 
The Ultimate Guide to Breastfeeding

A Collection of Essays for Smartmom

Copyright Smartmom 2015

Published with SmashWords
TABLE OF CONTENTS

About SmartMom

The Benefits of Breastfeeding

Getting Educated

Lactation Consultants

Breastfeeding Nutrition

The Importance of the Breastfeeding Latch

Breastfeeding Positions

The First Few Days

Keeping a Schedule and Planning Ahead

What to Expect

Breastfeeding Pain

Breastfeeding In Public

The Pumping Mom's Survival Guide

# About SmartMom

Founded in 2014, SmartMom is a community of moms dedicated to helping each other be the best parents they can be. With over 100,000 members, the community is a vibrant and positive place to get advice, share stories, and receive encouragement.

SmartMom is currently available for iPhone only, but the android version will be available soon. Click here to download SmartMom in the iOS app store.

SmartMom was created by Social Qnect, a Founder Equity company.

# The Benefits of Breastfeeding

By Andrea Newell

To breastfeed or not to breastfeed is one of the most hotly contested issues between mothers and is a very personal choice. However, numerous experts and years of research say that if mothers are able to breastfeed, it has a long list of health, psychological, financial and even environmental benefits.

Although baby formulas have come a long way, there is no substitute for breast milk as an amazing source of nutrients for your baby that adjusts to every stage of your baby's life. The World Health Organization (WHO) advocates breastfeeding exclusively for six months and continuing for at least two years while introducing other age-appropriate foods as your baby develops. The American Academy of Pediatrics also recommends six months of nothing but breastfeeding (no water, formula or other food or drink) for the first six months, then breastfeeding along with other foods for another six months, and to keep breastfeeding as long as the mother and baby can afterward. (4)

### Breast Milk Changes As Your Baby Grows

By the time your baby is born, your body knows to start producing colostrum, a thick, yellowish substance that some call "liquid gold" due its rich protein content. Colostrum supplies your baby with special nutrients that he or she needs during the first few days of life to build a strong foundation for future good health and guard against infections. The primary immune element responsible for guarding your child against illness is secretory immunoglobulin A (IgA) which is found in large amounts in colostrum. Less of it is found in mature breast milk. It defends your baby against infection by generating a protective coating on the mucous membranes of the intestines, nose and throat. (1)

If your baby comes early, your body knows it, and your colostrum contains even more protein and needed fats that benefit premature babies. Colostrum is thicker than more mature breast milk because of its increased protein content. It is also lower in sugar and has a lot less fat. (4) "Colostrum helps a newborn's digestive tract develop and prepare itself to digest breast milk." (7)

After several days (two to five), your milk will begin to change, becoming thinner and lighter in color and will increase in volume as your baby needs more to eat, a period referred to as breast milk "coming in." This is the onset of "transitional milk," which your body produces after colostrum, up to ten to fourteen days after birth. After about two weeks, transitional milk becomes mature milk, which is thinner and described as watery and sometimes bluish. These changes in breast milk track along with your baby's development and growth and provide essential proteins and nutrients at each stage. Your breast milk supply will increase and wane as your child's needs do. (4)

### Breast Milk Defends Your Baby Against Illness

Scientists and doctors can't completely explain how breast milk adapts to your infant's needs, but they do know that breast milk guards your child against illness better than formula. "Human milk provides virtually all the protein, sugar and fat your baby needs to be healthy, and it also contains many substances that benefit your baby's immune system, including antibodies, immune factors, enzymes and white blood cells." (4) The key seems to be exclusive breastfeeding (no water, formula or other food) for six months or more.

While you are breastfeeding, especially if you breastfeed for six months to a year or longer, chances are you'll catch a cold or flu during that time. You might be worried that you'll pass your illness on to your child through breastfeeding, but actually in most cases, your doctor will advocate continuing to breastfeed while you are ill. This is not only because sudden weaning can be upsetting, but because your baby benefits from the antibodies (a tailored form of IgA that wards off the specific illness) you are passing on, and in many instances either won't get sick, or will only contract a mild form. Your antibodies will also reduce your child's risk of developing ear infections, stomach viruses, pneumonia, urinary-tract infections, or certain types of spinal meningitis.

If you have a family history of food allergies or eczema, breastfeeding can decrease the risk of developing both (IgA comes into play here, as well). Human milk, unlike cow's milk or soy milk, contains human milk proteins. Cow and soy milk, which doesn't integrate with your baby's system as well as human milk, can actually cause an allergic response or be harder to digest.

There are other illnesses that studies have shown have lower numbers in breastfed children, both during breastfeeding and later in life, including, dental cavities, childhood acute leukemia and other cancers, type 1 and 2 diabetes, high cholesterol, Sudden Infant Death Syndrome (SIDS), obesity later in life, and, in girls, breast cancer. A study by the National Institute of Environmental Health Sciences reported that breastfed children have a 20 percent lower risk of dying between 28 days and a year than children on formula. The longer children were breastfed, the lower the risk. (1)

### Health Risks for Formula-Fed Vs. Breastfed Babies

A formula-fed baby has _____________ the chance of contracting _______________ as a breastfed baby does during the time that they are breastfeeding.

2 to 7 times—allergies, eczema

3 times—ear infections

3 times—gastroenteritis

3.8 times—meningitis

2.6 to 5.5 times—urinary-tract infections

2.4 times—diabetes, type 1

2 times—Sudden Infant Death Syndrome (SIDS)

1.7 to 5 times—pneumonia/lower-respiratory-tract infection

1.5 to 1.9 times—inflammatory bowel disease

1 to 6.7 times—Hodgkin's lymphoma

Adapted from: American Family Physician, April 1, 2000, Vol. 61, No. 7. Reprinted in Meek M.D., Joan Younger; American Academy Of Pediatrics; Sherill Tippins. The American Academy of Pediatrics New Mother's Guide to Breastfeeding. Random House Publishing Group. 2011.

### Breast Milk Aids Brain Development

Breast milk has also been linked to facilitating higher brain development due to the fatty acids in it. Studies show that scores on IQ tests and other cognitive assessments were higher for children who were breastfed than for children who received formula, outside of socioeconomic factors and the mother's intelligence measurement.

"In a study of more than 17,000 infants followed from birth to 6 1/2 years, researchers concluded from IQ scores and other intelligence tests that prolonged and exclusive breastfeeding significantly improves cognitive development.

Another study of almost 4,000 children showed that babies who were breastfed had significantly higher scores on a vocabulary test at 5 years of age than children who were not breastfed. And the scores were higher the longer they had been nursed." (1)

Premature babies with very low birth weight who were given breast milk soon after birth showed improved mental development scores at 18 months, versus premature infants that were given formula. Retesting at 30 months showed that the high scores persisted, and the breastfed babies had a lower rate of repeat hospitalization for respiratory issues.

Breastfeeding is no guarantee that your child will be a genius, but experts agree that breast milk gives children the best chance for healthy growth in infancy and early childhood when the brain is developing rapidly.

### Breastfeeding Can Lessen Obesity Rates

The Centers for Disease Control and Prevention reports that childhood obesity has "more than doubled in children and quadrupled in adolescents in the past 30 years. In 2012, more than one third of children and adolescents were overweight or obese." (2)

One of the reasons the American Academy of Pediatrics promotes breastfeeding is to decrease your child's chances of becoming overweight or obese. The American Journal of Epidemiology published 17 studies that reported that breastfeeding reduces this risk. Again, the length of exclusive breastfeeding correlates with the lower rate of obesity, so the longer, the better.

Experts believe that breastfeeding counters excessive weight gain later in life, because:

• Breastfed babies learn to eat until they are full, which builds healthier eating habits at an early age.

• Breast milk has less insulin in it than formula. (Insulin activates the generation of fat.)

• Breastfeeding gives babies more of a hormone called leptin, which researchers think helps regulate appetite and fat.

• When measured against breastfed babies, formula-fed infants gain weight faster in the first few weeks. This is linked with later obesity. (1)

### Breastfeeding Comforts Your Baby

Your baby is happy in your dark, quiet womb for nine months. At birth, he or she emerges into a bright, loud world and needs the comfort of your closeness. By holding your baby and breastfeeding, you are reassuring him or her and developing an important bond. From this, your baby begins to realize that he or she is protected, loved and cared for. Emotional well being is as important as the protein and antibodies your baby is getting through breastfeeding. Experts believe that infants learn better with a close emotional attachment to an adult. Breastfeeding is the first step to building a close relationship between you and your baby. (4)

### Breastfeeding is Good for Moms

Breastfeeding has lots of benefits for mothers, too. When you breastfeed, your body produces a hormone called prolactin, which makes you feel peaceful, helping you relax and concentrate on your baby, along with oxytocin, which makes you feel more love and affection. These happy feelings help mothers enjoy breastfeeding; perhaps do it longer and breastfeed subsequent children.

Oxtocin also helps your uterus contract back to its pre-pregnancy size more quickly and helps stem postpartum bleeding. In addition to helping your baby defend against many illnesses, breastfeeding is also linked to reduced rates of illnesses later in life for mothers, too. Mothers who breastfeed are less likely to have ovarian or breast cancer, and some studies report that breastfeeding is linked to an increase in bone density, warding against osteoporosis and fractures later in life (although this proof isn't conclusive).

### Lose weight

One huge benefit of breastfeeding is that can help mothers lose pregnancy weight, where formula feeding cannot. Breastfeeding depletes the fat cells stored in your body from pregnancy. When you breastfeed, your body uses the calories that you consume, as well as these fat cells, to produce milk. This occurs even when you increase your diet to include 300-500 more calories a day (the amount recommended during breastfeeding to maintain a good energy level and milk production). Most women lose an initial fifteen pounds right after birth, and then one to two pounds a month for about six months, and usually more slowly after that. Many women find that it takes the same amount of time after birth to lose the weight as the length of their pregnancy took to gain it.

### Combat postpartum depression

After analyzing more than 9,000 study abstracts, the National Institutes of Health determined that women had a higher risk of postpartum depression if they did not breastfeed or stopped breastfeeding early (before the recommended six months). When oxytocin is released during breastfeeding, it not only inspires a peaceful, content feeling, it wards off feelings of depression.

"One study found that women who had high amounts of oxytocin in their system (50 percent of breastfeeding moms as opposed to 8 percent of bottle-feeding moms) had lower blood pressure after being asked to talk about a stressful personal problem." (1)

### Delay subsequent pregnancies

Exclusive breastfeeding can prevent the return of your menstrual period, especially during the first six months, which can create a needed delay between children. The most effective period of this "natural" birth control is the first six weeks (although it is not 100 percent foolproof). After that, your period might not return right away, but the only guarantee of preventing subsequent pregnancies is employing a form of birth control. After six weeks of breastfeeding, your milk supply will be stable, and your doctor can recommend a method that is safe and doesn't interfere with your milk production. There are several choices available.

### Lower risk of developing diabetes

Mothers can be at greater risk for diabetes due to the extra fat stored on the body from pregnancy, combined with the fact that pregnancy can reduce glucose tolerance and increase insulin resistance, which can contribute to gestational diabetes. However, studies are suggesting that breastfeeding can counteract these imbalances, showing that the longer a woman had breastfed, cumulatively, during her childbearing years, the less likely she was to develop type 2 diabetes, regardless of BMI, which is a possible risk factor. Women with gestational diabetes are considered to be at higher risk of developing diabetes after giving birth, but recent studies report that this risk is much less for women who breastfeed for more than nine months. (6)

### Better heart health

A study in 2009 showed that women who breastfed longer were at less risk for developing cardiovascular disease (even after adjusting for sociodemographic and lifestyle factors, family history and BMI). Breastfeeding for more than 12 months resulted in women having a 10 percent less chance of developing it than women who did not breastfeed. Other complications seemed to be more prevalent in women who did not breastfeed, like aortic calcification and high blood pressure. The exact medical reason isn't clear, but researchers think that it might be related to higher cholesterol levels during pregnancy that are reduced faster by breastfeeding, and the higher levels of high-density lipoprotein (HDL, or "good cholesterol") found in breastfeeding mothers. (6)

Studies are still ongoing, and some show that as women age, the breastfeeding defenses might grow thin, as the risk numbers for cardiovascular disease for women in their 70s were about the same regardless of the amount of time they breastfed.

### Mitigating cancer risk

Much has been written about the reduced risk for breast and ovarian cancer if you breastfeed. Scientific American actually says that some studies conclude "not nursing puts some women at higher risk."

A 2010 paper reported that for every 12 months a woman spent breastfeeding, the risk that she would develop breast cancer dropped 4.3 percent. Additionally, breastfeeding could better a woman's chances of not getting breast cancer even if there was a family history of it. (6)

"Whereas the potent drug Tamoxifen can reduce risk for those with a mother or sister who had breast cancer by about half, 'moms who had breastfed at all had about 60 percent less risk,' (paper author) Alison Stuebe (an assistant professor in the Division of Maternal Fetal Medicine at the University of North Carolina in Chapel Hill) says. 'That's a pretty significant statistic.'" (6)

The medical links aren't always entirely clear, but experts think that the some of the reasons for the lower rate of breast and ovarian cancer might be due to structural changes in breast tissue as a result of breastfeeding, and that lactation reduces the amount of estrogen your body generates. Since breast and ovarian cancer can be exacerbated by estrogen, suppression might lower the risk. (1)

Ovarian cancer risks can also be associated with breastfeeding. Mothers that didn't breastfeed (not women who had never had children, but women who went through the birth process and didn't breastfeed afterward) had 1.5 times more risk of developing ovarian cancer compared with breastfeeding mothers, although another study reported that the defense was most effective if the women had breastfed the last child they gave birth to. Another theory is that mastitis (infections of the milk ducts) can be beneficial, creating antibodies that seem to ward off ovarian cancer.

### Breastfeeding is More Convenient

Infants need to eat often and you'll soon notice that not having to make a bottle each time your child is hungry is a time-saver, especially in the middle of the night. You can breastfeed almost anywhere and have to pack much less gear without bottles, formula, nipples and a cooler and worry about sterilization.

### Breastfeeding is Better for Your Budget

Breastfeeding, of course, saves you money. Breastfeeding is free, while formula can cost upwards of three dollars a day, and sometimes close to $10, depending on the type of formula and how much your baby eats. The combination of formula and bottle-feeding supplies can cost more than $1,500 a year.

On a larger scale, when breastfeeding protects infants from illness (requiring fewer doctor visits, prescriptions and hospitalizations), millions of dollars are saved in healthcare costs. "In one study, a group of formula-fed infants had $68,000 in health care costs in a six-month period, while an equal number of nursing babies had only $4,000 of similar expenses." (5)

The Office on Women's Health, the U.S. Department of Health and Human Services, estimates that the United States would save $2.2 billion each year if more babies were breastfed, (8) where Scientific American puts that number at $13 billion, if 90 percent of women breastfed their babies exclusively for the first six months. (6) At the same time, parents of breastfed babies miss less work to care for sick children than parents of formula-fed infants. This translates into lower employer medical costs, as well.

### Breastfeeding is Better for the Environment

Without the clutter of bottles, nipples and formula cans mean less is going into our landfills. Breast milk appears when you need it, increases as your child grows and needs more to eat, and dries up after weaning. No packaging, no waste.

### Breast Milk is Always Available and Contaminant-Free

In most parts of the U.S., we enjoy clean drinking water, electricity and a temperature-controlled place to sleep and shelter our children, although with the rising number of homeless, food-insecure homes and minimum wage workers struggling to pay their bills, this is far from a certainty for many. In many other parts of the world, it is a way of life. For breastfed infants, nursing protects them from the risks of an unclean water supply. Unexpressed breast milk doesn't need to be kept refrigerated, it is always at the right temperature during feeding, and it helps regulate your child's body temperature (helping to keep it from dropping too low in chilly weather). (8)

Breastfeeding is no guarantee that your child will be brilliant and illness-free and you will never get cancer or diabetes, but an overwhelming number of experts agree that breastfeeding gives infants the best nutrients possible and facilitates the mother-child emotional bond, which is the main reason some women give for breastfeeding, despite all its other benefits.

The information in this article came from the following sources:

1. BabyCenter,  How Breastfeeding Benefits You and Your Baby

2. Centers for Disease Control and Prevention, Childhood Obesity Facts

3. HealthyChildren.org,  Benefits of Breastfeeding for Mom

4. Meek M.D., Joan Younger; American Academy Of Pediatrics; Sherill Tippins. The American Academy of Pediatrics New Mother's Guide to Breastfeeding. Random House Publishing Group. Kindle Edition. 2011.

5. The Natural Resources Defense Council, Benefits of Breastfeeding

6. Scientific American,  How Breastfeeding Benefits Mothers' Health

7. WebMD, Breastfeeding Overview

8. The Office of Women's Health, U.S. Department of Health and Human Services, Women'sHealth.gov,  Why Breastfeeding is Important

# Getting Educated

By Megan Van Sipe

There is so much more to breastfeeding than bringing baby to the breast so they can eat. For such a natural process, it truly does take a lot of work, persistence, support, and education! There are many things you can and should do to prepare yourself for your breastfeeding journey. The best thing you can do is to educate yourself as much as possible so that you are empowered with knowledge of techniques, problems and their solutions, and resources to have on hand so you are aware that there is help out there when you need it. Many moms quit trying not just because it's hard, but because it's hard and they don't feel empowered, determined, and supported. Use your time before your baby arrives to pack your proverbial breastfeeding tool bag so that you will not be surprised by the challenges you may face.

Starting out by reading a highly rated breastfeeding book will already have you so much more prepared than if you had just tried to wing it and use your instincts (instinct really can be misguiding when it comes to breastfeeding as you will learn). Armoring yourself with facts will help you know when to trust yourself and when to tell yourself to listen to the pros. Then, it's time to seek out some local resources through your hospital, birthing center, and local mom's groups or even breastfeeding groups. Take to the Internet to seek out reputable breastfeeding websites and blogs so you can keep yourself immersed with new information, and find answers to your more specific questions. You may even find some nice communities of mothers this way. As prepared as you can be mentally and emotionally for the journey ahead, there are a few tools you will need as well so educating yourself on the purpose of a nipple shield and how you might use a breast pump are just as important!

### Books

Before you're even close to having your baby, pick up a breastfeeding book! You don't need to read every book on the market, because many of them will contain similar information. They are not all created equal, of course, and you may find the details different as there are sometimes conflicting opinions among experts and authors. Choose one that has the best reviews and sounds like it would appeal most to you. As you read it, know that later when you have your baby in your arms for the first time, the information you read will come flooding back to you and finally make sense.

The Breastfeeding Book

The Breastfeeding Book, written by well-known and respected Dr. William Sears, is a practical guide that covers everything from perfecting the latch, increasing supply, to pumping and storing breast milk - and most importantly is working mom friendly! It's encouraging to have a resource that tells you "you can do this" even as a mother working outside the home.

The Womanly Art of Breastfeeding

Often called "The Bible of Breastfeeding", The Womanly Art of Breastfeeding is endorsed by Le Leche League International. This book is so diverse in its' content that even experienced breastfeeding mothers can benefit from reading it. Included in the book are real life stories, photos, scientific nutritional facts, nursing in special circumstances (premature babies, special needs, or multiples) and even includes references to support groups to encourage creating a support network for yourself.

Breastfeeding Made Simple

Breastfeeding Made Simple helps you to understand the seven natural laws of breastfeeding, and helps navigate the intricacies of the new relationship you will be having with your baby. A focus on establishing comfort for you and baby in your feeding routine will gently guide you into an empowering relationship that's nourishing and rewarding.

The Nursing Mothers Companion

With information that goes beyond the "how and why" of breastfeeding, The Nursing Mothers Companion offers a quick guide format to help provide answers to your questions easily and efficiently. It digs into topics such as relactation, introducing solids, nursing after cesarean, and nutrition advice.

### Hospital Resources

If you're having your baby at a hospital or birthing center, utilize them for their resources to help educate mothers who are pregnant or breastfeeding. These resources are often free when you're going to be giving birth there, and many often provide low cost or free classes as well as information and other services. Check your hospitals' website for a list of breastfeeding resources they provide. Many offer lactation consultants (an invaluable resource!), breastfeeding classes, recommendations to websites, and informational books and pamphlets.

The most valuable resource you could glean from your hospital or birthing center is a Lactation Consultant so make this one of your top priorities when you have your next visit. Lactation Consultants are experts in breastfeeding, and can help you perfect the baby's latch, show you different holds until you find some that are comfortable for you, show you how to use your pump, walk you through issues you may have such as a plugged duct or mastitis, and even weigh the baby before and after feeding and talk to you about what is normal with milk production and how to feel confident in your supply! Ask about the services they personally provide. Do they visit your hospital room right after birth? Do they make home visits? What is the cost? Can you call them months after birth for help when you're having issues or questions? Put her number into your phone and keep it there!

### Local Groups

La Leche League is the leader in breastfeeding advocacy, support and community. You can use their website as an information resource but you can also check for a local group that you could attend! Connecting with other experienced breastfeeding moms in your area is a huge asset to you and could not only provide you with help when you need it, but some emotional support or even friendship.

