The Baby and Toddler Guide

Breastfeeding Your Baby

Breastfeeding is the most natural and nutritious way to encourage your baby’s development. Attempts to improve upon nature’s miraculous feeding system have been unsuccessful. Neither the nutrients found in the milk you produce nor the special benefits these nutrients provide can be duplicated. Simply put, nature does the best job of providing for your baby’s needs.

Our hope is that after considering the material presented in this booklet, you will join thousands of other mothers who have chosen to breastfeed. As you will see, the physiological and psychological rewards are many for both you and your baby.

Advantages

Breastfeeding is the natural next step in the continuum of pregnancy. For the past nine months, your body has been preparing a very special blend of nutrients in the exact proportions your baby needs. Human milk is a unique combination of fats, sugars, minerals, proteins, vitamins and enzymes, custom-made to promote brain and body growth.

Colostrum is the perfect starter food for babies. This clear to creamy to golden-yellow substance is found in the breasts during pregnancy. A few days after baby’s birth, it begins the change to mature milk. Colostrum provides unmatched immunity against bacteria and viruses, thus protecting vulnerable newborns from a host of diseases to which they are exposed. In addition, colostrum acts as a natural laxative to clear the meconium (first stool) from the baby’s intestine, thus decreasing the chance of jaundice. Colostrum also contains the natural sugar lactose, which helps stabilize the newborn’s blood sugar level, preventing hypoglycemia.

The advantages of breastfeeding are plentiful, as colostrum is slowly replaced by mature milk and baby continues to breastfeed. While cow’s milk and formula mixtures can trigger allergic reactions and are often difficult for baby to digest, your milk is perfectly designed specifically for your baby. Studies show that breastfed babies have fewer ear and diarrhea infections; experience less vomiting and acute respiratory illness; and are at lower risk for childhood diabetes, lymphomas and Crohn’s disease. Even the activity of sucking at the breast enhances the development of oral muscles and facial bones.

As an added bonus, breastfed pre-term babies tend to have a higher IQ than their formula fed playmates.

Breastfeeding offers baby emotional as well as nutritional benefits. Skin-to-skin contact helps to reduce the stress babies experience as the enter the world from the security of the womb. Tension quickly subsides as baby is comforted by the sight of the mother’s face and the familiar sounds of her breathing, voice, and heartbeat. Thus begins the important process of mother-infant attachment.

And baby isn’t the only one who benefits from the breastfeeding experience. When baby is put to the breast immediately after birth, the resulting release of the hormone oxytocin into mother’s system speeds delivery of the placenta and constricts uterine blood vessels to minimize blood loss. Repeated release of oxytocin through nursing causes the uterus to return to it’s pre-pregnancy size quicker.

The milk-producing hormone, prolactin, is another wonderful by-product of breastfeeding. Called the "mothering hormone", it have a releasing effect on mother and stimulates maternal instincts. The ongoing production of milk burns calories, helping you lost weight gained during pregnancy. And women who breastfeed have been shown to have less incidence of pre-menopausal breast cancer, cervical cancer and osteoporosis.

Add to these primary advantages the practical facts that your milk is always the right temperature, absolutely fresh, perfectly clean, instantly available, and you have the most nutritious, convenient feeding system there is-at the lowest cost!

Before Baby Arrives

Though breastfeeding is natural, technique is a learned skill. It is important to get started correctly, even before your baby is born. You need to know well in advance how to identify and avoid possible problems, and where to turn if difficulties do arise. Most breastfeeding problems occur during the first few weeks as you and your baby begin establishing your nursing patterns. With proper and prompt attention, the majority of these difficulties disappear as quickly as they develop.

Plan to learn as much as you can about breastfeeding. You will be making an important investment in you and your baby’s continued good health. Reading this booklet is a wonderful start! You may also choose from an abundance of valuable reference materials. Several excellent books on breastfeeding are listed in the last section of this booklet.

Also available is an informative, beautifully directed videotape co-produced by Medela and La Leche League International (pronounced La Lay-Chay League). For more personalized instruction, plant to attend La Leche League (LLL) meetings or prenatal breastfeeding classes given in conjunction with your childbirth education series or by a lactation consultant.

