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Women’s Health Matters

SDOOBG01

55• Rev

ised

 4/12

Your Guide to Breastfeeding Your Newborn Baby

Congratulations on your decision to breastfeed. Breastfeeding is a learned skill; it may take awhile before everything works smoothly. This booklet will give you pointers to help you get started. It includes tips on positioning your baby, caring for your nipples, and increasing your milk production. Common problems associated with breastfeeding, pumping, & storing your milk are addressed. The pleasure and benefits of nurturing your baby through breastfeeding are well worth the initial efforts. Benefits to you include bonding with your baby, assisting in postpartum weight loss, shrinking the uterus back to its pre-pregnancy state, and reducing the amount of blood loss after giving birth.

The American Academy of Pediatrics recommends exclusive breastfeeding for at least the first six months of life, with no upward limit on duration. You are making a positive health choice when you breastfeed your baby. 

Getting Started

Breastfeed your baby as soon as possible. Babies have a quiet alert period for about an hour after birth. This is the ideal time to put your baby to breast for the first time. Hold your baby skin to skin at your breast and let her/him familiarize her/himself with your breast and nipple. Colostrum is the first milk from your breast and is perfect for your baby. It provides antibodies and meets the complete nutritional needs of your baby. If your baby is sleepy or unable to latch in the first 24 hours, the best thing for you to do is to keep your baby skin to skin on your chest. 

Initially, milk production begins as the pregnancy hormones decrease. It then becomes baby driven, the more your baby nurses, the more milk you will produce. Feed your baby whenever s/he appears hungry. Feeding cues include putting hands to mouth, smacking her/his lips and “rooting” for the breast with her/his mouth. Eight to twelve feedings in 24 hours are normal to build up your milk supply during the first few weeks and will decrease the chance of excess weight loss and jaundice in your baby. If your baby is actively breastfeeding, do not switch breasts. Let your baby decide when  s/he is finished. If s/he seems hungry after the first breast, burp your baby and offer your other breast. Your baby may spend 20–40 minutes or longer at each feeding.

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Your baby begins to learn to use her/his tongue, lips, and jaw in a coordinated way to transfer milk from your breast. If you avoid introducing bottles until breastfeeding is well established, you will create a plentiful milk supply and baby will be content. 

If you are unable to breastfeed your baby, you should begin pumping your breasts within 24 hours after giving birth. Pump your breasts as frequently as if your baby were nursing. 

Proper Positioning and Latch

Position and latch are the most important aspects and the basis for comfortable breastfeeding and abundant milk supply. Get comfortably seated with your feet slightly elevated with pillows, water and snacks all close at hand. The cross cradle and clutch (football) holds are wonderful for first-time moms because you have more control of your baby. This allows you to teach her/him how to feed in a way that will be comfortable for you and will create abundant milk for her/him. Once you are breast-feeding well, you can move to the more relaxed cradle hold and the restful lying down position. A correct latch is very important. If the baby is latching well, your nipples may be tender during the first few days, yet they will not be damaged with broken or scabbed skin. 

Breast support

You may also need to support your breast for your baby using the C-hold. Using your free hand, form a letter ‘C’ and then place your thumb on the upper part of the breast and your fingers underneath. The C-hold allows you to control and shape your breast towards your baby’s mouth so your baby can effectively latch. 

Cross cradle hold instructions for left breast

Lay your baby on a pillow or two so her/his nose is facing your left nipple, with her/his chest facing your chest. Support her/him close to you, allowing her/his head to tilt slightly back with your right arm across her/his back. Your right hand is behind her/his neck, supporting the head and shoulders. 

Cross Cradle Hold   Football Hold  Cradle Hold

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Support your breast with your left hand using a C-hold to allow as much breast tissue as possible into your baby’s mouth. The same positioning will be done on the right breast with opposite hands.

Clutch (football) hold instructions for left breast

Lay your baby on a pillow at your left side supported by your left arm. Your left hand is supporting the base of her/his head. Your baby should be facing your breast with her/his nose below the nipple. Support your breast with your right hand using the C-hold if needed. The same positioning will be done on the right side with opposite hands. This position is nice for moms with cesarean section births as it alleviates placing pressure on the abdomen.

Cradle-hold instructions for left breast

Cradle your baby’s head in your left elbow, supporting her/his body with your left forearm and hand. Her/his body is chest to chest with yours. Support your breast with your right hand using the C-hold if needed. The same positioning will be done on the right breast using opposite arms.