Search for a group near you:

llli.org/webus.html

Local Milk Sharing

Human Milk for Human Babies is an organization that connects mothers who are in need of breast milk with mothers who are willing to donate theirs! Keep this organization in mind once you have your baby and are in need of milk if breastfeeding isn't going well. This could be an option for you before buying a can of formula. On the flip side, if your milk is coming in at full force and you're filling a deep freezer, consider donating some to a local mother who needs your help!

Websites

There is so much information out there that goes beyond what can be put into a book. New problems, questions, or even success stories are happening all the time. Breastfeeding focused websites are worth a visit and are packed with supportive information. Bookmark the following websites and browse them for their wealth of facts, stories, and resources. When you're informed deeply about why you should breastfeed, and how you should breastfeed, and where and when and how much you should breastfeed - you're going to be much more empowered and determined to make it happen. This is a wonderful gift to give yourself and your baby.

La Leche League

La Leche League is an empowering organization started by 7 women with a call to action to change the norms of society in support of breastfeeding mothers. Over the history of their organization, they've created communities, educational tools, and motivated women everywhere to try and succeed in the art of breastfeeding. On their website, you can ask questions, listen to podcasts, interact in the forums, find a local group near you, and learn about the laws regarding breastfeeding to fully educate yourself before and during your journey.

Kelly Mom

A goldmine for articles on all topics regarding breastfeeding, Kelly Mom is the place to search if you have a specific question. With articles like "What should I know about buying a used pump?" to "what do authorities say about breastfeeding past the first year" to "sadness and depression after weaning" you'll never feel alone with your questions or problems. You can find pregnancy, nutrition, health and parenting topics there as well.

The Leaky Boob

Personal stories can be so encouraging and inspiring, and most importantly, they are realistic and relatable. The Leaky Boob has Q&A posts along with many personal stories by moms of all types and situations. It's amazing to read about what moms will go through to feed their babies.

WHO

The World Health Organization is the leading authority for health in the United Nations and has a plentiful selection of trustworthy articles, resources, and support that you can feel comfortable utilizing due to their high standards for health and great respect and protection of breastfeeding.

### Tools

Breastfeeding is so wonderful because it is essentially free! This is comforting and gives you a little extra room in your budget in order to get some convenience tools to make breastfeeding easier. Although you can nurse your baby very minimally without fancy products - there are a variety helpful tools that are staples in the breastfeeding routines of many! Pillows to position the baby, nursing tops and bras, covers, breast pumps, pads, nipple shields and creams are all going to become part of your vernacular as a nursing mommy.

Support Pillows

The way you position the baby is key to establishing a good latch from the beginning, and as the baby grows, you'll have to find new ways to hold them that is more comfortable for their size. Breastfeeding pillows such as the Boppy, My Breast Friend, or  Gia Angled Nursing Pillow are placed on your lap to give you a comfortable and secure place to rest the baby and your tired arms on while you're settled in for long nursing sessions. They're incredibly helpful as baby gets a little bigger and becomes pretty heavy to hold in one position for long periods of time - especially if they fall asleep and you don't want to move!

Nursing Covers

Whether you're out in public or just over at a relatives house, there might be times when you want to feed the baby with a bit of privacy. Consider packing your diaper bag with a nursing cover and a Muslin swaddle blanket, which you can use to drape over your shoulder. The nursing covers, like Udder Covers, are great when you've got a tiny baby and you're fiddling with her latch and need to cover up a bit. When they get older they don't like being under fabric, so a thin muslin blanket allows you to strategically place it on them without covering their face. You should never feel like you have to cover up, so don't hide from others to protect their feelings. This is about the comfort of you and your baby.

Nursing Tops & Bras

While we are on the topic of modesty and comfort, we can't ignore how important it can be to add some really functional breastfeeding-friendly tops into your wardrobe. Pulling your tops down at the neckline works for some styles and body types, but over time you'll realize that the necklines become very stretched out and you've ruined your shirt. Lifting your top up from the hem can be ok if you're layering, but all the fabric by your baby's face isn't always comfortable either. For the amount of time baby spends at the breast, it really is worth your money to get a couple of neutral nursing tops that you can wear with everything. Three to five tank tops that can be worn alone or layered under your regular tops, two or three t-shirts and a long sleeved shirt or hoodie would be a great stash of basics. Then pull out all of your button up blouses and move them to the front and center of your closet! Easy access and comfort are your new goals.

If you've never shopped for nursing wear before, be forewarned, it can get expensive! Remember, you might be wearing these tops until your child is a toddler, and then pulling them back out for future children, too! So shop wisely, but do invest in some staples that you'll be able to wear week after week, for many months or even years.

Boob Design, with a tongue-in-cheek yet literal name out of Sweden, creates high quality maternity and nursing clothes with a super functional "entry" for baby to eat easily and modestly. They even make breastfeeding friendly pullover hoodies! Keep an eye out for them on Zulily, when they often have great deals on some of their classic pieces.

Glamourmom offers great longer length tanks and tops that give full coverage to your body and are wonderful for full-busted moms. Snap down tanks are a staple and can be worn every day as a base layer under your regular clothes. They're also the easiest thing to wear to bed for nighttime feedings.

Momzelle understands functional basics and focuses on offering tanks, tees, and long sleeved shirts and dresses in easy to wear solid colors. Their tops are easy to pull up just enough to nurse baby, while the rest of you stays covered. The modest prices will have you filling your closet with new classic wardrobe staples in your life as a nursing mom.

Milk Nursing Wear sets itself apart with its fresh modern focus on fashion while still being functional for breastfeeding. The look of their clothes is very working mom friendly! They are not only committed to style but to supporting and encouraging nursing moms.

Yummie Tummie is a brand of breathable shape wear that also makes a shape wear nursing tank. This could easily be worn instead of a nursing bra in those first few weeks at home when you're feeding the baby around the clock. It would be great to invest in one and consider it as one of your nursing bras.

Nursing Bras

It's really hard to know what you like until you start breastfeeding and can try out a bra in action. For this reason, it might be wise to only buy one or two nursing bras to start with, then pick up a couple more once you've figured out your likes and dislikes of the bras you started with. Make sure the bra is very simple to open and close with one hand, that it's supportive (light padding) but not snug, and that there is some room to grow into the cup when your milk production is at its highest. You should also avoid underwires and synthetic fabrics. You want natural, breathable, and lightly fitted to your body. If your breasts are on the small side, you can also get by with wearing nursing tanks as a bra at least at home and at bedtime. Just don't forget to wear your breast pads!

Breast Pumps

If you're planning on going back to work, finding a great breast pump should be one of your top priorities, since you're going to be spending a lot of quality time with this machine! You may not have success with just any old pump, so it is important to get a highly rated, double electric pump if you're going to be pumping daily. The  Medela Pump In Style is one of the best in efficiency and effectiveness, and the  Medela Freestyle is another mom favorite. Be sure to purchase extra tubes because they do occasionally need to be replaced. You might even want to consider going hands free to pump so you're able to multitask! There are many bras made especially for pumping that hold the cups right onto your breast, so you can sit and try to relax and not hold or fiddle with pump parts. Simple Wishes, and even LLLI (La Leche League) are good brands to look into. If you would like to pump just to have a little backup milk stash in your freezer but will mainly be breastfeeding straight from the source, you can get by with something more basic like a single electric, or even a manual pump. The manual pumps, such as  Philips Avent Comfort Manual Breast Pump, are great for times where you just need to express some milk while you're away, and don't want or need to invest in an electric pump.

### Breast Care

Your main objective when taking care of your breast is to make sure your baby has a great wide open latch. The more comfortable the latch, the less pain and irritation you will feel. Despite a great latch, it is very normal to feel pain, soreness, and skin irritation or even a little bleeding in the first 4-6 weeks (after which it gets so much better). Hang in there and seek out some tools to help care for your breasts and sore nipples in that first trying month. Breast pads, which will help catch all the leaking, are the most necessary tool of the trade. Moms who have a lot of leaking love Lansinoh disposable pads, while those who don't need as much protection can get by with washable cotton pads. It's important to care for your nipples with a natural nipple cream after each feeding during the first weeks while you're still tender. Motherlove and Earth Mama Angel Baby both make wonderful natural balms that work well and are safe for baby. For pain relief, try out some cooling packs that you stick right into your bra after feeding baby, such as Soothies Gel Pads by Lansinoh. If heat feels better but the shower pressure is painful, a thoughtful product called the Shower Hug (which you wear like a strapless bra) protects your sensitive skin so you can shower comfortably and still benefit from the relief and relaxation of the hot water. Your Lactation Consultant may even recommend a Nipple Shield if you're having problems due to nipple shape or pain. You don't necessarily need one of these ahead of time, but just be aware that the option is there.

Your breastfeeding journey is a beautiful, natural process and although that might have sounded like a lot to learn and prepare for, so much of breastfeeding is a learn-as-you-go relationship that will continue to grow and change as you and your baby grow and learn together. Don't stress and worry that you won't be able to do it. With the support of your lactation consultant, the reference books and websites, and the help of other breastfeeding women around you, you can do this. Focus on learning the basics, gathering your tools, and rounding up some breastfeeding support in the form of a lactation consultant and some local mothers or friends you can call so that they're right there in the moments you need them!

# Lactation Consultants

Tamar Mekredijian

Becoming a mother for the first time is overwhelming in so many ways. You endure pregnancy, labor and delivery, and suddenly your life is changed forever by a little bundle that completely depends on you. These days, many new moms are urged to breastfeed rather than give their babies formula. This is because studies have shown that breast milk carries nutrients that are beneficial to babies and conform to their specific needs. Breastfeeding is also beneficial for the mother. Studies show that breastfeeding mothers get more sleep than those who feed their babies formula, and more sleep means a decreased chance of developing post part-um depression. It's become more and more common for mother to choose breastfeeding over formula feeding, but what they don't realize is that in the midst of this huge life change called motherhood, breastfeeding can be challenging, both physically and emotionally.

When I gave birth to my daughter, the nurses brought her to me soon after and told me she was hungry. I was extremely nervous. After all, it was my first baby, and I didn't know what to expect. My husband and I had both agreed that we wanted her to be breastfed. We thought our instincts as parents would just take over, but we were incredibly sleep deprived and didn't really know what to do. We practiced skin-to-skin time with our daughter, but ultimately, she was not latching well and the nurses were concerned. She was jaundiced and was losing weight fairly quickly. The word "formula" began being tossed around and I was very discouraged. Finally, one of the nurses informed us that there was a Lactation Consultant making her rounds. The nurse explained that she specialized in helping mothers learn how to breastfeed. We jumped at the chance to meet her. After spending just ten minutes with the Lactation Consultant, I already felt more confident and even more determined to continue breastfeeding. We asked to see a consultant each time I fed my daughter while I recovered at the hospital. When we left, we hired a consultant to come to our home when we faced a few problems with latch - without her help, we would not have been able to continue the breastfeeding relationship that we wanted.

Lactation Consultants are amazing resources for knowledge about breastfeeding and are trained to help educate new mothers about the benefits and the process of breastfeeding. They help with troubleshooting physically and support mothers emotionally through the process of learning how to breastfeed and overcoming obstacles along the way.

Here is a Q&A with International Board Certified Lactation Consultant, Tess Johnson, from Fresno, California:

What is a Lactation Consultant? What are their specialties?

A Lactation Consultant is a health care professional that has the education, training, and experience to help mothers with a wide variety of breastfeeding challenges. In addition to a strong knowledge base that covers a wide spectrum of lactation problems, each consultant may also choose to specialize in various areas of interest, such as working with premature babies, assisting mothers with low milk production issues, resolving latch difficulties, and many more possibilities. There are several different types of specialists in the field of lactation, but usually the term "Lactation Consultant" is reserved for those who hold an international certification, or the title of IBCLC (International Board Certified Lactation Consultant.) As an example, I first became a Certified Lactation Educator in 1992, but advanced my practice to become an IBCLC by 1998.

Why did you choose this profession?

I was an RN (registered nurse) first. I was working in the postpartum unit of the hospital, and I realized very quickly that breastfeeding assistance was one of the most frequently requested aspects of patient care by new mothers. I wanted to be proficient in it, yet I had only received a short lecture on the subject in nursing school. So, I began to follow the Lactation Educator around as she visited with the patients, every chance I had, learning directly from her. It was a great way to see the techniques in action, and I picked up a lot of skills from her that I could use as a bedside nurse. About a year later, when that Lactation Educator was preparing to leave on her own maternity leave, I was asked to attend formal training in the field of lactation so that I could take her place while she was away. It was the start of a lifelong passion for me, and I realized that the more I learned, the more I wanted to know. That has never changed!

Do you believe that breastfeeding is best? Please explain.

I absolutely do. Both the act of breastfeeding and the actual breast milk itself are worth all of the effort we put into them, in my opinion. But there's more to it than what the studies have shown us. I mean, obviously, there have been countless health benefits demonstrated in research studies conducted all over the world, and it's truly amazing how our milk is designed to protect our babies, as well as maintain our own health. But what seals the deal for me isn't the science; it's the relationship that is built through breastfeeding or even through providing breast milk. Through 22 years of clinical practice, I have seen that even when things don't go as planned, and a mother must supplement, or must pump, or when she experiences some other limitation to the original plan, she can still capture an aspect of the breastfeeding relationship that is special and lasting. I've been privileged to witness the powerful connection between mother and baby that comes from giving a part of ourselves to our little ones, and I've seen that overcoming the bumps in the road provides a sense of personal accomplishment for the mother, so when there is some level of breastfeeding taking place, it all seems valuable to me. Therefore, yes, I believe it's best, yet I have learned to see "success" in many different ways. It doesn't have to be the textbook-version of success to be beneficial.

When do you think a mother should look into hiring a Lactation Consultant? Why?

Due to the fact that there is a lot of natural instinct that leads moms and babies in the right direction, some new mothers settle into the breastfeeding relationship fairly easily with their babies, and that's great! But virtually every mother can benefit from the reassurance that comes from having a trained pair of eyes watching a feeding, or from receiving a few pointers on how to establish a more comfortable and efficient latch. I just saw a mother this week who was lactating well, was not in any particular pain, but who just didn't feel confident with her breastfeeding yet. So we spent a couple of hours together, working through her concerns, one by one. I weighed her baby, I listened to her worries, and I was able to show her in a tangible way that her baby was already thriving well. She expressed to me as I left that, more than anything, she felt relieved. She had anticipated that breastfeeding was going to be a problem, due to many stories that had been thrown her way by friends and family, but for her, breastfeeding seemed to be going well, and that was not what she had expected. She kept waiting for the "other shoe to drop," but it never did, and her worry that trouble may be just around the next corner had been unsettling. After our visit, she was finally able to trust what she already suspected: her baby was breastfeeding well.

Certainly, if there are any significant problems occurring, such as very sore nipples, painful engorgement, poor weight gain by the baby, or other areas of concern, a Lactation Consultant can help the mom achieve comfort and confidence much more quickly than if she were to try to resolve the issues on her own. It's pretty important to get help fast when the going is tough because little issues can turn to big ones in a very short time. Many women are tempted to give up when breastfeeding challenges arise in the beginning because, let's face it; those first few weeks find us very tired and unsure of ourselves. A visit or two with a Lactation Consultant can really build the skills and confidence in a new mother, ensuring that she won't give up on her goals too easily. So, whether or not there are significant problems at hand, there can be a tremendous benefit to sitting down with a skilled LC.

What should a mother expect during a session with a Lactation Consultant? Is it important to ask for a follow-up session?

At most sessions with a Lactation Consultant, there will be an assessment of the mother as well as the baby, and a direct observation of a feeding. The LC will be looking at the baby's attachment to the breast, may take some weight checks to evaluate the baby's milk intake, and will ask quite a number of questions about the mother's birth history, her pain level, her baby's diaper count and feeding behaviors, and many other specifics. A mom should expect to have plenty of opportunities to ask questions and voice her concerns during the visit. She may receive some hands-on help with positioning her baby, and hopefully, she'll have a chance to also attempt the same techniques without the helping hands of the LC, so that she ends the session knowing that she can achieve the same success independently. If she feels that she is more confident at the end of the session than when it started, that's a great thing. But she may still want to request a follow-up session just to ensure her continued success after that visit is over.

What is the most important piece of advice you give all mothers during their first session with you?

I like to remind new moms that breastfeeding really is a relationship: a very intimate and important one. So, like other very close relationships, there's first a "getting to know you" phase, when there may be some awkwardness and uncertainty between the partners. That's normal, and it's okay for things to not feel perfect at first. Due to the strong commitment between mom and baby, though, these awkward feelings are gradually replaced by feelings of closeness and familiarity, and eventually everything will feel quite easy between you. So I think my best advice is to remember to give the relationship time to build, and not to expect perfection in the early days.

What is the most common breastfeeding problem you encounter? How do you help solve it?

Probably the most common problem is sore nipples in the first days after birth. Often, moms are worried that they're "doing it wrong" when this happens, but I hate for moms to feel they're doing things wrong. It's just new for mom, as well as for baby. There's not necessarily a right or a wrong; there's more like just a time that it takes to adjust and build skills out of instincts. I like to show a new mom that her baby will be most coordinated and focused when held very close to her body, preferably in a skin-to-skin manner. Sometimes, this is all I have to suggest. The close skin-to-skin holding often brings out baby's best instincts, and sometimes the latch just fixes itself! If not, I like to help mom find a few key points where she can stimulate the baby's best feeding reflexes for the deepest latch, such as touching her nipple to the area right above the baby's mouth. When a mom sees the baby open a little wider from this type of stimulus, she learns quickly how to get that deeper latch.

What type of medical advice are you allowed or do you give to clients? What do you do if you encounter or discern a medical problem with the baby?

Much of what I do is observation and assessment, followed by suggestions for what may be causing the problems at hand, and possible solutions. I cannot, however, diagnose illness or provide medical treatments. When it appears that something medical may be interfering with breastfeeding success, I can offer a mother suggestions on what types of questions to ask her physician, and I will encourage her to consult with the doctor immediately if it appears that a medical intervention is necessary. If I encounter a problem with the baby that needs medical attention, I can, with mother's permission, call the doctor directly to discuss my concerns while I'm still with them. I have definitely done that before. For example, I recently arrived at a mother's house and noticed immediately that the baby was not only very sleepy, but quite jaundiced as well. The mother had thought he looked a bit yellow, and was having trouble getting him to latch on (which was why she had called me), but she wasn't sure how much of a concern it was. Judging by the baby's sleepiness and poor output that day, I determined that his jaundice might have crossed the line into the abnormal realm. So, the mom allowed me to call the doctor directly, and the doctor offered to send the baby directly for a lab test. It was good that he did, because the baby was actually admitted to the hospital for phototherapy that afternoon. I had the mother start pumping, and we rescheduled our lactation consultation for a later date when he was feeling better and back at home. He went on to breastfeed well after his jaundice was resolved.

Have you come across new moms who are emotionally drained or unstable due to breastfeeding issues? How do you help them?

I definitely have. My heart really goes out to moms in this situation because, even though they desperately want to breastfeed, sometimes the stress of it all becomes overwhelming. It can be even more crippling if the mother is not getting any sleep. So occasionally, I have to encourage a mother to take a break from breastfeeding and get some sleep. If the baby is in need of feeding while mom catches up on sleep, there are breastfeeding-friendly ways to provide the necessary milk, such as finger feeding with an SNS supplementer, or dropper-feeding. If sleep for mother still doesn't help her emotional state, or if she is too anxious to even fall asleep, I contact her doctor for a medical evaluation. Sometimes, the priority must absolutely be to focus on mom's health first--before trying to fix the breastfeeding, because all of the hands-on lactation help in the world won't resolve anything if the mom ends up feeling broken. Once I have mom feeling more fortified, my focus on solving any breastfeeding issues can resume. In a situation like this, I often remind the mother that her breastfeeding relationship with her baby is a long-term one, not short-term, and therefore, there's plenty of time to get back to the journey of cultivating it. If a few hours or days of self-care will keep a mother's health intact, it will be worth a brief pause in the breastfeeding plan.

How do you deal with a situation in which a mother wants to give up breastfeeding? Do you push them to continue? How do you encourage them?

One of the most important things for me to remember as a Lactation Consultant is that I'm there to help a mom reach her goals. I'm not there to help her reach mine. So, if she truly feels that she wants to stop, I am not likely to talk her out of it. However, knowing that these decisions don't come casually, I will gladly talk it over with her if she's open to that. I like to make sure that she really feels secure in her decision, and that her feelings about her experience are generally healthy and positive. Sometimes, a mother who feels ready to give it up may not realize that there is a possibility of combining breastfeeding with formula feeding. She may have been under the impression that if she is not breastfeeding exclusively the whole experience will fail. However, as I mentioned earlier, there are many versions of "successful" breastfeeding, and one way is not always the only way. So there are times when just having the conversation about options is what keeps a mother from walking away. And there have been remarkable moments when, even months later, I'll receive a text message photo of a beautiful, growing, glowing baby who is still enjoying some time at breast, when just a few months before, her mama thought she was finished.

How long do you believe a mother should breastfeed their baby? Why? Should they set a goal?

