Breastfeeding Basics
By Suzanne Dixon, M.D., and Angela Rosas, M.D.
Breastfeeding is the healthiest, most natural way to feed your baby. Each
mother's breast milk is uniquely formulated for her own baby, and is full of
infection-fighting cells and protein that will help keep a baby both happy
and healthy. Breastfeeding can be enjoyable for both of you. It can take
some practice at first, but there are many, many reasons to give
breastfeeding your best effort.

  Why Breast Is Best -- The Benefits for Baby

  The Benefits for Mom

  What to Expect at First

  Establishing a Good Milk Supply

  Bottle Strategies

  When to Feed Your Baby

  How Much Is Enough?

  How Much Is Not Enough?

  Milk on the Go





Why Breast Is Best -- The Benefits for Baby

The American Academy of Pediatrics recommends that mothers breastfeed their
babies for at least the first year of life, and exclusively for the first
six months. There are good reasons for such a strong policy statement.
Breastfed children are less likely to have ear infections, allergies,
vomiting, diarrhea, pneumonia, juvenile diabetes, and meningitis. New data
suggest that breast milk enhances your baby's brain growth. Breast milk is
easier for babies to digest than formula, cow's milk, or goat's milk. It
contains all the right minerals and the right balance of nutrients. And
breast milk is convenient: It's free, and it's always ready when your baby
is hungry, with no preparation involved. The health benefits continue for as
long as a mother and her baby want to keep breastfeeding.

The Benefits for Mom

Breastfeeding provides definite health benefits for you as well as your
baby. Besides being an ideal way to closely bond with your new child,
nursing helps stimulate hormones that shrink your uterus back to its
pre-pregnancy size. According to some studies, women who breastfeed are 50
percent less likely to get pre-menopausal breast cancer, and are at lowered
risk for ovarian cancer and osteoporosis as well. Breastfeeding also helps
you lose weight after pregnancy because it uses up the special kind of fat
you put on with pregnancy before it becomes an established part of your body
shape.
Nursing helps you lose that weight at exactly the right pace. You don't want
to lose too much weight right after giving birth, though. Nursing women need
an extra 5 to 10 pounds over their pre-pregnancy weight to keep their body
healthy while they nourish their child. If you lose weight too rapidly, it
could hurt your milk supply when your baby has a growth spurt and needs to
eat more. Those extra pounds will slip away naturally over the first six
months.


What to Expect at First

Your breast milk will come in a few days after the birth of your baby. Until
then, your breasts will be busy producing colostrum for your baby to drink
instead. This thick, yellowish substance is full of protein and antibodies
that will help your baby fight off diseases. Colostrum is intended to be
your baby's very first food, and his first "immunization" against diseases.
He has lots of stored water and fat to use while he takes in this precious
material. His tummy can only hold a teaspoon of liquid at this age, so he
doesn't need a lot to fill it.
Your body was made for breastfeeding, and your baby was made to nurse, but
that doesn't mean you won't need a little help to get started. While you're
still in the hospital, someone should help you put your baby to your breast
as soon as possible, help your baby latch onto your nipple, and show you how
to tell when he's nursing correctly. Ideally, breastfeeding right after
delivery helps to get things started. If you still need help after you go
home, ask the staff at the hospital whether they can recommend any
resources. Lactation services, the hospital itself, and health care offices
are good sources of help. Everyone needs some help, and even very
experienced moms will encounter special issues.

Once your milk does come in, your newborn may want to start nursing every
hour for the first day or two of life. This helps your body create a good
milk supply, one perfectly tailored to your baby's needs. In just two to
four days, your body will adjust itself to this "information," and your baby
will need to nurse less often, about every two to three hours, or 8 to 12
times in a 24-hour period.

This is part of the normal transition process, and it doesn't mean he's
dissatisfied with you, your milk, or your care. His fussing and crying means
that he knows what he needs, and how to signal those who can provide it for
him. At this age, you can expect a typical feeding to last between 10 and 15
minutes on each breast.


Establishing a Good Milk Supply

When you are nursing, good nutrition, plenty of fluids, and rest are all
essential. Sleep when the baby sleeps, and drink plenty of healthy liquids.
Milk, water, and juice are all good options. Relax. Get rid of unessential
tasks and disruptive people and pressure and focus on you and your baby.
You will need to maintain a basic healthy diet to keep up your breast milk
production, but you don't need anything fancy. Some breastfeeding babies are
quite sensitive to certain things in their mother's diet. If your baby seems
fussy after you've had a spicy meal, that may be the problem. But in
general, nursing mothers can eat whatever they wish, as long as it is
healthy.

Vegetarian mothers who breastfeed need to make extra sure they're getting
enough vitamins and minerals in their diet. Your health care provider will
be able to refer you to a nutritionist or dietician who can help you plan a
menu if you feel uncertain. Three healthy meals and two snacks will help you
feel better and maintain a good milk supply.

Sucking is very soothing to babies. But keep in mind that if you give your
baby a pacifier in the early weeks, he may eat less at your breast, which
will in turn affect your milk supply. A recent study showed that pacifier
use can interfere with the success of breastfeeding. So it is a good idea to
hold off on a pacifier until your milk supply is well established, which
generally happens by the end of the first month. Try swaddling him so his
hands are close to his mouth instead. That way he can soothe himself by
sucking on his hands, as he did in the womb.


