IN THIS CHAPTER
Breast or bottle — making the decision that’s right for you
Getting into the breastfeeding routine
Understanding the basics of formula feeding
Handling your baby’s developing digestive system
One of the first big decisions any new parents make is whether to breastfeed their infant or use formula and bottles. Although the majority of parents these days choose to breastfeed, the decision is by no means an easy one. If you find the decision difficult, take comfort in the fact that both choices are sound and legitimate. This chapter lays out the basic first steps you need, no matter which way you go.
Deciding between Breast and Bottle
Ask almost anyone — your obstetrician, your pediatrician, your friends, total strangers — and they will advise you to breastfeed. In fact, the American Academy of Pediatrics, the World Health Organization, and the Institute of Medicine all recommend exclusive breastfeeding for six months, followed by a combination of breast milk and complementary foods for up to at least 12 months of age. “Exclusive” breastfeeding means no food or drink other than breast milk — including water — unless medically indicated. Back in the 1950s, bottle-feeding became all the rage when scientists developed techniques to pasteurize and store cow’s milk in formulas appropriate for infant nutrition. Breastfeeding has regained popularity largely because people and scientific studies have recognized its many medical benefits.
However, the decision of whether to breastfeed isn’t simply a medical one. It also involves issues of convenience, aesthetics, body image, maternal bonding, and even conditions surrounding delivery. The decision about how to feed your baby is a personal one that every mother must decide for herself. Figuring out how to breastfeed takes an incredible commitment, so don’t feel pressured to do it if your heart isn’t in it or if the thought of doing it makes you feel stressed or uncomfortable. If you decide that bottle-feeding is the best decision for you and your baby, don’t feel guilty about it.
You may hear that breastfeeding offers the best opportunity for a mother to bond with her baby, but bottle-feeding can also be a very warm and loving way to interact with your baby — not only for the mother but also for her partner and whoever else may help care for the baby. And although breastfeeding offers certain undeniable benefits, bottle-fed babies are — and remain — perfectly healthy.
This section looks at these two options a bit closer and helps you make a decision that’s right for you. Whatever your decision, make it before you deliver so you have adequate time to prepare for the moment when your baby starts feeding. Some women elect to try out breastfeeding for a little while to see how they like it. Some decide from the beginning to use a combination of both breast and bottle (filling the bottle with either formula or breast milk that has been pumped and refrigerated).
Sizing up the advantages of breastfeeding
Breastfeeding gives your baby a tailor-made formula for good nutrition and a whole lot more. The following are some advantages for the baby:
· Human breast milk can strengthen the baby’s immune system and help reduce the risk of allergies, asthma, and sudden infant death syndrome (SIDS). It can also decrease the chances of pneumonia in the baby’s first year of life.
· Babies who are exclusively breast-fed for six months have a decreased number of ear infections (otitis media), fewer gastrointestinal infections, and a lower chance of developing necrotizing enterocolitis (NEC), a serious illness more commonly seen in premature babies but occasionally seen in term infants.
· When breast-fed babies grow up, they have lower chances of developing inflammatory bowel disease (Crohn’s disease or ulcerative colitis), celiac disease (a problem with digesting gluten), diabetes, childhood leukemia, and lymphoma. They also have a lower risk of adolescent and adult obesity.
· Breast-fed babies, when they enter school, have higher intelligence scores and higher ratings by their teachers.
· Mother’s milk contains nutrients that are suited to a baby’s digestive system. The most commonly used formulas contain proteins from cow’s milk that aren’t as easily digested, and your baby can’t readily use the nutrients it contains.
· Human milk also contains substances that help protect a baby from infections until his own immune system matures. These substances are especially plentiful in the colostrum that mothers’ breasts secrete during the first few days after the baby is born.
· Babies are more likely to have an allergic reaction to formula than to mother’s milk.
Following are some advantages to breastfeeding for the mom:
· Moms who breastfeed have less postpartum blood loss and an increased rate of involution (the uterus getting back to its normal, pre-pregnancy size). They also have lower rates of postpartum depression and are less prone to child abuse and neglect.
· If you breastfeed your baby, you have lower risks of adult-onset diabetes, rheumatoid arthritis, hypertension (high blood pressure), hyperlipidemia (high cholesterol), cardiovascular disease, breast cancer, and ovarian cancer later in life.
· Breastfeeding is emotionally rewarding. Many women feel that they develop a special bond with their baby when they breastfeed, and they enjoy the closeness surrounding the whole experience.
· Breastfeeding is convenient. You can’t leave home without it. You never have to carry bottles or formula with you.
· Mother’s milk is cheaper than formula and bottles.
· You don’t have to warm up breast milk; it’s always the perfect temperature.
· Breastfeeding provides some degree of birth control (although it’s not totally reliable — see the later section “Looking at birth control options”).
