Breast-Feeding
Common Concerns
You may sometimes doubt your ability to successfully breast-feed. It is common to have questions and occasional struggles. Remember, most breast-feeding issues are easily resolved when you know what to expect and have support from others.
Getting started and keeping it up
You may be unsure about how to begin breast-feeding. A lactation consultant is available at many hospitals and birthing centers. These consultants help you and your baby learn good breast-feeding techniques, such as getting a good latch and learning a variety of feeding positions.
Unless your baby is born needing immediate medical care, it is best to begin breast-feeding within 1 hour of birth. Also, immediate skin-to-skin contact with your baby after delivery may help promote long-term and successful breast-feeding.
With practice, you will get better at using the basic breast-feeding positions.
Try alternating feeding positions to encourage complete emptying of your breasts. Using different holds can help prevent you from developing plugged milk ducts.
Women who have had a cesarean delivery may prefer positions in which the baby doesn't rest on the abdomen, such as the side-lying position or the football hold.
Because the first 2 weeks of breast-feeding often are the most challenging, you may question your ability to continue. Your body is recovering from childbirth and adjusting to hormonal changes that can exhaust you and make you feel overwhelmed. You may also struggle with minor problems, such as nipple soreness or breast engorgement, that may make breast-feeding uncomfortable.
With proper planning, preparation, and support, you can breast-feed successfully. Physical conditions that may interfere with breast-feeding usually are minor, treatable, and temporary. For example, if you feel that you don't have enough milk, your health care professional can help you solve the problem.
Your milk supply and your baby's growth
During the first few weeks, you may have concerns about whether you are producing enough breast milk for your baby. The key to increasing breast milk production is emptying your breasts well and frequently. This means breast-feeding every 1 to 3 hours. Frequent breast-feeding increases your prolactin levels, which stimulates the breasts to produce more milk.
Most babies lose weight in the first several days after birth but regain it within a week or two. Weight gain is more rapid after mature milk is produced, about 10 to 15 days after you deliver your baby. After breast-feeding is established, your baby will also get more hindmilk, which provides additional fat and calories. Look for signs that your baby is getting enough milk and is growing well. If you continue to have concerns, see the When to Call a Doctor section of this topic.
If you are unsure whether your baby is getting enough milk, talk to your doctor. He or she can help you to determine the problem, if one exists. Do not supplement your breast-fed baby's diet with formula unless your doctor recommends it. Extra feedings with formula can interfere with your breast milk production and may lead to early weaning.
Typical bowel patterns of a breast-fed baby
Breast-fed babies usually have a small stool after every feeding for about the first 4 to 8 weeks. Stools are yellow, seedy-looking, and soft or runny. Gradually the pattern changes, and your baby will start to have larger stools. Newborns younger than 2 weeks should have at least 1 or 2 bowel movements a day. Babies older than 2 weeks can go 2 days and sometimes longer between bowel movements. It’s usually okay if it takes longer than 2 days, especially if your baby is feeding well and seems comfortable.
Your health and breast-feeding
Almost all mothers of newborns are able to breast-feed. However, talk to your doctor before breast-feeding if you:
- Have a chronic or infectious disease. Women living in developed countries who are HIV-positive should not breast-feed. Women who have conditions such as cystic fibrosis need to be monitored while breast-feeding.
- Use medication. Talk with your doctor before taking any nonprescription or prescription medication to ensure that your breast milk will not be affected.
- Have had breast surgery. If you have had breast reduction, augmentation, or biopsy, you will need to be closely and consistently monitored when you begin breast-feeding. Any of these surgeries may affect your ability to produce breast milk. Before your baby is born, talk to your doctor about any breast surgery you have had.
- Use drugs or abuse alcohol. Any substance that you use while breast-feeding, including smoking, can harm your baby.
- Have a minor illness. You can continue breast-feeding when you have a minor illness (such as the flu or a cold). Try to rest as much as you can and drink fluids. A mother's health very rarely interferes with breast-feeding. You should not breast-feed if you have active tuberculosis, HIV, or cancer that is being treated with chemotherapy. Talk to your doctor if you have any questions or concerns about breast-feeding when you are sick or if you need to take prescription or over-the-counter medications for your symptoms.
While you are breast-feeding, take extra care to avoid exposure to poisonous substances, such as fish that may contain mercury. Some of these substances can be passed on to your baby through breast milk.
Breast-feeding your sick baby
Breast-feed your baby who is ill whenever possible. Breast milk provides antibodies, nutrients, and fluids that are important for recovery. For more information, see the When to Call a Doctor section of this topic.
Some babies are born with problems that interfere with their ability to breast-feed right away. However, many of these babies can be fed breast milk using special techniques, such as cup-feeding or a feeding device called a supplemental nursing system. Circumstances that may delay feeding at the breast include:
- Premature birth. Premature babies often can be fed breast milk from a cup or with a supplemental nursing system. You may need to pump frequently to get your milk production started.
- Metabolic disorders.
- Cleft lip or cleft palate. If your baby is born with a cleft lip or palate, a lactation consultant may teach you ways to breast-feed, or breast milk can be fed to your baby using a bottle and special nipple.
- Low Apgar scores, which usually result in only a minor delay.
In rare cases, a breast-fed baby develops a sensitivity that shows up after the mother has eaten food that contains cow's milk or other dairy products. If a sensitivity is diagnosed by your doctor, continue breast-feeding while avoiding dairy foods. Talk to your doctor about proper food choices and other suggestions for a baby with this problem.
Breast appearance
Many women notice differences in how their breasts look and feel while during pregnancy and after having a baby. Initial changes (such as breast enlargement) are related to the body's preparation for milk production. Other changes, such as a darker color and increased size of the areola (the dark circle around the nipple) and more prominent nipples, are sometimes permanent. Changes generally are minor and result from pregnancy, not breast-feeding. Some changes, such as sagging, are influenced by heredity, the type of bra you wear, and the effects of aging.
Going back to work or school
Being away from your baby for long periods when you work or go to school requires planning and support for long-term breast-feeding success. Some workplaces allow women to have their newborns with them at work. For most, this is not an option. If you will be at work without your baby, be sure to select a breast pump that is convenient and comfortable. Explore your options for using a comfortable and private area at work or school to pump. Many workplaces and colleges have areas set aside for mothers to pump. Regular pumping is necessary to ensure that your breasts produce enough milk and to prevent your breasts from becoming uncomfortable and engorged. Consider how to properly store breast milk both at work and at home.
If possible, you may want to consider going to school or working part-time or three-quarter time for at least your baby's first year. Or you may want to investigate whether a flexible working schedule is possible. For example, depending on your type of position, some employers may allow you to work some hours at home.
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| Author: | Kathe Gallagher, MSW | Last Updated: May 10, 2007 |
| Medical Review: | Kathleen Romito, MD - Family Medicine Joy Melnikow, MD, MPH - Family Medicine | |
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| Topic Contents | |
| Topic Overview | |
Health Tools  | |
| What Is Normal | |
 | Common Concerns |
| Routine Checkups | |
| When To Call a Doctor | |
| Home Treatment | |
| Other Places To Get Help | |
| Related Information | |
| References | |
| Credits | |