Absolutely, you can still be active and breastfeed! For the first several weeks, until breastfeeding is well established, it is easiest to take your baby with you wherever you go, so he can nurse at the earliest signs of hunger (see breastfeeding in public). Fortunately, breastfed babies are very portable -- no bottles to pack, chill, and heat. After those three to four weeks, your baby can take a bottle of pumped breastmilk, if you are away from him. After a few more weeks -- once your milk supply is well established-- your baby may take formula occasionally, but it is better for your baby's health if you are able to delay the introduction of any formula for as long as possible -- ideally for at least 6 months.
Feeding a newborn takes a lot of time, regardless of what feeding method you choose. Because bottles work by simple gravity, a baby drinking a bottle may eat faster, and can go longer between feeds because formula is not easily digested. But, there is more work involved with bottle feeding. Mixing formula, heating formula, and cleaning and sterilizing bottles and nipples, all take up a lot of time and energy.
Breastfeeding may actually save you time. With a nursing pillow wrapped around you, you can have one or two hands free to do other things, like eat, comfort an older child, write, pay bills, even use a computer. In addition, you and your partner can get extra rest if you breastfeed when lying down -- and, no bottles to fetch in the middle of the night! This way, your sleep at night will be minimally disturbed, and you and your partner can wake up more refreshed.
When you are breastfeeding, you can feed your baby without even getting up at night, and can even feed your baby in your sleep. Breastfeeding while lying down allows you and your partner to get more rest.
You can introduce a bottle at three to four weeks--preferably not sooner. Even then, it should be a bottle of breastmilk, not formula. It is actually best if someone other than the mother gives bottles. In the meantime, there are many loving ways your partner and family can help with the baby, besides feeding.
No. Your body will make the perfect milk for your baby no matter what. For your own health, of course, it is best to eat a balanced diet regardless of how you feed your baby.
Some doctors recommend that mothers avoid peanuts during pregnancy and breastfeeding if allergies or asthma run in the family, as avoiding peanuts may help prevent the development of peanut allergy in your baby. (For details, see section on diet, below.)
Small amounts of alcohol are considered acceptable -- one drink a day or less, on average. Breastfeeding is still the healthiest way to feed your baby, even for women who smoke. However, for your own health and that of your baby, it is best to quit smoking, regardless of how you feed your baby. For more information, see our questions on our Alcohol, Smoking, Diet, and Medications section.
You can nurse discreetly by covering your baby and breast with a small blanket, or by nursing in a baby sling. Wear two piece garments, and always lift your shirt up from the bottom instead of down from the top. Turn your back when your baby first latches on. Try practicing with a mirror first. You can also buy special nursing clothes with concealed openings, so you don't have to lift your shirt. (http://www.motherwear.com, http://www.onehotmama.com/). You will be surprised at how few people notice you--except for other nursing mothers.
Remember that breastfeeding is something to be proud of, not be ashamed of. You are using your breasts for their intended purpose: to feed and nurture your child.
No. Pregnancy causes droopy breasts, not breastfeeding.
No. Your milk will be good, no matter what your feelings are. Nursing may help you feel better, too!
No. Your milk will remain good. Sex does not affect your milk.
Yes, but introducing formula too early has been shown to greatly increase the chance of breastfeeding failure. This is because your baby may be too full from formula to nurse frequently, and this will reduce your milk supply. Your body makes as much milk as your baby demands -- your baby will demand less if she's drinking formula.
Formula also takes a long time to digest, so your baby may not want to nurse for several hours after drinking formula. That's why giving formula may also make your breasts engorged and uncomfortable -- you miss the chance to feed your baby and empty your breasts.
In addition, early introduction of formula can affect your baby's immune system and is linked with an increased risk of certain diseases, such as type1 diabetes, diarrhea, and probably asthma. The American Academy of Pediatrics recommends that babies get no other food or drink besides breastmilk in the first 6 months.
You should avoid bottles altogether for the first 3 to 4 weeks, until your baby has had a chance to become skilled at sucking on the breast. After that, another person can feed your baby an occasional bottle of breastmilk. Introducing formula before your milk supply is well established can cause you to make less milk. Most authorities estimate it takes about 6-12 weeks to establish a good milk supply.