· Lactation (milk production) causes you to burn extra calories, which may help you lose some of the weight you gained during pregnancy.
· A breast-fed baby’s bowel movements don’t have as strong an odor as those of babies who are formula-fed.
· Breast milk is pretty much organic — no additives, no preservatives.
· Some studies suggest that women who breastfeed may reduce their lifetime risk of breast cancer.
There are a few situations in which breastfeeding is not recommended:
· If the infant has a rare genetic disorder called classical galactosemia
· If the mother is HIV-positive (see the next section)
· If the mother has untreated tuberculosis or brucellosis
· If the mother is taking certain medications, such as amphetamines, chemotherapeutic agents, ergotamines, or statins
Patients often ask whether they can breastfeed if they’re taking medications for psychiatric problems (psychotropic drugs — some antidepressants fall in this category). The jury is still out on this issue, but most providers feel that medications commonly used today for depression and anxiety are relatively safe and that not treating the problem could cause more danger to the baby than any small risk these medications may pose. Ask your doctor about medications you take on a regular basis.
Checking out why some moms choose bottle-feeding
You may decide to choose bottle-feeding for any of the following reasons:
· You don’t want to breastfeed. If your heart isn’t in it, it ain’t gonna happen. Too much trial and error is involved in making breastfeeding work for someone who’s not truly committed to succeeding.
· You’ve tried breastfeeding, and your breasts don’t produce enough milk to feed your baby (or babies!).
· Bottle-feeding better fits your lifestyle. Although many working mothers breastfeed, others feel that juggling the requirements of their job with those of breastfeeding is just too difficult.
· Some women find the whole concept of feeding their baby a “bodily secretion” unpleasant.
· Bottle-feeding enables others to feed the baby.
· If you have a chronic infection — HIV, for example — bottle-feeding helps ensure that you don’t pass the infection to the baby via breast milk. (Women who carry the hepatitis B virus can breastfeed as long as the baby has received the hepatitis B vaccine. If you are hepatitis C positive, it’s generally safe to breastfeed as well, according to the Centers for Disease Control and Prevention.)
· If you or your baby is very sick after delivery, bottle-feeding may be your only option. A mother or baby who’s in the intensive care unit (ICU) because of a complicated delivery often can’t initiate breastfeeding.
The mother can use a mechanical pump to empty the milk from her breasts and freeze the milk to feed to the baby up to six months later. Even if the baby can’t use the pumped milk at this time, pumping at least keeps the supply of milk flowing. Occasionally, a mother can restart the flow of milk later on, when she or the baby recovers, but this option isn’t always possible and often requires the assistance of a lactation specialist.
· If you’ve had surgery on your breasts, bottle-feeding may be your best bet; you may not be able to lactate. No medical evidence indicates that lactation has any effect on the progression of breast cancer after it has already been diagnosed, but some women who have had surgery or other treatment for breast cancer are unable to lactate. Also, some evidence suggests that women who have had breast implants produce less milk. However, many of these women produce some milk and can still breastfeed.
Latching onto Breastfeeding
Pregnancy goes a long way toward preparing your body for breastfeeding. The key pregnancy hormones cause the breasts to enlarge and prepare the glands inside the breasts to lactate. But you can prepare yourself for day-to-day nursing by checking out your nipples (if you’ve never really done this before) to see whether they are flat or inverted. You can certainly breastfeed if you have either of these issues, because your baby latches onto the areola, not onto the nipple, but drawing the nipple out a bit before delivery might help make things easier.
Be aware that stimulating your nipples late in your pregnancy can elicit uterine contractions. When you’re near the end of your pregnancy, ask your practitioner before doing this kind of stimulation. One way to get around this problem is to avoid the nipple itself and just rub petroleum jelly, an antibacterial ointment, or baby oil over the areola.
Inverted or flat nipples often correct themselves before the baby is born, but a few techniques during pregnancy can help things along:
· Use the thumb and forefinger on one hand to push back the skin around the areola. If this doesn’t bring out the nipple, gently grasp it with your other thumb and forefinger, pull it outward, and hold it for a few minutes, as shown in Figure 1-1. Do this exercise several times a day.
· You can also try wearing special plastic breast cups (available at most drugstores) designed to help draw out the nipple over time. This may or may not help, but it won’t hurt.
Illustration by Kathryn Born, MA
FIGURE 1-1: One method of correcting inverted nipples.
Start one of these preparation techniques for short sessions during the second trimester and then gradually increase the amount of time you work your nipples or wear the cups until your nipples stay out on their own.
Looking at the mechanics of lactation
The flood of estrogen and progesterone that your body experiences during pregnancy causes your breasts to grow — sometimes to an astonishing size. This growth starts early, within three to four weeks of conception, which is why the first sign of pregnancy for many women is breast tenderness. As pregnancy progresses, small amounts of serum-like fluid can leak from the nipples. But serious milk production doesn’t start until after the baby is born.
