Breastfeeding Support

Why Breastfeeding Is Important

Breastfeeding is a natural process that is nutritionally sound. Breastfeeding can help babies stay healthy and is a beautiful and intimate way to for mothers to get to know their newborn. Mother’s milk is perfectly matched to her baby’s needs. The contents of your milk change as he or she grows. Mother’s milk is more than food for the baby. Only mother’s milk also works like a medicine to protect your baby.

• Breast milk gives the infant the ideal balance of nutrients and infection-fighting antibodies. Mother’s milk contains live cells and other growth factors that help promote the best possible development.
• Parts of mother’s milk help to activate and develop you baby’s immune system.
• The special mixture of fats in mother’s milk helps develop the baby’s brain and eyes. This can never be made the same way in formula.
• Many of the benefits of mother’s milk extend well past the time you stop breastfeeding.
• Breastfeeding is also a part of mother’s relationship with their baby and promotes bonding.
• Breast milk can reduce the development of allergies in babies. The number one allergy in the US is the cow’s milk protein, casein. The second highest food allergy is soy. Baby formula is made from cow’s milk or soy. Early introduction of casein and soy can stimulate sensitivity to these and result in allergies later.

How Babies Benefit from Breastfeeding

• Less diarrhea, constipation, and spitting up
• More easily digested and absorbed nutrients
• Lower numbers and severity of respiratory, urinary, ear and other infections
• Less likely to suffer from childhood cancers, asthma, allergies, obesity, diabetes, eczema, and chronic bowel diseases
• Less risk of SIDS (sudden infant death syndrome)
• Better response to vaccinations
• Higher IQ and higher scores on test of development throughout childhood
• Healthier teeth
• Lower re-hospitalization rate

Benefits into adulthood:

• Lower cholesterol levels
• Less ulcerative colitis
• Less Crohn’s disease
• Less heart disease

Fewer complications for premature and pre-term infants, such as:

• Necrotizing enterocolitis (NEC)
• Chronic lung disease
• Special eye problems
• Infections

How Mothers Benefit from Breastfeeding

Breastfeeding is not only good for babies, but also has benefits for mothers. Some of the benefits specifically for mothers include:

• Helps women lose weight gain in pregnancy
• Lower risk of breast cancer
• Lower risk of ovarian cancer
• Lower risk of osteoporosis (thinning of bones)
• Less missed time at work and fewer doctor’s visits
• Less expense and more convenience feeding their baby
• Comforts baby quickly – so less crying and happier baby
• Breastfeeding hormones help mothers feel calm and connect with their baby
• Lower risk of heart and blood vessel disease and diabetes
• Less postpartum bleeding
• Lower risk of postpartum depression

Breast Fullness vs. Engorgement

Breast fullness: In two to three days after the baby is born, mother’s milk starts to change. Her body sends more blood to her breast to increase her milk supply and there may be some swelling of the breast tissue. The breasts become larger, firmer, and heavier. This fullness is normal. Some women are uncomfortable and may feel a throbbing sensation. This swelling only last a day or two if the baby is fed often and empties the breast regularly. Babies may have some trouble latching on if the breasts are too full. Use Reverse Pressure Softening (sustained finger pressure beginning at the nipple base and over the areola, pushing edema away from the nipple) before feeding can help the baby latch on.

Breast engorgement: If breast fullness does not go away with frequent breastfeeding or softening of the breast, breast can become hard, heavy, swollen and painful. This is engorgement. It is important to remove the milk. If a mother has questions after discharge from the hospital, she can call a Lactation Consultant for assistance. Engorgement can reduce milk supply, lead to blocked ducts or cause a breast infection. To avoid engorgement, counsel mothers to not skip feedings or supplement with formula often after her milk supply comes in.

Effective Ways To Relieve Engorgement and Get Milk Flowing

• Apply warm compresses to the breast before feeding. A wet warm washcloth or a shower can help widen the ducts and help the milk to come into the ducts in the breast.
• Massage the breast while nursing or pumping. Massage can trigger a let down of milk. Expressing some milk before nursing can help to soften the breast so the baby can latch more easily.
• If the baby is not able to soften and empty the breast, express or pump milk until the breasts are no longer hard or lumpy.
• If the breast still feel swollen after feeding or pumping, apply a cool pack on the breast for 10 to 15 minutes.

