Breastfeeding

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Breastfeeding

Breastfeeding

Overview

 

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
  • The American Academy of Family Physicians
  • The American College of Obstetricians and Gynecologists
  • The American Dietetic Association
  • The American College of Nurse-Midwives
  • The 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, if possible, continue until the baby is one year old and beyond. Ideally, solid foods should only be introduced after six months of age.

While most new mothers breastfeed in the weeks following birth (called the early postpartum period), less than 15 percent continue to nurse exclusively through six months. 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 2020, a national prevention initiative to improve the health of all Americans, set forth goals to increase breastfeeding rates.

Healthy People 2020 Goals

2020 Target

In early postpartum

81.9%

At six months

60.6%

At one year

34.1%

 

Diagnosis

 

Breastfeeding is a natural and rewarding process; however, it can be harder than it looks. If you have trouble breastfeeding, contact your health care provider or consult a lactation consultant or counselor. Breastfeeding challenges are often easily overcome with some support and, occasionally, treatment, so don’t give up.

What’s a Lactation Consultant?

Lactation consultants are professionals who are trained to help mothers who want to breastfeed their babies. Most hospitals and clinics have lactation consultants on staff to help new moms learn to nurse. They can provide encouragement and assist moms and babies with latching difficulties, painful nursing and other issues that may interfere with efforts to breastfeed. To find a lactation counselor near you, visit the La Leche League’s website: www.safegenericpharmacy.com.

Common Complications with Breastfeeding

There are several problems new mothers may experience when breastfeeding, including:

  • Sore or cracked nipples. This occurs most often because the baby is not “latching on” to your breast correctly.
  • Engorgement. When your breasts are engorged, they become swollen, hard and sore. They may become so full that the nipple flattens into the areola (the dark skin around the nipple). This can lead to plugged ducts or a breast infection.
  • Plugged milk ducts. These are common during breastfeeding and occur when the milk is not properly drained. The affected milk duct feels like a tender lump in the breast and can become inflamed and red; however, there are usually no other symptoms.
  • Mastitis. Also called breast infection, mastitis is often accompanied by a fever, chills and/or other flu-like symptoms. Less common than other complications, mastitis is caused by bacteria on your skin or by bacteria from your baby’s mouth that enters the breast through cracked skin. The affected breast may be red or have red streaks and may be painful and swollen.
  • Thrush (yeast infection). Also less common than other breastfeeding complications, thrush may be suspected if you suddenly get sore nipples after several weeks of successful, pain-free nursing. Other signs include pink, flaky, shiny, itchy or cracked nipples. You may experience shooting pains deep in the breast during or after feedings if the yeast has gotten into the ductal tissue of the breast.

 

Treatment

 

There are ways to treat or prevent problems that may develop because of breastfeeding. Even if you begin to have symptoms like sore nipples or other issues, it’s important not to give up before speaking with your health care professional or lactation consultant—or even a friend who has successfully breastfed her children. Here are some treatment options for the most common breastfeeding symptoms.

Sore Nipples

To treat or prevent sore, cracked nipples:

  • Make sure your baby is sucking properly. The baby’s mouth should take your nipple and as much of the areola (darker area around the nipple) as possible. If it hurts, you may need to reposition and start again. Be careful not to pull the baby away from the breast quickly; instead gently interrupt the suction by placing a finger in his/her mouth.
  • Offer the less sore nipple first, as the baby may suck more vigorously at first.
  • Let your nipples air dry between feedings. You may want to expose them to sunlight briefly.
  • Rub a small amount of breast milk or a breast cream that contains lanolin and water to soothe the area after a feeding. Your milk will help heal cracks and kill bacteria, which could lead to an infection.
  • Change wet nursing pads frequently. Use of washable cotton pads may cause less irritation than synthetic (i.e. plastic) backed pads.
  • Wash your nipples daily with warm water and pat dry. Avoid using soap, which can remove natural oils.
  • If you have an open crack in the skin, it may be better to nurse from the other breast temporarily, but be sure to pump the sore side until it heals a bit and isn’t sore.

Nipple soreness and chapping should go away within several days. If it doesn’t, you should contact your health care provider or lactation consultant.