During the first days after delivery, the breasts secrete only a yellowish fluid known as colostrum, which doesn’t contain much milk but is rich in antibodies and protective cells from the mother’s bloodstream. These substances help the newborn fight off infections until her own immune system matures and can take over. Colostrum is gradually replaced by milk.
Don’t be alarmed if your baby doesn’t seem to get much milk during the first few days. The colostrum is very beneficial on its own. Your baby probably won’t even have much of an appetite until she’s three to four days old. And she’s likely to need the first few days to practice sucking movements.
When your baby starts sucking on your breasts, it signals your brain to have the breasts produce milk. About three or four days after delivery, milk production sets in. When milk enters the ducts, the breasts become engorged with milk (see Figure 1-2). The engorgement can be so great that your breasts feel rock-hard and sometimes very tender. Don’t worry, though. When your baby starts feeding regularly and your milk starts flowing, the engorgement is no longer so intense. The letdown reflex (milk entering the ducts) occurs each time your baby feeds. After you’ve been nursing for a while, you may find that the mere sound of your baby crying or the feel of your baby cuddling next to you can trigger the reflex.
Illustration by Kathryn Born, MA
FIGURE 1-2: Your breasts contain a network of milk ducts, which start delivering colostrum during the first days after delivery.
Checking out breastfeeding positions
You can breastfeed in one of three basic positions, as shown in Figure 1-3. Use whichever position works and is comfortable for you and your baby. Most women alternate among the positions.
· Cradling: Cradle your baby in your arms with her head next to the bend in your elbow and tilted a bit toward your breast. (See Figure 1-3a.)
· Lying down: Lie on your side in bed with the baby next to you. Support the baby with your lower arm or pillows so that her mouth is next to your lower breast, and use your other arm to guide your baby’s mouth to the nipple. This position is best for late-night feedings or after a cesarean delivery when sitting up is still uncomfortable. (See Figure 1-3b.)
One concern about breastfeeding while in bed is that you may fall asleep and unknowingly roll over your baby. You may decide to keep a cradle or crib next to your bed so you can put your baby back to sleep right after you finish feeding, without disrupting your night’s sleep too much.
· Football hold: Cradle your baby’s head in the palm of your hand and support the body with your forearm. For extra support, you can place a pillow underneath your arm. Use your free hand to hold your breast close to the baby’s mouth. (See Figure 1-3c.)
Illustration by Kathryn Born, MA
FIGURE 1-3: The three basic positions for breastfeeding.
Getting the baby to latch on
If you choose to breastfeed, you can get started immediately after delivery, wherever you happen to be — the birthing room, the delivery room, or the recovery room. Begin as soon as the nurses have checked your baby’s health and your baby has settled down a bit from the delivery. Expect to feel a little awkward at first, and try not to get too frustrated. Many babies don’t want to breastfeed immediately. Have patience — you and your baby will eventually get the hang of it.
Babies are born with a suckling reflex, but many of them don’t follow it enthusiastically right off the bat. Sometimes babies need some coaxing to latch onto the breast:
1. Arrange yourself and your baby in one of the basic breastfeeding positions (see the preceding section).
2. Gently stroke the baby’s lips or cheek with your nipple.
This action usually causes the baby to open her mouth. If your baby doesn’t seem to want to open her mouth, try expressing (gently pressing out) a little milk — colostrum, really — and rubbing some on the baby’s lips.
3. When the baby’s mouth is wide open, bring her head to your breast and gently place her mouth over your entire nipple.
This prodding usually causes the baby to start sucking. Make sure that the entire areola is inside the baby’s mouth, because if it isn’t, she doesn’t get enough milk and you get sore nipples. However, don’t stuff your breast into your baby’s mouth. Rather, bring the mouth to your nipple, and let the infant take in the breast.
The tip of the baby’s nose should be barely touching the skin around your breast. The only way the baby can breathe while feeding is through her nose, so be careful not to completely cover the baby’s nose with your breast. If your breast obstructs the baby’s nose, use your free hand to depress your breast in front of her nose to let some air in.
Orchestrating feedings
After your baby latches on, you know that she is sucking when you see regular, rhythmic movements of the cheeks and chin. Several minutes of sucking may go by before your milk letdown occurs. In the beginning, let your baby feed for about 5 minutes on each breast per nursing session. Over the course of the first three or four days, increase the amount of time on each breast to 10 to 15 minutes. Don’t get too hung up about timing the feedings, though; your baby will let you know when she’s had enough by not sucking and by letting your nipple slip away.
If your baby stops sucking without letting go of your nipple, insert your finger into the corner of her mouth to break the suction. (If you just pull your breast straight out, you’ll end up with sore nipples.)