Sore or Cracked Nipples

Sore nipples can be discouraging and interrupt the pleasantness of breastfeeding. Some tenderness of the nipples by the second or third day after birth is common. This should improve by day 7 to 10. Continuing tenderness that causes redness, cracking and sore nipples is probably due to improper positioning and latch. Positioning and latch issues can be easily fixed. Call our lactation consultants for help. Do not let the problem get worse. Prevent sore and cracked nipples with the following measures:

• Learn how to properly position babies at the breast.
• Break the suction prior to removing the baby’s mouth from the breast.
• Apply some expressed breast milk to the nipple after nursing and allow it to air dry.
• Keep the nipple moist by applying lanolin after each nursing session.
• Wear breast pads between nursing session and change them when they are wet.

IMPORTANT: Some sore nipples can be the result of an infection. This needs medical treatment. Instruct mothers to talk to their health care provider or a certified lactation consultant if she has bright red shiny skin on her nipples and is experiencing itching. If the baby is fussy, seems to not want to nurse, or has a bright red diaper rash along with mother’s sore nipples, instruct mother to call her health care provider right away.

Blocked Ducts

The milk in the breasts flows through a series of ducts toward the nipples. Milk ducts can become clogged when milk is not flowing freely. This creates pea-sized hard, tender areas in the breast. Blocked ducts can be caused by skipped feedings, heavy breasts that are not well supported, a tight bra or under wire bras that put pressure over a duct, breast surgery, or poor positioning with nursing. Blocked ducts need to be cleared to restore milk flow and prevent infection.

Effective Ways To Relieve Blocked Ducts and Get Your Milk Flowing

• Take a warm shower or use warm wet compresses.
• Gently massage the breast before breastfeeding.
• While breastfeeding, gently massage the blocked area.
• Nurse often on the breast with blocked ducts. Position the baby so the baby’s chin is facing the blocked duct. This allows maximum suction toward the blockage.
• Express or pump milk if needed.

Mastitis

Sore or cracked nipple and blocked ducts can lead to mastitis if they are not corrected. Mastitis is inflammation of the breast tissue. Mastitis may or may not be accompanied by infection.

IMPORTANT: Counsel a mother to call a healthcare provider immediately if she has the following symptoms.

Effective Ways To Treat Mastitis

• Red, very sore, hard area on her breast
• Red streaking or breast tissue that is pink and tender over a large area
• Fever, chills, and flu-like symptoms
• Antibiotic therapy: instruct to finish the whole prescription even if she is feeling better.
• Nurse frequently: this is not a good time to stop breastfeeding.
• Apply warm compresses to the affected breast.
• Massage while nursing.
• Gently pump after or between feedings to promote breast emptying.
• Get plenty of rest.
• Drink lots of fluids.

Is the baby getting enough milk? 

It is normal to wonder if the baby is getting enough milk. Signs that the baby is getting enough milk include:

• The baby having a deep latch that is comfortable.
• A calm baby after feeding.
• A change in the color and number of baby’s stool. Meconium is the first sticky, black substance that your baby passes. Stools change to a mustard color, runny and seedy texture once you have a larger supply of milk.
• One to two wet and dirty diapers the first 24 hours is normal. Newborns will feed in short frequent burst sometimes every hour.
• By 3 to 5 days after delivery, with frequent feedings, the amount of milk will increase. At this stage, the baby should have at least 6 wet diapers and 3 to 4 dirty diapers in 24 hours.

Will Dad and my family feel left out if I breastfeed?

Fathers, families, and friends are an important part of mothers support team. Sometimes, however, they may express that they feel left out when a mother decides to breastfeed. Be sure to include the family in discussing the importance of breastfeeding so they can support your decision to provide breast milk. There are many ways these important people can help in baby’s care.