Side-Lying for left breast

Lie on your left side with a pillow under your head, behind your back, and between your legs. Place your baby on the mattress facing you with a rolled blanket behind her/his back to keep her/him close to your body. 

Latch

•  Touch your baby’s mouth to the breast just below the nipple.

•  Your nipple should be up near your baby’s nose.

•  Wait for her/him to open her/his mouth as wide as a yawn. 

•  Bring her/him quickly onto your breast with the heel of your hand.

If your baby is latched well, s/he will have as much breast tissue in her/his mouth as possible. More of the areola below the nipple is in her/his mouth than the areola above the nipple. This is because the lower jaw moves the most during breastfeeding.

How to tell if your baby is getting enough milk

It is important that you know that you DO have enough milk for your baby. Here are some of the ways you can tell.

Typical Feeding Patterns

•  Your baby should feed at least 8–12 times or more in a 24-hour period.

•   Your baby will let you know that s/he is hungry by smacking her/his lips, putting her/his hands to the mouth, or “looking around” for your breast. Offer to feed when you see these early feeding cues.

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•   Crying is a hunger sign and a late feeding cue.

•   Wake your baby to feed if s/he is nursing less than 8 times in 24 hours in the first few days of life. This can be done by undressing your baby and holding your baby against your chest/breast, skin to skin. Another way is to check your baby’s diaper. 

•   When your milk volume increases (days 3–5), you should hear your baby swallowing (sounds like “cuh”) during the feeding.

•   Your breasts should soften after feeding and your baby should be content.

Typical diaper output

•   Your baby should urinate at least once the first day of life, twice on day two, and three times on day three.

•   Once your milk supply is well established, your baby should urinate at least 6–8 times per day. If your baby is not having many wet diapers after the first week, contact your baby’s health care provider.

•   Urine should be clear.

•   During the first few days of life, your baby’s stools will be a black, tarry substance called meconium.

•   Your baby’s bowel movements should change color as milk intake increases. The yellow, mustard seed-like stool shows the baby is getting enough breastmilk.

•   If the bowel movements are still dark green/brown on the fifth day or your baby is not having bowel movements, call your baby’s health care provider. 

Breast and Nipple Care

•   Wash your hands with soap and water before each feeding.

•   Wash nipples each day with warm water and use a mild soap if needed. 

•   Wear a bra if you need support. Avoid bras that are too tight. Underwire bras may contribute to plugged ducts in some mothers.

Flat and Inverted Nipples

Flat and inverted nipples may not cause any problems with breastfeeding. Your infant needs to learn to open her/his mouth wide and close her/his mouth as far back on the breast as possible to take the nipple into the mouth. If you are having trouble getting started below are some tips:

•  Manually stimulate your nipple by rolling and gently tugging on the nipple with your fingers or a cold washcloth.

•  Pumping for a short time before feeding can help draw nipples out.

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•  Using a nipple shield to allow your baby to bring out your nipple.

•  When latching, try pulling back slightly on breast tissue to help nipple protrude.

•  Avoid pacifiers or bottles as this may make it more difficult for your baby to latch well.

•  Get hands-on help from a lactation consultant. 

•  Refer to breastfeeding guidebooks that have current information.

Breastfeeding Challenges

Sore Nipples

In the process of getting a ‘good’ latch, your baby pulls your nipple to the junction of her/his hard and soft palate at the back of her/his mouth. When your nipple is in this protected spot, it cannot be injured during breastfeeding. It is normal to feel some nipple sensitivity when the baby first grasps the nipple. This should decrease by the first couple of weeks postpartum. If your nipple continues to hurt after your baby’s first several sucks, your baby may not be well latched. Carefully unlatch her/him and try latching again. After the feeding, your nipples should look the same as they did at the start of the feeding. If they are pinched or creased, your baby is not well latched. (See Latch, page 3). If your baby is latched on well and in a good position, breastfeeding should become comfortable. 

Help for Sore Nipples

•  Start feeds on the less sore side first.

•  Use the clutch (football) and cross cradle hold as these are the easiest holds to use to improve your latch.

•  Change positions each time you breastfeed.

•  Release suction before you remove your baby from the breast: Put a clean finger in the side of your baby’s mouth between her/his jaws. Don’t pull your baby off your breast until you feel the suction break. 

•  Avoid pacifiers and bottles until breastfeeding is well established.

•  Warm compresses, massage, or a little hand expression before feeds can help your baby begin to get milk without a lot of initial sucking to start your milk flowing.

•  Expose your nipples to air as often as possible. When you can’t, wear breast shells between feeds to protect your nipples from your clothing (Use the ones with the large openings to expose the nipple and a portion of the areola to air).