When switching from one breast to the other, stop to burp your baby by laying her over your shoulder or your lap and gently patting her back. Figure 1-4 shows you some of the various burping positions. Burp her again when the feeding is finished.
Illustration by Kathryn Born, MA
FIGURE 1-4: There’s more than one way to burp a baby. Here are a few of the tried-and-true positions.
Typically, mothers initially breastfeed about 8 to 12 times a day (averaging 10). This pattern enables your body to produce an optimal amount of milk, and it allows your baby to get the proper amount of nutrition for healthy growth and development. Try to space the feedings fairly evenly throughout the day; of course, your baby has some influence on the schedule, and some babies prefer to cluster feed, nursing very frequently over a several-hour period.
You don’t have to wake your baby for a feeding unless your pediatrician specifically advises you to do so. You especially don’t have to wake your baby at night; if the baby’s willing to sleep through, just count yourself lucky. (However, going through the night without feeding may leave you with overfull, sore, and leaky breasts.) Nor do you have any reason to withhold a feeding if your baby is hungry — even if only an hour or so has passed since the last feeding. Also keep in mind that the number of feedings in a day may be less than average if you supplement breastfeeding with some formula feedings.
You can tell that your baby is getting enough milk if your baby
· Nurses ten times a day on average
· Gains weight
· Has six to eight wet diapers a day
· Has two to three bowel movements a day
· Produces urine that’s pale yellow (not dark and concentrated)
If your baby isn’t meeting these criteria or if you have any concern that your baby isn’t getting enough milk, call your pediatrician. Some women, no matter how diligent they are, need to supplement breast milk with formula because they just can’t produce enough breast milk to totally meet their baby’s needs.
BREASTFEEDING MULTIPLES
It may seem daunting, but some women with multiples successfully breastfeed. Your body can make enough milk for two or more babies at once, especially if you’re persistent and work up your milk production to a high level. Even so, arriving at a system that works for you takes some experimentation. You may breastfeed two babies at once or feed each one separately. The advantage to the first alternative is that you don’t spend all your time breastfeeding, but the second method is easier. You don’t have to deal with one baby finishing first and needing to be burped while the other one is still sucking. (Holding one baby over your shoulder and keeping another one at your breast can be tricky, no matter how many pillows and props you use.) You may breastfeed one baby, bottle-feed the other, and then alternate at the next feeding. You may breastfeed each baby a little at each feeding and then supplement with the bottle. Or you may breastfeed the babies for most of the day and then supplement with a bottle before bedtime when your milk supply is low.
Women who breastfeed twins need to take in even more calories and fluids. You need about 400 to 600 extra calories per day for each baby you’re breastfeeding. (Imagine how much you’d have to consume to breastfeed triplets! About 1,200 to 1,800 extra calories per day!) Also, you need to increase your fluid intake from 8 to 10 glasses per day to about 10 to 12 glasses per day.
If you do decide to try breastfeeding multiples, count on needing help from other family members and friends. Don’t be afraid to ask for it.
Maintaining your diet
During breastfeeding, as during pregnancy, your nutrition is largely a matter of educated common sense. Your breast milk’s quality isn’t significantly affected by your diet unless your eating habits are truly inadequate. However, if you don’t take in enough calories or water, your body has a difficult time producing adequate milk. You may also find that your baby reacts a different way to certain foods — for example, she may be extra gassy. If you pay attention to how your baby responds, you can figure out what foods to avoid.
Breastfeeding women should take in 400 to 600 more calories a day than they would normally eat. The exact amount varies according to how much you weigh and how much fat you gained during pregnancy. Because lactating does burn fat, breastfeeding helps get rid of some of the extra fat stores you may have. But avoid losing weight too fast, or your milk production will suffer. Also, avoid gaining weight while you’re breastfeeding. If you find that you’re putting on more pounds, you’re most likely taking in too many calories or not exercising enough.
You also need extra vitamins and minerals — especially vitamin D, calcium, and iron. Keep taking your prenatal vitamins or some other balanced supplement while you’re nursing. Also, consume extra calcium — either a supplement or extra servings of milk, yogurt, and other dairy products. Omega-3 fatty acids are also important for your developing baby — you should consume about 200 to 300 mg of these every day.
Breast milk is mainly water (87 percent). To produce plenty of breast milk, you must take in at least 72 ounces of fluid per day, which is about nine glasses of water, milk, or juice. Don’t go overboard, however, because if you drink too many fluids, your milk production may actually decrease. You also don’t want to markedly increase your calorie intake with high-sugar, high-carbohydrate, or high-calorie fluids. A good way to tell whether you’re getting the right amount of fluid is to monitor your urine output. If you urinate infrequently or if the color is a deep yellow, you probably aren’t getting enough. If you constantly run to the bathroom, you may be drinking too much.
If you find that your baby is fussy and has a hard time sleeping, you may be consuming too much caffeine. Try cutting back on the coffee or cola until you find the level your baby tolerates.
