How do I bring my baby to my breast?
When your baby bobs his or her head on your chest and starts moving toward the nipple, ease him or her down to face the breast. Support his or her buttocks with your elbow while your forearm supports the back and the palm of your hand supports the shoulders. Make sure the web between your thumb and first finger is at the nape of the baby's neck, your thumb is on one side of head and one or the rest of your fingers support the other side of the head. Notice that the baby's ear, shoulder and hip are in a straight line and the legs are curled around your waist. Your arm should support the baby's weight and a pillow can support your arm. Your other hand supports the breast with your fingers far away from the areola (the darker part of the breast). This is called the "cross cradle hold." If it is hard to support the breast, try putting a rolled facecloth under the breast.
Some mothers prefer the "clutch" or "football hold," a nice position for babies who weigh more than eight pounds. Bring the baby's hip to your hip with your elbow supporting the other hip and your arm supporting his or her side. The palm of your hand supports the shoulders. The web between your thumb and first finger is at the nape of the baby's neck, thumb on one side of head and one or the rest of the fingers supporting the other side of his or her head. Your arm supports the baby's weight and a pillow can support your arm. Your other hand supports the breast with your fingers away from the areola (the darker part of the breast). If it is hard to support the breast, try putting a rolled facecloth under the breast.
How can I help my baby latch on?
Support the baby's head and tilt it back slightly. Brush the bottom lip with the tip of your nipple to make the baby open wide as a yawn. With the baby's chin lifted and leading the latch, nose in line with your nipple, bring the baby to your breast. The chin will touch first and be deep into the breast with the nose not quite touching. Notice that the baby's neck is straight, making it easy for baby to swallow. A swallow sounds like an "ah" or a little puff of air. When the baby is latched well, you will hear a few swallows of colostrum. When your milk changes to mature milk (about day three or four), you will hear a swallow with about every 4 to 5 suckles. Keep the baby close to you, supporting the shoulders and back and bracing the buttocks against your side.
When your baby is latched well, it feels like a tug or a pull, but never painful. If there is any pinching or pain, be sure the baby's lips are rolled out and bring the baby closer to your body. If this does not help, re-latch. Most of the time if it hurts, it has something to do with positioning. Ask your nurse for help or once you go home, call the Warm Line at 1-800-711-7011 for help from a nurse or lactation consultant.
If the baby is not latched in five minutes, stop. You can hand express in the first 24 hours. If your baby is more than 24 hours old, pump. Keeping the baby skin-to-skin, you can feed him or her the expressed breast milk.
How long should my baby nurse/breastfeed?
Let the baby nurse as long as he or she is actively sucking and swallowing. You can watch the jaw move all the way to the ear and hear soft puffs of air. When the swallowing slows, massage your breast to move more milk into the baby's mouth and bring baby closer to you with the palm of your hand. When the swallowing stops, slide your little finger into the baby's mouth to release the suction and protect your nipple. Your nipple should have the same shape (gumdrop) as before the feeding. If it looks creased, like a used lipstick, be sure the baby opens wide and takes in more breast tissue at the next feeding. Breastfed babies take less air, so you only have to burp your baby for a few minutes. Offer the second breast if baby is still awake and showing feeding cues.
Babies will take about one to three teaspoons of the first milk, colostrum, at any one feeding in the first days. Feedings last about 10 to 20 minutes. It is healthy for your baby to nurse every 90 minutes to three hours from the beginning of the last nursing. But, since breast milk is more easily digested, feed your baby on cue rather than by the clock or a schedule.
How do I know if my baby is eating enough?
Wet diapers and stools are one of the ways you can tell your baby is taking in enough breast milk. See the breastfeeding log at the end of this section to help you keep track in the first busy days. Keep track of the color of the baby's stool, which will change in the first four days. This is another way to know your baby is taking in enough. Count any stool that looks like a tablespoon or more. Bring the log to the first pediatric visit or lactation consultation.
Weight gain is the best way to tell if your baby is getting enough. It is normal for babies to lose about 7 to 8% of their weight in the first five days and return to birth weight by 10 to 14 days. You will establish a milk supply for baby in the first three weeks. The more the baby eats, the more your body produces. That is why we and the American Academy of Pediatrics advise you to exclusively breastfeed your baby, avoiding formula, bottles and pacifiers in the first three to four weeks if all is going well. Then your supply will meet your baby's needs as long as you choose to nurse.
What can I do if my nipples are sore?