• “Kangaroo Care”, is an excellent way for Daddy to feel close to his new baby. There are many benefits for the baby from “Kangaroo Care” including better regulation of temperature, better oxygen levels, better blood sugar levels, and stimulation of senses that help nerve and brain development.
• At home, important support people can help ensure mother’s rest and recover well. Helping with older siblings is a very important job. Also, family and friends can help with baby care jobs such as bathing, dressing, burping and diapering.
• For mothers who decide to pump and collect breast milk for their baby, fathers and other family members can fill in labels for mother’s milk storage containers. They can help by cleaning breast pump parts and encourage pumping at regular times. While mother rest or are doing other necessary things in their life, fathers, grandparents, aunts and siblings can feed the baby the milk you collect.

Will breastfeeding hurt?

Breastfeeding should not hurt! There may be some nipple tenderness the first couple of days until the nipples adjust. Mothers will feel some tugging on the breast when the baby latches on initially. Any discomfort should go away within a minute or two.

Most complaints of pain while breastfeeding relate to how the baby is attached, also called “latched on.” Most of the time an uncomfortable latch can be quickly and easily taken care of. A lactation consultant will help find a comfortable position and teach mothers how to help the baby “latch on”.

I don’t have any milk. What now?

Many women think they don’t have enough milk. But, mothers make milk starting in the fourth month of pregnancy. Newborns stomachs are the size of a marble at birth – one teaspoonful (5 ml). Mothers have enough colostrum to fill their baby’s stomach as soon as he or she arrives. Do not over fill a baby by offering early feedings of formula. This may delay mother’s milk from “coming in” and decrease the amount of milk she make later.

Is it normal to be uncomfortable with the idea of putting my baby to my breast?

• Some women are not sure they will be comfortable with breastfeeding. It can be intimidating the first time. Please discuss this concern with your patients.
• Some women choose to collect breast milk by pumping as an alternative to nursing at the breast. They will need a good pump if they plan to regularly pump breast milk.
• Some women worry about their privacy and being able to breastfeed discreetly especially while in the hospital with staff and visitors coming and going. Ask us and support people to help mother to have quiet, private times with her baby so she can get off to a good start.

Are my breasts too small for breastfeeding?

Breasts and nipples come in many shapes and sizes. The size of the breasts or nipples does not determine success in breastfeeding. Most women, even with very small breasts, are able to produce enough milk for their baby. Even if the nipples are flat or inverted, mothers can successfully breastfeed their baby.

What do I do if I tried and could not make enough milk?

• Many women have tried to breastfeed only to find that their milk supply was too small to satisfy their baby. This is usually because of early and frequent use of formula before the breasts develop the cells needed to make large volumes of milk.
• Breastfeeding early and frequently ensures a good milk supply. If the baby is not able to be placed to the breast, frequently emptying the breast, early pumping and using a breast pump at the baby’s bedside can help boost mother’s milk supply. Also, frequently holding the baby skin-to-skin increases mother’s milk supply.
• Most mothers pump only drops of milk for the first few days. This is normal.
• Many things – such as high blood pressure, premature labor, medications, and Cesarean birth can delay “coming in” of mother’s milk.
• Many things can temporarily decrease milk supply: illness, hormone changes, stress, having a setback in a baby’s condition, and especially lack of frequent emptying of the breast.
• If you think milk supply is low, be sure to call our certified lactation consultants for ways to increase milk supply. I have to go back to work so it is better not to start breastfeeding. Today, many women return to work soon after giving birth. Ask our lactation consultants for information about preparing to go back to work and how to approach employers about helping mothers continue to breastfeed after returning to work. Continuing breastfeeding can be a benefit to mothers, babies and employers.
• Having access to a breast pump when mothers return to work makes it possible to breastfeed as long as she want.
• Remember, providing any amount of breast milk for the baby is beneficial for mother and baby, no matter how long she breastfeeds. Even if she decides to stop breastfeeding before returning to work, every drop counts in giving the baby a healthy start.

Are the medications I’m taking safe for my baby?