Looking at birth control options
Although breastfeeding decreases the likelihood of ovulation, it by no means guarantees that you won’t become pregnant. For a woman who chooses not to breastfeed, it takes an average of 10 weeks after the birth to resume ovulation — that is, to become fertile again. About 10 percent of women who do breastfeed also begin ovulating again after 10 weeks, and about 50 percent start up again by 25 weeks — about six months — after their babies are born. Clearly, breastfeeding isn’t a great form of birth control.
Before you resume intercourse, consider using some effective form of birth control, because chances are you don’t want to become pregnant again right away. You can use birth control pills (some are okay with breastfeeding), barrier methods (condoms, a diaphragm, and so on), or long-acting progesterone shots (such as Depo-Provera). One of the newer forms of birth control (Nexplanon) is a tiny reservoir that contains a progesterone-like substance and is placed below the surface of the skin on the inner part of your arm. The reservoir slowly releases the medication and can prevent you from getting pregnant for up to three years. They can even be implanted while you’re in the hospital recovering from your delivery, and they don’t interfere significantly with breastfeeding. Discuss your options with your practitioner before discharge from the hospital or at your six-week checkup.
EXPECTANT MOTHERS ASK …
Q: “Can I breastfeed while I’m on the Pill?”
A: It’s fine, although it may affect the amount of milk you produce. Pills that contain estrogen decrease the amount of milk that you produce, and if you take them too soon after giving birth, they may make it difficult for your body to start milk production. However, after breastfeeding is well established, they’re fine. Some women find that the newer progestin-only pills are a better alternative — they have less effect on milk production — but they’re slightly less effective.
Determining which medications are safe
Just about any medication you take gets into your breast milk but usually only in tiny amounts. If you need to take a medication while breastfeeding, try taking the lowest dose possible and, as a rule, take it just after you finish a breastfeeding session. That way, your body breaks down most of the medication by the time you need to breastfeed again. In general, don’t deprive yourself of medications that you really need just because you’re afraid that some of it may get to the baby and cause harm. Check with your doctor about medications to be sure that they’re fine to take while breastfeeding.
The following medications are okay to take while breastfeeding:
· Acetaminophen (such as Tylenol)
· Antacids
· Most antibiotics
· Most commonly used antidepressants (see the earlier section “Sizing up the advantages of breastfeeding”)
· Antihistamines
· Aspirin
· Most asthma medications
· Decongestants
· Most high blood pressure medications
· Ibuprofen (such as Advil or Motrin)
· Insulin
· Most seizure medications
· Most thyroid medications
Handling common problems
One of the greatest misconceptions about breastfeeding is that it comes easily and naturally to everyone. Breastfeeding takes practice. Problems can range from a little nipple soreness to, in rare cases, infections in the milk ducts.
Sore nipples
Many women experience some temporary nipple soreness during the first few days that they breastfeed. For most women, the pain is mild, and it goes away on its own. For some, however, the soreness gets progressively worse and can lead to chapped or cracked nipples and moderate to severe pain. If your breasts are heading in this direction, take action before your suffering gets out of hand. The following list outlines some remedies:
· Review your technique to make sure that your baby is positioned correctly. If the baby isn’t getting the entire nipple and areola in her mouth, the soreness is likely to continue. Try changing the baby’s position slightly with each feeding.
· Increase the number of feedings, and feed for less time at each feeding. This way, your baby won’t be as hungry and may not suck as hard.
· Definitely continue to feed on the sore breast, even if only for a few minutes, to keep the nipple conditioned to nursing. If you let it heal completely, the soreness will start all over when you feed from that nipple again. You may want to feed on the least sore breast first, because that’s when your baby’s sucking is most vigorous.
· Express a little breast milk manually before you put the baby to the breast. This action helps initiate the letdown reflex so that the baby doesn’t have to suck as long and hard to achieve letdown.
· Don’t use any irritating chemicals or soaps on your nipples.
· After your baby finishes feeding, don’t wipe off your nipples. Let them air-dry for as long as possible. Wiping them with a cloth may cause needless irritation.
· Exposing the nipples to air helps to toughen the skin, so try to walk around the house with your nipples exposed as much as possible. If you wear a nursing bra, leave the flaps open while you’re at home. Your nipples will toughen from the fabric of your clothes rubbing against them.
· If you’re using pads to soak up leakage from your breasts, change them as soon as they get moist, or they may chafe your nipples.
· Try massaging vitamin E oil or ointment, olive oil, or lanolin into sore nipples and then letting them air dry. Udder Cream and Bag Balm, products developed to treat chapped teats on milk cows (yes, cows), have found new popularity among breastfeeding women. Many drugstores and cosmetics stores now sell these creams.
