In 1997, the American Academy of Pediatrics published a policy statement
on the advantages of breast milk to your baby and the advantages of
breast feeding to you, the mother, and to the nation as a whole. There
is strong evidence that feeding your baby breast milk provides a
decreased incidence and/or the severity of:
Lower respiratory infections
Urinary tract infection
Late onset sepsis in premature infants
Breast milk provides your baby possible protection against:
Sudden infant death syndrome (SIDS)
Asthma and Allergic diseases
Other chronic digestive diseases
Benefits to the mother include:
Increased levels of oxytocin resulting in less post partum
bleeding and more rapid uterine involution
Earlier return to pre-pregnant weight
Delayed resumption of ovulation with increased child spacing
Improved bone remineralization post partum with reduction of hip
fractures in the post menopausal period
Reduced risk of ovarian cancer
Reduced risk of premenopausal breast cancer
Benefits to the nation include:
Reduced health care costs
Reduced employee absenteeism attributed to child illness
Reduced parental absence from work resulting in lost income
Financial savings to the family of the cost of formula for one
Decrease in the environment burden of processing, transporting
and disposing of formula products
Source: American Academy of Pediatrics. Breastfeeding and the
Use of Human Milk. Pediatrics: Vol. 115 No. 2. February 2005. 496-506.
Getting Started Breast Feeding
Your breasts have been preparing for breast feeding during your
pregnancy. Your areola is darkening, your nipples are becoming thickened
and toughened, and your breasts are changing from non-lactating to
lactating. An entire system is developing in your breasts for lactation.
Your nipples are becoming more supple so that your baby can extend your
nipple into the back part of his/her mouth to properly suckle. Please do
these 2 tests to check and see if your nipples are graspable and will be
able to be extended deep into your baby's mouth:
Stimulate your nipple with cold water, cold air, or your fingers and
watch your nipple's response. Does you nipple extend and stay protruding
or have no response to your stimulation? Does your nipple or part of
your nipple retract and fold into your breast? Then try the pinch test.
Place your fingers about 1/2 to one inch behind your nipple and gently
"pinch" your fingers together. Your fingers are the "jaws" of your baby.
Does your nipple continue to protrude or does your nipple flatten or
invert-retract into your breast? Please contact your lactation
consultant if your nipple does not protrude and continue to remain
protruding in response to the two tests. A lactation consult to evaluate
your nipples for graspability may be beneficial. Use of breast shells in
the weeks of pregnancy and between nursings after delivery can be
Your breasts have been making colostrum (pre-milk) from about your 23rd
week of pregnancy. Colostrum resembles melted butterscotch candy and is
sticky and thick. Colostrum is loaded with protective antibodies and
antivirals for your baby. Colostrum is very sweet and highly laxative
and helps your baby excrete the first bowel movements of thick black
meconium. Your baby will receive colostrum in the exact amount he/she
needs at each nursing on the day you deliver and for following three to
five days of age. Supplemental feedings are usually not needed.
Sometimes a baby will need supplemental feedings if a problem exists
such as low blood sugar, elevated bilirubin, refusal to latch and breast
feed, early gestation, low birth weight, or antibiotics. Your baby's
physician, your staff nurse, or the lactation consultant will discuss
this need with you. Your baby may not be fed formula without your
consent, you will be involved in the decision. If formula is temporarily
needed, the baby may be fed by cup or by bottle. Ask for information on
your choice of cup or bottle feeding. If your baby needs supplemental
feedings, ask your staff nurse for help with pumping your breasts to
stimulate your milk supply even if your baby is nursing each feeding.
Between day three and five after delivery, your breasts will be in
transition-changing from the production of colostrum to the production
of breast milk. You will notice a gradual change in the fullness of your
breasts. Initially you will notice that your breasts feel warmer to the
touch and that the breast tissue will feel denser or thicker, if gently
squeezed. As your baby requires more milk and demands more frequent
nursings, your breasts will respond and produce more breast milk. Your
breasts work on the principle of demand and supply, the more breast milk
that your baby demands, the more breast milk your breasts will supply
for feedings. The initial breast milk you will produce has a slightly
golden whitish color. This is transitional milk and is a mixture of
colostrum and breast milk. Mature breast milk is produced at about 1 to
2 weeks after delivery and the color changes from bluish-white to milky
white as the fat content rises throughout the feeding. The color and
taste of your breast milk is affected by your diet, medications and
vitamins. Babies like the variety of breast milk flavors that your diet
provides. Variety is "the spice of life". Breast milk will separate when
stored, the fat or cream rises to the top of the container, shake well
to mix before feeding to your baby.