Engorgement

If your breasts are engorged (overly full), breastfeed frequently to help empty your breasts and relieve fullness and pain. If this is too painful, try to manually express some milk to provide a natural, soothing lubricant. This may also make it easier for the baby to latch on to the nipple. To ease engorgement, take a warm shower or apply warm compresses for a few minutes before breastfeeding. If your baby is not latching on well, use a pump to reduce engorgement and help your milk flow. Use cool compresses between feedings to reduce swelling.

Plugged Milk Duct

This is a common problem for many breastfeeding mothers. Treatment may include: getting extra sleep or rest; applying heat compresses or taking a hot shower; massaging the blocked milk duct toward the nipple during nursing; and breastfeeding from the affected breast to help loosen the plug. Applying cool compresses to your breasts after feeding may also help.

Mastitis

If you suspect mastitis, or a breast infection, you should consult your health care provider right away. He/she will prescribe antibiotics and may recommend an analgesic to relieve the pain. Hot showers or compresses before breastfeeding can help by increasing circulation to the affected area.

In most cases, you can continue nursing through breastfeeding problems, even an infection. Emptying your breasts frequently can often reduce inflammation and relieve the problem.

 

Prevention

 

Breastfeeding is a unique experience for each woman and her baby. You may not experience the same (or any) breastfeeding symptoms a friend had, while you may have more trouble getting started than your mother did (or not). Many difficulties associated with breastfeeding can be minimized. The benefits of staying committed, whenever possible, to breastfeeding always pay off.

Here are a few tips to further explain why breastfeeding is valuable to you and your baby’s health now and in the future, as well as how to prevent complications.

  • Breastfeeding offers a wide range of health benefits and reduces the risk of certain illnesses for both mom and baby.
    • Breast milk has antibodies that bolster you baby’s natural immunity to fight common childhood infections, including diarrhea, ear infections, respiratory infections and bacterial meningitis. It can also lower the risk of some chronic illness (e.g., juvenile diabetes, some childhood cancers, irritable bowel syndrome/colitis, overweight and obesity). Because breastfed babies tend to be healthier, they have fewer:
      • Illnesses (less severe and shorter)
      • Sick care visits
      • Hospitalizations
    • Breastfeeding helps moms recover from pregnancy and childbirth and can reduce the likelihood of certain cancers (e.g., breast, ovarian) and osteoporosis.
  • Before starting to breastfeed, talk with your health care provider about any prescription or over-the-counter medications or herbs you are taking, just in case these can pass into your milk and harm your baby.
  • Limit alcohol and caffeine, which can easily pass into your milk. The effect of alcohol is related to the amount you consume. It’s OK to have the occasional beer or glass of wine (one glass or less a day). Time feedings so they occur two hours later, so the alcohol is no longer in your system.
  • Avoid certain kinds of fish and shellfish that contain high levels of mercury. These include shark, swordfish, king mackerel and tilefish. You can safely eat up to 12 ounces (two servings) per week of fish low in mercury, which include shrimp, canned light tuna, salmon, pollock, clams, haddock, trout and catfish.
  • Get plenty of rest and eat a well-balanced diet. As a new mom, you are probably feeling overly tired and may not be eating as well as you should be. This can lower your resistance to illness, making breast infections more likely.
  • Some women experience problems when breastfeeding, such as sore or cracked nipples, engorgement or blocked milk ducts, especially during the first four weeks. There are preventive steps you can take to limit their occurrence and reduce the likelihood of breast infections that may develop as a result. Here are some helpful tips:
    • Breastfeed frequently for your baby’s health and to help empty your breasts.
    • Check your baby’s position and the way he/she is latched on to your breast. If he/she is not latched on properly, nursing may hurt, and your breasts will be overly tender and sore.
    • Let your nipples air dry between feedings.
    • Wash your nipples daily with warm water. Avoid using soap on the nipple area or lotion that may contain alcohol, because both can dry the skin.
    • Manually express some milk on your nipples to provide a natural moisturizer or use a breast cream that contains lanolin and water to soothe the area.
    • Don’t skip feedings. Frequent breastfeeding is the most important thing you can do to protect your breast milk supply when with your baby. Frequently pumping when separated from your baby is equally important.