· Apply dry (not moist) and warm (not hot) heat to the nipples several times a day. You can use a hot water bottle filled with warm water.
Pain from breast engorgement
When the breasts become engorged with milk, they can hurt. One way to avoid painful engorgement is to begin breastfeeding right after the baby is born. Other strategies include wearing a firm — but not tight — bra and massaging the breasts before feeding. Massaging facilitates letdown and relieves some of the engorgement. You can also try placing warm compresses on your breasts. (Some women feel that ice packs work better — try both and see which works best for you.)
Clogged ducts
Sometimes, some of the milk ducts in the breast become clogged with debris. If this happens, a small, firm, red lump may form inside the breast. The lump may be tender, but it’s usually not associated with a fever or excruciating pain. The best way to treat a clogged breast duct is to try to completely empty that breast after each feeding. Start the baby out on that breast, when she’s most hungry. If the baby doesn’t completely empty the breast, use a breast pump on that side until all the milk is drained. Applying heat to the lump and massaging it manually is helpful. You can also try letting the spray from a warm shower fall on your breast to promote milk release. Most important, keep feeding.
If the lump persists for more than a few days, becomes very painful, or is associated with a fever, call your doctor to make sure that you’re not developing an abscess.
BREASTFEEDING RESOURCES
If you have special problems or if you want more in-depth information about breastfeeding, contact one of the following organizations:
· La Leche League International or La Leche League USA, 1400 N. Meacham Rd., Schaumburg, IL 60173; phone 1-877-4 LA LECHE; website www.llli.org or www.lllusa.org
· American Congress of Obstetricians and Gynecologists, 409 Twelfth St. SW, Washington, D.C. 20024; phone 800-673-8444; website www.acog.org
· American Academy of Pediatrics, 141 Northwest Point Rd., Elk Grove Village, IL 60007; phone 800-433-9016; website www.aap.org
· International Board of Lactation Consultant Examiners; phone 703-560-7330; website www.iblce.org
· International Lactation Consultant Association; phone 919-861-5577; website www.ilca.org
· American College of Nurse-Midwives, 818 Connecticut Ave. NW, Ste. 900, Washington, D.C. 20006; phone 240-485-1800; website www.midwife.org
Mastitis (breast infection)
Breast infections (mastitis) occur in about 2 percent of all breastfeeding women. Bacteria from the baby’s mouth usually cause the infections, which are most likely to happen two to four weeks after delivery (but can occur earlier or later than that). Infections are more common in women who are breastfeeding for the first time, who have chapped nipples with cracks or fissures, and who don’t empty their breasts completely at feedings.
The symptoms of mastitis include a warm, hard, red breast; high fever (usually over 101 degrees Fahrenheit); and malaise (like when you have the flu and your whole body feels achy). The infection in the breast may be diffused, or it may be localized to a particular segment of the breast (known as a lobule). If the infection is localized, the redness may appear as a wedge-shaped area over the infected portion of the breast (see Figure 1-5). If these symptoms develop, call your doctor immediately. More than likely, he’ll prescribe an antibiotic and may even want you to come into the office for an examination.
Illustration by Kathryn Born, MA
FIGURE 1-5: An outer view and an inner view of a wedge-shaped mastitis.
Continue to breastfeed your baby while you have the infection. It’s not harmful to the baby; after all, the bacteria probably came from the baby’s mouth. If you stop breastfeeding, the breast will become engorged, making your discomfort even worse. Acetaminophen (such as Tylenol), ibuprofen, or warm compresses may help relieve the pain from mastitis while the antibiotics take effect (usually in about two days). Drink plenty of fluids, and get as much rest as you can to allow your body’s natural healing powers to work. Take your medication for the fully prescribed amount of time to help make sure that the infection doesn’t recur.
Breast abscess
If mastitis isn’t treated aggressively or if a milk duct remains clogged, a breast abscess can develop. In fact, breast abscesses form in as many as 10 percent of all cases of mastitis. Symptoms of a breast abscess are extreme pain, heat and swelling over the area of the abscess, and high fevers (over 101 degrees Fahrenheit). Sometimes doctors can treat abscesses with antibiotics, but often the abscess needs to be drained surgically.
If you develop a breast abscess, you can continue to breastfeed on the other side, but you should stop feeding on the side of the abscess until the problem subsides. Check with your doctor before resuming feedings on that side.
FOR PARTNERS: OFFERING LACTATION SUPPORT
LeBron James makes dunking a basketball look as simple as flushing a toilet, but that doesn’t mean you can do it. If your partner chooses to breastfeed, keep in mind that it’s not as easy as it looks, especially at first. Issues will arise, and although you can’t be the one to solve those issues, your support is a major factor in her success. Be positive and upbeat, listen to your partner when she talks, and thank her profusely for making such a wise decision for both the baby’s health and hers.