The most important contact before and during your breastfeeding experience will be with certified lactation consultants and/or support organizations such as La Leche League International and the Nursing Mothers’ Council. By attending League meetings, for example, you will have the opportunity to meet and compare notes with other breastfeeding mothers. As your questions are answered, you will receive the helpful tips and reassurance you need to make your breastfeeding experience even more rewarding.

As with any skill, the keys to successful breastfeeding are practice and patience. Learn all you can and then surround yourself with people who will offer you the encouragement you need. Be easy on yourself. Relax and enjoy this special and wondrous experience.

A Simple Nipple Test

To determine if your nipples are flat or inverted, simply place your thumb and index finger on the areola, the dark area surrounding the nipple. At the base of the nipple, compress gently but firmly. If you nipple flattens or retracts (inverts) into the breast, you can begin wearing breast shells during the last couple of weeks of pregnancy. These plastic shells are worn under a bra and create slight pressure at the base of the nipple, drawing it out. It is important to do this "pinch test" because although some nipples appear erect, they may invert when the areola is compressed.

After birth, if baby still has difficulty attaching to your breast, contact a lactation consultant, LLL Leader, or the Nursing Mothers’ Council.

How Your Breasts Produce Milk

Milk is produces and stored in the glandular tissues (alveoli) of your breasts. It collects in pockets (lactiferous sinuses) located beneath the areola until it is released by a baby’s sucking. Stimulation of the nipples causes the mother’s pituitary gland, located in the bran, to secrete prolactin, which initiates and maintains milk production. The first milk your baby receives at each feeding is the milk that has collected in the pockets between feedings. This low-fat foremilk is high in protein and satisfies the baby’s thirst. As breastfeeding continues, a second hormone called oxytocin is secreted. Oxytocin causes the tissue around the alveoli to contract, thus squeezing the high-fat hindmilk down the ducts and into the pockets where it is available to satisfy your baby’s hunger.

Many mothers experience a tingling or rushing sensation in the breasts as this "let-Down" or milk ejection reflex (MER) occurs. Other mothers notice only that sucking becomes longer and slower, and that baby begins to swallow rhythmically. Keys to establishing a quick let-down are relaxation and confidence that your body is doing exactly what it was designed to do: feeding your baby the world’s best baby milk – products by you!

Breastfeed Immediately

Successful breastfeeding is the combined result of practice, patience, and proper positioning. Breastfeeding as soon as possible-preferably within an hour after birth-will get both of you off to a good start. Keeping your infant with you during your hospital stay will help you get to know and immediately respond to his cues. In addition to beginning the important cycle of milk supply and demand, early breastfeeding allows your baby to receive the benefits of colostrum. Rich in nutrients and antibodies, colostrum is the first milk you produce and is your baby’s perfect starter food.

Immediately after birth, your baby will be in a quiet alert state and generally receptive to breastfeeding. (If your baby isn’t ready the very first time you try to breastfeed, try again within the next half-hour or so.) Within a couple of hours, your baby will become quite sleepy; drowsiness may last for several days.

Avoiding Artificial Nipple Preference/Confusion

Your Baby begins to learn and practice the correct breastfeeding suck with the very first nursing experience. When both breasts and bottle are offered in the early days, your baby may become nipple confused or may simply prefer the bottle nipple. Breastfeeding is a process for the baby; bottle-feeding, however, is passive and requires a different type of suck. A baby who is bottle-fed early can have difficulty transferring to the breast. Avoid using any rubber teat (nipples) or pacifiers (soothers, dummies) during the first weeks. If your baby needs supplementation for a medical reason, use a cup. Yes, even a tiny baby can drink from a small medicine or paper cup!