I usually suggest that a new mother have some general breastfeeding goals in mind, but to focus on short-term goals first. It can be daunting to think about months or years when your nipples are sore or your breasts feel engorged, and you haven't slept well for a while. So, it helps to think in terms of days or weeks at first. I have one mom that I'm working with right now who is literally working through her goals one day at a time. She knows that the American Academy of Pediatrics recommends at least a year of breastfeeding (with six months of that time being exclusive breastfeeding), but she cannot yet think in those terms. She had a hard time envisioning herself nursing a baby at all in the beginning, but she is doing it for the baby's health and for her own recovery, and it's slowly "growing on her." I feel that most women should be encouraged to strive for at least the first six to eight weeks, knowing that during this time, most of the challenges are likely to get ironed out, and by that point, the breastfeeding relationship has had time to build strength. At this point, longer-term goals may be easier to set.

Have you ever had to tell a mother that she needs to stop breastfeeding due to medical issues and/or medications she must take? Please explain.

I have, although this is very rare. Years ago, I took care of a mother who had a rare blood disorder, and her only hope for a safe recovery after the birth was to take powerful medications. At first, we hoped that she would eventually be able to wean off of the medications, so I set her up with a pumping and dumping plan to protect her milk supply. However, she eventually was told that her situation was not improving the way that it should have, and long-term drug therapy was going to be necessary; all of her medications were simply incompatible with breastfeeding. It was hard for her to accept, at first, but oddly enough, even though her milk wasn't saved during the pumping phase, she said that the act of pumping gave her a little bit of comfort. Just seeing her body make milk, feeling the hormones respond to the stimulation from the pump, helped her bond with her baby somehow. She gradually weaned herself from pumping, and made a conscious effort to love her baby at every feeding, just as if she had been breastfeeding. So, again, success can come in many forms.

How do you encourage mothers whose milk is insufficient or seems to be drying up?

Firstly, it is most important that the baby is always properly fed, so my primary focus is to help the mother develop a plan that protects the baby's needs while preserving her own goals of breastfeeding. Often, using an at-breast supplementer achieves this. By placing a feeding tube at the breast, attached to a supplemental milk source, we can allow the baby to keep growing as a breastfeeder while his mother works on improving her milk production. The at-breast supplementer has a bit of a learning curve associated with it, so I like to practice with mom and baby directly while they learn. However, after a couple of uses, it's usually not bad at all, and it can keep both mother and baby "in the game" for much longer than if multiple bottle-feedings are done.

Please share your favorite success story with a client. What was the main issue? How did you help her overcome it?

I have so many favorites; it's very hard to choose! Each mom inspires me. Each one makes me want to shout from the mountaintops when she finally achieves what she thought she could not do. But one who stands out in my mind occurred just a few years ago. The mother and father had a deep desire for their baby to be breastfed, yet I noticed immediately that Mom appeared to lack self-esteem. She had apparently struggled early in life, but she and her new little family were determined to make things work. It did not help matters when her baby, a late preterm five-pounder, struggled to even latch on for a single moment. Rather, she fussed and cried at the breast every time her mother tried to feed her. Mom's milk supply was low. Baby was underweight and low on fluids. Initially, even a nipple shield and an at-breast supplementer were not helpful, so mom had to resort to pumping for her, and the milk was given to the baby by cup or finger-feeder, oftentimes by the baby's devoted dad. Despite the mother's generally low self-esteem, she plugged on and didn't give up. I did everything in my power to keep her feeling encouraged and hopeful, helping her to see even the smallest daily achievement as good reason to continue the next day. So she did. She pumped religiously, and continued to attempt feedings for several weeks. As is often the case with reluctant nursers, little by little, her baby began to latch on. First, using a nipple shield with the added flow of the supplementer, then later, once mother's milk had developed more, she breastfed with the shield alone. Finally, there came a time when the baby's weight gains were consistent, when she was no longer fighting the latch, and when her strong and patient mother was able to stop using a nipple shield! She was successfully breastfeeding, and the whole family was loving it. This mother even came to my Mom-to-Mom Support Group to inspire other moms to stick with their breastfeeding goals. Mom, Dad, and their sweet little baby remained in touch with me throughout the next couple of years, often sending pictures of a chubbier and more radiant baby every few months. Likewise, her mother now appeared confident and radiant, as well, as if she had discovered something in herself that she never knew had been there before. Breastfeeding can be a real self-esteem booster, and I'll never forget that lovely little family.

Do you believe every mom should spend some time with a Lactation Consultant, whether while recovering from labor and delivery at the hospital or afterwards at home? Please explain.

I do recommend that every mother spend at least some time with a Lactation Consultant after giving birth, even if it is just a brief conversation about the mother's general feelings about the early feedings, or to check the baby's latch visually while still in the hospital. Regardless of the number of times a mom has nursed before, each new baby enters this world with his or her own set of strengths and weaknesses, so it can be expected that no two breastfeeding journeys will be exactly alike. Every mother, therefore, deserves the support and assessment skills that a Lactation Consultant can offer. Additionally, even a brief visit with a Lactation Consultant can serve as a reminder to the mother to seek further evaluation quickly if any problems surface. If no lactation services are offered in the facility where baby is born, then I would think it wise for mothers to seek a consultation soon after they have settled in at home.

Spending time with a Lactation Consultant during the first few weeks of motherhood can make all the difference in your confidence as a breastfeeding mother, equipping you with knowledge about positioning, how to achieve a deep latch to avoid nipple soreness, scheduling, when to introduce pacifiers and a bottle, etc.

# Breastfeeding Nutrition

By Carly Hill

After nine months of food restrictions, food aversions and food cravings, by the time you give birth, you're probably yearning for some normalcy to return to your diet. The good news is, now you can – even if you're breastfeeding. You don't have to keep nearly as close of an eye on your diet after you give birth as you did while your baby was in utero. In addition, you have a whole lot more wiggle room to indulge in luxuries like soft cheeses, wine and sushi. That being said, while you are breastfeeding, you _do_ need to keep in mind that certain things you put into your body do pass through to your breast milk and can even affect your supply. Healthy breastfeeding nutrition is of the utmost importance for new moms.

### What SHOULD I Be Eating?

Putting parameters on a breastfeeding diet can get a little complicated. Planning is great, but once you have your baby, you may learn that certain food groups will upset your baby's stomach. Many babies have reactions to dairy and improve when dairy is cut from their mothers' diets. So, this is just a set of guidelines, provided your baby cooperates.

 What to Expect suggests the following daily diet for breastfeeding moms:

• Protein – 3 servings

• Calcium – 5 servings (that's an increase from your pregnancy requirement of 4)

• Iron-rich foods: 1 or more servings

• Vitamin C: 2 servings

• Green leafy and yellow vegetables, yellow fruits: 3 to 4 servings

• Other fruits and veggies: 1 or more servings

• Whole-grain and other concentrated complex carbohydrates: 3 or more servings

• High-fat foods: small amounts – you don't need as much as you did during pregnancy

• 8 cups of water, juice, or other non-caffeinated, nonalcoholic beverages

• DHA-rich foods to promote baby's brain growth (look for it in wild salmon and sardines, as well as DHA-enriched eggs)

• Prenatal vitamin daily

### Choose Organic Options Whenever Possible

Whether it is medicine, alcohol, or pesticides – any types of contaminants will pass through to your breast milk, having an effect on you and your baby. The best thing you can do to avoid contaminants is to eat organically, as much as possible. If you're unable to drop the extra bucks it takes to maintain an exclusively organic diet, just make sure that your diet is varied.

If you're on a corn-on-the-cob kick and you buy it from the same supermarket that gets it from the same farmer, and those corncobs are heavily coated with pesticides, your breast milk will be heavily laced with pesticides.

Just make organic choices when you can, and when you can't, make sure your diet has plenty of variety.

### Loosening the Reins on Pregnancy No-No's

If you're pregnant, you probably have a long list of things you want that you've been unable to have while pregnant. The good news is, if you're breastfeeding, you can loosen up with the restrictions quite a bit, but there are still some precautions to take with your diet when breastfeeding.

### Alcohol

Sipping on a glass of your favorite wine is a no-no when you're pregnant, but you can be a little more flexible when you're nursing. When it comes to alcohol, it's all about timing. If you're going to have a drink, you'll want to do it right after a nursing session, then, to be on the safe side, you'll want to "pump and dump" as they say. For your baby's next feeding, offer a bottle of previously pumped breast milk, and instead of nursing the baby, pump that milk (which probably still has traces of alcohol in it) and dump it down the drain.

### Caffeine

When you were pregnant, you were told to avoid caffeine altogether, or at least limit it to one 12-ounce cup a day, since high caffeine consumption has been linked to risk of miscarriage and stillbirth. But, once you birth that baby of yours, you can loosen up on the caffeine a bit.

According to La Leche League, you can down up to five 5-ounce cups (less than 750 ml) of coffee a day with no effect on your baby. Trust me, that extra cup of coffee will do wonders when you're living on random sleep-spurts. Just don't overdo it.

Also, keep your other sources of caffeine in mind. Teas, sodas, chocolate and many medications can contain caffeine and if you _are_ overdoing your intake, you'll notice your infant jacked up on the drug too – "wide-eyed, active, alert, and perhaps fussy."

The take-away from this is, you can loosen up and pick up your caffeine habit where you left off, just be mindful of how much you are consuming and pay attention to your baby. If you are having too much caffeine, it can affect your infant.

### Fish

Good news. You can make date night a sushi night once again. In fact, according to the FDA and EPA's latest guidelines, pregnant and breastfeeding moms don't eat enough fish. With all the restrictions you're given during pregnancy, it's easy to just say, "Eh, there are too many 'don'ts,' so I'm just going to avoid fish altogether." But, that's no good. According to these new guidelines, breastfeeding moms should be eating 8 to 12 ounces of low-mercury fish each week – that's 2 or 3 servings a week.

That being said, you'll still want to avoid high-mercury fish such as tilefish, shark, swordfish, king mackerel, fresh tuna, sea bass, mahi-mahi, grouper, amberjack, and of course, fish from contaminated waters.

When it comes to canned tuna or any other type of canned fish, you'll want to limit yourself to 6 ounces per week.

Eating fish is good for you and your baby, as along as it's the right kind of fish and the right serving size. Keep a copy of this page handy when you're ordering out or grocery shopping so you can be sure to get those omega-3s!

### What About Medications?

When breastfeeding, you need to be mindful, just as you were during pregnancy. There are certain medications that are fine to take during pregnancy and others that are not. If you are medicating yourself and feeding your baby exclusively breastfed milk, your baby is getting traces of the medication you're taking. So, don't take any medication without asking your doctors and/or pharmacist if the medication you've been prescribed is safe to take while breastfeeding.

The reason it's important to consult a doctor is that there is not a pat answer for every medication. There are a myriad of factors to take into consideration. Luckily, doctors and pharmacists are well trained and will be able to direct you, but as a mom, you always want to understand the "why" behind the decision.

So, here is a complete list of questions and answers, taken straight from La Leche League that will be considered by the experts when it comes to selecting medication for breastfeeding moms.

**What is the age of the baby?** The younger the baby, the less able he is to eliminate a drug from his system. A full-term newborn can metabolize a drug easier than a premature baby, but is less able to metabolize a drug than an older baby. At about two weeks of age, the full-term baby's liver is mature enough to metabolize most drugs.

**What is the baby's weight?** The more the baby weighs, the less he will be affected by a drug, as drug doses in children are usually calculated by weight.

**How much human milk is being consumed?** A baby who is exclusively breastfed will receive more of a drug than a baby who is receiving solid foods as well. A toddler who receives more nourishment from food than from breastfeeding would receive even less of a drug.

**What is the general health of the baby?** Is the baby premature? Does he have any illnesses or health problems? These kinds of problems could make the baby more susceptible to medication.

**What is the nature of the mother's illness?** It helps to get as much information as possible from the mother regarding her medical problem, including what her health care provider may have said.

**Has the drug been given to infants?** A drug commonly prescribed for infants is usually a good choice for a breastfeeding mother.

**Has the drug been given to other nursing mothers?** A drug that has a history of use by nursing mothers is a better choice than a new, possibly untested drug.

**What is the duration of the drug therapy?** The duration of the drug therapy can affect its compatibility with breastfeeding. A drug considered compatible with breastfeeding when taken for a few days may not be compatible when taken over a long period of time.

**Is the drug short-acting?** A short-acting form of the drug may be a better choice for a breastfeeding mother than a longer-acting form that stays in the mother's system for a longer period.

**How is the medication being given?** A drug given by mouth is less concentrated than one given intravenously. However, a drug may be given intravenously because it is inactivated or not absorbed by the digestive system, so the baby's digestive system would also inactivate or not absorb the drug.

**How well can the baby excrete the drug?** Some drugs accumulate in a baby's system and can potentially build to toxic levels. A drug that is quickly eliminated by the baby is more compatible with breastfeeding.

**Does the drug interfere with lactation?** Breastfeeding mothers should avoid some drugs because they affect breastfeeding itself (the let-down or milk supply).

If you do need to take medication while breastfeeding, be sure to schedule your medicine intake around your nursing so that your baby will only have minimal exposure.

If, of course, it is medically necessary for you to take a medication that poses health risks to your baby, you will need to discontinue breastfeeding.

### What SHOULDN'T I Be Eating?

As Always, Avoid Processed Foods

Just as you always should, stay away from pre-packaged, processed, or fast food. Eating meats, fruits, vegetables, and whole grains will provide you with all the nourishment you need to survive the boot camp-like experience it is to live with a newborn baby.

Although you will produce nutrient-rich milk despite your diet, your baby does get traces of what you eat through your milk. Many people don't think about vitamin D. If you're not getting much vitamin D, you and your doctor will be able to pick up on that through a blood test and may recommend you take a supplement to ensure your baby is getting enough through your breast milk.

If you're a vegetarian, you need to be taking B-12 - a vitamin found in animal-based foods that is important for your baby's brain development.

### What if My Baby is Fussy/Gassy/Colicky – How Should My Diet Change?

The first course of action any doctor or lactation consultant will take for a colicky baby is altering mom's diet.

William G. Crook, M.D., developed what is called the "Elimination Diet" – specifically for breastfed babies that may be sensitive to food in the mother's diet. Of course, you can alter this depending on the severity of your baby's symptoms, but the point of this diet is to eat the least allergenic foods in every food group. Try this for two weeks, since it can take that long for the allergens to leave your system and your baby's.

Dr. Sears' trusted  website on breastfeeding lays out the plan rather simply:

• "Eat only range-fed turkey and lamb, baked or boiled potatoes and sweet potatoes (with salt and pepper only), rice and millet as your only grain, cooked green and yellow squash for your vegetable, and for fruit, pears and diluted pear juice. Drink a rice-based beverage drink in place of milk on cereal or in cooking. Do not yet use soy beverage. Take a calcium supplement. (Rice products, such as rice beverage, rice-based frozen dessert, rice pasta, rice flour, and millet are available in nutrition stores.)

• At the end of two weeks, or sooner if the colic subsides, gradually add other foods to your diet, one every four days, starting with those less commonly allergenic (such as sunflower seeds, carrots, beets, salmon, oats, grapes, California avocado, peaches). Wait a while before you add wheat, beef, eggs, nuts, and corn. Avoid for the longest time dairy products, soy products, peanuts, shellfish, coffee, tea, colas and other beverages containing caffeine, chocolate, gas-producing vegetables (broccoli, cauliflower, cabbage, onions, green peppers), tomatoes, and citrus fruits. Vegetables and fruits are often tolerated in cooked form sooner than in raw form.

• Keep a record of the foods you eat and the problem behaviors; try to correlate baby's fussy spells with what you've eaten in the past day or so. This gives you a clearer perspective and helps you stay objective, which is hard to do when you are sleep-deprived. This is especially important when baby has stayed fussy past four months of age.

• Do not starve yourself. It may feel, the first day or two, as though there is not enough for you to eat; but you can still eat a nutritious diet. You just have to eat more of the "safe" types of food until you determine what your baby can tolerate. Colicky babies usually respond to mother's diet changes dramatically and quickly, often within one or two days. With the older baby who is night waking, you may have to wait longer to see results. Typically, mothers will find that when they change their diet baby may sleep better for a few nights only to start waking again a lot for a few days or a week or so, at which time the sleep again improves. It's important to know this so that you will not be tempted to give up when you think "it's not working." Older babies are often less sensitive to fruits and vegetables in mom's diet (and their own), so at this stage we recommend mainly _protein elimination_ , namely dairy, beef, eggs, chicken, shellfish, soy, corn, wheat, and peanuts (plus any other foods you have learned bother baby). Research has shown that some foreign proteins get into some mothers' milk more than others', and of course some babies are more sensitive to these proteins than other babies."

It's kind of like a big science experiment. Once you've eliminated all the foods suggested above, you can slowly add foods back in and make note of what it is you added that doesn't agree with your baby. It may wind up only being a few foods that you need to avoid, if you keep a detailed journal and pay specific attention to what you're eating.

### Don't Beat Yourself Up

The good news is, even if you're not getting all the nutrients you need, your baby will be well-fed because your breast milk is going to provide your baby with all he or she needs, no matter what you're putting in (or not putting in) your body. Following "The breastfeeding diet" isn't as much about taking care of your baby, as it is about taking care of yourself.

If you're more causal and carefree with your diet and lifestyle choices, you might shrug a chapter like this off. But, once you have a newborn, everything changes. There's no way you will survive sleepless nights and endless screaming spells if you're not getting the nutrients you need to function the best you can.

### Breastfeeding and Weight Loss

Now is Not The Time for Counting Calories

Gay Bearzi, RN, IBCLC, is a lactation consultant at Sinai Hospital in Baltimore. She told  The Bump, "The myth was that you had to increase your calorie intake 500 calories per day to make milk, but we're learning you don't have to eat that much." The reason for that is during pregnancy, your body laid down fat stores (the reason why you gained more weight than just the weight of the baby and your placenta). So, when you're breastfeeding, you don't have to worry that you won't eat enough to produce milk. Just eat when you're hungry.

"How'd you lose that baby weight so fast?" they ask you. And you smile, knowing that your rapid weight loss is thanks to the miracle workout that is breastfeeding.  Women's Health Magazine claims that breastfeeding after you give birth can burn about 350-500 calories per day. That's like one really intense spinning class or a 5-mile run right there – all done from the comfort of your own rocking chair while bonding with your precious new baby. Amazing, isn't it?

"But...my sister didn't lose weight quickly...and she breastfed..."

Some women get frustrated after they give birth. They hear the talk of breastfeeding burning calories and wonder why it's not working for them. Well, to those women, I'd say, just like any exercise program, you're not going to see results unless you are also following a healthy diet as well. Doing the elliptical every day is all well and good, but surviving off of ice cream and Twinkies isn't going to do much for your figure.

### Crash Dieting = Bad Idea

After feeling about as dainty and fit as an obese elephant for the past year, you're probably _very_ ready to return to your skinny jeans and shirts that can't double as potato sacks.

But, here's the thing. Although your body will produce nutritious breast milk for your baby despite variations in your diet, if you are not eating _enough,_ your milk supply could be affected – meaning, your body may not produce enough milk to feed your baby. Similarly, if your diet is heavy on one food group, completely leaving out the others, that can affect your breast milk quality and quantity as well.

You will be amazed how quickly the pounds drop off if you just eat healthy and breastfeed. Now is not the time to restrict calories, though. Just eat what your body needs, relax, and enjoy this short time you get to spend holding your baby in your arms while you nourish him with your own body. It's amazing, really.

### Thirsty as a Camel!

Given the amount of fluid your body is exporting on a daily basis, it is totally normal for you to be extra-thirsty. Make sure you've always got a drink by your side, as you could get dehydrated quickly if you don't drink enough water.

### Make Healthy Foods "Grabbable"

"You look overwhelmed...how can I help?"

Friends and family members will likely say this to you when you are bouncing your fussy newborn on your knee and you may shrug and say, "I... don't know."

Breastfed moms have the difficulty of not being able to accept much help. You can't really rely on your mom or partner for late-night feedings when the baby is drinking out of your body.

So, your support system may not be able to be of much use when it comes to feeding your new baby, but here's an idea. Have them prepare healthy snacks for you that are grabbable (a word we at SmartMom invented that means "easy for mom to grab"). Grabbable snacks are a new mom's best friend. You will have so much feeding and pumping and laundry and changing diapers to do, it will be very tempting to grab whatever food is around, but usually, the most grabbable foods are not the most healthy or nourishing.

Have your loved ones help you out by cutting up raw veggies, fruits, nuts, and cheese sticks and putting them into zip lock bags or Tupperware containers that you can easily grab out of the fridge. Foods that are healthy AND "grabbable" are a new mom's best bet.

# The Importance of the Breastfeeding Latch

By Carly Hill

Babies are born every day. They cry. They poop. They spit up. They drink milk. That's what they do. You'd think that something as natural as breastfeeding would come easily to mother and child, but it can be much trickier than you would expect.

When you take a look at all the problems associating with getting breastfeeding going, they are almost all about issues with getting the baby to latch properly.

The breastfeeding latch is very important because it allows your baby to drink effectively – and to draw enough milk out of the breast. For the mother, a good latch is key to a pleasant breastfeeding experience.

