you feed the baby on the opposite side. Pumping the affected side may also be necessary.

Breast Augmentation
There is still some question as to whether it is safe to breastfeed if you have silicone breast implants, but there is no conclusive evidence that infants are harmed. The surgery for breast implants usually does not interfere with milk ducts or the nipples unless the incision was made around the edge of the areola. This surgery should not prevent successful nursing. However, plastic surgery to reduce the size of breasts may interfere with breastfeeding, especially if the nipples were transplanted. If you have had plastic surgery on your breasts, you may only find out whether or not you can successfully breastfeed by trying.

Premature Babies, Twins, and Triplets
Many premature and seriously ill babies are able to breastfeed. Human milk has been shown to be very beneficial to premature and sick newborns by helping growth and preventing many diseases. If your baby is not able at first to nurse, you can collect your milk and feed your baby by tube or cup. Express your milk at the times when your baby would usually feed, so that your body becomes used to the schedule, usually about eight times per day by electric breast pump. Most hospitals have breastfeeding experts to help you get started. Once you start to breastfeed, let your baby nurse often to build up your milk supply.

If you have twins, it is possible to breastfeed them at the same time, having one baby at each breast. You can hold one baby at each side, called the "football hold," or you can cradle them both in front of you with their bodies crossing each other, as they would have been in utero. Alternate the breast each baby uses at each feeding or at least once a day. You may supplement feedings with formula if this is too difficult, or if you are not producing enough milk.

With triplets it is possible to breastfeed, but most mothers supplement feedings with formula. Nurse two of the babies at a time and give formula to the third. At the next feeding, give the formula to a different baby. It is important that all three babies have a chance to breastfeed.

Weaning Your Baby
There is no "right" time to wean. It depends entirely on the desires and needs of you and your baby. Either one of you can begin the weaning process.

Some babies lose interest in breastfeeding between 9 and 12 months of age or after they learn to drink from a cup. If you notice this starting to happen, do not try to force your baby to keep breastfeeding. Understand that this is not rejection, but the first sign of your child’s growing independence. You may feel sad, guilty, lonely, or depressed about giving up the closeness and intimacy that comes from breastfeeding. These feelings are natural. Cuddle and interact with your baby even more, and remember that weaning is a natural step in helping your child to grow up.

You can wean your child first to a bottle and then to a cup, or directly to a cup. During weaning, you can express milk with which to feed your baby from the cup or bottle, or you can use infant formula. Because formula cannot provide all the special nutrients and protective qualities that your milk can, your baby benefits the longer she drinks human milk.

If you choose to supplement breastfeeding with formula, along with breast milk, you will still need to express milk. This keeps your milk production going and your breasts from getting engorged.

If using a bottle, introduce it gradually over several days. Use it with one feeding and work your way up to more. It helps if your baby is not extremely hungry, because then she may be more patient when trying out the bottle. It also helps if your spouse or a caregiver introduces the bottle when you are not around. Many babies will get very upset if they are given a bottle when their mother is in the house; they may even refuse the bottle because they want to breastfeed instead. Do not force your baby to take a bottle. It may take time. Excess pressure on the baby to take a bottle may cause her to refuse the bottle totally.

After bottle-feedings have started, some babies may get frustrated when they breastfeed because the milk does not flow as fast from the breast as from a bottle.

The following tips may help:

• Try to select a bottle nipple with a slow flow
• Pump for 1 to 2 minutes before you breastfeed
• Massage the breast as you nurse to help the milk flow
• Use relaxation techniques with feeding to enhance milk flow
• Offer the breast before your baby gets very hungry so that he is not impatient

Weaning to a cup has the following advantages over a bottle:

• Eliminates the step of weaning first to a bottle and then to a cup
• Bottle-feeding for long periods of time or while sleeping can lead to tooth decay
• Drinking from a bottle while lying flat can lead to middle ear infections
• Bottles can become a security object, especially after a child is 1 year old

To introduce your baby to a cup, start with a trainer cup with two handles and a snap-on lid with a spout. Or you can use a small plastic glass. This will keep spills small as your baby tries holding the cup in different ways (or throws it). Don't be surprised if your baby treats the cup as a plaything at first.

Offer your milk when available, starting with just one meal a day. It may be easiest to substitute a cup for breastfeeding at the midday feeding first and the nighttime feeding last.

Once you have stopped breastfeeding entirely, your breasts will stop producing milk very quickly.

Resources
Learn as much as you can about breastfeeding before your baby is born. Read, watch videos, and talk to other women who have breastfed. Many hospitals and health organizations offer breastfeeding classes.

Your best sources of information are:

• Your obstetrician and pediatrician
• Prenatal instructors and lactation consultants at your local hospital
• La Leche League International, a worldwide organization dedicated to helping families learn about breastfeeding