If your nipples feel sore, you should:
- Have your nurse help you with positioning the baby; if you are at home, call the Warm Line at 1-800-711-7011.
- Pump and feed the baby if nursing hurts after one minute.
- Hand express a few drops of milk, rub into the nipple and allow to air dry to help healing.
- Dip a facecloth or sponge in a mix of one quarter teaspoon of salt and one cup of lukewarm water. Put on your nipples for 10 to 15 minutes, three to four times a day until healed.
- Try wearing a soft nursing pad inside your bra or wearing soft, loose clothing. Be sure to change pads after each feeding to prevent infection.
- Try using breast shells, which are plastic, dome-shaped pieces with the large ring backing to prevent any rubbing and air holes to promote healing; center the shell over the nipple and your bra holds it in place; wear between feedings during the day.
What is engorgement, and what can I do for it?
When your milk changes to mature milk, your breasts may feel very full and firm. If the baby cannot latch and/or you have pain, you can:
- Put ice packs wrapped in a clean cloth (bags of frozen peas or corn work well) on your breasts for 10 to 15 minutes.
- Massage breasts to help the milk start to drip.
- Hand express milk to soften the areola (dark part) of the nipple.
- Put warm cloths on your breasts for 5 to 10 minutes if you do not see a drop of milk, and massage again.
- Nurse every one to three hours.
- Take pain medication as prescribed by your care provider.
You can also try a technique called "reverse pressure softening" to reduce swelling of the areola. This briefly moves the swelling backward into your breast and helps the nipple soften and go deeper into the baby's mouth during breastfeeding. This technique should never cause you pain.
To do reverse pressure softening, you should:
- Curve your fingers (Fig. 1 or 2).
- Press inward toward the chest and count slowly to 50.
- Keep the pressure firm but not enough to cause pain.
- If you'd like, someone else can help, using thumbs (Fig.5).
- If breasts are large or very swollen, lie on your back to do this.
Do this right before every feeding. It may take two to four days before your breasts feel comfortable. Make pumping sessions short. Use a low vacuum.
What if I can't express milk by hand?
If your breasts are heavy and hard and your nipples are flattened out, you might be unable to express milk by hand.
- Apply ice packs to breasts for 10 to 15 minutes, then apply warm compresses for 10 minutes.
- Try expressing milk by hand by placing the soft pad of your thumb about 1½ to 2 inches above your nipple and the soft pad of your first finger 1½ to 2 inches below your nipple. Press your fingertips directly back toward your chest wall without stretching the skin. Now press your fingertips together behind the nipple and press forward to express drops of milk. Do not pull the breast tissue forward. The drops that come out may encourage your baby to latch, or you may need to use a pump.
- Expressing milk can also soften the areola and help the milk let-down.
- After feeding, you can apply an ice pack or pump additional milk to reduce your pain.
Do I need to use a pump?
If your baby is nursing enough to make the breasts soft, you do not need to pump. However, you may need to remove breast milk if:
- Your baby only takes one breast, and the other is getting engorged
- Your areola needs to be softened so your baby can latch when your breasts are too full
- You can't latch your baby for two consecutive feedings or for six hours after the first 24 hours of life
- You are going out for a few hours or are going to be separated from your baby for a feeding
- You are returning to work or school
We recommend that you wait three weeks before giving your baby a bottle if breastfeeding is going well. There are many ways to feed breastfeeding babies without using bottles and rubber nipples. If you have questions, ask your nurse or call the Warm Line at 1-800-711-7011.
How do I store breast milk?
If your baby is healthy, follow these instructions for pumping and storing your breast milk at home:
- Use plastic bags, plastic bottles, glass bottles or containers.
- Clean all containers and use covers or seal the bags.
- Date each container so the oldest milk will be used first.
- Freeze a small amount (2 to 4 ounces) at a time so it will thaw and warm up faster and less will be wasted.
- Do not touch the inside of the container and always seal it well.
- If you are using plastic nurser bags, make sure it is a bag that can be frozen, use a twist tie to seal the bag, double the bag, and store it in an airtight container.
- Store the containers inside the refrigerator or freezer, not on the door, to maintain a constant temperature.
- Thaw frozen milk under running warm water, in a bowl of warm water, or overnight in the refrigerator, gently shaking the milk to mix the layers.
- NEVER warm breast milk on the stove or in the microwave.
- NEVER add cooled milk to previously frozen milk.
- Do not freeze in glass.