A baby who suckles with an improper latch will cause bleeding, raw, chafed nipples.

It is common for mothers to give up hope and throw in the towel saying, "Breastfeeding just isn't for me." But, if you can be patient and determined enough to do everything it takes to get your baby to latch, breastfeeding should prove to be a wonderful blessing for you and your child.

### Timing is Everything

Many mothers make the mistake of not trying to nurse immediately after birth. Ybreast.com explains, "Babies are born with the instinctive drive to locate the breast _immediately_ following birth. They have certain involuntary reflexes that encourage them to crawl – yes, _crawl,_ toward their mothers' breast. Within minutes of being born, babies are stretching and elongating their tongue muscles, rooting their heads and smacking their lips."

A baby who is laid on his mother's chest immediately after birth has a better chance of latching right away.

Now, if you wait too long, you might lose your window and have a much harder time getting your child to latch on. Those reflexes that your baby is born with start to disappear just two hours after birth.

When my daughter was born, the nurses gave me the option of either letting the baby try to nurse right away or after she'd been cleaned up. I wish I had tried right away because it took me and my daughter 9 or 10 days to get the latch down. During that time, I pumped every hour, trying and failing to get my daughter to breastfeed.

Many hospitals will give newborns pacifiers and bottles immediately, which really messes with the latching process. Bottle nipples are easier to suck than the breast, so if your baby is exposed to synthetic nipples from the get-go, a proper latch will be more difficult to achieve.

I read about a woman who gave birth to her baby and then watched as the nurses whisked her baby awake to weigh her and measure her. Just in the short amount of time it took the nurses to check her out and clean her up, by the time she returned to Mom's arms, she lost interest in the breast.

Sometimes, it is impossible for you to nurse immediately after birth. Maybe you had a difficult labor or a C-section, or your baby was in distress.

This is not the end of the world. Just do your best to stimulate your nipples immediately after the baby is out. Apparently, the way our bodies are designed, if the nipples aren't stimulated after birth, your body will think the baby didn't make it. Producing milk will be more difficult if you don't stimulate your nipples – either by hand or with a breast pump.

Even if you don't feed immediately, you can still get it.

I pretty much did everything wrong. I allowed the nurses to give my daughter a pacifier and even a bottle (I think) before I got my chance. But, with the help and guidance of a lactation consultant, I was able to breastfeed successfully for 13 months.

### So, How Do I Know If My Baby is Latching On Properly?

You will _know_ if he isn't. It will hurt. Breastfeeding isn't supposed to hurt. Here are some signs of a good latch, listed on  EveryDayfamily.com:

• Cheeks are rounded

• Mom can hear the baby swallowing

• The ears move

• Baby falls off the breast after feeding, or is very relaxed after feeding

• On the contrary, here are some signs of an improper latch:

• Baby making a clicking or smacking noise

• Dimpled cheeks

• Nipple feeling like it's rubbing against the roof of the baby's mouth

You may think (or even be told) that your nipples are just sensitive and that the pain will subside, but if you feel any pain after the first few seconds of breastfeeding, there is probably a problem with how your baby is latched on.

### Don't Be Intimidated

Full term babies are born with an innate ability to breastfeed as soon as they are born. The survival instinct kicks in right at birth and although it might not be _easy_ at first. Your baby _will_ get a handle on it.

Babies know how to breastfeed, even while they are in the womb – somewhere around 32 weeks gestation. Rooting is also an instinct that will come naturally to your baby.

Did you notice your nipples darkening and expanding during your pregnancy? And, what about that weird dark line running up your stomach? As weird looking as those symptoms are, they serve a purpose. When your baby is born, he is actually capable of pulling himself up your body, following the dark line, to the dark nipples to suck and survive. It's incredible.

Practice makes perfect. What might start off awkward and uncomfortable feeling will soon feel completely natural and painless. So, don't fret. Don't overthink it.

Some babies are faster learners than others. Typically, a baby who is born full term and naturally without a difficult labor or any drugs or epidurals, will learn the proper latch earlier.

### How Can I Help My Baby Latch?

First off, don't rush your baby. As a new mom, it's unnerving and stressful to hear your baby crying. A lot of moms get so distressed when their baby cries that they immediately start shifting their baby's positions and trying things. But, babies need time. If your baby is rooting and clearly hungry, leave her at your breast and let him struggle a bit. It's hard to watch your child and you just want to _fix_ it, but latching on is a learned skill and you need to give your baby a chance.

That being said, positioning is key.

If your baby is latched on correctly, most of your areola should be in your baby's mouth. Your nipple should go all the way to the back of the baby's mouth.

Dr. Sears recommends the cradle hold. Here are some practical tips on how to get your baby into the proper cradle hold from  AskDrSears.com:

• "Place one or more pillows behind your lower back, and/or shoulders so that you are comfortable and relaxed.

• If you're in bed, put pillows under your knees.

• You'll need at least one pillow in your lap to bring baby up to the level of your breast, and another under the arm that will support your baby as he breastfeeds.

• If you are sitting in a chair, use a foot stool or something else to raise your lap so you don't have to strain or lean over to get your baby closer to your breast."

During my first two weeks of breastfeeding, I couldn't figure out why I was having so much trouble. So, I hired a lactation consultant to come to my house. After one hour, I was a breastfeeding pro.

The lactation consultant showed me a handful of techniques – all involving how to hold the baby, really. It seems simple and as a mom, you might feel foolish. _How hard can holding a baby to my chest be?!_

It's not _hard_ once you know what you're doing, and of course it's much easier to have someone _showing_ you what to do, rather than just reading about it. But, if you're looking to give it a good try before you hire a professional – here a couple things to keep in mind.

When offering the breast, follow these tips from Dr. Sears...

"First, squeeze out a few drops of colostrum or milk to moisten your nipple. Then, cup your breast with your hand, palm and fingers underneath and thumb on top. Keep your fingers clear of the areola, the darker area around the nipple, so that baby can take a big mouthful of breast. If your breasts are very large, use a rolled-up hand towel under your breast to support its weight."

Wait until your baby's mouth is open very wide before guiding him onto the nipple. If the baby doesn't open his mouth automatically, Dr. Sears suggests you "tickle baby's lower lip to encourage her to open her mouth wide –really wide." Your baby's top and bottom lip should be turned out.

### Tips from Veteran Breastfeeding Moms

Instructions and even tutorial from a consultant are invaluable, but sometimes some of the most helpful advice comes from other moms who have been there, done that.

Here are just a few tips from regular moms like you. You can read all of them at  BabyCenter.com.

" – **Don't watch the clock** to see how often or how long your baby is nursing. Instead, go with your instincts. If your baby is rooting around or crying, then feed him or her – even if you just did. – Gina Locke, Grapevine, Texas

\- **I'm a pediatrician mom** of a 3-year-old whom I breastfed for eight months. My son was extremely hard to start: Despite making our first attempts (unsuccessful) in the first hour and knowing what to do, it took almost two days to get him latched on. In the interim, we finger-fed with an SNS (supplemental nursing system) and glucose water while I pumped to get my milk supply going. The SNS was a lifesaver. We finally hooked it to my breasts and were able to get him latched on by the third day. – _Dara Hogue, Cupertino, California_

_-_ **I've been solely nursing** my baby since birth and now, at 9 weeks, she's a big healthy baby. I had very sore latch-ons at the start, and I found that if I stayed ahead of her intense hunger I was better off. I would check on her around the time I thought she would be waking to eat and watch for tongue sucking and lip-smacking in light sleep. If I put her to the breast when she showed early signs of hunger, she wouldn't suck as hard as when I waited until she was fully crying and really hungry." – _Kathy Kent-Knurek, Chicago_

\- **When I had my daughter,** I knew I wanted to breastfeed. Unfortunately, she didn't latch on right away, so I began supplementing with formula. Hospital staffers tried everything from round-the-clock attempts to pumping and inserting feeding tubes in the baby's mouth while I tried every nursing position known. The baby knew how to suck, but she just wasn't getting the knack of it. Finally, we tried the plastic breast shield. My baby was able to suck the large plastic nipple and draw the milk rather than search for my small nipple. I had visions of using the shield from then on, but luckily I lost it and was forced to teach the baby to take my own nipple. I had to use a syringe to "pull" the nipple larger, but in time, thanks to the baby's suckling, my nipples conformed. The rewards for not giving up have been great! – _Alison O'Donnell, Pawtucket, Rhode Island"_

* * *

After reading all these accounts, here is what is clear. Getting your baby to learn the proper latch is sometimes harder than you might anticipate. But, the good news is there are many things you can try – whether it is use of supplies like a nipple shield or syringe, or visits with a lactation consultant.

Those first few days after birth are an easy time to give up, but mothers who stick to it and don't give up reap the reward of successful, painless nursing.

Getting your baby to latch is _the_ hurdle to overcome. Breastfeeding pain is almost always due to an improper latch. Once you get the latch, you'll feel like a pro. Give yourself and your baby time. Don't give up. It will be well worth it.

# Breastfeeding Positions

By Kristin Miller

**Breastfeeding begins soon after you welcome your little one into the world.** After all the waiting, planning and preparing, your baby has arrived! The planning and preparation doesn't stop once the baby is born. Once you have your little one in your arms, their need to feed will closely follow your first bonding moments. Breastfeeding will continue to foster that bond. In the beginning, the goal is to simply get the hang of breastfeeding. You will most likely be focused on fostering your newborn's latch, checking for the correct sounds and motions, and monitoring how you feel during the experience. Another important detail to focus on is breastfeeding position. There are many positions to try for different reasons. There is no "correct" position; it is a very individual preference. Just like parenting, finding the right position will be a case of trial and error! The keys to finding the right position for you are finding the right support material, examining your needs, examining your baby's needs, and ultimately seeing what works.

**Breastfeeding support materials are crucial for new moms.** You probably registered for some breastfeeding supports, and that's great! If you are delivering in a hospital, these supports should be part of your packing list. Although the hospital will provide pillows to keep you comfortable, most breastfeeding support materials are extra firm to provide optimal support. It may be cumbersome to pack it for the hospital, but keeping you comfortable post birth is an important thing to do. I had an emergency C-section after going to the hospital to be monitored for dehydration, and we didn't think to pack my breastfeeding pillow because we didn't think the baby would be born yet! When my husband went and got it the next morning, breastfeeding became so much easier with the pillow designed to assist and support me. There are many nursing pillows on the market today; the choices seem endless! Below are some of the top rated pillows by Mommy Edition for you to consider when choosing what pillow will best fit your needs. (Source mommyedition.com/top-rated-nursing-pillows)

The New Boppy Nursing Pillow

This pillow is the name most synonymous with nursing pillow. Boppy has to be the most popular brand out there, recognized by moms and registry purchasers alike! They redesigned their original pillow to give it the extras that moms need. This updated version has a soft and hard side, providing you with whatever level of firmness you need. It is taller, enabling you to simply use the pillow while nursing where you may have once needed to prop additional pillows underneath. Because of its C shape, it can also be used for propping up the baby, tummy time and neck support for you while bottle feeding or relaxing. The main downside is that the cover is not removable, so in order to wash it the whole pillow must be washed.

My Brest Friend Deluxe Pillow

This pillow has some great features for both mom and baby. A great feature for mom is built in lumbar support. Moms often have poor posture during nursing, and this pillow helps prevent that! The storage pocket is an excellent addition, providing space for a bottle of water, cell phone, lotion or whatever you need close at hand while feeding. Its firm, flat design keeps babies at an even level, preventing them from shifting forward or backwards. This affordable option also has a model for twins, making it a great choice for moms of multiples. Smaller petite women may find it to be too bulky, so try it out at a store before choosing this as your breastfeeding pillow.

Luna Lullaby Bosom Baby Pillow

This is the largest pillow in this list. It is ideal for curvaceous moms, C-section moms or mothers who plan to nurse for more than a year. It has a removable cover making it easy to clean. This pillow can also be used with multiples. In addition to being a breastfeeding pillow, the Luna Lullaby Bosom Baby Pillow can also be used by mom as a maternity sleeping pillow or for neck support while sitting. Some would say the pillow is too bulky for their taste, or that the fabric is too warm. As stated previously, testing out these pillows beforehand will help you make the best decision for you.

The Nesting Pillow Organic Nursing Pillow

If you are trying to keep your items organic, this is the nursing pillow for you! This pillow, which feels similar to a beanbag, is made with organic cotton and buckwheat hulls. Since it is filled with buckwheat and cotton, the pillow does not cause babies to overheat. As with other pillows, The Nesting Pillow has multiple uses including being effective for C-section moms, back and neck support for mom, tummy time, and assisting babies to sit up. Although the cover can be removed for washing, this pillow's cover only comes in white. Babies come with lots of stain potentials! This is also an expensive pillow, which can be tricky to master, so consider saving the receipt in case you decide it's not the pillow for you.

San Diego Bebe Twin Eco Nursing Pillow

This pillow is ideal for moms of multiples. It is large enough to support two babies at one time with a firm pillow with just the right amount of support. The top's angle allows for better latching, a great feature for new moms and babies alike. Some models even come with back support and a built in nursing cover! This pillow also has a storage pocket, which is essential for moms who will most likely have both hands taken up. The covers are machine washable, but come in limited color options. Some users say it loses shape in less than a year, so be aware that the investment in this pillow may have to be made again if it is the right pillow for you.

My Brest Friend Inflatable Travel Nursing Pillow

If you plan on traveling with a young baby and do not want to pack a bulky nursing pillow, this is a great addition to your registry. This inflatable pillow travels well due to its lightweight design. The built in lumber support is a great feature for moms after hours of traveling. The cover is machine washable, allowing you to rid any germs easily. Its low price makes it a strong consideration if you would like to use the leftover suitcase space for some extra onesies! You will have to blow it up before using, and most likely refill it after a few uses, just like an air mattress or inflatable tube.

**As was stated previously, try out your pillow beforehand.** Read the manual or watch YouTube videos to see if you can get the hang of setting up the pillow on your own. Chances are you will not always have assistance when you need to nurse your baby. See how easy it is for you to maneuver the pillow with one hand. If you find one that you like that isn't on this list, try it out! These were just a few suggestions to help you comfortably get your baby into position to feed.

**There are many breastfeeding positions for you to choose from.** It's not like you see in the movies where all the moms hold the baby the same way and all is well. Breastfeeding positions are not just about your comfort, they can help with how effectively you breastfeed your baby. If your baby doesn't seem to be eating well in one position, try another! You may find yourself changing positions because of your comfort, to support your baby's feeding needs, or because of your baby's growth. The following are the top positions according to the popular breastfeeding group La Leche League. (Source: http://www.llli.org/faq/positioning.html)

**Laid Back Breastfeeding.** This position is exactly like it sounds! In this position, the mom lays back on some sort of support to be slightly elevated. The right amount of elevation will allow the baby to be on top of you without the danger of falling off. With the baby's face toward you, allow the baby to be in any position comfortable; this could include stomach to stomach or cradling the baby's back. The baby's cheek should be touching your breast, promoting rooting and eventually latching. This position creates a great opportunity for skin to skin during nursing. Skin to skin would be especially helpful if a baby is irritable when it's time to nurse.

**Cradle Position.** This is the most common breastfeeding position, often seen on movies, ads and television as the normal breastfeeding position. It is a good position to use for newborns because mom offers support and can clearly see the extent of the baby's latch. The baby lies across your lap as you cradle them on their side. For this position, baby should be at nipple height, so use that handy nursing pillow! The baby's head should be in your forearm while your inner arm and palm support the baby's back. If you are doing the position correctly, there should be a straight line from the baby's ear shoulder and hip. This is an ideal position for moms who give birth vaginally. C-Section moms may have difficulty putting the baby on their lap due to their healing incision.

**Cross-Cradle Position.** This is a hybrid of the Cradle Position, and is also a good choice for the early days of breastfeeding. Contrary to the cradle position, your opposite arm supports the baby's neck and back with the support of a pillow (For example, if you are feeding on the right breast, your left hand would support the baby). Your fingers cup the baby's head while your palm supports the baby's back, essentially creating a second spine. In this position, wait until the baby opens its mouth then move the baby up to your breast. This is a good position for babies who are, well, lazy! Some babies take longer to come out of their sleepy newborn state than others, and getting them to latch may be challenging. The Cross-Cradle Position can help you control the baby's latch. If you find that you need to give your baby a little extra help to start feeding, blow on their face, get them naked, or wipe them with a cold washcloth. This position is only using one hand, so your other is free to stimulate your baby to get them to latch.

**Clutch/Football Position.** Imagine how a NFL player running towards the end zone holds their football: that's this position! To do this position correctly, cup your baby's head with your hand so he is facing you and his mouth is toward your nipple (For example, your right arm supports the baby to feed on your right breast). As always, use a pillow to support the rest of your baby's body. Their legs will go behind you under your arm. Make sure their heels face the ceiling; this prevents them from launching themselves during the feeding. This is a good option for C-section moms, as it keeps the baby away from the healing incision.

**Side-lying Position.** This position is a tired mom's bread and butter. In this position, you and your baby will lay on your sides while facing each other. For added support for your baby, place their head on your forearm to hold them close and prevent rolling away. Another additional measure to prevent rolling away is to place a pillow or towel behind the baby's back. Keep in mind that the baby's ears, shoulder and hip should be in one straight line for optimal milk consumption. C-section moms beware: you may think you want to do this in the middle of the night, but check yourself when the baby wakes to see how your body is feeling. Turning sideways could put added strain on your stitches; so holding off until your stitches are clear may be a good idea.

**Finding the best position means finding the most comfortable position for you** _and_ **your baby.** Babies need help in positioning too! Despite using a nursing pillow, babies will still need your help getting ready to feed. There are many red flags that may come up between the two of you that will cause you to try out new positions.

**Position red flags for mom.** These will be easy for you to notice, since you are evaluating yourself! Monitor how you feel while feeding. Now, breastfeeding may be painful at first, but your breasts should not be in pain for the entire feed, nor should the rest of your body be in pain for the entire feed (For more information, see "Breastfeeding Pain" section). If your breasts or nipples are in pain for long periods of time, consider trying a new position to assist your baby's latch (For more information, see "The Importance of the Latch" section). There will be an understandable amount of discomfort when you begin breastfeeding, as you most likely will not be monitoring your posture at one o'clock in the morning! However, if you are in constant pain in your arms or back, consider trying a less strenuous position. Also, try adding more pillows if you feel the position is working for your baby but your body needs more support. My son experienced a growth spurt and gained a pound in one week! That pound seemed to magnify my back pain, and I changed positions to alleviate the strain. This has helped me build up strength as he has continued to grow at rapid fire pace! Remember, if you or the baby are uncomfortable, you will probably have a difficult time while breastfeeding. If you can't seem to find the right position where you feel comfortable, considering contacting a lactation consultant to help you figure out what will work best for you (For more information, see "Lactation Consultant" section).

**Position red flags for baby.** For the first few weeks of your baby's life, you are getting to know each other. Your new relationship is in a warp speed motion of becoming intimately acquainted with one another while breastfeeding. Although it can become mechanical, especially during the third middle of the night feed, be sure to monitor your baby for red flags. Babies general let you know when they are upset, but newborns may not know something is wrong. First, be sure their nose is clear in the position you have chosen. Babies use their nose to suck, swallow, breath, and if it is covered it can be detrimental to eating _and_ breathing. If your breast is too large for your baby and their nose is continually covered, push your finger down on it near your baby's nose to ensure clear passage. If this doesn't work, try a position where your breast will not be pressed downward on your baby's mouth and nose. A big red flag is gulping and choking. This is most likely caused by a forceful letdown, channeling too much milk at one time to your baby. Another read flag is an extra fussy baby during the feeding. This could be for many reasons, including reflux, food allergy, gas, or too much milk at once. Once you have ruled out reflux, gas, or an overabundance of milk, consult your doctor concerning potential food allergies or sensitivities. If you or your doctor believes that the baby's irritability is related to one of the other red flags, the following are some positions that can be helpful when trying to help your baby be in a comfortable while eating.

**Best position for a baby with reflux or frequent spitting up.** Babies who frequently spit up or have reflux have many of the same symptoms and recommendations for breastfeeding. It is recommended to feed babies with reflux and frequent spitting up often, as they may not be able to keep their food down to process it. Reflux can be magnified and spitting up can be caused by forceful letdown combined with a position that doesn't meet the needs of your baby. The Laid Back breastfeeding position would be a great position for babies with reflux or frequent spitting up (Source kellymom.com/health/baby-health/reflux/). As the baby gets older, it may be harder to continue this position as the baby grows. An adjustment could be made to keep your baby upright while breastfeeding. To do this, lie on your back and allow the baby to lie on you, arms on your stomach and chest, hands touching your breasts. The baby will look like she is kneeling to eat. This is recommended for babies with good head control, allowing them to turn away when they are finished. Another option, which is good for using in public, is seating the baby upright and next to you facing toward your breast. Support their head as they lean in to feed. (Source  kellymom.com/bf/got-milk/supply-worries/fast-letdown/#positioning) It may not make your baby stop spitting up or rid them of reflux, but it will help both mom and baby enjoy nursing with less discomfort.