Most medications are safe for babies when you breastfeed. A physician or lactation consultant can help identify any medications that might cause potential problems with breastfeeding. IMPORTANT: Counsel mothers to talk to their healthcare provider and lactation consultant after going home before taking any new medications while breastfeeding.

I had breast surgery…can I still breastfeed?

Some types of breast surgery can interfere with a women’s ability to breastfeed. It is best to discuss the individual surgery with the doctor and lactation consultant to know if she is able to breastfeed. In most cases, breastfeeding the baby is the best way to know if she is able to produce milk.

Will my breasts leak?

It is true that a nursing mother’s milk will “let down” sometimes when she is not nursing, for example, even when she hears someone else’s baby cry. Applying gentle pressure to the nipples usually stops the flow of milk. She can protect her clothing by wearing disposable or washable breast pads inside her bra. These should be changed when they become wet. Leaking becomes less common as time goes on.

Breastfeeding Holds & Latches

There are several ways to hold a baby when breastfeeding. There is no “right” hold when breastfeeding. Find a hold that feels good to the mother and baby. Just like any new skill, breastfeeding takes practice and patience.

Find a hold that lets mother relax her shoulders and arms. If mother chooses to sit up, find a seat with good back support. Try using a footstool to take pressure off her back and pillows to make her comfortable. Many women choose to use a special nursing pillow made to give support to her arms and baby while breastfeeding. Boppy pillows are hard to use in a hospital bed. Some mothers like to breastfeed while lying on their sides. This works well after a Cesarean birth or for women with large breasts.

No matter what hold is used, check the following important points:

• Wash your hands before beginning.
• Helping the baby latch on is difficult if the baby is crying or upset. Calm the baby by snuggling or putting the baby skin to skin before attempting to nurse. Placing the baby skin-to-skin in the beginning helps the baby to seek the breast.
• The baby should be pressed against mothers body with feet, bottom, and shoulders pulled in close (no gaps). Hold the baby by placing the palm of mother’s hand on the upper back. Wrap the thumb and middle finger around the base of the baby’s skull placing the finger tips below the baby’s ears to prevent the baby from turning sideways. DO NOT push on the back of the baby’s head. The baby should be positioned so the head, shoulders, knees, and chest face the breast.
• Hold the breast with a “C” hold. “C” hold means four fingers underneath the breast and the thumb on top of the breast. Position your fingers and thumb to run in the same direction as the baby’s lips. Make sure the fingers are well away from the areola. Gently lift and support the breast so the nipple is pointing upward. This makes it easier for the baby to get more of the areola in his or her mouth. Also, having a roll under a large breast for support can be helpful.
• Position the baby’s nose so you can lightly tickle his or her upper lip up with the nipple. It may take several attempts before the baby opens wide, like a yawn. The baby’s ears, shoulders and hips should be in a straight line, no twisting or turning.
• The baby’s head should be free to tilt back a bit. The chin should touch the breast first. Use the tips of the fingers at each ear at the base of the head or jaw line to keep the baby facing the breast. Pushing on the back of the baby’s head makes it difficult to get an effective and deep latch.
• Be patient until the baby opens the mouth wide. Do not allow the baby to latch onto the nipple only! This can be painful. Also, this can cause the skin on the nipple to break down and become sore.
• When the baby opens wide, quickly and gently push from behind the baby’s back and shoulder blades toward the breast. The lower lip should be further away from the nipple than the upper lip. This is called an “asymmetrical latch.” Breastfeeding comfort depends on where the nipple lands in the baby’s mouth. Toward the back of the baby’s mouth is a soft “comfort zone” the nipple needs to reach.
• A clicking sound means the baby is not on the breast deep enough. If you need to remove the baby from the breast and try again, break the suction between the baby and breast by placing a clean finger near the corner of the baby’s mouth. This helps prevent sore nipples.
• A correct latch-on is a learned response. Be patient!