•  Applying some of your own breast milk to the nipple and areola after nursing helps to protect and soothe your nipples.

•  Avoid vitamin E oil on your nipples as this should not be ingested by the baby and must be cleaned off before the feeding.

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•  Lanisoh and Purelan are lanolin creams to soothe tender nipples. Apply sparingly. They do not have to be wiped off before feeding. Note that the lanolin will stain your clothes- consider using a breast pad.

•  Hydrogel dressings provide moist wound compresses that may speed healing and may be very soothing.

Although breastfeeding should be a comfortable experience, some mothers may have some tenderness or soreness during the first few weeks. If you have sore nipples after you leave the hospital, call a breastfeeding resource person in your area. 

Engorgement

Engorgement may occur in the first days after delivery. As low-volume colostrum changes to higher volume mature milk, your breasts will feel full and may become hard and uncomfortable, especially just before a feeding. This usually lasts 2–3 days. Sometimes the breasts are so firm that your baby has difficulty latching. 

Help for engorgement

•  Breastfeed frequently, at least 10–12 times in 24 hours. Frequent feeds are the most important thing you can do to resolve this overfull feeling.

•  Make sure your baby is well latched when feeding. A thorough feeding will soften the breasts, making them feel empty.

•  Some mothers find that applying a warm, moist towel to your breasts for 2–5 minutes or taking a warm shower before breastfeeding helps improve the milk flow.

•  If your baby has trouble latching onto your swollen, full breasts, try hand expressing or pumping for a few minutes to remove a little milk and soften the areola before s/he feeds.

•  If your breasts become so full that your baby cannot latch-on at all, your milk should be expressed and fed to your baby. Examples of alternative feeding methods are spoon-feeding, cup feeding, and finger feeding. The nurse or lactation consultant may teach these techniques to you.

•  Express milk after breastfeeding either by hand or with a pump if your breasts still feel uncomfortably full after a feeding, but try not to over-pump. This can encourage your breasts to make more milk than your baby needs and prolong your engorgement.

•  Many mothers find that placing ice packs on their breasts after feedings helps to relieve some of the swelling and pain. Ice packs can be used for up to 20 minutes every couple of hours. Lying down while applying ice may help relieve fullness and aid in the natural drainage of the breasts. 

•  Some mothers find using green cabbage leaves on their breasts soothes and helps to relieve engorgement. Wash the leaves, crush them, and put them all around your breasts. They can be changed every 2-3 hours.

If you continue to have pain or if you have a fever (>100.4°), check with your health care provider. 

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Plugged Ducts

A plugged duct can feel like a hard, red, or painful lump on a breast. These occur when milk is not drained from a duct causing inflammation. A plugged duct may occur when your baby is not well-latched, feeding infrequently, or weaning rapidly. A plugged duct may also occur when an ill-fitting bra is worn or when using an inefficient breast pump. The best treatment is to drain the milk by breastfeeding.

Help for Plugged Ducts  

•  Make sure your baby is well latched onto breast. (See Latch, page 3.)

•  Breastfeed frequently on the affected side.

•  Position your baby so that her/his chin points to the blocked duct.

•  Alternate breastfeeding positions so your baby can more completely drain the breast.

•  Gentle massage around the plugged duct while in the shower and while breastfeeding can help with drainage.

•  Use warm compresses over area before feeding.

•  Soak the breast in a basin of warm water and gently massage the affected area of the breast before expressing milk.

•   Increase your fluid intake.

•   Rest as much as possible.

Mastitis

Mastitis is an inflammation of the breast that may be the result of an infection or a plugged duct. The milk is generally not affected. Symptoms include having a hard, red, painful area on your breast, fever over 100.4 degrees, and flu-like symptoms. 

Help for Mastitis

•  Any infection of the breast should be seen by a health care provider, and antibiotics are usually necessary.

•  Increase frequency and duration of breastfeeding to help with breast drainage.

•  Change breastfeeding positions frequently.

•  If your baby cannot breastfeed from the affected breast, pump that breast until your baby can resume breastfeeding.

•  Rest as much as possible. Go to bed with your baby close by for the first few days of antibiotics. Put off all non-essential tasks or get help with cleaning, shopping, etc. Your job is to rest and nurse.

•  Take a mild pain medication as recommended by your health care provider.

•  Apply warm compresses to the breast several times per day before breastfeeding.

•  Increase your fluid intake.

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Pumping

•  Always wash your hands with soap and water before pumping your breasts.