**Best position for a gassy baby.** Gassy babies are not happy after breastfeeding, and for good reason! They don't know how to express the digestive pain that they are going through. There are many things you can do to help a gassy baby. A few options include monitoring "gassy" foods you may eat that could contribute to the problem, burping the baby often, keeping the baby upright after feeding, and giving the baby a stomach massage about thirty minutes after feeding. When it comes to the best feeding position for a gassy baby, it is recommended that an upright position will allow a smooth flow of the milk to your baby and aid in digestion. The Laid Back breastfeeding position would be perfect for this, making sure that you elevate yourself to almost completely sitting up and laying your baby on her belly side down. (Source breastfeeding-problems.com/baby-gas-pain.html)

**Best position for forceful letdown.** Forceful letdown is when the milk supply drops into your breasts and is overwhelming to your baby. There will be choking or spitting sounds if this is happening for your little one. Possible side effects were listed above, showing that adjustments in position are needed for forceful letdown. As stated previously, any upright position will help the milk go down smoothly. In addition to having your baby in an upright position, consider ways to help your baby with forceful letdown. Pumping for a minute or two before feeding will help get some of the explosive amounts of milk out, helping your baby avoid the "opening of the floodgates" effect. It is also suggested that you should allow the baby to eat from one breast until they pull away. If they are filled up from one breast, pump the other breast to alleviate engorgement. Trust me, freezing extra breast milk is only a good thing! Your baby will catch up to your supply as his stomach grows. (Source kellymom.com/bf/got-milk/supply-worries/fast-letdown/)

**There are a few cautions you should be aware of when it comes to breastfeeding positions.** Whether you feel like a veteran or are barely staying afloat from the on demand feeding, there are two breastfeeding position cautions I want to leave you with.

**Don't fall asleep.** This seems like a silly thing to say, but when you are in the trenches of feeding at 11:00PM, 1:00AM, 2:30AM, 4:00AM and so on, you are tired. The easiest solution would be to feed the baby in the side-laying position. My word of caution is: know thy self. If you fall asleep easily, be extra aware of the potential that you may fall asleep while feeding your baby. If this happens, you may not be aware of covering the baby, pushing the baby, or the baby rolling out of bed. I personally fall asleep within seconds, so I never used the side-laying position. I caught myself falling asleep in my glider chair while breastfeeding, so I stopped using that to nurse in the middle of the night. I made sure to put myself in a position where I was awake as possible because I was exhausted. You can set an alarm on your phone as a precaution to wake you up if you think you may fall asleep.

**Continue to use support as you continue on your breastfeeding journey.** Breastfeeding pillows are not just for newborns! As your baby grows, support is still important for you both. I personally got lazy about breaking out my nursing pillow, especially at 5:00AM, and developed tendinitis in my wrist due to overusing it to support my baby. If you lose the support in your breastfeeding positions, you may run the risk of injuring or straining your neck and back as well. Continue doing what works, no matter how cumbersome the setup is! (For more information, see "The Perfect Breastfeeding Setup" section).

**Your breastfeeding positions will become part of your everyday life.** Remember that these special moments will be even more enjoyable when both mom and baby are comfortable.

# The First Few Days

By Kristin Miller

### Get ready for a great big adventure!

Having a baby is just the beginning. If you have chosen to breastfeed, that adventure will add an enriching experience to raising your baby. Believe it or not, your baby will begin the breastfeeding process shortly after being born, continuing the bond of mom as the food provider. Here is what you can expect in the first few days of breastfeeding.

### What are my options?

It is good to know what you as a mom would prefer to do with breastfeeding. You could choose exclusively breastfeeding, a combination of formula and breastfeeding, or strictly formula. In this article, we will discuss situations where the mom is exclusively breastfeeding, but information discussed will be useful to moms who also choose to do formula and breastfeeding or strictly formula. Exclusively breastfeeding means that your child will only be taking in nourishment from you. This is an important decision to make your medical team aware of if you give birth in a hospital to avoid any confusion.

### The Initial Feed:

What you can expect right after a vaginal birth

There will be a bit of chaos, pain, excitement and joy following your birth. There will be a lot going on: a baby screaming, possibly the gender will finally be revealed to you, and tears of joy between you and your partner. Babies are usually placed on the mom's skin after birth to regulate temperature, calm them and create the bond between mom and the baby that has been inside for so many months. After the baby is taken to be cleaned, weighed, and tested, mom will receive her bundle back for the initial feed. This is a beautiful moment to be shared between mom and baby, the moment when they connect in the outside world in a very real way. Incredibly, babies have an instinct to eat. Some may need more assistance than others, but if they are hungry, they will learn quickly. Breastfeeding USA suggests a series of steps to follow for babies learning to latch: (Source  breastfeedingusa.org/content/article/baby-led-latch-how-awaken-your-babys-breastfeeding-instincts)

• Aim for a calm beginning.

• Use skin to skin to reconnect with your freshly cleaned newborn. Give your baby kisses and speak reassuringly.

• Follow baby's lead.

• Look for cues from your baby that they are ready to eat.

• These cues usually include rooting, or bobbing their head around your chest, or energetically moving around. This shows that your baby is hungry!

• Support the baby while latching. Support your baby as you guide them to your chest, allowing the baby's face to brush against your breast. This will be a guide as your baby finds it's way to latching on.

What you can expect right after a C-Section

The experience with a C-section is a bit different. You will also experience a bit of chaos, pain, excitement and joy following your birth. However, after meeting your bundle of joy, there is still work to be done on you. You will remain on the operating table for your medical team to complete the procedure, around thirty minutes or so. You will then be led into recovery, where you will get to enjoy the initial feed.

### Possible Latching Scenarios:

A good latch is the goal for all moms

Although it seems fairly easy: put the baby up to your breast, baby opens mouth, baby eats, it's not always that simple. If you are one of those whose baby seems to pick up breastfeeding right away, congratulations! Although having a good latch means, "breastfeeding is not supposed to hurt", the first few days of feeding may leave you sore. Your breasts, possibly already tender from pregnancy and hormones, are now changing to become the life source for your baby. The initial latch in a feed, even a good latch, may take your breath away with a pinching feeling. This will only go away with time as your breasts get used to breastfeeding.

A good latch

According to AmericanPregnancy.org, These are the signs that indicate that your baby has a good latch:

• Your baby's tongue is seen when the bottom lip is pulled down.

• Your baby's ears wiggle

• There is circular movement of your baby's jaw rather than rapid chin movement.

• The baby's cheeks are rounded

• You do not hear clicking or smacking noises, like they are giving you kisses.

• You can hear your baby swallowing or gulping.

• The baby's chin is touching your breast.

• When your baby comes off the breast, your nipple is not flattened or misshaped.

• Any discomfort ends quickly after the baby initially latches on.

• Your baby ends the feeding with signs of satiety/satisfaction. It is often joked that babies look "milk drunk", relaxed and satisfied.

(Source americanpregnancy.org/first-year-of-life/latch/)

A bad latch

If your baby has a bad latch, always unlatch and attempt to latch again properly. To unlatch a baby, put your finger in the corner of their mouth and remove their mouth from your breast. Using your finger breaks the suction and saves your breasts from further trauma. According to  WhatToExpect.com, these are the signs that indicate your baby has a bad latch:

• You feel nipple pain while breastfeeding. This doesn't mean the initial pain when your baby latches due to sensitivity; this is pain due to the baby possibly chewing instead of sucking. I have heard from countless new moms that they let painful breastfeeding go on for too long, creating cracked nipples and soreness that could have been avoided with proper latching.

• You hear clicking or loud sucking noises.

• Your baby grabs on to any part of the breast to eat, missing your nipple.

For more information, see the section "The Importance of the Latch" and "

### Post Birth Help

There are different kinds of help a breastfeeding mom can receive after having a baby

Do not be afraid to ask for help, it is what you are paying for! Although you may feel confident about your breastfeeding abilities, or don't want to bother the hospital staff, getting assistance in the beginning of breastfeeding is priceless. Here are the people who can be of assistance to you as you begin your breastfeeding journey.

Lactation Consultants

You should become best friends with the lactation consultant. Every hospital has one, so request seeing one as soon as possible. Make sure you see the lactation consultant who has IBCLC (International Board of Lactation Consultant Examiners) after their name. This ensures that this individual has been medically trained, performed 500 supervised clinical hours, and passed an exam. I was fortunate that my son latched on immediately and never struggled, but I made sure that the lactation consultant came to see us in the beginning and end of our hospital stay. She confirmed that my son was doing a great job, but offered advice on alternate positions to make breastfeeding more comfortable for me. Please see the Lactation Consultant section for more information. (Source: http://www.second9months.com/what-does-that-mean/)

Nurses

Nurses are often trained in lactation skills. Find out what your hospital's policy is regarding nurses certifications. My own hospital required all nurses to take a lactation course, ensuring that each one of them was able to offer me assistance when needed. Nurses can also help with adjusting your bed, getting you extra pillows, and ensuring you have privacy when needed. Although they are extremely helpful, remember that a lactation consultant has received extensive training in this specialized area and is best equipped to assist in the challenges of learning to breastfeed.

Doctors, midwives, and doulas

Although these people are trained to assist with birthing, and may be familiar with breastfeeding practices, they are not trained experts in this field. Seek out a lactation consultant with any breastfeeding questions.

For information, see the section "Lactation Consultants".

### Colostrum and Milk

Colostrum is the "first milk" you produce for your baby

It is yellowish color, not the typical white milk you imagined. That's because you are feeding your baby colostrum, special milk that is low in fat but high in carbohydrates, proteins, and antibodies that your baby needs. Colostrum helps your baby enter the real world, providing it with protective nutrients as they transition to eating. (Source lalecheleague.org/faq/colostrum.html)

Once your milk comes in, you'll know it!

Generally colostrum switches over to milk anywhere from two to five days after giving birth. Your breasts will noticeably increase in size, possibly leak, and feel extremely heavy. Your baby will be eating often, and your body is ready with plenty of milk. Once you get your milk in, your baby may want to eat more often. (Source  kellymom.com/bf/concerns/mother/when-will-my-milk-come-in/)

Worried your milk has not arrived?

I was worried on my fourth night in the hospital that my milk wasn't in yet. My son was 6 pounds 5 ounces at birth, and the doctors were discussing supplementing with formula if my milk didn't arrive soon. My nurse offered to help me by giving me a breast pump in between feeds to stimulate production. Using a breast pump is also beneficial if you are experiencing latching issues by telling y our breasts that someone needs nourishment! Even if your baby has to supplement formula for a bit, continue to use the pump. It prepares your body to produce enough milk to meet the demands of feeding a newborn.

### Breast Care Products

Treat your breasts with extreme care

In the first few days of breastfeeding they are working harder than ever and need to be cared for! Early care will help keep you breastfeeding as comfortable as possible. Here are a few must have products while breastfeeding:

• Lanolin by Lansinoh (Link lansinoh.com/products/hpa-lanolin). If you get one product for breastfeeding, this is the one to get! This ointment helps soothe dry, cracked or sensitive nipples. It is safe to leave on your breasts, no need to clean off before feeding. My philosophy was to stay ahead of any potential issues, so I put Lanolin on after every feed in the initial weeks. Although I experienced mild soreness and cracking, I'm convinced it would have been worse if I didn't continually apply this product.

• Breast pads. You will probably experience some leaking, especially in the early days. Using breast pads create a cushion between your breast and your bra. There are reusable and disposable pads available.

• Nursing bras. These undergarments not only help make breastfeeding easier, it helps support your ever-expanding chest. A great addition to your nursing bra collection would be a sleep bra. These bras help you stay comfortable with minimal support so you can enjoy the sleep in between feeds.

• Cooling/Heated compresses. A great way to comfort sore breasts or nipples is through cooling or heating pads. Cold compresses can help relieve engorgement, swelling, or pain. Heated compresses can help relieve mastitis or plugged ducts. You can provide your own from home, either a bag of frozen vegetables or a heated towel will do the trick. Lansinoh also makes a fantastic product that can be used as a cold or heated compress called the Thera Pearl 3 in 1Breast Therapy (Link  lansinoh.com/products/therapearl-3-in-1-breast-therapy).

### Breastfeeding Nutrition:

You may be ravenous in the first few days of breastfeeding

If you had a hospital birth, it doesn't help that the hospital food may not be what you want! Communicate with your spouse, family and friends to ensure you have food that you will enjoy and eat. Breastfeeding takes a lot of energy and calories, so food is fuel for you! Eating snacks in between meals will help you keep up your strength. Here are a few easy snack choices to have on hand at the hospital and at home for the first few days of breastfeeding:

• Trail mix

• Whole Grain Cereal

• Fruit

• Vegetables and hummus

• Fruit Popsicles

• Yogurt

Hydration is also extremely important as you begin breastfeeding

Breastfeeding can dehydrate you quickly. As a new mom, it is easy to forget to eat, but it is even easier to forget to drink! A great method to ensure you're drinking is to have a refillable water bottle with you at all times. Drink while nursing and aim to finish the bottle each time you nurse. Hydration while breastfeeding will probably mean that you have to drink even if you are not thirsty. Here are a few alternate options for hydration if you are not a water drinker!

• Sparkling water

• Sports drinks – Do not replace all your water with this, as it is high in sugar.

• Coconut water

• Juice (not from concentrate)

• Coffee and Tea – Try alternating caffeinated and decaf options

For more information, see the section "The Breastfeeding Diet".

### The Power of Stress and Rest

There are many factors that can affect your milk supply in the early days of breastfeeding

One factor you can control is your stress level. Another factor you can control is the amount of rest you are getting. These two factors are ultimately interrelated. Here are a few reasons you may be stressed or lacking rest, and how to combat them in the early days of breastfeeding.

What to do when it hurts

There are multiple reasons you could be in pain right after giving birth, whether from a vaginal birth or C-section. You could also be in pain from the early stages of breastfeeding. All these types of pain can cause you to stress, ultimately affecting your recovery, milk supply, and breastfeeding. If you are in a hospital, ask the medical team for advice on controlling your pain, whether it is cold or warm compresses, pain medication, or assistance with breastfeeding from a lactation consultant. By lowering your pain level, you will allow your body to continue recovery and function, as it should without adding the stress of dealing with pain. After my C-section I tried to take half of the dose of the prescribed pain medication at first. That was not a smart decision for me, as I could not last the amount of time before I was able to take the next dose due to the level of pain I was in. Discuss with your medical team all alternatives and choose one that you are most comfortable with to alleviate your pain. Your goal is to be as comfortable as possible so you can breastfeed to the best of your ability. For more information, see the section "Breastfeeding Pain".

Sleep when the baby sleeps

You have probably heard this multiple times, and you have probably even said it to other moms! It's easy to say it, harder to do it. When in the initial stages of recovery and breastfeeding, your rest is just as essential as your nutrition. Your baby also sleeps a lot at this point, albeit it is not consistent. Try to get in some quality naps while the baby rests. If you're in the hospital, try to take advantage of the nursery and let them care for your baby for a while. I did this at night and it was a great decision for me. My son was monitored by nurses while I slept, and when he was hungry they brought him to me. When I tried having him in the room with me at night, he made so many "sleeping noises" that woke me up and I couldn't fully rest. When you're home, it can be awkward when people say, "go rest! I'll hold the baby!" However, this is a gift that should be taken advantage of. In the early stages you may get an hour, give or take, of downtime between feedings. If your baby is resting or someone is willing to take over for a bit, take the time to refill your energy tank. Your breastfeeding self will thank you.

Low stress feeding

Generally, breastfeeding moms fall into two categories: those who care and those who don't care about breastfeeding in front of others. I thought I was going to be the type that cared, but when there's a crying hungry baby, I ended up throwing "modesty" to the wind! I had a friend (And fellow mom) visiting me in the hospital who opted to leave the hospital room when I had to feed my son. She said she wanted to give me privacy, which was priceless as I was two days in to breastfeeding! However, some visitors may not understand the frequency of feeding, and how important it is to get in a groove in the beginning. If you are stressed by breastfeeding in front of others, your baby knows it, feels it, and will react negatively to that stress. Not only will your baby react to the stress, your milk supply will follow suit as well. Being stressed while trying to breastfeed can lower your milk supply or hinder your let down (when your milk is released into your milk ducts). (Source  breastfeeding.about.com/.../) Here are a few solutions if you find yourself stressed about breastfeeding in front of others.

• **You can use a cover.** Whether it is a blanket or a "hood", you can cover yourself in order to feel more comfortable. Aden and Anaias (Link adenandanais.com) blankets are fantastic to use while breastfeeding. A nursing cover, such as Udder Covers, (Link uddercovers.com) provides even more coverage. However, in the beginning days of breastfeeding, your newborn may not take well to having a cloth on top of them while they are still learning to latch and feed. Remember that your baby's comfort and stress level is just as important as your own.

• **You can leave the room.** Do not worry if people will find you rude. If you feel more comfortable nursing in a separate location, then do it. Excuse yourself and go about your nursing business.

• **Ask for privacy.** This may be your only option if you are receiving endless visitors in the hospital. Ask your significant other to take the lead if you give them "the look". They can then address your guests and say, "Thank you so much for coming, it was so nice to see you! I think we need to work on feeding this baby now."

For more information, see the section "Going Outside: Tips for Breastfeeding in Public"

Above all, enjoy the journey

These are precious moments that you will never get back. Your baby will never be five days old again. Despite the lack of sleep, the soreness, and the immense reality of being a parent, cherishing the bonding moments will be forever ingrained in your memory. Once you get past the first few days, your body adjusts to its new job. You get used to your new breast size, figure out which position works best for you, and start to feel more and more comfortable in your role as a breastfeeding mom. When it gets a bit overwhelming in the first few days remember this: you are capable of much more than you think. Your beautiful baby is proof of that.

# Keeping a Schedule and Planning Ahead

By Amanda Caswell

Typically in the hospital the nurses will ask you to keep track of how often you breastfeed, how long the baby eats and how often you change your baby's diaper. Even after leaving the hospital, some mothers feel more comfortable keeping a log of this information. Most mothers will benefit from the safety net of logging the feedings and diaper changes until they are reassured that they have established a healthy breastfeeding schedule with their baby. Tracking this information also provides a nice reference for the baby's doctor to ensure that the baby's weight gain pattern is adequate. Documenting is a healthy way to address any concerns should they arise.

There are a number of ways to track the breastfeeding data, including an Excel or Word Document, a simple notebook, or with an app for your smartphone. Whichever method you choose, it is in your best interest to be sure it is portable or printable so you can bring it to your baby's pediatrician appointments as it will provide valuable information for your doctor. Of course, having a portable documentation method is also handy for you as you may not be breastfeeding in the same location ever feeding.

New moms might be wondering what exactly they need to track. If you're breastfeeding, you should be writing down the time you begin and end each nursing session, which breast you start on, whether you switch breasts during the feeding and how long on each breast you nurse. If you are bottle-feeding, track the time you begin and end each feeding session as well as the number of ounces your baby eats during the session.

This valuable information will help you learn a number of things. If your baby is not gaining the recommended amount of weight your doctor recommends for his age, then a feeding chart might help you and your doctor figure out exactly why. Additionally, a feeding chart will help you become more aware of your baby's hunger patterns, allowing to you to create a routine to suit your baby's needs.

### Developing a Feeding Schedule for Newborn

From the moment your baby is born, he or she is going to be hungry. Almost immediately after giving birth, your baby will probably be ready to eat. But from there, it can get tricky. Knowing how soon your baby needs to feed again, how often he or she should be eating or how to establish an eating schedule is often confusing to new mothers.

One thing that is often surprising to new mothers is just how much their child can eat. In fact, some experts say many women worry that they are not making enough milk because of how often their baby eats. Upon tracking the amount their baby is eating, new moms think that because their baby is eating so often, or because their breasts do not feel as full as they did in the beginning, that they are not producing enough milk for their child. This is almost never true.

But keep in mind, because breast milk is so easy to digest, babies who breastfeed eat more often than those who eat formula. The schedule is, on average, every one and a half to two hours. This is morning and night. However, you do not need to wake your baby to feed him at night. If he is sleeping, even if two hours has passed, let him sleep!

Once you have developed a regular schedule, the feedings may drop from 12 to 8 times a day. However, depending on growth spurts, the feedings may go back up. And, you will find that some days your baby simply needs more milk. Just like adults they may be hungrier on some days more than others. Keeping track of your baby's breastfeeding schedule will help you anticipate when they will be hungry and you will be able to pinpoint when the growth spurts are happening.

### Tracking the Breast

As you are tracking the feedings, you also need to keep track of which breast you are using at each feeding. Up until a few years ago, doctors suggested that women switch breasts in the middle of the feeding. The baby would start on one breast and finish on the other. However, today doctors believe that one breast per feeding is best. The reason for this new development is because there are two types of milk in each breast. The first type of milk expressed is "fore milk" which simply quenches the baby's thirst while supplying proteins and minerals, sugars and fluid. However, the "hind milk" or second type of milk following the fore milk is much more filling and hardier. It is a creamy, high fat, milk which supplies satisfying and nutritious milk. It is crucial for your baby's growth and development.