Signs of a Good Latch-on

• Baby’s mouth is wide open.
• The baby’s chin is firmly touching the breast and the head is tilted back.
• You may hear the baby swallow ( a soft sound like “ca – ca”).
• Both lips are rolled outward.
• Mother feels a tugging at the breast but no pain.
• There are several periods of active sucking, swallowing and stopping to breathe and rest ring a feeding.
• IMPORTANT: If breastfeeding hurts, seek help right away from a certified lactation consultants (IBCLC).

Feeding Frequency & Newborn Cues

Once mother is comfortable and the baby has a good latch, let the baby nurse as long as he is sucking and swallowing or until he lets go. Some newborns get all the milk they need in 20 minutes, but others may take 35 to 45 minutes.

• Do not let the baby nurse on one breast for more than 30 minutes.
• Take the baby off the breast and try to burp the baby.
• Breastfed babies don’t always need to burp.
• Offer both breasts throughout the day.
• Start the next feeding on the breast the baby nursed on less at the previous feeding. This supports good milk production and prevents the breasts from over filling.

Remember; feed the baby every time the baby is hungry. Yes, even if mother just nursed an hour ago. Watch for hunger cues! Most newborns nurse only about 4 times in the first 24 hours, but by day four are nursing 8 to 12 times in 24 hours. In the early sleepy days, babies may not show signs of hunger as often. Wake the baby at least every 3 hours and try to get the baby to nurse. Massaging the breast while the baby is nursing can increase milk flow and keep the baby nursing.

Hunger Cues

Hunger cues are special movements and sounds the baby makes when he or she is hungry. The baby may:

• Flex and wiggle arms or legs,
• Hold his or her fist tight, bring hands up to the mouth and suck on the hands,
• Be in a light sleep with eyes moving under his lids or looking with bright alert eyes,
• Turn the head toward a touch on the cheek (this is also called “rooting”),
• Make suckling motions of the mouth,
• Bob the head when held skin-to-skin, or
• Make squeaky noises.

Crying is a late sign of hunger. However, crying doesn’t always mean the baby is hungry.

Signs a Baby Is Not Hungry

• Letting go of the breast or falling asleep after a long feeding
• Turning away from the breast
• Resisting going to the breast
• Arms resting calmly along the side of the body

Waking Baby

A sleepy baby for the first 36 hours after birth is normal. Baby’s first two hours of alertness are followed by 36 hours when your baby may be very sleepy. Don’t worry; this sleepiness is followed by increased wakefulness and interest in breastfeeding. Do not give baby formula because he or she is too sleepy to breastfeed.

To wake a sleepy baby to eat:

• Take some clothing off and undress him to the diaper. Putting the baby next to mother’s skin will keep the baby warm.
• Change the diaper or burp the baby.
• Give the baby a massage – gently rubbing the inside and outside of the palm of the hand can stimulate the baby to suck.
• Express some milk onto the baby’s lips. Drops of milk on the nipple can stimulate a latch.
• Switch breast or try a different position.

Notes

Avoid supplements with formula and avoid use of bottles and pacifiers. Newborns should not receive supplements with formula unless medically indicated. Offering supplements with a bottle disrupts the baby’s natural sucking instinct, changes the pH of the gut allowing changes in gut flora, and causes over filling of the baby’s stomach with casein protein that is difficult for the newborn to digest. Overfilling the stomach can cause spitting up or uncomfortable abdominal cramping and a fussy baby.

Babies should always be offered the breast first. The next best option is expressed breast milk. If mother is unable to put the baby to breast, a breast pump should be set up within six hours and mother instructed on pumping. The baby’s stomach capacity is only 5-10 cc in the first 24 hours and does not reach the size of a ping pong ball (1ounce) for 2 weeks. Mothers should be counseled to limit supplemental feeding and to give a maximum of 15 cc for the first 2-3 days only if advised to supplement breastfeeding by their baby’s doctor.

For lactation support you can call the UAB Lactation Department with any questions or concerns at 205-975-8334. We also make appointments as needed.

