BREAST FEEDING

HOW TO BREAST FEED: Before we get started let me say that breast feeding is a natural process that has been going on for millennia and will not stop with your baby. Worrying too much about the breast feeding actually makes it harder to do and since we can fix anything that goes wrong, just sit back, don’t put too much emphasis on one bad feeding and enjoy the process. The nurses in the newborn nursery do an excellent job teaching breast feeding. Most of what you will need to know will come from them. Some key points to know before leaving the hospital are: how to attach the baby to the nipple, how to remove the baby from the nipple and how to care for your breasts. Do not leave the hospital until you are comfortable with all of these or you may end up with very sore nipples, breast infections or premature weaning to formula. I will be happy to help you anytime with breast feeding problems so please call me if you encounter any problems and before switching to formula.

HOW OFTEN: There are many opinions on how often to breast feed. I would prefer a conservative approach at first, to give you the best chance at breast feeding your baby as long as you wish to. At first, you should feed your baby on demand, even up to every hour. This will actually make your breast milk come in quicker and last longer. At first you will feed 10 to 12 times a day, but this will drop to every 2 to 3 hours or about 8 times a day within a week or so. With your first baby, breast milk comes in on day 3-4. Each baby after the first, the breast milk comes in on day 2-3. Each time your baby eats he or she may get a different amount from you. The amount they get could be from 1 to 6 ounces, therefore it seems like putting them on a schedule would be difficult. With time, the amount they get from you at each feeding will become more consistent and a schedule will develop on its own. At first it will take you 20 to 30 minutes each feeding, but this will be down to 10 to 15 minutes within a few weeks. The problem with breast feeding so often is that you may get little sleep at first and your nipples could get sore, therefore, you will have a balancing act to perform. Please be assured all women that give the gift of breast milk to their babies go through this and we can help you through any problems you may have. If you desire, we can put your baby on a feeding schedule at about 5-7 days of age. Do this by only feeding your baby every 2 to 3 hours and soothing however you can until that time is up. Certainly a gradual change from every 1 to 2 hours to every 3 hours is advisable. You can give them a little water to tide them over until the next meal. Some babies simply do not follow schedules well and I would caution against being too strict with any schedule, especially when breast feeding. The extreme pro-breast feeding folks would prefer that you feed on demand and not supplement until 1 year of age. Clearly this is not appropriate for all women. I would not let your baby sleep more than 6 hours without a feeding until he or she is a few weeks old. If you do need or want to give water, then use only sterile or distilled water for the first 4-6 months. Please see the bottle feeding section for how to make sterile water. Giving water is not necessary for most breast fed babies, please see the section on constipation for how to tell how much water your baby needs.

HOW MUCH MILK IS MY BABY GETTING? What goes in your baby will come out the other end. Don’t look at the stools, look at urine output. Therefore, if your baby is urinating from 5 to 8 times a day, then your baby is getting enough breast milk. The quality of your breast milk is almost never a problem if you eat well, drink plenty of water and take your prenatal vitamins. We will weigh your baby at each office visit to ensure proper growth. Should your baby urinate less than 5 times a day, then examine your baby for signs of illness, dry lips or mouth and call me if you are concerned. All babies lose weight in the first 4-6 days while breast milk is waiting to come in. This is a normal process. Babies are born with a little extra fluid on board to accommodate this natural event. We expect the baby to regain their birth weight by the 2 week check up.

BURPING: You should nurse on each side for 5 to 15 minutes, then burp and switch sides and continue this as long as your baby wants to feed. If you find your baby gassy, then you may want to burp more often. Often breast fed babies do not burp well, but remember we are only burping to get rid of excess gas. If your baby has no signs of excess gas (spitting up, gassy, crying a lot), then your baby does not need burped more than you are already doing.

MEDICINES YOU MAY TAKE WHILE BREAST FEEDING: All listed are safe and if not listed, then you should call me before taking the medicine. First some general rules about medicines and breast feeding:

Don’t take anything unless you need to.

Take short acting medicines and single ingredient medicines.

Try to take the medicine right after breast feeding, so that very little will be left before the next feeding.

Do not assume vitamins ( other than prenatal ) and herbal teas are safe as they may NOT be.

Excessive alcohol and smoking reduce breast milk production and do get to the baby.

Drink no more than 1 alcoholic drink per hour and do not breast feed until you are no longer under the influence.

Take the smallest adult dose that will work for you.

Fever reducers: Acetaminophen (Tylenol), Ibuprofen (Motrin, Advil), Naproxen (Aleve)

Pain relievers: the above ok, best to ask the doctor prescribing AND the pharmacist, make sure to mention your breast feeding.

Decongestants: Sudafed ok, Actifed ok

Cough relievers: Robitussin DM  ok

Antibiotics: Amoxicillin-Rx, Keflex-Rx, Bactrim-Rx. (Almost all of the older, cheaper antibiotics are safe. Always tell the prescribing doctor that you are breast feeding. If he/she does not know if the medicine is safe, he/she can call us).

Antivirals: ( for Influenza, Herpes or Chicken pox ): Acyclovir - ok, Tamil (oseltamivir) - ok

Antifungal: Lotrimin topical or Diflucan oral ( both for vaginal yeast infections ) both ok

If the medicine you need to take is not on this list, then call your physician or the lactation specialist that you spoke with in the hospital (if delivered at CAMC Women and Children's call 388-2180). The pharmacist will be able to check databases also.