Routine Breastfeeding Teaching for the Newborn
How often should I breastfeed?
Encourage your baby to feed at least every three hours, counting from
the start of a feed to the next start. Your baby may feed as soon as 1
hour after finishing. Shorter more frequent feeds are beneficial for mom
and baby in the first several days. If you baby is over six pounds, your
baby may sleep for a six-hour stretch at night.
How long should I breastfeed?
Your baby may nurse five to 30 minutes per breast or longer if demanded.
Offer the second side as baby's choice—feed or save—then switch and
start the next feeding on that second side. For twins: one baby nurses
on one breast per feeding, 10–40 minutes or longer, switch breasts per
What is a correct latch?
You will feel pulling, suction, pressure, and at first it may be
uncomfortable, but not be painful and should feel comfortable as baby
begins to consistently suckle. Watch for your baby's cheeks to puff out,
with both top and bottom lips flanged out like a fish, notice TMJ or jaw
joint movement—you should see baby's jaw open wide, pause slightly then
close. Use one hand supporting your breast and one hand around the
baby's neck while learning. Maintaining a constant and firm but not
painful breast squeeze during suckling helps the milk flow. When the
baby pauses, gently encourage baby to begin suckling again by pumping
your breast with your hand.
Am I producing milk?
It takes most women 50–75 hours (up to three days) after childbirth for
the breast milk to switch from teaspoons of wonderful colostrum to
ounces of transitional breast milk. Within five to 12 days, you will be
producing mature breast milk. When the baby feeds and the breast is
stimulated, prolactin causes milk production and oxytocin causes the
milk to eject from your breast and flow—you may feel sleepy, thirsty and
relaxed as you breastfeed. During the first seven days or so, you will
notice either a gush of vaginal bleeding and/or your uterus cramping as
you colostrum/milk flows to your baby. After seven days, you will
actually feel your breast milk flowing.
How much should I drink?
Drink enough fluids, particularly water, to satisfy thirst. Sip one to
two large glasses of liquid with every breastfeeding or pumping unless
fluids are restricted by your physician.
Is my baby getting enough?
Keep a log and measure what is coming out. Monitor baby's output by
counting urine and stools. Call baby's pediatrician and contact a
lactation consultant if below expected amounts.
If you have a maternal history of breast reduction or breast surgery,
previous poor milk supply, minimal breast changes during pregnancy, use
of nipple shield, large blood loss, hormonal imbalance, polycystic
ovarian syndrome, or baby with weight concerns or inadequate output:
Pump both of your breasts after every feeding with electric
breast pump and double set up for 10–15 minutes until milk
volume is well established (usually by two weeks)
Feed pumped breast milk to baby after nursing via baby cup or
bottle (mother's choice)
We suggest the Avent bottle and 0 or #1 Avent nipple if bottle
Moms may use formula for supplement if you choose, but
supplementing with your own pumped milk is the best
If your baby has a weak suck, tongue thrust, is unable to latch or stay
latched or is a very sleepy baby, finger-suck training can help—(in the
hospital) use hospital bottled sugar water (D5W) or (at home) one pinch
of sugar in one cup very warm tap water.
Interest: Stimulate your baby's interest by dabbing
sugar water on baby's lips and wait for the baby to actively
lick his/her lips, re-dab as needed.
Practice: Baby practices by sucking on parent's clean
finger dipped in the sugar water—nail short, positioned down on
baby's tongue, no nail polish.
Transfer: After baby has a vigorous sucking pattern on
the finger, dab the nipple with sugar water and gently transfer
baby to the breast and breastfeed your baby.
For more information, call 1.866.CALL.MLH.