•  You should begin pumping with a hospital grade pump within 24 hours after giving birth if your baby is not able to breastfeed. Pumping every 2–3 hours during the day and every 3–4 hours at night (about 8 times per 24 hours) will help establish a good milk supply. Expect very small amounts of milk at the beginning. 

•  Placing a warm, wet compress on your breasts for 15–20 minutes or taking a hot shower facing the water jets before expressing may improve milk flow. 

•  Clean the pump parts that come in contact with the milk with hot, soapy water, rinse, and allow to air dry after use. You may also boil the kits or place in dishwasher daily. Follow the directions that come with your pump.

•  If you are pumping because you want to store breast milk to bottle feed occasionally, the best time to pump for most mothers is in the morning, once the baby is over 2 weeks old. 

•  Breastpump stations are available for use throughout UCSF hospital & campuses. Please bring your own supplies.

Hand Expression

•  Massage your breast gently towards the nipple.

•  Place your thumb above and two fingers below areola.

•  Gently push straight back towards chest and compress areola. Milk should begin to drain easily when your hormones assist with the milk release.

•  Continue for several minutes and then rotate your fingers to compress other areas behind the nipple.

Using a hand pump

•  Choose a hand pump that is easy to use. It should not be painful.

•  Massage breasts gently towards the nipple.

•  Center the pump flange over the nipple. Begin pumping with a steady slow pull, repeating until milk no longer flows.

Using an electric pump

•  Center the pump flange over your nipple.

•  Set suction level on minimum. Pump 10–15 minutes, increasing the suction to whatever is comfortable and effective for you. Turning the suction on too high does not produce more milk and may result in sore nipples.

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•  Pump both breasts at the same time for 10–15 minutes. If you are pumping your breasts one at a time, pump for about 5–7 minutes on the first breast. Then do the same on the other breast, and repeat each breast for about 5 minutes.

Handling and storing your milk

•  Storing and feeding from the same bottle decreases the risk of contamination that can occur when the milk is poured from the storage container to the bottle.

•  Label each bottle with the date and time of expression, as this will help you feed the milk in the sequence it was pumped.

•  Refrigerated or frozen milk should be stored in the back of the refrigerator or freezer to avoid changes in temperature each time the door is opened. 

•  Defrost milk in the refrigerator overnight or place the bottle in warm (not hot) water for several minutes. Never microwave breast milk as it will destroy some components and it may become so hot that it can burn your baby’s mouth.

•  When thawing frozen milk, label milk as thawed when completely thawed (no ice crystals present) to start acceptable time limits.

•  Use fresh breast milk whenever available. Freezing decreases some of the immune and digestive functions of breast milk.

Breast Milk Storage for Term Infants*

Human Milk Room Temperature RefrigeratorRefrigerator 

Freezer (0°/-18C)Deep Freezer 

(<0°)

Freshly expressed breast milk

Up to 6 hours Up to 5 days Up to 6 months 12 months

Previously frozen, thawed in fridge

Up to 4 hours 24 hours Do not re-freeze Do not re-freeze

Previously frozen & brought to room 

tempUntil feeding ends Up to 4 hours Do not re-freeze Do not re-freeze

Previously frozen, warmed and fed

Until feeding ends  Up to 4 hours Do not re-freeze Do not re-freeze

*Storage time may vary for premature or sick babies. Please check with your baby’s healthcare provider.

Adapted from, Jones, F. (2011). Best Practice for Expressing, Storing and Handling Human Milk. In hospitals, homes, and child care settings. 3rd Ed. Human Milk aBanking Association of North America, pg. 44.

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Nutrition for the Breastfeeding Mother

Your diet during breastfeeding is important for the health of your baby as well as your own health and milk supply.

•  Try to eat without skipping meals, even if you do not feel hungry. An additional 400–500 calories per day above your usual intake is the standard recommendation for breastfeeding women. Your appetite should increase as you become accustomed to breastfeeding.

•  It is rare that you would need to avoid a certain food. A diet with a variety of protein sources, calcium-rich foods, and fruits and vegetables is the best diet for you. If you think your baby is reacting to a specific food you are eating, check with a breastfeeding specialist or your baby’s healthcare provider.

•  Continue to take a prenatal vitamin daily while you breastfeed.

•  Calcium is an important nutrient for breastfeeding mothers. The goal is five servings of calcium-rich foods per day. If you are unable to meet the goal, take a calcium supplement daily.

•   Adequate fluid intake is important for milk production and to fight off fatigue. Aim to drink enough so that you are urinating every two to three hours and the color of urine is pale yellow.

Notes

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