The Law of Supply and Demand

Milk production works on the principle of supply and demand. The more your baby breastfeeds, the more milk you will produce, totally meeting your baby’s needs. It is the frequency of breastfeeding as well as the milk removed from the breast that stimulates further milk production. Babies who are given supplemental bottles of water or formula breastfeed less frequently, ultimately decreasing the milk supply. Supplements, unless medically indicated, should be avoided for three to four weeks, until your milk supply is well-established and your baby is latching on to the breast without difficulty. Babies need to be breastfed at least 8 to 12 times in 24 hours the first 2 to 4 weeks, or until well above birth weight.

Attaching Baby to The Breast

Latching the baby on correctly is the key to a pleasant, rewarding breastfeeding experience. Nursing behavior patterns are established early. One set, bad habits are difficult to correct. Make sure you and your baby get off to a good start. A variety of reading materials and videos are helpful, but there is nothing like hands-on assistance from an experienced healthcare provider. Don’s hesitate to ask for help the first few times. If you are still having difficulty by the time you leave the hospital, contact a lactation consultant or a LLL Leader.

Step 1

For most women, sitting up in bed or in a comfortable chair is easiest for breastfeeding. Make sure you are relaxed before you put your baby to the breast. Use pillows on your lap, under your arms and behind your back. Putting your feet on a footstool to raise your knees slightly above your hips will eliminate back strain and put your body at the right angle. The Nursing Stool from Medela is a footstool designed especially for breastfeeding. If you do not have a stool, use a thick telephone book or an overturned wastebasket.

Make sure your baby is comfortable and feels secure and supported. Nestle the baby in your arm at the level of your breast. The baby should be turned toward you, chest to chest, his head and trunk in a straight line, so that he doesn’t have to strain or turn his head to attach to the breast. Tuck the baby’s lower arm into the pocket betw4een the two of you; if necessary, hold his upper arm down gently with the thumb of your supporting hand. Be careful not to tilt the baby’s head down, as it will be difficult for him to swallow in that position. A very slight extension of the baby’s head, with his chin touching your breast, will help keep his nose clear without your having to press on your breast tissue.

Step 2

Hold your breast with your fingers underneath and thumb on top, making sure all of your fingers are placed well away from the areola. It is sometimes helpful if you roll your nipple between your fingers for a couple of seconds to help it become more erect. Then manually express a couple of drops of colostrum to entice the baby to take the breast. A woman with large breasts may find it comfortable to help support the weight with a follows washcloth or diaper under the breast.

Step 3

Gently tickle the baby’s lower lip with your nipple to encourage him to open his mouth wide. The moment he opens wide, almost like a yawn, quickly pull him in close to you. Do not lean forward, trying to put your breast into the baby’s mouth. Instead, pull the baby toward you so that he has a large mouthful of breast tissue. His chin should be pressing into your breast; his nose should be just touching your breast. Keep supporting your breast with your hand until the baby is latched on and is sucking well. Women with large breasts may have to support their breast throughout the entire feeding; smaller breasted women may not need to do this.

The key to successful latch-on and preventing nipple soreness is teaching your baby to take a large portion of the areola into his mouth.

As mentioned earlier, your milk collects in the pockets located beneath the areola. To empty these reservoirs effectively, the baby’s mouth must be position over them. If the baby sucks only on the nipple, little milk will be drawn out, and you will become quite sore. If your baby doesn’t latch on properly right away, continue to encourage him to open his mouth wide and then pull him close to you again. Don’t be afraid to repeat these steps several times until your baby gets the idea.

If you feel any pain after your baby starts sucking rhythmically, stop, and break the suction by inserting your finger into the corner of his mouth between the gums. Then try again. Latch-on discomfort is common in the first week or two, but any pain should subside in a few seconds. Take a deep breath, relax, and enjoy breastfeeding! You may even find yourself drifting off to sleep-a good sign the prolactin and oxytocin are flowing. Grab a little catnap while you are at it!