The most important role for Dad is to stay informed about the process of breastfeeding. Many complications can arise, and the more you know about how to help your partner through those issues, the more likely Mom and baby will be able to work through them.
One of the most common reasons women have for ceasing breastfeeding is that it’s uncomfortable or painful. (Breastfeeding should not hurt after Mom and baby establish the correct feeding positions.) But sometimes problems do arise — sore nipples, pain from breast engorgement, clogged ducts, and more can frustrate even the most dedicated breastfeeding moms.
Remember that it’s the mother’s decision to quit breastfeeding if she so chooses; it should never be your suggestion. If lactation issues arise, don’t tell her to throw in the towel and go buy some formula, no matter how frustrated or tearful she becomes. Listen to her concerns, help her find resources to correct problems, and ultimately be supportive no matter what she decides.
Whenever your partner decides for any reason to stop breastfeeding, thank her for the time she has invested in doing so and congratulate her on her achievements. You both should be proud of the hard, rewarding work you’ve done.
Bottle-Feeding for Beginners
Suppose you’ve decided to forgo breastfeeding in favor of formula. Or you’ve been breastfeeding for a while, and you want to switch. This section goes over what you need to know to get your baby started on bottles.
Stopping milk production
If you decide to formula-feed, you need to stop the process of milk production in your breasts. Milk production is triggered by warmth and breast stimulation. To stop the production of milk, create the opposite environment. Here are some suggestions:
· Make the change gradually, dropping one feeding every day or two.
· Wear a tight-fitting bra, preferably one without underwire that can compress the delicate tissues. Sports bras often work well. Wear the bra 24/7 except when showering.
· Apply ice packs to your breasts when they become engorged (usually around the third or fourth day after your baby is born).
· Keep ice packs inside your bra, or use small packages of frozen vegetables, like peas or corn, which you can easily fold to fit within a bra. (We don’t recommend going out in public this way, though.)
· Place cold cabbage leaves inside your bra. Cabbage works chemically to reduce the production of milk.
· Let cold water run over your breasts during a shower. Pat nipples dry instead of rubbing, which can irritate the tissue.
If you’re going to breastfeed for a short period of time (6 to 12 weeks), consider giving your baby one bottle of formula per day while nursing to help make the transition easier.
Engorged breasts can be very uncomfortable. If you’re in a great deal of discomfort, you may want to ask your doctor about pain medication. Fortunately, the engorgement usually lasts only 36 to 48 hours and seldom requires medical help.
Choosing the best bottles and nipples
You won’t have any trouble finding a wide choice of bottles and nipples. Some babies definitely demonstrate a preference for one type of bottle or nipple over another. You may have to experiment to discover what tools work best for you and your baby. Four-ounce bottles are good for the first few weeks or months. Later, when your baby drinks more, you can switch to the 8-ounce bottles. Make sure that the bottles you use don’t contain the potentially harmful chemical BPA. If you buy new bottles, this shouldn’t be a problem, but older bottles may not be BPA-free.
Here is some information on bottles:
· Some bottles are actually plastic holders in which you insert little transparent plastic bags that hold the milk or formula. The advantage of this type is that you can throw away the empty milk bag, and you don’t have to worry about sterilizing the plastic container. Also, because the plastic bag is designed to collapse, less air gets into the bag and into the baby’s stomach.
· Some bottles are angled, which also helps to allow less air to be taken in by the baby, leading to less gas.
· Nipples come in a wide variety. Newborn nipples have a smaller hole, and the size of the hole increases with the age of the baby (nipples generally come in newborn, 3- and 6-month sizes, and then larger ones for older babies). Orthodontic nipples are designed to mimic nature’s design. Some nipples are made out of latex; others, of silicone. Silicone nipples are clear, have less of an odor, and are firmer. Your baby may demonstrate a strong preference for one type over another or may not notice much of a difference.
Feeding your baby from a bottle
Your mother, grandmother, or any number of well-intentioned friends may tell you to sterilize bottles by boiling them in water, but most pediatricians think that this step is unnecessary. After all, a mother who breastfeeds doesn’t have to boil her nipples!
Many parents choose to warm their baby’s bottle, but heating it isn’t necessary. If you choose to, though, you can warm a bottle in different ways. Many parents purchase bottle warmers especially designed for this task. But if you don’t want to take up kitchen counter space with another appliance, you can place bottles in a container filled with hot water.
If you use the microwave to heat your baby’s bottle, be careful. The breast milk or formula may heat unevenly, and some parts of it may be too hot for the baby. However, if you shake the bottle after warming it, it may be okay. Just make sure you squirt some onto your wrist to check the temperature first. Some formula manufacturers don’t recommend microwaving their product, so make sure to read the information on the side of the packaging.