Another perk of using only one breast per feeding is that the more watery fore milk is what often causes cramps and gas. By sticking to only one side per feeding, your baby will have less gas and will feel better which will make him less cranky. You can keep track of which side you feed on with an app or documenting it in your notebook or breastfeeding chart. Other trick is putting a safety pin on your bra strap. Move the safety pin after each feeding to the breast you need to start on for the next feeding. You could use this switching side method with a bracelet, hair tie or ring.

Your doctor will help you determine exactly how much your baby should be eating. Every newborn has their own individual needs so be sure to follow your baby's cries and cues as a guideline. During the first month, babies that are bottle-fed should drink approximately 2 to 3 ounces every 3 to 4 hours. After the first month to 6 months, your baby should be consuming about 4 to 6 ounces every 4 hours. Babies who are breastfed will need to eat for 20 to 60 minutes between eight and twelve times a day.

With all these numbers and the fact that you're a new mom and probably running on very little sleep, it can be tough to keep track of everything in your head. Luckily, there are a number of helpful resources and tools to help take the guesswork out of breastfeeding and diaper changes. The following are a few popular options to consider for your tracking needs.

Smartphone Tracking Apps

1. _Baby Nursing/Feeding:_ Brought to you by American Baby magazine and Sevenlogics Inc. this easy-to-use app helps you track your baby's nursing progress, growth, diaper changes, doctor's visits, and more. This is a free app available on the App Store. You can record all the feedings by simply pressing "Start" and "Stop." This app will help you keep track of your most recent feedings, daily average, and accumulative totals.

2. _LactMed:_ As a breastfeeding mom it is important to be aware how the medicines you take affect your baby. This app is part of the National Library of Medicine's Toxicology Data Network and has an entire database of drugs and dietary supplement that may affect a woman's breast milk. The app includes information on the levels of the substances in breast milk as well as in infant blood and possible adverse side effects in the nursing infant. Where appropriate, therapeutic alternatives to the drugs are suggested. This app is free and available on the App Store.

3. _Medela:_ This free app from the App Store can track the feeding schedules for up to 6 babies! You can track your baby's weight, feeding schedule and diaper changes. It also provides breastfeeding and pumping friendly locations in your area. Breastfeeding/pumping tips and storage guidelines also make this a helpful tool for any breastfeeding mother.

4. _Baby Feeding Log:_ This app gets right down to business with no frills. Keep track of everything from breastfeeding, bottle-feeding, diaper changes and sleep schedules. All of the information can be easily emailed to the user in the form of a spreadsheet.

5. _Eat Sleep: Simple Baby Tracking:_ You can simply track your baby's eating, sleeping and diaper habits without messing with timers, alarms or even typing. This free app available on the App Store lets you keep track of all of the important stuff with a one-finger tap style. You can view all of the eating, sleeping and diaper events for each day or view the combined or individual history of any activity. This app lets you keep track of trends from day to day, week-to-week and month-to-month so you can be ultra-aware of your child's habits. Another great feature of this app is the note-taking features that allow you to track special events or a change in the routine. This app works for multiple children at once if necessary.

6. _Pump@work:_ Developed by a Certified Lactation Consultant, this app is total breast milk management. Tracking tools and advice are at your fingertips. The features include custom daily milk packaging recommendations, daily breastfeeding news and educational tips on breastfeeding, storage, health and tips to ease the transition as you head back to work. All of the tips, tracking information, history of breastfeeding and storage graphs can be instantly emailed to you. Multiples can be tracked using this app too. The overall goal is to help reduce breast milk waste and track your baby's feeding schedule even as you head back to work. The cost is $1.99 on the App Store with 50% of the profits donated to California Breastfeeding Coalition.

Another tool you might want to consider is a Breastfeeding Chart. You can download these for free on the Internet. These can help you keep track of what time you last breastfed, for how long, and what the output was. With a breastfeeding chart you will easily be able to see if your baby is getting enough milk. Because it is portable and all you need is a pen, you can take it with you and keep your baby on a regular feeding routine. Some women like to use a breastfeeding chart instead of an app because it allows the husband, partner or caretaker to see the schedule as well as add any necessary documentation.

### Yes, It's Normal!

As much as you do to keep track of feedings, it's necessary to know that your baby's schedule could change at any time. Even after a pattern has been established, one day he will be eating every two hours, the next he may cluster feed. While a schedule is important to follow, be prepared and flexible for changes. The following things are normal so, if you are like other new moms, you can stop worrying about them:

1. Frequent and long feedings. Typically, your baby will feed for about 20 to 30 minutes. However, some days it might be longer and more frequent. Just as you are finishing burping your baby after a feeding, he might be ready to eat again. This is normal and healthy.

2. Changing nursing pattern from one day to the next. One night your baby may wake up 3 or 4 times during the night to feed, other nights only once or twice. It is normal to have a varying feeding pattern. For the most part, your baby will eat around the same time every day with variances based on growth spurts. During growth spurts, your baby will nurse more often for several days and may act fussy. Common spurts occur the first few days at home, 7-10 days, 2-3 weeks, and 4-6 weeks.

3. Cluster nursing (very frequent to constant nursing) for several hours, usually in the evenings is normal. The cluster feedings may coincide with the fussy times that happen during growth spurts for the first few months.

While you may not need to track your baby's feedings and diaper changes for more than a few months, it will certainly help you in the beginning. Documenting will give you a better understanding of what to discuss with your doctor and most of all give you peace of mind that your child is eating enough, gaining weight, and has a healthy digestive system.

# What to Expect

By Carly Hill

Once you've got the first week of milk madness under your belt, you'll probably look at yourself in the mirror a thousand times a day, in a haze of exhaustion and ask yourself, "Is this normal?" about anything and everything. You'll continue to wonder what to expect with a newborn that is nursing - how often and how much will they eat?

Although everyone is different, and every nursing mom has her own set of stories, babies and the art of breastfeeding is an art that you can master.

### How Often Will I Nurse?

The more frequently you nurse, the greater your milk supply will be. Just as there are a myriad of opinions and methods when it comes to how you should teach your baby to walk and how you should comb your baby's hair, there are many different approaches to getting on a breastfeeding schedule. Parents fall into one of three camps. There are those who opt for a baby-led schedule, those who opt for a parent-led schedule, and then those who opt for a combo of the two.

Here is a look at all the different approaches.

### How Do I Time It?

 KidsHealth.org answered the question, " _Are feeding intervals counted from the time my baby starts or stops nursing?"_

The article said, "You count the length between feedings from the time when your baby _begins_ to nurse – rather than when he or she _ends –_ to when your little one starts nursing again. In other words, when your doctor asks how often your baby is feeding, you can say "about every 2 hours" if your first feeding started at 6 a.m. and the net feeding was around 8 a.m., then 10 a.m., and so on."

Of course, this will make it feel like you are, as my husband called me, a "milk factory." It will feel like it's all you do at first, but very soon you will get into more of a predictable pattern.

### What to Expect When Baby is Hungry or Full

Here is a complete list of signs that your baby is hungry, taken from  KidsHealth.org:

• Moving their heads from side to side

• Opening their mouths

• Sticking out their tongues

• Placing their hands and fists in their mouths

• Puckering their lips as if to suck

• Nuzzling against their mothers' breasts

• Showing the rooting reflex (when a baby moves its mouth in the direction of something that's stroking or touching its cheek)

• In turn, here are signs that your baby might be full:

• Slow, uninterested sucking

• Turning away from the breast or bottle

Breastfed babies do not overeat; so don't stop your baby when she's actively sucking. You'll know she's finished when she's falling asleep or slowing down.

### How Long Will My Baby Nurse?

The rule of thumb here is to watch your baby, not the clock. Let your baby nurse as long as she wants to on one side before switching. This ensures that she does get to the higher-calorie hind milk. It's hard to even give a time frame of what's normal because truthfully, some babies will nurse for 5 minutes and other babies will stay on the breast for an hour. Both are normal. But, the average time is about 30 minutes per nursing session.

If your baby is a long nurser, chances are she'll stay fuller a little longer. And, also, babies get more efficient the older they get, so what took them 20 minutes as a newborn might only take 5 when they are a few months old.

When babies are going throw growth spurts around 3 months and 6 months of age, they may start nursing more frequently. It is recommended that you allow the frequent nursing when it happens to accommodate your babies needs. Your baby will naturally settle back into a normal nursing pattern.

When wondering how long your baby will be glued to your breast, keep in mind all the factors. Your baby's nursing speed depends on how slow or fast your milk flow is, which varies from person to person. It's also depends on your baby's energy level, mood, and positioning.

### How Do I Measure Quantity?

Unlike moms who are measuring ounces as they bottle feed, you're not really able to measure how much milk you're putting out when your baby drinks from your breast. Your body will produce what your baby needs and if you let her nurse until she's satisfied, your body will be sure to produce enough milk for the next feeding. However, it's helpful to know how many ounces to feed if you want to pump milk to feed your baby from a bottle.

The research says that breastfed babies drink an average of 25 ounces per day between 1 and 6 months old, so if you want to figure out how much expressed milk to feed her in a bottle, first estimate the number of times she nurses per day. Then divide 25 ounces by that number. That should give you a good idea.

Kelly Mom has this handy calculator you can use, so you don't have to do the math.

### Baby-Led Schedule

Those who take a baby-led approach are more laid back when it comes to the routines of their child. You look for cues from your baby and feed her when she is showing signs of hunger, whether or not she just got through with a feeding.

Just because some parents take this approach, it doesn't mean they are living in a bubble of chaos. Babies naturally fall into a routine. But, if you read the cues, that routine will shift slightly from day to day. Baby's first nap of the day might have happened at 9 a.m. today, but tomorrow, she might not get tired until 11:30, so you'll adjust your plans accordingly.

Although this may appear to be the new trendy way, the philosophy has been around for a long time, dating back to 1946 when famous pediatrician, Benjamin Spock, wrote a book on the baby-led philosophy titled, _The Common Sense Book of Baby and Child Care._

To help you understand this philosophy more clearly,  Baby Center quotes pediatrician Cheryl Hausman, medical director of the University City Primary Care Center at the Children's Hospital of Philadelphia who explained, "Babies come in all shapes and sizes. Our job as parents is to meet our baby's needs, rather than force them to meet our needs...It's okay to gently guide babies, for example, to take a morning and an afternoon nap. But we get into trouble when we demand that the nap occur at a very specific time."

If you choose to parent with this philosophy, the question of "How often?" is answered simply by saying, "Feed on demand." _Of course, you should never let a baby go more than 4 hours without a feeding, even during the night._

If you choose to take on this approach, here is a list of good books that can help you.

_The Attachment Parenting Book: A Commonsense Guide to Understanding and Nurturing Your Baby_ , by William Sears and Martha Sears

_The Baby Book: Everything You Need to Know About Your Baby From Birth to Age Two_ , by William Sears and Martha Sears

The American Academy of Pediatrics _Caring for Your Baby and Young Child: Birth to Age 5_ , by Steven P. Shelov and Robert E. Hannemann (Editors)

The American Academy of Pediatrics _Your Baby's First Year_ , by Steven P. Shelov (Editor)

_Dr. Spock's Baby and Child Care, Eighth Edition_ , by Benjamin Spock and Robert Needlman

_Touchpoints: Birth to Three, Second Edition_ , by T. Berry Brazelton and Joshua D. Sparrow

The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Newborn Baby Sleep Longer, by Harvey Karp

### Parent-Led Schedule

Those who decide to handle breastfeeding with this approach are the ones calling the shots, as the name "parent-led" suggests. Parents who choose this method lay out very specific times for when their baby will eat, play, and sleep. Supporters of this approach will say that consistent timing and scheduling helps to regulate their baby's internal clock, giving them the structure they need to thrive.

Parents who choose this path aren't usually setting arbitrary time schedules. They do, typically, schedule based on the research available of a baby's natural rhythms. Baby's trained this way will obviously be more predictable and will likely sleep through the night sooner.

Supporters of parent-led schedules will say that babies who nurse on-demand aren't getting enough hind-milk because they are simply "snacking" and getting the breast every time they cry. They will tell you that because they are not getting enough of the rich, fatty hind milk, they are not sleeping as well. (Note that this line of thinking completely opposes the baby-led line of thinking).

The best-known advocates of parent-led scheduling are Gary Ezzo and Gina Ford. To learn more about this philosophy, you can read the books they put out. Ford's book is titled, _The New Contented little Baby Book._ Ezzo's book is called, _On Becoming Baby Wise: Giving Your Infant the Gift of Nighttime Sleep (Fourth Edition)._

It's important to note that although this wasn't always the case, parent-led scheduling is controversial these days. The American Academy of Pediatrics strongly recommends nursing babies on demand – when they show the first signs of hunger (alertness, activity, mouthing, rooting around). They consider crying to be a "late indicator" of hunger. The whole "Baby Wise" way, which started from Ezzo's book, created controversy in 1997 as many pediatricians noted that a lot of "Baby Wise" babies were underfed. Being too rigid with feedings can result in your baby not gaining enough weight and even dehydration. Ezzo responded by tweaking his advice and adding a coauthor in his latest editions of the book.

If you choose to stick to a schedule with your baby, there is absolutely nothing wrong with that, as long as you are sure to be flexible enough with the system to ensure that your baby is getting enough milk every day. Getting your baby on a schedule is a great thing to do. You can start routines early that will carry on into childhood. Just do so, responsibly and be open to making changes if your baby needs to gain more weight or is not thriving.

### Combination Baby Schedules

Parents don't necessarily fall into one of the two categories listed above. There is a third group that chooses to use a combination of the two extremes, when it comes to breastfeeding their babies.

A combination schedule is basically a mix between being parent-led and being baby-led. Unlike full-blown baby-led parents, you will set a timetable for when your child will eat and sleep and play and you'll try to follow the routine each day, but unlike the parent-led, they are known for their flexibility.

Those who get behind the idea of a combination schedule look for their baby's cues when it comes to hunger or exhaustion and they'll adjust the schedule accordingly.

Here is a list of the best books to read if you want to know more about combination scheduling.

Healthy Sleep Habits, Happy Child, by Marc Weissbluth

Secrets of the Baby Whisperer: How to Calm, Connect, and Communicate With Your Baby, by Tracy Hogg and Melinda Blau

_Jo Frost's Confident Baby Care: What You Need to Know for the First Year from America's Most Trusted Nanny_ , by Jo Frost

_The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Newborn Baby Sleep Longer_ , by Harvey Karp

### What to Expect: Week 2 – Week 6

Most newborns at this stage nurse between 8 to 12 times in a 24-hour period. Keep this in mind, when wondering how often you should nurse – you CAN'T nurse too often, but you CAN nurse too little.

Many women from Mom's and Granny's generation will quote the mantras of their time. They'll say things like, "Don't ever wake a sleeping baby." Although your REM cycle might appreciate that, we now know that if a newborn isn't fed every 2-3 hours throughout the night, she could become malnourished.

Although you can find many different "methods" when it comes to nursing on a schedule, the simplest way to do it is to feed your baby when she's hungry.

It is a good idea to get your baby on a rough schedule, but she _should_ be eating no less than 8 times per day (that's including sleeping hours).

When your baby shows signs of hunger (rooting, sucking on fingers, etc.) it's time to offer the breast. If you wait too long, your baby will become frantic and feeding will be a stressful event, rather than a soothing one.

Kelly Mom offers a great little list you can look back to, when you're asking yourself "Is this normal?"

"The following things are normal:

• Frequent and/or long feedings.

• Varying nursing pattern from day to day.

• Cluster nursing (very frequent to constant nursing) for several hours – usually evenings – each day. This may coincide with the normal "fussy time" that most babies have in the early months.

• Growth spurts, where baby nurses more often than usual for several days and may act very fussy. Common growth spurt times in the early weeks are the first few days at home, 7-10 days, 2-3 weeks, and 4-6 weeks."

This information may make your weary mind even wearier, but don't worry. This phase, although it may feel long, is short-lived. Your baby will naturally go longer between feedings, as she grows. She may cluster nurse occasionally during a growth spurt, but generally speaking, it _will_ get easier!

Something else to keep in mind is that it is completely **normal** that you are feeding your baby more frequently than bottle-feeding mom's are feeding theirs. The reason for this is that your baby's body digests breast milk more easily, so it is passing through her system faster.

Whether you decide to go the way of letting your baby set the schedule or not, you need to let your baby nurse on demand for the first month, at least, while you're still establishing your milk supply. This means letting your baby nurse about every 1 ½ to 3 hours. Frequent nursing, although exhausting for you, is the best way to establish a good milk supply. Your baby will naturally nurse less frequently, if you let her call the shots, but if you do want to get her on a set schedule, wait until month two.

Keep in mind; newborns should **never** go more than 4 hours between feedings, even at night.

### What to Expect: 2 Months

Once your baby is about 2 months old, you should be nursing your baby about 7 to 9 times a day. That would mean you're likely having a nursing session every 2 hours, maybe 3. Your baby may be spending less time nursing because she's getting better at it. Now the rule is, your baby should nurse at least 6 times for every 24-hour period.

### What to Expect: 3 Months

Between now and next month, your baby should be nursing at least every 4 hours during the day. 3 Months is growth spurt time though, so there may be a part of this month where your baby wants extra, and you should give it to her. If your baby is naturally starting to give up her night feeds, she'll probably eat more during the day.

### What to Expect: 4 to 7 Months

From 4 to 7 months, your baby should now be nursing at least 5 times per 24-hour period, and one of these feedings is probably a night feed. Some babies this age may only nurse for 3 to 5 minutes. Part of that is because they are distracted with the beautiful world before them and the other part is that you've probably introduced solids somewhere around this time (6 months is the norm). So, they may be filling up partially on human food now.

*Fun Fact: According to BBC, if you are still nursing your baby when she is 6 months old, you are in the 1% of mothers who have breastfed for this long! Hoorah!

### What to Expect: 8 Months

Your baby should be having about 5 to 7 feeds per day. According to Johnson, babies who are breastfeed between 7 and 9 months have higher intelligence than those breastfed for less.

### What to Expect: 9 Months

Your baby should be nursing between 4 to 5 times at this point. She may be starting to lose interest now that she's becoming a foodie. Read your baby's cues. Your breasts will accommodate her needs and supply more or less milk for her, based on the demand.

### What to Expect: 10 to 11 Months

Now that your baby is crawling and cruising, maybe even walking, her nursing patterns may become erratic. She may even begin to self-wean. Breast milk, however, is still the most important part of her diet.

### What to Expect: 1 Year Old

According to  TheAlphaParent, "many of the health benefits this year of nursing has given your child will last his entire life. He will have a stronger immune system and will be much less likely to need orthodontia or speech therapy."

The American Academy of Pediatrics recommends that you nurse your baby for at least a year "to help ensure normal nutrition and health for your baby." You don't have to stop now, though! Many babies this age continue to nurse 2 or 3 times a day – maybe in the morning and at night.

### What to Expect: 16 Months

Your breast milk continues to provide normal nutrition and protection against illness at this stage. According to a study done by Gulick. E, breastfeeding toddlers between 16 and 30 months old have been found to have "fewer types and shorter duration of illness and to require less medical care than their non-breastfeeding peers."

### What to Expect: 2+ Years

The World Health Organization strongly encourages breastfeeding through toddlerhood. They say, "Breast milk is an important source of energy and protein, and helps to protect against disease during the child's second year of life." As your child drinks less and less, your milk will become more and more concentrated- kind of like colostrum again. This will give her an extra boost of immunity.

# Breastfeeding Pain

By Carly Hill

Talking to some breastfeeding moms, you'll hear words and phrases thrown around like "easy, natural, relaxing, comforting, and a great way to burn calories." But, talk to other moms, _or_ that same glowing mom on a bad day and you might hear different words and phrases that are more like, "throbbing, aching, itching, burning, peeling, sore..."

The list goes on.

Breastfeeding should be painless once you get the hang of it, but you've got to be patient for the first two weeks of aches and pains and learning to get to that point.

Some women are lucky enough to avoid the dark side of breastfeeding, but most will, at one point or another, experience some temporary discomfort.

When you are facing pain of any kind, it's important to know first, _why_ you are having problems, and next, what you should do about it.

### What Kind of Discomfort Should I EXPECT?

Breastfeeding itself is not painful, but the first few weeks, while your body and baby are getting the hang of things, are usually a little bit uncomfortable.

When you first start out, even if your baby is properly latched on, you might have 30 to 60 seconds of pain, but that should subside after a minute. If your baby isn't latching properly, or isn't getting your nipple deep enough into her mouth, that will cause pain too. But, minor twinges are just part of the learning process and within a week or so, the worst days should be behind you.

Something else you will feel that first week or so is stomach cramps. Having stomach cramps when you first start breastfeeding is _completely_ normal and _completely_ temporary. Remember, a full-grown baby just left your uterus, so your uterus has some major shrinking to do and it shrinks by contracting, which feels like menstrual cramps.

What's amazing about breastfeeding is that it helps to shrink your uterus more quickly; so nursing mothers may have less blood loss after pregnancy and will probably lose weight faster.

When you feel stomach cramps while nursing, it just means your uterus is shrinking back to its pre-baby size. Hooray! Feel the burn!