Breastfeeding Styles

Just as babies have different personalities, so too do they exhibit a variety of breastfeeding styles. Some babies latch-on and start sucking immediately, getting right down to business. Others take the slow and easy approach, simply enjoying this special time with mom. Breastfeeding is not only a mode of providing nutrition, it is also a special way of nurturing your baby. Although the terms "breastfeeding" and "nursing" are used interchangeably, breastfeeding could be used to describe the nutritive sucking that your baby does while feeding. Nursing describes the non-nutritive, sleepy type of suck your baby does when simply relaxing and enjoying being at the breast. Nutritive sucking is a slow, long, drawing, rhythmic sucking accompanied by swallowing. Non-nutritive sucking is lighter, faster, and less intense. Swallowing is minimal or absent. Babies will often suck quickly and intensely at the breast when they first attach, a sort of "priming the pump" to initiate the let-downs before they settle into the rhythmic deep sucking that characterizes breastfeeding.

Burping

In the very early days of breastfeeding, most babies will swallow little or no air and may not burp at all after feeding. Breastfed babies generally swallow less air than bottle-fed babies. After your baby has finished feeding on one side, burp him before offering the other side. Remember, effective burping techniques require placing firm pressure on your baby’s tummy. Lean the baby’s weight against the heel of your hand as he sits on your lap, or drape him over your shoulder or on one knee, and firmly pat or rub his back. If your baby doesn’t burp in a minute or so, don’t worry; just continue with his feeding.

Working and Breastfeeding

In addition to understanding and mastering the art of breastfeeding, working mothers face added challenges imposed by their schedules. Growing support by employers and a variety of innovative aids are making breastfeeding a viable option for mothers who work outside the home.

First and foremost, take full advantage of your maternity leave to establish a good supply of milk before going back to the job. The longer you can stay home and concentrate on breastfeeding your baby, the easier it will be to maintain your milk supply after you go back to work. Fatigue is a working mother’s biggest enemy, regardless of how you choose to feed your baby. One of the ways to minimize fatigue in your first few weeks back is to return to work on a Thursday rather than on a Monday. If possible, take the nest two Wednesdays off, so that you aren’t working more than two days in a row. This schedule will get you back into the swing of things slowly, giving both you and your baby a bit more time to adjust to the change in routine.

Breast pumping Tips

Breast pumps come in a variety of styles. Most important is that they breast pump be safe, effective and comfortable. Always read the manufacturer’s instructions before using your pump.

A healthy infant is far more effective at emptying the breast than any pump. Remember, breastfeeding is a learned process. Be patient. It may take several tries before you are comfortable and proficient.

Here are some basic tips to boost your breast pumping know-how:

Always wash your hands before breast pumping.
Use deep breathing techniques to relax and assist with let-down.
Apply warm compresses to your breasts 10 minutes before pumping.
Move the pump’s breast shield around to stimulate more milk ducts.
If let-down is difficult, have a drink of water, juice or tea before or during pumping.
Your ideal pumping time will depend on your baby’s schedule. If you want to prepare a bottle, try pumping in the morning after feeding when milk is most plentiful.

To maintain an adequate milk supply, frequent feeding or pumping is essential. Milk supply may diminish over time, especially if your baby is ill. When he/she begins breastfeeding again, however, milk production will increase.

Finally, remember to take good care of yourself! East a balanced diet, drink plenty of fluids and get lots of rest.

Recipe for Working Mothers

It is especially important for working mothers to remember that milk production is based upon the principle of supply and demand. The key to maintaining a sufficient milk supply is to breastfeed often.

If your baby is under four months old, you should express your milk during the work week when your baby would breastfeed if you were home. Additionally, you should breastfeed in the morning just before going to work, again as soon as possible after work, frequently during the evening and whenever baby wakes at night. Breastfeeding at night causes your prolactin level to rise, thus helping you to relax and enjoy a good night’s sleep. On weekends or days off, breastfeed your baby as often as possible. Keep in mind that it isn’t unusual for your milk supply to drop toward the end of the work week. Breastfeeding as much as possible and luxuriating in the rest that it provides, will help increase your supply for the next week. When the baby is four months old, you can probably reduce the number of pumping to one or two times during your working hours.

Some companies offer on-site breast pumps and access to lactation professionals.