Printable Patient Resources

• Guide to Pumping Breast Milk
• Pump Log
• Baby’s Second Night

Electronic Resources

• Office of Women’s Health: Your Guide to Breastfeeding (Patient Education Booklet)
• Academy of Breastfeeding Medicine: Clinical Protocols for Care of Breastfeeding Mothers and Infants
• CDC: Breastfeeding Report Card 2014
• Office of the Surgeon General: Call to Action to Support Breastfeeding
• Best Start: Guidelines for Nursing Mothers (tummy size, output, feeding frequency, and weight)

For Partners & Dads: You Can Help

There are several ways you can help mom have breastfeeding success with your new baby, including:

• Giving mom quiet, uninterrupted time with baby.
• Helping mom get comfortable: providing a seat with good back support, giving her a footstool to take pressure off her back, plus pillows to help her relax.
• Helping mom get enough rest by taking care of older siblings and helping around the house.
• Bringing baby to mom to feed.
• Helping with baby by bathing, dressing, burping, and diapering.
• Filling and labeling storage containers if mom is pumping, as well as cleaning breast pump parts.
• Feeding baby its bottle if mom is pumping.
• Being a good listener and supporter when mom needs to talk about her breastfeeding concerns.
• Taking part in skin-to-skin contact with your baby helps baby feel calm and connected.

What to expect (timeline)

• Birth. The first hour after birth is a good time to breastfeed for the first time.
• First Day. Baby will be sleepy for the first 36 hours of life, so feedings will likely be short and scattered. Your baby will drink about 1 teaspoon of colostrum—a rich, thick, yellowish milk—at each feeding. Feed the baby whenever he or she displays hunger cues. Because babies sleep a lot in the first day or two, we encourage you to unwrap and stimulate your baby to observe for hunger cues 8-12 times a day. Your baby may not nurse every time you attempt to wake him or her. This is a good time for both you and your partner to get rest.
• “Second Night.” After the first 36-48 hours, your baby is likely to be sensitive to stimulation and be fussy. Usually this isn’t hunger but instead is your baby’s desire for a familiar environment that is calming and quiet. Place baby on your or your partner’s chest, skin to skin, and he or she will feel more secure.
• First Week. Feedings will take place frequently, at least 8-12 times a day and often without a schedule. White milk has come in by this time, and because it is more digestible than formula, breastfed babies will eat more often than those on formula.
• Up to 6 Weeks. Feedings will be less frequent and take less time.

Supportive Words

• Just like any new skill, breastfeeding takes practice and patience.
• Most new moms pump only drops of milk for the first few days. This is normal.
• Many things can temporarily decrease milk supply, including illness, hormone changes, stress, having a setback in baby’s condition, and especially lack of frequent emptying of the breast.
• Questions about breastfeeding are normal. The lactation consultants and nurses at UAB Medicine are available to help us at (205) 975-8334. Or, we can call the National Breastfeeding Helpline at (800) 994-9663 for support.
• Compliment her on how amazing it is that she is providing food for your child and how she responds to the baby’s hunger cues.

For Grandmothers: You Can Help

While infant formula has improved over the years, substituting it for breast milk is not risk-free. Breast milk is best for the optimum health and development of your new grandchild, and your encouragement and support can make a big difference in the success of your daughter’s breastfeeding. By helping her care for her baby and household, as well as offering words of encouragement and support, you can empower her to achieve breastfeeding success and provide optimal nutrition for the health of her and your grandchild.

You Can Help

• Hold the baby while mom showers, eats a meal, or gets some sleep.
• Help older siblings feel special and important during this time of change by giving them attention and praise.
• Help mom and dad cook, take care of household chores, and run errands.
• Comfort mom if she feels pressured to host visitors by limiting guests and encouraging her to rest and concentrate on breastfeeding in the early days after delivery.
• Let her know how proud you are of her for breastfeeding by offering words of encouragement.

Supportive Words

• It’s okay to ask for help.
• UAB Medicine lactation consultants are available to provide support at (205) 975-8334, or call the National Breastfeeding Helpline at (800) 994-9663.
• Just like any new skill, breastfeeding takes practice and patience.
• Encouraging words like, “I’m so proud of you!” go a long way.