### Engorgement Pain is Its Own Thing

Many women give up their attempt at breastfeeding within the first week. They think that because it's not easy that first week, it won't _ever_ be easy. But if you can push through the first week or two, breastfeeding will become a walk in the park and a memory you will cherish.

You can't go into breastfeeding with the mentality that it will always be as hard as it was the first week. The first week, your breasts are engorged and your body doesn't know how much milk to produce yet. So, give it time.

If you haven't read up on engorgement, you and your partner will be in for quite a surprise. The first few days after you give birth, your breasts may not change much at all. Then, come the third or fourth day, your (probably already huge) breasts will transform into enormous, otherworldly breasts. When your milk is just coming in, your breasts may swell up to three times (yes, 3!) their size. They will be huge. They will be hard. They will be uncomfortable.

They will not stay this way.

This phase will only last for a few days – a little over a week, tops. To ease your discomfort during the engorgement phase, place some warm washcloths onto your breasts before nursing. After a nursing session, use cold packs and massage gently. This will help a lot, and this soreness will not last.

Your baby will drain a lot of this milk, and your body will figure out how to meet your particular baby's needs over the course of the week.

Whatever you do, **don't pump excess milk** during that first week. When you pump milk, your body will think your baby needs more, so it will produce even more! Just feed your baby and don't pump at first and your body will slow down the milk production and tailor it to your baby just perfectly.

### Post-Engorgement Causes of Pain

According to lalecheleague.org, the most common causes of pain during breastfeeding are _incorrect positioning at the breast_ and _suction trauma_.

These problems can be ironed out with the help of a trained lactation consultant. If your positioning isn't correct and you _don't_ seek the help of a lactation consultant soon enough, your nipples can become more easily infected by bacteria or yeast.

If you notice a white dot on the tip of your nipple, it could be a bleb. A bleb is a white, clear, or yellow milk blister. You can overcome a bleb by using warm compresses and nursing frequently, as strange as that sounds. You'd think that sticking a baby on a tender, hurting organ would be the last thing you should do, but the more you nurse, the better it will feel and the sooner it will heal.

If you happen to notice a small lump on your breast, you might have a plugged milk duct. The treatment for this is simply hot packs, massaging, and continuing to nurse.

If your nipples hurt when exposed to cold, you may be suffering from nipple vasospasm, or Raynaud's of the nipple. Your nipple could appear blue or red and blanched. This is a very painful condition. Warm showers and heating pads might help, but you may need to talk to your doctor about taking some anti-inflammatory medication.

Another cause of tenderness or pain might be a typical skin condition that you'd expect to see on other parts of your body – eczema, psoriasis, and even poison ivy (avoid naked hiking at all costs!). If your breast or nipple skin appears rashy, you might want to check with your doctor and make sure you don't have some sort of underlying skin condition.

Breasts and nipples can also get sore or tender if you have an allergic reaction to some sort of new shampoo, soap, detergent, medication, or even food that your (older) baby was eating before you started nursing. If you have a mango allergy, for example, and you feed your baby a mango, and then your baby nurses, you could be looking at the problem.

Another possibility is your actual anatomy. If you have inverted or flat nipples (nipples that turn inward rather than protruding out or nipples that don't become erect when your baby is nursing), you might have a harder time breastfeeding and pain might be frequent. If this is the case, meet with a lactation consultant or doctor who can help you learn some techniques that can make nursing easier on you and your baby.

If you have raw nipples accompanied by shooting or burning pain during or after feedings, or a deep pain within your breast, you may have a yeast infection (otherwise known as thrush).

Here are some more problems listed by La Leche League that could be causing prolonged pain:

• Sucking problems

• A retracted or improperly positioned tongue

• Strong clenching response

• Nipple confusion

• Improper breast pump use

No matter what you think the cause of your pain might be, don't hesitate to contact your doctor and/or a lactation consultant. One visit with a consultant could save you a lot of pain and all the frustration that comes from trying to self-diagnose.

The bottom line is, nipple soreness and occasional pain is not usually anything to be alarmed about, **but** any kind of soreness that gets increasingly worse or lasts for more than a week should be a red flag that something is not right.

If your pain is especially severe and accompanied by fever, redness, red streaks, chills, or any other flu-like symptoms, you might have _mastitis_ or some type of infection, in which case you should contact your doctor right away. But in most all cases, you should be able to continue to nurse.

When in doubt, call your doctor or consultant. That's what they're there for.

### Is There a DIY Way to Check if My Positioning is Right?

If you have positioning concerns, refer to the breastfeeding positions portion of this book, but here is a very quick series of questions you can ask yourself to see if you've got the basics figured out. This excerpt was taken directly from BreastfeedingBasics.com.

• " _The classic cradle hold is the most common nursing position._ Sit upright in a comfortable chair, with a pillow supporting your back, one under the arm holding the baby, and another in your lap to bring him up to the level of your breast. You will be spending a lot of time in this position, so make sure that you are comfortable, and are not straining the muscles in your arm, neck, shoulder, or back.

• _Your baby should be positioned on his side, with his whole body facing yours._ He should not have to turn his head to reach your breast (try turning your head to one side and swallowing – you'll be surprised at how difficult it is to do).

• Cradle his head in the crook of your arm, with his body along your forearm and your hand cupped under his thighs or buttocks. _His ear, shoulder, and hip should be in a straight line_

• _When you offer your breast, use your free hand to support it with your thumb on top and hand underneath, forming a "C"._ Make sure your thumb and fingers are behind the areola (the dark area around the nipple). Gently stroke his lower lip with your nipple – this will encourage him to reflexively open his mouth. Wait for him to open wide, like a yawn, then quickly pull him in close with the arm that is supporting him. Bring him to the breast rather than pushing the breast toward him.

• _His mouth should cover a large portion of the areola_ (at least an inch). If your  areola is large, his mouth may not cover the entire area, but he should be far enough back on the areola so that his gums bypass the nipple and compress the milk sinuses underneath the areola. The nipple should be centered in his mouth, above his tongue. His lower lip should be covering more of the areola than his upper lip.

• _He should be pulled in close so that chin and nose touch your breast._ Don't be afraid that he won't be able to breathe – that's why newborns have little pug noses and receding chins. I can't remember the last time I saw a story in the news about a baby suffocating at his mother's breast. Can you? If his nose does seem to be blocked, lift your breast or pull him in closer to you. If you press down too firmly on the top of the breast to create an airway, you may pull the nipple to the front of his mouth, which can cause nipple soreness."

 AskDrSears.com has a lot of good advice about breastfeeding and one idea they suggest, if your baby isn't seeming to take enough nipple tissue in his mouth, is to make what they call a "breast sandwich."

"Support your breast with fingers underneath, thumb on top, well behind the areola. Press in with your thumb and fingers to flatten the breast while at the same time pushing back toward your chest. This makes the areola longer and narrower and easier for a baby to take into his mouth."

Here's another big one – NEVER pop your baby off the breast. If you are trying to take your baby off the breast and you simply pull the baby away, your nipple will hurt for a _long_ time. Always- **always** -always-always break your baby's suction by sticking your finger into the corner of his mouth first. Or, you can press down on your breast gently, where the baby has his mouth.

### Treatment for Pain

Sometimes, you might experience a little soreness during the beginning of a nursing session, but if you are still in pain throughout the entire feeding, your first step should be to get help from a lactation consultant so you can figure out what's wrong and how to fix it.

Lactation consultants are so helpful because they will get up close and personal and help you correct any issues you might be having with your technique. Just one visit to a consultant might solve your problem.

In the meantime, don't be popping any painkillers. Remember, when you take medicine, traces of it go into your breast milk, so don't ever take anything without consulting your doctor. The best options you have to soothe your discomfort are warm compresses and warm showers.

If you are just experiencing typical soreness because of engorgement or latching issues, here are some soothing ideas from  Whattoexpect.com you can try:

• Expose your nipples to air briefly after each feeding.

• Dry your nipples with your hair dryer (set on warm, not hot).

• Use breast shells to keep your nipples from rubbing against clothing.

• Express a bit of milk and rub it on the nipple and areola, then leave it to dry to help with cracking.

• Use medical-grade lanolin-based cream (you'll likely get some from the hospital) to help with cracking.

• Slap some wet tea bags on your nipples to relieve soreness (make yourself a cup of tea with them first because you won't want to do anything but toss them after.)

If nursing is unbearably painful and you have to wait on an appointment with your lactation consultant, you might want to take a one-day break and pump, rather than breastfeed.

Just make sure you don't stop all nursing/pumping if you plan on nursing long term, because then you risk losing your milk supply. If possible, you'll want to nurse through the pain.

Despite how it seems, breastfeeding will not slow down the healing process. It has an amazing way of helping things along, on the contrary.

### To Nipple Shield or Not To Nipple Shield...

Lactation consultants and nurses are usually hesitant to offer the nipple shield right away. There is a place for a nipple shield, as they can sometimes help protect sore nipples during a feeding or help a baby learn how to go from bottle to breast, but experts don't love them because they often cause more problems than they solve.

If you're unfamiliar with the nipple shield, it basically looks like a very thin bottle nipple that you simply stick onto your own nipple before your baby latches on.

This might help some, but it can also cause your baby to become dependent on it (which is a headache) and it may also cause future problems because your baby will have to re-learn latching the natural way.

If you do use a nipple shield, and your lactation consultant recommends it, just do so sparingly.

### Preventing Future Pain

Have you ever heard people say that the less you try something, the easier it will be? This can sometimes be true of the overly ambitious new mother. You might get so caught up in doing breastfeeding the "right" way that you won't give your baby a chance to figure it out on his own.

Babies are wired to self-latch. It's really frustrating when your baby is hungry and fussy and can't seem to figure out how to latch on. You might shift and re-shift and not be giving your baby time to orient himself.

Try this. Take a deep breath, relax, and get into a semi-reclining position. Lay your baby tummy-down on your body and just let your baby's head be near your breast. Just like little baby animals, your baby will naturally bob his little head around and move into a pain-free position on his own. So, give your baby time to figure it out and be patient.

It's not always best to run to the rescue and re-situate too soon.

That being said, positioning is very important. Make sure that when you are holding your baby, your nipple is pointed toward his nose, so when he opens his mouth and tips his head back, your nipple will slide into his mouth deeply. Once your baby's mouth is open, your nipple should be aimed at the roof of his mouth.

Something else to keep in mind is that you want to unlatch your baby as little as possible. Sometimes, your baby might latch on, and you might feel uncomfortable, so your natural instinct will be to stick your finger into the baby's mouth, unlatch, and try again in a new position. The problem with this (other than your hungry baby getting frustrated and less cooperative) is that you are risking unnecessary damage to your nipple if the baby has trouble latching on again and you have to go through that process repeatedly.

A better approach might be leaving your baby to drink while you shift your position and attempt to get more comfortable.

When you're not nursing, air your nipples out. Allowing them to chafe against your bra isn't going to do you any favors, so as much as possible, let them breathe.

Be cautious about using lanolin or other creams if you're not sure what is causing your soreness. Any sort of nipple cream could worsen your problem if, for example, you're dealing with thrush or something like that, rather than just typical soreness. The human body is amazing, and actual breast milk can help heal cracked, bleeding, or blistered nipples.

Just express a little milk onto your nipple and let it air-dry there. Breastfeeding nipples usually heal very quickly if you just keep at it.

### Keep Your Chin Up

Remember, breastfeeding pain is temporary and usually ancient history once you've gotten through the first 7 to 10 days. But, of course, you may run into problems here and there over the course of your breastfeeding stretch. Don't get discouraged though. Babies were made to breastfeed, and the breast heals amazingly quickly. It's own milk heals its wounds and frequent nursing speeds up the healing process. Hang in there!

# Breastfeeding In Public

By Carly Hill

There is nothing more natural than breastfeeding your baby. It's such a short and special season that you get to bond with and nourish your child. No one will deny the health benefits that come from breastfeeding an infant, but not everyone appreciates seeing it happen in action.

Aside from that, even if you find yourself in a group of supportive people who are completely comfortable with you nursing in front of them, breastfeeding in public places is challenging for many reasons.

There are a lot of factors to consider – what you'll wear, where you'll be, who you'll be around, etc. If you're not confident with what you're doing or you don't have a plan, you may find yourself mumbling under your breath in a tizzy, "I am _never_ leaving the house again! Nursing in public is just TOO STRESSFUL!"

The problem with that is you can't actually "never leave the house again." You've got to live your life. And, although your first few attempts of being a nursing mother in the outside world might not be the easiest thing you've ever done, it definitely doesn't have to be a nightmare.

Get a strategy in place, and before you know it, you'll be nursing in public like a pro. Here are some things to think about...

### Know Your Rights

One thing to keep in mind is that federal law is cheering you on. You are legally entitled to breastfeed wherever you want. As  WhatToExpect.com put it, "...if you have a right to be somewhere with your baby and you can feed your baby a bottle, then certainly you have the right to breastfeed."

No, you don't have to do it in a dirty bathroom stall. No, you don't have to "step inside here, ma'am." Everyone has their own opinions on how a woman should breastfeed and moms are going to have different standards when it comes to modesty. But, knowing what is legally allowed and what isn't is an important starting point.

As of 2010, Federal law mandates that employers must allow nursing mothers breaks to breastfeed or pump during their workday. Also, none of the fifty states forbid breastfeeding outside the home. Only two states put any limitations on it whatsoever (Illinois and Missouri).

You can read more general information about federal law on breastfeeding from the Center for Disease Control and Prevention government website. To see exactly what's in the books in your state, visit the website for the National Conference of State Legislatures here -  NCSL.org.

But, the take-away from all the legal language you'll find on those government sites is this: **You're allowed.**

With breastfeeding becoming more and more popular again in American culture, you're not likely to get too much negativity from passersby, provided you aren't being intentionally obnoxious about showing the world what you're doing.

Of course, you might encounter people who are uncomfortable with the knowledge that they are talking to you while there's a human eating from one of your private organs; its just part of it. But, despite the opinions of others, you need to know that you have every right to feed your baby wherever you are, no matter what uncomfortable bystanders may tell you.

### Know Your Schedule

Yes, babies can be unpredictable. Yes, every day you will find yourself learning something new and changing your way of doing things. But babies do follow patterns. Depending on their age, babies eat at specific times each day. Yes, it changes, but you know when feeding time is and so does your baby.

Now, when you're at home, you can be a little more flexible. But, when you're out, it is _key_ that you feed your baby a little before feeding time.

If your baby eats at 2 p.m. every day and you wait until 2 p.m. to nurse, your baby is likely to be so desperate and frantic to feed, you will make a scene and wind up flustered and frustrated. However, if you attempt to feed your baby a little earlier, your baby will be less desperate, and you'll be much more likely to have a calm, peaceful feeding.

Beside the fact that it will be less stressful for you and your baby, you will also be more discreet.

Having a baby latch successfully and drink is wonderful and incredibly discreet. Having a baby scream and flail and pull at your shirt and nursing cover is sure to make you the center of attention.

Save yourself the headache, and feed early.

Once you get the hang of it, you can breastfeed in the middle of crowded subway and people might not even notice; that is, _if_ you're sure to sidestep your baby's hunger-panic, by not waiting until the last minute to offer the breast.

### Be Wardrobe Ready

Picking up a nursing top or a nursing bra at a department store can be a little intimidating. _Why are there so many latches? Where do I put this flap?_ But, having a nursing wardrobe is hugely helpful when it comes to breastfeeding in public.

Many women are comfortable in loose fitting tanks and sports bras and they don't necessarily feel the need to stock up on nursing wear, but nursing apparel is out there for a reason.

You can find nursing tops now that are comfortable and trendy, but so smartly designed that you could feasibly have your baby attached to your breast without a cover and no one would notice (unless they're _really_ paying attention, of course). It's all about the placement of the material. Look around and see what works for you. But, just remember, nursing clothes are designed to make breastfeeding easier and more discreet, so don't let all the clamps and clasps intimidate you.

Now, some women might not want to spend a lot of money on nursing clothes, especially if they don't plan to nurse long-term. For those women, just make sure not to wear restrictive clothing. Don't wear dresses that you'll have to completely take off in order to give your baby access to the breasts. Most of what you wear should be two-piece, unless it's a dress specially designed for nursing. You want to put yourself in things that stretch and are loose-fitting. Otherwise, you will make something easy and natural into something difficult, uncomfortable and frustrating for you and your baby.

Don't worry. You'll have plenty of time for form fitting cocktail dresses and chiffon tops in a few months, but right now, go for the drape-y look.

Here are a few other great tips for discreet public nursing taken from one of the breastfeeding experts,  Dr. Sears:

1. Two-piece outfits, with loose tops are the best. You can lift the shirt from the bottom so the baby can get at the breast. The rest of the fabric will drape around the baby's head to cover any exposed skin.

2. If you're wearing a shirt or blouse that buttons, unbutton it from the bottom up, rather than the top down.

3. Think of nursing in terms of snuggling your baby under your clothes rather than getting your breast out.

4. A loose jacket or cardigan sweater can provide extra coverage for your middle.

5. Drape a lightweight blanket or shawl over your shoulder and over baby as you nurse.

6. An old t-shirt worn under a sweater or another shirt can provide extra coverage and protect your middle from icy drafts. Cut slits in the t-shirt at breast level. When you lift the outer shirt, the t-shirt stays in place.

7. A baby sling is a real boon to discreet nursing. You can stroll through department stores or play with a toddler in the park while keeping baby latched on behind the fabric of the sling.

8. Wear a large t-shirt over your swimsuit for discreet nursing at the beach. Or look for swimsuits made especially for breastfeeding women.

9. If you yearn to wear dresses, look for special styles for nursing mothers, with hidden openings at the breast. These are available from catalogs and can sometimes be found in maternity shops.

10. Nursing bras with cups that are easy to unfasten with one hand can make it easy to get your baby started at the breast, but refastening bra cups often requires two hands. You might have to wait to do this until you have a private moment–a reason to avoid clingy or sheer tops when you're out with baby.

11. Prints and loose styles camouflage leaking–and spit-up stains.

### It's All About Location

Just like a cop or detective might have a natural tendency to "case the joint" when he walks into a room - looking for exits, suspicious types, and escape plans - a nursing mom will learn to case any room or public place she walks into, looking for the ideal place where she can inconspicuously and successfully feed her baby without any riffraff.

Here are some things you can think about when toting a nursing newborn around each of the following locations:

Restaurants: The first words out of your mouth when you get to the hostess' stand should be, "Do you have a booth available?" Booths are about as private as it gets, when you're in a restaurant setting. Look for booths that are located on the side of the restaurant or in the corners. Even if being discreet isn't all that important to you, nursing your child while seated at a table in the middle of the restaurant will be difficult and distracting.

The Mall: The mall is actually a really great place to take a nursing baby. Why? Because there are private nursing rooms galore, or as non-nursing moms will recognize them, "fitting rooms." It's always a good idea to ask the store employees first, or just let them know you'll be nursing your child in the fitting room, so they don't get worried or suspicious about "that lady who's been in the fitting room for forty-five minutes." Be mindful of whether the particular store you're in is crowded. You don't want to keep people waiting, so you might be better off trying a store that's quieter. Malls also have a lot of chairs and couches scattered about, many of which are near large, fake potted plants. Those spots are great for nursing too and you'll find them every few steps you take.

Family Rest Areas: Women who have gotten used to breastfeeding might be most at ease stepping into a restroom, where they feel more comfortable being exposed. Others think it gross and unsanitary, but it is definitely worth checking out the restroom area when you're in a new place. There are many public places nowadays that offer rocking chairs and changing tables – special areas just for nursing mothers. Take advantage! Baby stores and kid stores usually have superb nursing areas available to moms and they are usually located in or near the restrooms.

Nurse on the Go in a Sling: Many of the baby sling carriers on the market are perfect for discreet nursing. Your baby might not nurse as easily while you are walking from Macy's to Gymboree, but it's worth a try. Those slings hold your baby so snugly and close to you, and the material covers any breast that would be exposed, so give it a try. Practice at home and see if your baby is willing to be a flexible eater.

Church: Church can actually be an ideal breastfeeding location. Many bigger, more modern churches offer "cry rooms" or "nursing areas" where nursing moms can watch the service on a screen in a soundproofed room. This is great. Churches that don't offer areas like that are likely to have many quiet, private rooms, or you can always use the church nursery and feed your baby in the rocking chair there.

### Get a Nursing Cover

This is a tricky tidbit because there are a lot of women these days that are strongly opposed to nursing covers. These women are trying to make a difference in our society's view of breastfeeding – trying to help Americans stop sexualizing the female body. Whether or not you're one of these women, you won't find any nursing mother disagree with the idea that it would be nice if our culture viewed breastfeeding as a loving way to nourish your child, rather than an opportunity to sneak a peek at a sexual organ.

It's interesting that only a generation ago, breastfeeding was not very common. I recently spoke to my husband's grandma about it, and she said that when she gave birth, the doctors and nurses gave her baby a bottle without even asking if she wanted to breastfeed. They just assumed everyone would bottle feed, because that's what was "in fashion" back then. But, now, thankfully, society is definitely more open and appreciative to mothers who choose to breastfeed their children. Of course, you can't escape the fact that America _does_ sexualize the female anatomy, making it tricky.