Saving leftover formula or breast milk generally isn’t a good idea. However, some pediatricians say that reusing a bottle once is okay, so talk it over with your baby’s doctor. In any case, don’t leave a bottle filled with milk sitting outside the refrigerator for very long, because warmth encourages the growth of bacteria that can upset your baby’s stomach.
Choose your formula with the help of your pediatrician. Call his office prior to delivery and find out what he suggests you use. Many formulas come premixed, but some come in either a powder or concentrated liquid form, both of which require you to add water. The powder and concentrated liquid forms cost less, but they may not be available in as wide of a variety.
All kinds of formulas are available, including organic formulas. The jury is still out as to whether there are clear medical benefits to organic formulas. They may be more costly, and some have extra sugar, so check with your pediatrician about whether organic is the way to go.
Some babies develop an allergic reaction to their formula; they may have an upset stomach or develop a skin rash. If your baby becomes allergic, talk with your pediatrician. He may want to switch your baby to a soy-based formula or to a hypoallergenic formula.
Pediatricians generally caution against propping up a baby’s bottle by laying it on a pillow next to the baby’s mouth, because propping implies that the baby is being left unattended. Also, laying a baby flat on her back with the bottle propped creates more potential for choking. Propping a bottle may also promote tooth decay.
The most common position for bottle-feeding your baby is to hold the baby cradled in one arm, close to your body. Put a pillow on your lap, which eases the strain on your arms and neck. Most parents find it easier to always hold the baby in the same arm and in the same direction. For example, if you’re right-handed, you may want to hold your baby in your left arm and the bottle in the right. When the baby is a little older and has better control of her head and neck muscles, you may want to lay her in front of you along your legs for a change of pace. This way, you and your baby can make eye contact.
Here are some other tips for parents who are bottle-feeding (whether with formula or breast milk):
· Don’t swaddle the baby too much or keep her too warm during feeding. The baby may get so comfortable that she falls asleep instead of feeding.
· Change the baby’s diaper in the middle of a feeding if she falls asleep. This may help to wake her up so that she can finish the rest of the bottle. However, it’s usually not necessary to coerce a baby into finishing a feeding; she knows what she needs and may stop before the bottle’s empty because she’s full.
· To check whether your baby is hungry, put the tip of your finger into her mouth to see whether she starts to suck.
· Keep the bottle tilted in such a way as to completely fill the nipple with the formula or milk, thereby minimizing the amount of air your baby gets.
Burp your baby at least once midway through a feeding and again at the end of a feeding. Babies often take in air along with the milk or formula they drink, and burping helps them get rid of it. It also makes them more comfortable and able to eat more.
Dealing with Baby’s Developing Digestive System
Your baby has a brand-new digestive system, and it requires considerable breaking-in. Long story short: Babies spit up. A lot. Whether they’re breast-fed or bottle-fed, newborn babies are likely to vomit as often as two times per day. Try these suggestions for dealing with spitting up:
· Keep a cloth over your shoulder when burping or holding your baby so you don’t have to constantly change, or ruin, your clothes.
· Keep a small bib on your baby during and after feeding so you don’t have to constantly change, or ruin, all the baby’s clothes.
· Burp your baby after each feeding.
· If you’re bottle-feeding, stop partway through the bottle to burp the baby instead of allowing the baby to drink the entire bottle in one shot.
· Don’t play with the baby too much after feeding. Jiggling the baby or moving the baby around a lot can lead to more spitting up.
· 
If your baby seems to be spitting up large quantities or if the spitting up is very forceful, let your pediatrician know.
Sometimes, spitting up or vomiting several times a day is a sign of something as simple as overfeeding, or it may indicate a condition known as gastroesophageal reflux, or GER, which is a digestive disorder caused by gastric acid from the stomach flowing into the esophagus. It’s common in babies, although it can occur at any age. If your newborn is showing symptoms such as pain when spitting up, irritability, inconsolable crying, gagging, choking, or refusal to eat, you should definitely speak to your pediatrician. In this case, she may have gastroesophageal reflux disease, or GERD, a more serious disorder.
Your pediatrician diagnoses GERD by conducting a medical history, physical exam, and certain diagnostic tests. These tests may include an upper gastrointestinal series, endoscopy (placement of a flexible tube with a light and camera lens into the organs of the upper digestive system), pH testing, and gastric emptying studies.
The need for treatment for reflux depends on your baby’s age, overall health, and medical history; the extent of the problem; and your baby’s tolerance for specific medications, procedures, and treatments. Sometimes reflux can be improved through feeding changes. Try these suggestions:
· After feeding, place your baby on her stomach with her upper body elevated at least 30 degrees, or hold her in a sitting position for about 30 minutes.
· If bottle-feeding, keep the nipple filled with milk or formula so your baby doesn’t swallow too much air.
· Adding a feed thickener, such as rice cereal, may be beneficial for some babies who are about 6 months or older. Check with your pediatrician.
· Burp your baby frequently during feedings.