Double Pumping

Double pumping kits offer time-saving benefits by allowing you to express both breasts simultaneously. By cutting pumping time virtually in half, you can successfully complete a pumping session during a regular break period (15 minutes). In addition, research indicates that double pumping may increase prolactin levels, your milk producing hormone. This unexpected side benefit is important to working mothers and mother or preterm infants who may have difficulty maintaining and increasing milk supply when the baby isn’t available for breast stimulation. Mothers experience in using double pumping can learn single-hand techniques for even easier pumping.

Storing Breast milk

Human milk varies in color, consistency and odor, depending on the mother’s diet and storage container used. Because breast milk is not homogenized, the cream will separate and rise to the top of the container. Breast milk may be safely stored by carefully following these steps:

Wash your hands well with soap and water before touching your breasts or any milk containers. Avoid touching the inside of bottles or caps.
Pump or express milk into a clean collection cup.
Transfer the milk into a clean storage container. If you can pump directly into a storage container, such as a Medela CSF bag, it will lessen the chance of contamination.
Label the container with the date and amount of milk collected; be sure to use the oldest milk first.
To inhibit the growth of bacteria, breast milk, which is not used immediately, should be refrigerated, or if stored for more than 24 hours, frozen. Check with your hospital for specific storage instructions.

For longer storage, freeze your breast milk. Frozen milk may be stored in a refrigerator freezer for six months or in a deep freeze (-20 C) for up to 12 months.

Fill the container only ¾ full to allow room for expansion during freezing. Freeze the milk in 2oz. to 4oz. Portions. These smaller amounts will thaw quicker. If your baby doesn’t drink the entire portion, there is less waste. It is possible to combine fresh milk with frozen milk. To prevent premature thawing, always cool milk before combining it with previously frozen milk. The amount of newly added milk must be less that the amount of milk already frozen. Never refreeze breast milk.

Thawing Frozen Breast milk

Place the sealed container of milk in a bowl of warm water for about 30 minutes, or hold the container under warm running water. Never microwave breast milk; micro waving can alter the composition of the breast milk and result in burning your baby.
Swirl the container to blend any fat that my have separated and risen during thawing.
Feed thawed milk immediately or store in the refrigerator for a maximum of 24 hours.

Traveling With Breast milk

When caregivers take bottles of breast milk along on outings, milk should be kept cold until feeding time to ensure that it will be fresh and safe for your baby.

Common Problems

Engorgement: During the first week after delivery, as colostrum is changing to mature milk, your breasts will become full. This normal postpartum fullness usually diminishes within three to five days. Engorgement may develop if your baby does not adequately remove the milk from your breasts. During this time, your breasts will feel hard, painful, and hot. The fullness is due in part to extra blood, lymph and swelling, not entirely to accumulated milk. Excessive fullness of the breasts can also lead to swollen areolas and flattened nipples, making it difficult for the baby to latch on and subsequently causing sore nipples.
You can prevent engorgement by:

Breastfeeding your baby frequently-8-12-time in 24 hours
Avoiding supplements of water or formula for the first 3 to 4 weeks unless medically indicated.
Expressing your milk if you miss a feeding.
Weaning your baby gradually.
If you do become engorged:

Apply warm, moist compresses to the breast for a few minutes just prior to breastfeeding. Avoid any additional heat to the breast as this brings more blood to the area increasing swelling.
Hand express to soften the areola before breastfeeding. Gently massage your breasts before and during breastfeeding.
If your baby is unable to latch on, you will need to express your milk. In this case, using a hospital-type electric pump is best.
After breastfeeding or pumping, try using icy cold compresses on the breasts to relieve discomfort and decrease swelling.
Wear a good fitting, supportive bra.
If you have further problems, contact you lactation consultant of LL Leader.
Sore Nipples: Some mothers will experience nipple tenderness for the first few days when baby starts nursing. This latch-on discomfort should disappear as soon as the baby begins rhythmic, nutritive sucking. Pain after this initial discomfort generally indicates that the baby is not attached to your breast correctly. Incorrect latch-on and/or improper positioning not only causes sore nipples, but can contribute to ineffective emptying of the breast as well. If you have blisters, cracking, burning, bleeding, and/or pain throughout the entire feeding or between feedings, it is recommended that you talk with a lactation consultant, LLL Leader, or the Nursing Mothers’ Council.
You can prevent sore nipples by:

Positioning your baby correctly at the breast, chest to chest, so that both of you are comfortable.
Breastfeeding your baby frequently, 8 to 12 times in 24 hours.
Making sure your baby opens his mouth wide and attaches properly to the breast with his mouth well behind the nipple on the areola.
Releasing the baby’s suction prior to taking him off the breast.
Gently patting your nipples dry after each feeding.
Expressing a little breast milk onto the nipples and massaging it into the nipples and areola.
Massaging in a small amount of USP Modified Lanolin if your nipples are dry.
Avoid using soap on the breasts or nipples; soap can remove natural protective oils. Water is all you need to clean your breasts when you bathe.
Limiting the amount of time your baby sucks non-nutritive during the first few weeks.
You can manage sore nipples by:

Determining the cause of soreness by contacting a lactation consultant, LLL Leader or the Nursing Mothers’ Council.
Using deep breathing, soft music, or other relaxation techniques before and during breastfeeding.
Limiting feeding time on the sore nipple.
Breastfeeding on the least-sore side first.
Expressing a little milk to stimulate let-down. (Also express if the breasts become engorged.) Expressing makes the areola softer, the nipple more erect, and latch-on easier.
Using nonplastic-lined bras, and/or bra pads. Change the pads frequently to keep the nipples dry.
Using a little USP Modified Lanolin on the nipples if they become dry or cracked. The lanolin forms a moisture barrier so nipples stay dry.
Using Medela breast shells to keep clothing and west nursing pads off the nipple to prevent further irritation.
Inadequate Milk Supply: Most mothers will produce a sufficient milk supply if they breastfeed their baby often and long enough. If your baby does not regain his birth weight by three weeks, or is gaining very slowly, it is possible your milk supply is low. Contact a lactation consultant or LLL Leader to determine the reason for your low milk supply. Medela’s SNS may be helpful if your baby needs supplementation. The system will provide appropriate breast stimulation while you are supplementing, which will help increase your milk supply. It might be helpful to keep a breastfeeding diary for the first four to five days after delivery.
Questions

When will my milk come in?
Mature milk production begins about 30 hours after delivery, but may not be evident for two to five days. Timing varies depending on you baby’s ability to latch on properly and how frequently and effectively your baby sucks. Generally, the more babies you have had, the sooner your silk "comes in." Keep in mind that until mature milk is present, your baby is receiving rich colostrum, which has three times the protein of mature milk and is just right for meeting your baby’s needs during those first few days.

How often (and long) should I feed my baby?
Babies need to be nursed as often as they indicate a desire to breastfeed. Watch for your baby’s cues. Rooting, brushing a hand across his face, or making little sucking motions are all indications that it is time to breastfeed. Babies will demonstrate feeding cues for up to 30 minutes before they start crying. Crying can cause your baby to have an uncoordinated suck, making it more difficult to initiate feeding.

Most babies need to breastfeed at least 8 to 12 times in 24 hours for the first few weeks. Once you and your baby are synchronized, the frequency and duration of feedings per day will decrease. This process takes about six weeks, just about the length of time it takes for you to completely recover physically from the birth process! Let your baby breastfeed as long as he wants to on the first breast; he’ll let you know when he Is finished, either by spontaneously coming of the breast or by drowsily moving into non-nutritive "nursing." You can burp the baby and offer the other breast. If your baby takes it, fine; if not, that’s fine too.

There aren’t any "rules" about having to take both breasts at a feeding. The next time the baby is ready to feed, you can offer the side he finished on or didn’t take. Keep in mind that sometimes babies love to be put to the breast simply for closeness and comfort, not because they are necessarily hungry. Generally speaking, most babies will breastfeed every 1 ½ to 3 hours for 5 to 15 minutes per breast.