We know so much more about the countless benefits of a mother's breast milk now, and that has helped breastfeeding to be more commonplace, but no matter what your stance is, any time a sexual body part is exposed, there are going to be strong opinions.

So, if you're one who wants to forgo nursing with a cover in order to impact society, then do your thing! You've got the legal right. Of course, you can still be _polite_ about it.

Many women are proud nursing mommas who would love to help get the culture more comfortable with public breastfeeding, but still want to be discreet and put others at ease. For this reason, I'd say every mom should at least own a nursing cover. You can feel out a room – get a sense of your surroundings and wear the cover when your circumstances dictate that it might make you and others around you more comfortable.

Nursing covers are also great for those women who just aren't comfortable whipping them out in public. Everyone's got their own perspective and personality, and for shyer types, the nursing cover is man's greatest invention.

The way that nursing covers are designed, you can breastfeed your baby, fully exposed, be sure that there is no blanket or material obstructing your babies nose, and you can see your baby at the same time, while covered up.

Nursing covers also allow you more freedom when it comes to choosing your outfits. When you're wearing a cover, you don't need to think about breast exposure as much. You can wear that cute dress you bought, and give your baby access through the top of the dress. No one will notice if you're wearing a nursing cover.

Any mom looking to feed discreetly should invest in a nursing cover (or two) with the wire section around the top. Unless someone is standing directly over your head, they won't see a thing and may not even notice what you're doing.

Even if you don't plan on using one, it's a good thing to keep stashed in the diaper bag, just in case. You never know what situation you might be thrown into. Maybe you're all about breastfeeding openly, but you might have a day where you just want to put your sunglasses on and be incognito. Covers are good to have for so many reasons, so put it on your registry and stash it way.

### Have Confidence

All that being said, if you go into public breastfeeding blindly, you will likely be fumbling around nervously – eyes darting back and forth – wondering who is looking at you, who might be offended, and what they are saying about your public decency or parenting style.

From the moment you become a mother, you're bombarded with advice, whether it's wanted or not. Every mom has an opinion and feels very strongly about it and a lot of these moms aren't shy to give you their two cents. So, if you've been a mom for even a few hours, you're likely already used to constant feedback – whether it be coming from the check-out lady at Target, your mother-in-law, or the highly opinionated blog posts that your friends keep sharing on your Facebook page.

So, given the fact that you _will_ be bombarded with opinions, you need to decide how you feel about public breastfeeding and get a grasp on this sooner than later; in the words of Taylor Swift, "Shake it off."

Read what you want to read. Ask advice from people you want to listen to. Then, make up your mind, do what you want, and smile politely at people who criticize your decision to breastfeed in public as you let it roll off.

Whether you choose to wear a cover, invest in a nursing wardrobe, or just breastfeed uncovered is up to you, so decide what you want to do and stick to your guns.

Know that you are giving your child the most wonderful gift by choosing to breastfeed, and just because you made that decision, it doesn't mean you should lock yourself behind a closed door for twelve months.

Just own it – for your sake and for the sake of your child.

Having fears and insecurities won't help a thing. You know how dogs can smell fear? Well, babies sort of can too. If you aren't confident in what you're doing, you'll likely find that you have a more difficult time getting your baby to latch and stay on. If you're uncomfortable, even an infant will pick up on that.

On the flip side, if you feel secure with yourself, your decisions, and the wonderful thing you're doing for your baby, your baby will feel safe and secure as well.

If you're not really sure where you stand or how you feel about public breastfeeding, there is an abundance of resources. Check out reputable websites like La Leche League, Ask Dr. Sears, Kelly Mom, What to Expect, Baby Center, and of course, SmartMom.

There are many great sites out there, all supportive of breastfeeding, that discuss related topics from every angle. Do your research, decide where you stand, and then you can feel good about your plan going forward.

# The Pumping Mom's Survival Guide

By Christina Maki

I once had a fellow breastfeeding mother insinuate that I am an exclusive pumper because I didn't want to put in the time and effort required to make feeding at the breast work for my son and I. The idea of me pumping because I'm too lazy to do otherwise amused me so much that I unabashedly snorted at her, thinking about the growing collection of used bottles next to my sink that I was going to have to deal with as soon as I got home.

Anyone who thinks that pumping to feed your baby is an easy endeavor has obviously never done it exclusively. It's hard work! I carry a very heavy hospital-grade pump with me literally everywhere I go, I attach myself to it every three hours, and I am constantly having to work my schedule around when I can pump and strategically placing myself in locations with electrical outlets during those times. And then there are those bottles I mentioned, which have to be cleaned and sterilized several times a day. It's definitely not the lazy mom's choice!

Whether you're pumping exclusively or just using your pump to express milk while you're away from your baby, there are lots of ways you can help make sure pumping goes as smoothly as possible. It's not always as simple as just attaching the pump and watching the milk flow; there's a definite science to pumping, and it takes some getting used to! In the past few months, I've gone through a lot of trial-and-error to find strategies that maximize my milk output and minimize my stress, and today I'm sharing this wisdom with you in this survival guide for pumping moms.

### Getting started

Consider your first two days with your newborn like a boot camp for your breasts. Your milk will likely come in between three and four days after your baby is born, but in the meantime your colostrum will nourish him or her. During this period, making sure your breasts are frequently stimulated is very important in order to build an adequate milk supply. Here's how to make sure you get off to the best start possible.

**Pump early and pump often.** Most birth centers and maternity wards will supply new moms with a very efficient medical-grade pump to use while you recuperate from childbirth. In between breastfeeding your new little one, utilize that pump every 2-3 hours. It's probably going to seem like your nipples are constantly attached to something, be it a baby or the pump, but breast milk production is a supply-and-demand process. Every time your baby feeds or you pump, you are creating a demand for milk, and your body will respond by producing more of it. Even if you pump and only get a few drops, you are letting your body know that there is a hungry baby around that needs nourishment. The more stimulation you provide, the better your milk supply will be!

**Stimulate both breasts at once.** Hospitals and birth centers supply double-electric pumps, which makes this pretty easy. Either feed your baby on one breast and pump on the other, or use both flanges on your pump at the same time. The first option takes some finesse, and it may be too difficult to manage. I, personally, was never able to make it work. If that's the case, don't sweat it--enjoy feeding your baby and concentrate on bonding with him or her. Just make sure you are changing sides during your feedings so your baby is stimulating both breasts each time. If your baby isn't yet hungry enough to empty both of your breasts, just pump once he or she is done.

**Don't stop when your milk does.** When you express your milk, you will notice that at some point it slows down to just a dribble, and then the flow will eventually stop altogether. Don't switch off the pump just yet, though! Keep going for another five minutes after the milk stops flowing. This accomplishes a couple of things: it allows your milk to let down a second time if there is more of it waiting, and it also tells your body that you haven't quite gotten enough milk this time, encouraging more production. My lactation consultant also told me that I should always pump for at least fifteen minutes, regardless of how quickly my supply was depleted. So if I emptied my breasts in five minutes, I kept going for another ten to signal to my body that I needed more milk.

### Choosing your pump

One of the most important things you can do to maximize your success with pumping is to select the right equipment. If you're not sure how to go about choosing a pump or sizing your flanges, here are some quick and dirty tips.

**Investigate your options.** Before you go about selecting your pump, you should first check with your insurance company to see if they provide one. Because of a new provision in the Affordable Care Act, most insurance companies are required to provide some sort of pumping apparatus. For some plans, this only covers a manual pump, but with other plans your options may include a double electric or even a hospital-grade pump if your doctor deems it necessary. Many insurance plans require you to go through certain vendors to obtain your pump, so your selection may be limited. If this is the case and your preferred pump is not available, some insurance companies will allow you to upgrade to the pump of your choice if you agree to pay the cost difference. Knowing what's available to you before you begin making your selection can help you decide on a pump that will be effective and affordable.

**Do your research.** Read reviews online, talk to a lactation consultant, and ask around to other pumping moms. Finding out what others' experiences have been like can help you whittle down your options and give you some good food for thought when you make your final decision.

**Consider your individual needs.** If you have a previous medical issue that may affect your milk supply, such as a past surgery or other procedure that may have damaged your milk ducts, you may need more than just a standard-issue electric pump. Hospital grade pumps are often best for women who have special needs in regard to milk production, as they are more aggressive and will be more effective at expressing stubborn breasts. Your insurance company may cover rental of one of these pumps, or you may have to pay for it out-of-pocket. If you've had a surgical procedure on your breasts and have concerns about your ability to adequately express your milk, investigating the possibility of obtaining a pump like this is an excellent idea.

**Make sure your flange is appropriately sized.** Get a group of ten different women together from anywhere in the world and you're likely to have ten very different sets of nipples. Our bodies aren't one-size-fits-all, and neither is your pump! A lot of women who have trouble pumping encounter problems because they are not using a correctly sized flange. The flange, sometimes called a breast shield, is the funnel-shaped piece of your pumping setup that rests against your breast, drawing your nipple in. Most pumps come with a 24mm flange, but the sizes range anywhere from 21mm to 36mm, depending on the manufacturer. When your pump is in use, your nipple should be drawn into the tubular part of the flange easily, and your nipple should move freely back and forth without touching the sides of the flange. If your nipple is touching the inside of the tube, your flange is probably too small. On the flip side, if your nipple seems to be dwarfed by the size of your flange and you are seeing more of your areola pulled in than your actual nipple, it's probably too large. In addition to being uncomfortable, an incorrectly-sized flange can cause plugged ducts or mastitis and can affect the quantity and quality of your milk, so ensuring that you are using the right size for your breasts is very important.

### How to make more milk

For the most part, as long as you stimulate your breasts adequately, the majority of women will produce plenty of milk for their growing babies. However, some women have trouble building and maintaining a good milk supply. If you are concerned about your supply, here are some ways you can encourage your breasts to increase production.

**Take good care of yourself.** It's not easy to put yourself first when there is a new baby in the house, but it's very important to remember that your baby needs you at the top of your game in order to thrive. It is totally _not_ selfish to make sure you are keeping up on self-care so you can adequately feed and care for your new little one! Make sure you are eating plenty of healthy foods and getting enough nourishment. Pay special attention to your protein, calcium, and iron intake, especially if you are a vegetarian or a vegan. Now is NOT the time to start a diet--your body needs extra calories to produce milk, so it's totally okay to have another helping of yogurt or spread a bit more peanut butter on your morning bagel than you normally would! You should also make sure you are drinking plenty of water. Don't force more water on yourself than you need, but keep in mind that your body needs to be well hydrated in order to make milk. If you aren't getting enough, you'll see your production take a sharp nosedive, so drink up! Getting plenty of rest is equally important. It can be difficult, especially when your baby keeps waking you up in the wee hours of the morning, but try to sleep whenever you can. If the baby is napping, you should be, too!

**Power-pump.** This is one of the best ways to tell your breasts to make more milk. As I mentioned earlier, breast milk production works on a supply-and-demand basis, so the more demand there is for milk, the more your body will make. Power-pumping sessions simulate what would happen if your baby were going through a growth spurt and needing very frequent feedings. Instead of pumping every three hours for fifteen minutes, you pump for a shorter period of time, say ten minutes, and increase the frequency. I typically alternate ten minutes on the pump and then twenty minutes off, so I'm pumping twice an hour, and I do this for as long as I feasibly can during the day. Since I'm an exclusive pumper, it's easy for me to just pass the baby off to my significant other for a few hours and concentrate on pumping, but it may be more challenging for moms who are able to breastfeed. If that's the case, just pump on a really frequent schedule between your feedings and it will accomplish the same thing. Yes, this is a very annoying way to spend your afternoon, but boy, is it effective!

**Fully deplete your supply every time.** My lactation consultant advised me never to let my breasts get full. If I was feeling engorged, she said, I was overdue for a pump. Make sure you are regularly and fully draining your milk supply so that your body is encouraged to refill. Once you have finished pumping, hand-express your breasts to get the last few drops out. Fully emptying yourself not only encourages your body to produce more, it also helps prevent painful conditions like plugged ducts and mastitis, so make sure you're getting as much as you can out each time you pump.

**Consider galactogogues.** No, that's not the name of a race of Star Trek aliens! Galactogogues are substances that encourage milk production. They can be synthetic or natural. One of the most commonly touted herbal galactogogues is fenugreek, which can be taken alone or in combination with other herbs like blessed thistle and marshmallow root. Some foods are also cited as galactogogues, like oatmeal, brewer's yeast, fennel, and alfalfa. According to many medical sources, there have never been studies done on foods or herbal remedies for lactation support that prove their effectiveness, but women for thousands of years have sworn by these natural substances for increasing milk supply. You can even find recipes online for lactation cookies, which contain many of these ingredients and taste fantastic. If natural sources fail, you can also speak to your doctor about pharmacological galactogogues like metoclopramide and domperidone. Both of these medications work to increase milk by suppressing your body's production of dopamine. Dopamine inhibits the production of prolactin, the hormone that tells your body to produce milk, so by decreasing the dopamine in your system, you allow for more prolactin and in return can see a drastic increase in milk supply. Metoclopramide is widely available for lactation support with a doctor's prescription, but domperidone is harder to come by in the United States. It is only prescribed by certain doctors and can only be obtained through certain compounding pharmacies, so if you are interested in using it, you'll want to have a conversation with your care provider about whether or not it is available in your area.

### Bring in reinforcements

If you are having trouble breastfeeding, pumping, or establishing your supply, there are a number of ways you can get support from experts and medical professionals to help ensure your success. Here are some resources you can access when things get rough.

**Look online.** There are a plethora of online resources for breastfeeding moms that can offer advice and support. Doing a simple web search may give you just the answer or encouragement you are looking for! Just remember to take any advice you see on the Internet with a grain of salt and consult your care provider before putting it into action.

**Find a local support group.** Breastfeeding and pumping are not easy tasks, and anyone who says otherwise is a dirty rotten liar. Sometimes, the act of feeding your baby can be incredibly frustrating and stressful, and simply talking to other parents who are dealing with the same frustrations can really be a huge help. Ask your health care provider about local support groups like La Leche League, which typically meet on a regular basis and offer support and advice to new moms who are struggling with breastfeeding.

**Consider a lactation consultant.** The same provision in the Affordable Care Act that provides new mothers with breast pumps has also opened up lots of insurance coverage for visits with lactation consultants. These women are specially trained on the ins and outs of breastfeeding and can offer support via email, phone, or personal consultations. During a face-to-face meeting, they will often observe a breastfeeding session to ensure that the baby is latching correctly and suckling efficiently. They can also help with selecting a breast pump and flange appropriate for your needs and discuss other concerns like milk supply and breastfeeding laws in your area.

**Call your care provider.** There are situations that can arise during breastfeeding where you need to address your concerns with a medical professional. Your OB-GYN or midwife can help with everything from recommending support groups and consultants to prescribing galactogogues or heavy-duty nipple creams, and can answer any health questions you have regarding your breasts. You should definitely call your care provider if you suspect you have a clogged milk duct or mastitis. Symptoms of plugged ducts include tenderness, hard lumps in your breast, swelling, redness, or a hot feeling either inside your breast or on the surface of your skin. If you experience any of these, contact your provider for advice. They will often suggest warm compresses and frequent pumping to help loosen and dislodge the clog. However, if you experience any of those symptoms along with a fever, red streaks on your breast, chills, body aches, malaise, or fatigue, you should get in to see your provider as soon as possible. Mastitis is an infection of the breast, and if left untreated it can lead to an abscess or a systemic infection. Your doctor or midwife may suggest bed rest, warm compresses, gentle massage, and an analgesic or anti-inflammatory to help with the swelling and pain. In some cases, you may also need to take an antibiotic to knock out the infection. And while it may be uncomfortable, pumping or nursing while you have a plugged duct or mastitis is safe and usually encouraged. If you stop emptying your breasts, you could exacerbate the problem, so it's best to just keep on keepin' on!

### Get some extra gear

In addition to your pump, there are lots of extras you can get that will help keep your nipples in good shape, help you collect and store your milk safely, and save your sanity while you're attached to the pump.

**Invest in a good nipple ointment.** Whether you choose pure lanolin, organic nipple butter, or just smear on some plain ol' coconut oil, making sure your nipples are well moisturized can really contribute to your pumping success. The ointment will protect your delicate skin from getting chapped or cracked, and it also helps to form a seal around your flange, providing the best possible suction. If you find your nipples are really sore, you can even get prescription-grade creams that will help reduce discomfort and prevent infection. Always ask your care provider first about using a cream that isn't specifically made for use in breast-feeding, though! You wouldn't want to use something that could potentially harm your baby if it was ingested.

**Select a good milk storage system.** There are a couple of different ways to store your breast milk. Depending on your refrigerator or freezer size and your preferences, one way may work better than another. Storage bags are the most popular way to go, and there are options on the market ranging from simple, cheap plastic collection bags to environmentally friendly biodegradable versions made from corn. There are even some bags that have special adapters that allow you to pump directly into the bag, which saves you a step and prevents the risk of potentially spilling your precious liquid gold. These bags are sterile until opened, giving you a safe way to store your milk without having to worry about contaminated containers. Bottles are another way to store milk, but these must be sterilized between each use to ensure that they are free of germs and bacteria that could potentially harm your baby. Whichever way you choose, be sure your hands and surfaces are clean before transferring breast milk to your storage container, and follow safe breast milk storage guidelines.

**Go hands-free.** One of the best pieces of advice I got from another exclusively pumping mama was to get a hands-free pumping bra. These things are total sanity savers! If you're going to spend hours of your day attached to a pump, you might as well be able to get something done while you do it! I originally made my own by simply cutting a couple of small X-shaped slits in the cups of an old bra, but when the strap on that bra broke, I ended up buying a commercially made version. The design is very simple; the flanges of the pump fit through holes or slits in the fabric of the cups over your nipples, holding them in place. The suction of the pump ensures that they stay in the correct position, allowing you to use your hands for other things. I use mine nearly every time I pump, which lets me read books, play with my son, fold laundry, check Facebook or Twitter on my phone, and even use my laptop while I'm making milk. In fact, I typed the first section of this post while pumping. Now that's what I call multi-tasking!

### Have pump, will travel.

There will probably be times when you need to take your pump with you outside of the house, whether that's going to work for a few hours or leaving for a week-long vacation. I'll just be honest here: traveling while pumping can be pretty obnoxious. But following these tips can help you make the most of your pumping when you're away from home.

**Make sure you can power your pump.** If you're talking to your boss at work about places to pump, it's important to select a room that has electrical outlets if you are using an electric pump! Seems like a no-brainer, but I almost chose a room at my facility that didn't have a free spot for me to plug mine in. If you don't have electricity, you can't pump! Along these same lines, it might not be the best idea to take a camping trip out in the middle of nowhere if you're a pumping mama, unless you want to lug a generator along with you. And if you're traveling outside the country with an electric pump, make sure you've got the proper plug adapter for it, since other areas of the world often have different outlet configurations and voltages.

**Keep things cool.** Breast milk should be stored in cool temperatures, so if you're pumping on the go, it's important to keep a cooler with ice packs around to store your milk. If you're on a road trip in a hot car, be sure you change your ice frequently! You can store your milk this way for up to 24 hours. Once you reach your destination, make sure it gets into a refrigerator or freezer. (Which brings up another point--make sure your destination _has_ a refrigerator or a freezer!)

**Know your airport's guidelines and accommodations.** If you plan to fly the friendly skies while you're pumping, it's important to do a little research ahead of time. Many airports have designated rooms for nursing and pumping, which will allow you to have a private, quiet space to do your business. If not, you may be stuck pumping wherever you can find a publicly accessible outlet. If pumping in public makes you uncomfortable, you may want to invest in a nursing cover or bring a blanket to wear while you pump. When it comes to airport security, the TSA has put forth pretty clear guidelines in regard to breast pumps and stored milk. Your pump and your storage bottles and bags, whether empty or full, are allowed onto planes, and there is no limit to how much you can carry. However, it's important to separate and declare these items to the agent performing your security check in order to prevent you from being delayed, and you may be subjected to additional explosive screenings for these items. It should also be noted that your pump does not count as an additional carry-on. It is considered a piece of medical equipment, so you can have it on the plane with you along with your allotted number of carry-ons and personal items. Pumping in flight can be cumbersome, but airlines tend to be very accommodating to breastfeeding mothers. Be sure you check your airline's guidelines for breastfeeding on planes. Some prefer that you pump while covered, or may reseat your neighbors if they complain about being uncomfortable. There are definitely major strides that need to be made in normalizing breastfeeding, and many airline policies reflect that. Don't let that stop you, though! Do what you feel you need to do to feed your baby and let your flight attendant sort out the rest.

I hope these tips and tricks are helpful as you settle in to your pumping routine. While it can sometimes be an irritating part of life with a new baby, pumping can greatly improve your milk supply and keep your baby fed when you have to be separated, and for moms like me who pump exclusively, it can be the deciding factor in whether or not you are able to give your baby breast milk at all. The health benefits of breast milk for new babies are numerous, and every drop you can give your little one gives them nourishment and protection like no other food can. Committing to pump means you are an amazing mama. Don't ever let anyone tell you any different!

And now, if you'll excuse me, I have some bottles that need washing.