Bottle Strategies

If you want your baby to try a bottle, start at 2 to 4 weeks at the
earliest. Don't be surprised if at first your baby refuses to take a bottle
of expressed breast milk, however. A breastfed baby simply knows better than
to take breast milk from a bottle when mom is right there. He can smell his
mother, and knows the routine. You will probably have better luck if you
have dad or the babysitter offer a bottle of expressed breast milk without
you there.
If you start to add formula to a breastfeeding baby's diet, your milk supply
will diminish by the amount of formula you give your baby. It's certainly up
to you, but think twice about introducing formula now that your milk supply
is established. Whatever you decide, be confident that any amount of breast
milk is better than none as far as protecting your baby's health goes.


When to Feed Your Baby

Feed your hungry newborn on demand — that is, whenever he wants to eat. He
won't eat much at any one feeding in these first days since his stomach is
so small, but he'll want to nurse often. Most newborns will need about 10 to
12 feedings in a 24-hour period, or one feeding every one to three hours.
When establishing your milk supply, wake your baby up to feed if he sleeps
more than three hours during the day or four hours during the night.
Otherwise he'll wake up too hungry to feed well. When things get up and
running, he'll wake you up as he needs to.

How do you know your newborn is hungry? Look for signs such as:

Rooting reflex (opens his mouth and turns his head to where he thinks your
breast might be)
Nuzzling at your breast
Making sucking motions or putting his hands in his mouth
Crying (a late sign of hunger — you don't need to wait for howling)
Breast milk is all a baby needs by way of nutrition until the sixth month.
That's when the AAP recommends introducing a baby to solid foods to
supplement his diet. He'll continue to get most of his nutrition from breast
milk (or formula), however, until he's 1 year old.


How Much Is Enough?

Like lots of new breastfeeding mothers, you might not be sure when your baby
has had enough to eat. You will know he is getting something if you can hear
him swallowing as he nurses. Another clue is how well your baby sleeps after
a meal. If his tummy is full and his diaper is clean, he will probably fall
right back asleep after feeding.
Other signs your newborn is getting enough to eat:

He produces about six wet diapers every day after your milk comes in and
between two and five loose, yellowish stools each day until he's 6 weeks
old. Some babies are such efficient breast milk processors that they pass
stools very infrequently.
His urine is a pale yellow, not deep yellow or orange.
Your breasts feel soft and "empty" after each feeding.
During the first week of life, it's expected that a baby will lose several
ounces, up to 10 percent of his birth weight. After the first week, however,
your baby should be steadily gaining, and should at least be back at his
birth weight by the end of the third week. By the third week his face should
be rounding out as well. Your health care provider will weigh your baby at
each visit.

If your baby doesn't seem to be thriving or gaining weight, or you're
worried about any signs that he's not getting enough, contact your health
care provider.


How Much Is Not Enough?

Occasionally you may feel that your baby isn't getting enough milk. Your
baby may seem hungry after a prolonged feeding, and yet you feel "empty."
This is nature's way of making your milk supply keep up with your baby's
growth spurts.
To further help you increase your milk production, nurse frequently as your
baby demands. You also need to drink more fluids and get enough rest. This
may mean that for a day or two, you may have to divert more time to nursing
and resting yourself than to your other activities. Be assured that your
baby is fine, as long as he feeds vigorously and continues to urinate and
stool normally as suggested above.

It takes about 36 to 48 hours for your body to adjust to the baby's
increased needs. It's the baby's job to nurse frequently to give your body
the right signals. So let him do his job. If you give him a bottle, he'll
get lazy on the job and your body won't get the "increase" order correctly.

All nursing mothers go through brief periods where supply doesn't meet
demand. Nature's way of meeting this increased demand is for the baby to
nurse. Relax and enjoy these natural rhythms.


Milk on the Go

If you are going back to work, you can still breastfeed your baby by pumping
milk at work once or twice each day and bringing the milk home for the next
day's lunch. And we recommend that you do. It's one way to feel very close
when you have to be away.
There are several ways to express your breast milk — by hand, with a hand
pump, or with a motorized electric pump. Nursing frequently in the evening
and at night will keep up your milk supply and can give you the special
closeness to your baby that you may have missed while at work.

You can leave expressed breast milk at room temperature for about six to
eight hours, or in the refrigerator or a cooler for 3 to 5 days, if you need
to, since it contains natural preservatives. You can also freeze breast milk
for future use, although it loses some of its disease-fighting properties.
After freezing, it still contains the best balance of nutrients for your
baby. Thaw frozen milk by setting it out at room temperature or running it
under warm water. Once unfrozen, do not refreeze.

Stored milk should be gently shaken, as the fat will have separated and
risen to the top. Mix it up for an even meal and an easy flow through the
nipple.

Be sure your workplace has a clean, private, relaxing place for you to
express your milk. It will make a lot of difference in your attitude and
your success. If such a place isn't made available, speak up. Many employers
are willing to help out if you let them know what's needed for you and the
other nursing women at your workplace. There is a real financial payoff for
employers who help out: less absenteeism for parents who are at work
(because of fewer days spent at home with sick kids), higher employee
satisfaction, and better retention, too.







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