Does my baby need bottles?
Giving your baby supplemental bottles in the early days may lead to nipple confusion/preference and can adversely affect your milk supply. Unless you are advised to do so for a medical reason, you should not give a breastfeeding baby bottles or water or formula for the first 3 to 4 weeks. If supplementation is necessary, it can be done with a small medicine spoon or a cup. Giving bottles every day or every other day so your baby "gets used to taking a bottle" is not necessary. After the first few weeks, giving him a bottle of expressed breast milk periodically, when it is convenient for both of you, is all you need to do. If your baby balks at taking a bottle, you can always feed him using a small cup or a medicine spoon.

What if I don’t have enough milk or my baby is gaining weight poorly?
Most delays in milk production result from an upset in the supply and demand balance. Avoid giving supplemental bottles. Temporarily postpone your other commitments to focus your energies toward establishing a breastfeeding routine with your baby. Try these methods for increasing milk productions:

Take your baby to bed with you. Nap-and night-nursings are time-tested remedies for enhancing a baby’s weight gain.
Remember the law of supply and demand, and increase the frequency of feedings to at least one every two to three hours. Wake your baby during the day if he sleeps more than three hours. Even a sleepy baby will nestle at your breast and stimulate milk production.
Look at, caress, and groom your baby as he breastfeeds. These maternal behaviors stimulate milk production.
Undress your baby before feeding to allow skin-to-skin contact. This action may help awaken sleepy babies and stimulate less enthusiastic nursers.
Watch for your baby’s feeding cues and capitalize on the times that he seems ready to eat.
Don’t try to wake your baby from a deep sleep; wait until he is in a light sleep or drowsy state.
Try "switch-nursing" to encourage more enthusiastic breastfeeding if your baby seems to fall asleep quickly. Also called the "burp and switch" method, switch-nursing allows your baby to feed on the first breast until his suck diminishes and his eyes begin to close. Take the baby off your breast, burp him and latch him on to the other breast. When sucking diminishes, take him off, burp and switch again so he nurses at least twice on both sides.
Double-nursing is another effective method for increasing the volume and fate content of your milk. Feed your baby until he is content; keep him upright instead of putting him down to sleep; burp him well, and 10 to 20 minutes later, breastfeed him a second time. Be sure to keep him upright for 10 to 20 minutes after a feeding to allow the trapped air bubble to be burped up, leaving room for a "topping off."
Above all, relax during breastfeeding to permit an effective milk ejection reflex. Seek the support of breastfeeding and mothering organizations such as LLLI or contact a lactation consultant.

How do I know if my baby is getting enough milk?
After the first month or so, you will intuitively know that your baby has been satisfied by his heavier look and weight. In the first few weeks, it is not as easy to tell, particularly for first-time mothers. Here are some signs to look for:

Your baby will have 6 to 9 wet cloth diapers (4 to 5 disposable diapers) and 2 to 5 (or more) bowel movements every 24 hours. The color of the stools can vary from yellow to tan with a mustard-like consistency. Urine should be pale yellow to almost clear in color.
Your breasts may feel full before a feeding, less full after. You may leak between feedings or leak on one side while feeding on the other.
You will feel your baby sucking vigorously and hear him swallowing. Many mothers (though not all) feel a tingly or pinchy sensation with the milk ejection reflex. Often baby will drift off to sleep at the breast after a vigorous feed, a good indication that he is satisfied.
Sometimes a baby will seem satisfied at the breast, but when he is put down, will start to fuss and root again. This behavior is not necessarily an indication that your milk supply is inadequate. Your baby may simply enjoy being held and cuddled. And not want to give it up for a crib or an infant seat. Using a baby sling during the day will keep him cuddled next to you while you go about your daily routine.

Why does my baby want to nurse all the time?
Your baby will breastfeed more frequently in response to sudden growth spurts. Babies can grow as much as ½ inch in a 24-hour period. No wonder they need to breastfeed frequently for several days! Breastfeed as frequently as your baby indicates a desire. Your milk supply will soon catch up to his increased needs. Giving bottles of formula at this time will only sabotage the natural supply and demand cycle, and you will be unable to catch up with you baby’s needs.