 

Facts to Know

 

  1. Breastfeeding is highly recommended. The American Academy of Pediatrics (AAP) and other leading health organizations strongly recommend exclusive breastfeeding (with no formula or solid foods) for the baby’s first six months of life. Breastfeeding should ideally continue through the first year of life or beyond.
  2. Breast milk is preferred for all infants, including premature and sick newborns, with few exceptions, according to the AAP. Human milk is rich in nutrients and easier to digest.
  3. Breastfed infants are healthier. They have fewer deaths during the first year and experience fewer and shorter illnesses than formula-fed babies.
  4. The health benefits add up. The longer you breastfeed, the greater the health benefits for you and your baby.
  5. Supply will meet demand. Many mothers worry about whether their babies are getting enough milk. Your milk supply will respond to your baby’s needs—the more your baby suckles, the more milk will be produced.
  6. Breastfeed early. Try breastfeeding within the first hour of giving birth. This is an important time to bond with your baby and learn breastfeeding techniques from a lactation consultant or nurse on staff.
  7. Some new mothers experience difficulties breastfeeding. In fact, many mothers report problems during the first few weeks, such as sore nipples, breast pain or swelling. If problems persist, talk with your health care provider or ask to be referred to a lactation consultant. The good news is that most of these problems can be resolved with patience, practice or treatment.
  8. Working mothers can and should continue breastfeeding. More and more new mothers are returning to work and plan to continue breastfeeding. Make sure to speak with your employer or human resources manager before returning so you can discuss the logistics of pumping at work. Find out if there is a private room you can use and how you will fit pumping breaks into your schedule. Know your rights. Many states have laws that require employers to set up a space for you and/or allow unpaid or paid time to accommodate pumping breaks.
  9. In some cases, breastfeeding is not recommended. For example, mothers with certain health conditions can pass illnesses on to the baby through breast milk. These include:• 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.�

  10. Breastfeeding has economic benefits. Mothers of breastfed babies tend to have fewer missed work days and shorter absences because breastfed babies are better able to fight off infection and are sick less often. Companies incur fewer insurance claims for infant illnesses. Breastfeeding saves families money because it’s a lot less expensive than formula.

 

Key Q&A

 

  1. How often should I breastfeed?Babies need to be breastfed frequently and until satisfied. This may mean breastfeeding eight to 12 times a day or more for about 15 to 20 minutes at each breast. Let your baby determine the feeding schedule (otherwise known as nursing on demand). 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)

  2. How long should I breastfeed?Babies should be fed with breast milk only—no formula—for at least the first six months of life. It’s important to continue breastfeeding for as long as you can, ideally until your baby is one year old or beyond. The longer you breastfeed, the greater the health benefits for you and your baby.
  3. How do I know if my baby is getting enough milk?Many mothers worry about whether their babies are getting enough milk. An easy way to gauge whether your baby is getting enough is to pay attention to his/her weight and the number of wet and dirty diapers. This may include:

    • Consistently gaining weight after the first three to seven days after birth. Babies often lose some of their weight (about 7 to 10 percent) within the first week.
    • Six to eight wet diapers and three to four yellow, seedy bowel movements by day five.

  4. What is colostrum?Colostrum, also called “first milk,” is a thick, yellowish fluid that helps your newborn’s digestive system grow and function. Even though it looks like a small amount, this is the only food your baby needs until your milk supply comes in, usually within five days of giving birth. Colostrum is rich in nutrients and provides protection against infectious diseases. Because colostrum is so nutrient rich, a very small amount is an entire feeding, so new mothers should not doubt that they can supply their babies’ needs.
  5. How do I know if my baby has latched on properly?If your baby has latched on correctly, he/she should have your entire nipple and most of the areola (the dark skin around your nipple) well into his/her mouth. Make sure your baby’s whole body is turned toward your breast, not just his/her head. Try positioning a pillow just below your breasts to ensure the baby is resting comfortably at the same level as your nipple. Your baby’s suckling should be even, and you will hear his/her swallows.
  6. Should breastfeeding be painful?No. Although you may experience some discomfort and tenderness during the first few days, breastfeeding shouldn’t be painful. You may feel the slightest tug or pressure sensation. If breastfeeding hurts or you have flu-like symptoms (fever, chills, feeling run down), contact your health care provider.
  7. What is a lactation consultant?Lactation consultants are professionals who are trained to help mothers who want to breastfeed their babies. Most hospitals and clinics have lactation consultants on staff to help new moms learn how to nurse. They can provide encouragement and assist moms and babies with latching difficulties, painful nursing and other issues that may interfere with efforts to breastfeed. To find a lactation consultant near you, visit www.safegenericpharmacy.com.
  8. What is the let-down reflex?You may experience a tingling or tightening sensation (some women describe it as a pins and needles sensation) as your milk lets down and fills your breasts. This reflex means your milk is ready to flow. This sometimes occurs in response to your baby’s cry or when a feeding is overdue.
  9. How can I maintain my milk supply?Your milk supply will respond to your baby’s needs—the more your baby suckles, the more milk will be produced. If you’re concerned about your milk production, increase the number of feedings a day. Other steps to take include:

    • Pumping when you return to work or plan to be away from your baby for an extended period of time
    • Getting plenty of rest
    • Eating a nutritious diet with plenty of calcium
    • Delaying introducing formula or solid foods until six months of age at the earliest

  10. Are there foods or medications that I should discontinue while breastfeeding?Pay attention to foods that might bother your baby. If you notice a pattern, avoid the food for a few days and then reintroduce it to see what happens. Most mothers who eat a balanced diet and don’t have a history of allergies won’t need to restrict the foods they eat, except for a few things. Caffeine and alcohol can get into your milk, so limit their intake. You should also avoid certain kinds of fish and shellfish high in mercury; these include shark, swordfish, king mackerel and tilefish. You can safely eat up to 12 ounces (two servings) a week of fish and shellfish low in mercury, including shrimp, canned light tuna, salmon, pollock, clams, haddock, trout and catfish. Some medications may be harmful to your baby if they pass into your milk. Be sure to check with your health care provider about which foods, beverages and medications are safe for you and your baby.
  11. Can I continue breastfeeding when I return to work?Yes. A growing number of new moms are returning to work and can continue breastfeeding thanks to breast pumps and storage containers, as well as policies that encourage workplaces to be supportive of nursing. Pumping can help you maintain your breast milk supply and keep you connected to your baby, even when you are away. Employers benefit because breastfeeding moms often need less time off for sick babies.
  12. How long can I use stored milk?The following are some guidelines for freshly expressed breast milk storage from the FDA and the CDC:

    • At room temperature (66–72°F) for up to 10 hours
    • At 72–79°F for four to six hours
    • At 86–100°F for up to four hours
    • In a refrigerator (32–39°F) for up to eight days
    • In a freezer contained within a refrigerator for up to two weeks
    • In a self-contained freezer unit for three to four months
    • In a deep-freezer (0°F) for six to 12 months

  13. What are the most recent guidelines for pregnant and breastfeeding mothers about eating seafood?Some fish contain high levels of mercury that can harm your baby’s developing nervous system if eaten regularly. However, a recent federally funded report released by the Institute of Medicine (IOM) showed that the heart benefits of seafood outweigh the risks. The report showed that omega-3 fatty acids found in fish promote healthy vision and brain development in infants whose mothers consume seafood while they are pregnant or nursing.

    So does this mean you should eat fish or not? The answer is you should eat fish, but you should make sure it’s the right kind. Guidelines issued jointly by the U.S. Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) note that pregnant women can safely eat up to 12 ounces (about two servings) a week of a variety of cooked fish and shellfish with lower levels of mercury, such as shrimp, clams, oysters, salmon, catfish, crab, haddock and trout. If you choose tuna, stay away from albacore, or white tuna, which contains higher levels of mercury than canned tuna. The FDA and EPA also recommend that women of childbearing age, pregnant women and breastfeeding women not eat shark, swordfish, king mackerel or tilefish, which have high levels of mercury.

    In addition, they recommend that you check local advisories about the safety of fish caught by family and friends in your local lakes, rivers and coasta. If no advice is available, eat up to six ounces (one average serving) per week of fish you catch from local waters, but don’t consume any other fish during that week. And as always, talk with your health care professional about the risks of eating fish and shellfish while breastfeeding

 

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 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. Find out what your state laws say about support of breastfeeding women in the workplace. Many states have laws supporting working breastfeeding women.

A 2007 survey of working mothers conducted by HealthyWomen 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 others 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/esa/whd/fmla.
  • 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. Many working mothers note that breastfeeding helps them feel less guilty about being a working mother because breastfeeding is the one thing that nobody else can do for their children.

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.

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