Some babies love to be held and nursed frequently as a way of helping them to adjust to life outside the womb. In fact, the first three to four months of life for all babies is a transition from the womb to the world. During "increased appetite" days, set aside other commitments to focus your energies on your baby. Sleep when your baby sleeps to recharge your system after these high-need periods. "Wearing" your baby in a sling or front carrier may be helpful. Just as a toddler needs a periodic hug and kiss to make the world right again, a newborn may need to be cuddled and even nursed for a while. As babies get older, they learn other ways of self-comforting, and breastfeeding sessions generally become shorter and less frequent.

What diet should I follow while breastfeeding?
There are not "rules" to follow about your diet. A healthy, well-balanced diet, high in protein and complex carbohydrates, similar to the one you consumed during pregnancy, is all that is necessary. Because a lactating woman is extremely energy efficient, there is no need for extra calories. Drink water or other beverages when you are thirsty; eat when you are hungry. Lose weight by avoiding high-calorie/low-nutrition snacks. Control your weight through regular exercise rather than crash diets, which can present health risks to both you and your nursing baby. If you must diet while breastfeeding, contact your lactation consultant, physician, LLL Leader, or the Nursing Mothers’ Council for specifics.

Are there foods to avoid while breastfeeding?
Although you will get plenty of unsolicited advice about dietary restrictions while you are breastfeeding, there aren’t any foods that a mother should routinely avoid. Babies can be fussy and can have excess gas-just because babies are fussy and babies have gas, not because you had broccoli for dinner last night. Occasionally, a baby may be sensitive to something in the mother’s diet. The most common sensitivities are to protein antigens that are found in cow’s milk, soy, wheat, fish, corn, eggs, and nuts. If you believe your baby is reacting to something in your diet, eliminate that food for two to three weeks, then try it again. Generally speaking, you should east a healthy, well-balanced diet, with no restriction. Any food (even chocolate!) in moderation is usually fine. If your baby continues to be unusually fussy and gassy, contact a lactation consultant, LLL Leader or the Nursing Mothers’ Council.

What about breastpumps?
Breastpumps are helpful in stimulating, maintaining and expressing milk in cases involving working or engorged mothers, and premature or sick infants. Breastpumps are available in a variety of types, depending on your preferences and needs. For a rental station in your area, call Medela’s Breastfeeding National Network (BNN) at 1-800-TELL YOU.

I’m a tense person. How can I relax better during nursing?
While the milk-producing hormone prolactin has a natural relaxing effect on the breastfeeding mother, sometimes additional help is needed. The Medela audiotape Breastfeeding Your Baby, includes specific relaxation techniques that will help improve your milk ejection reflex. Setting up a special "breastfeeding station" in your home may help create an environment in which you can unwind.

Select a comfortable chair (a big easy chair or rocking chair with arms is nice), and a footstool to raise your lap . Surround yourself with everything you might need: pillows, telephone, books, nutritious nibbles, juice, water, and extra diapers. Try relaxing to soothing classical music or use the relaxation techniques you learned in your childbirth class or on the Medela cassette. If you have a toddler who demands your attention, set up your nursing station on the floor or in the child’s room. Include an assortment of pastime supplies for him, such as special toys, snacks, books, and music.

When should I wean my baby?
Around the world, babies are breastfed an average of two to three years. There is, however, no "right" time to wean. Weaning is an individual decision for each mother and baby. Most babies will not show signs of wanting to wean before eight to nine months at the earliest. The American Academy of Pediatrics recommends breastfeeding exclusively for the first four to six months, gradually introducing new foods after that time. Breast milk for at least a year is preferred, using formula if your wean before that time. When you or your baby decide to wean, you should do so gradually to prevent the discomfort of engorgement and to help maintain your baby’s sense of security. Dropping one feeding every few days and replacing it with formula or cow’s milk (depending upon your baby’s age), will allow your breasts to adjust to the decreased demand in comfort. Most mothers drop the late night or early morning feeding last as this feeding is often a special snuggle time with the baby.