The more your baby nurses, the more milk you make. Your body makes more milk in response to your baby's appetite. If you have twins, you'll make twice as much milk. A newborn should nurse 8 to 12 times a day, and may need to be wakened to feed if not nursing this often. Your baby's mouth should be opened wide, with the tip of your breast resting at the back of his throat. You should notice baby moving his jaw up and down while nursing, and you should be able to hear his swallows. Swallows sound like a quiet "k" in the first day or two, and then actual "gulps" as your milk supply increases. If he didn't swallow, he didn't eat.
Watch your baby, not the clock. Don't time his feeds. Instead, switch sides when baby's swallowing slows down, or baby takes himself off the breast. Sometimes, a baby may take a "break" during a feed, and nurse for comfort for a minute or two, before going back to swallowing. You can tell he's full if he's no longer showing signs of hunger, such as sucking on his hand, or moving his mouth. He should be relatively content, especially after a feed, and may fall asleep after a good feeding. Your breasts should feel softer and lighter after a good feed.
You cannot tell if you have enough milk by offering a bottle after a feed, or by pumping to see how much milk you make. A contented, full, breastfed baby may still take a bottle after a feed, even if not hungry, because bottles work by simple gravity, and milk from a bottle will go easily into a baby's mouth. Measuring your milk by pumping is also very inaccurate--even the best pumps are not nearly as effective in removing milk as a baby who is nursing well. Often moms get little milk out with pumps, but their babies are eating fine and growing normally. It is far more accurate to listen for the sounds of swallowing, and to make sure the baby is no longer showing signs of hunger when finished with a feed.
It's normal for babies to lose a little weight before your milk comes in -- babies are born with a little extra fluid in their bodies. If your baby loses more than 7-10% of his birthweight, you should be evaluated by a lactation consultant as soon as possible in the hospital. Your baby should be weighed about 2 days after going home, and if the weight gain does not seem adequate, he should be weighed again on the same scale 1-2 days later. He should be gaining 1/2 to one ounce a day. If not, see a certified lactation consultant as soon as possible.
Since what goes in must come out, check your baby's diapers -- he should have frequent wet (or heavy) diapers. As your milk comes in, he should be having at least 3 yellow stools a day -- if this is not the case, be seen promptly by a certified lactation consultant and by your baby's doctor.
You can make more milk if you feed early and often -- at the earliest signs of hunger. So, offer the breast to your newborn if his eyes are open, if he's making movements with his mouth, or if he's sucking on his hands -- don't wait until he cries. You can make more milk if you sleep near your baby and nurse lying down (which allows more time at the breast), if you do not use any formula (except for a medical reason), and if you do not use a pacifier. (See our tips, Making Milk is Easy -- 10 Steps to Make Plenty of Milk.)
Your baby eats so often because he is growing so rapidly, and because your milk is the perfect food -- so easily and quickly digested (as compared to formula). Think how much you would have to eat if you wanted to double your weight!
If your nipples are sore beyond the first few days, chances are your baby is not positioned correctly on your breast. His mouth should be opened wide, with as much of your breast in his mouth as possible. Your nipple should stay in the back of this throat. His nose and chin should be touching your breast, and his chest resting square against yours. "Chin to breast, and chest to chest." Sometimes, a slightly turned-in lip can cause soreness. You can prevent this by getting in the habit of flipping his lips outward each time each time he latches on. "Mouth open wide like a shout, with lips flipped out." Support your baby and your arms with a pillow, and support your breast with one hand so that your baby doesn't start sliding off and pulling down on your nipple.
When you take the baby off, make sure you break the seal first, by pulling back the corner of his mouth, or inserting your finger into his mouth. You may need a lactation consultant to observe you breastfeed -- don't wait to get help if you need it! To soothe sore nipples, rub a little breastmilk on them and let them dry, or use purified lanolin cream, which is available in the baby section of most drug stores.
Occasionally sore nipples might be caused by a yeast infection on the nipples and in the baby's mouth (thrush, also known as candida or monilia). This typically causes soreness even when the baby isn't nursing. Your nipples may be pink, there may be white patches in the baby's mouth, or the baby may have a characteristic diaper rash, or there may be no obvious signs on either mother or baby. Treatment is with a prescription of nystatin liquid for the baby's mouth, and nystatin cream for mom's nipples. You both will need to be treated, whether or not you both have signs of yeast infection.
Frequent feeding does not cause sore nipples.
If your breasts are too full, it may be hard for your baby to latch on well. Squeeze a little milk out by hand to soften the breast. Then, nurse more often!
If this happens after you leave the hospital, it generally requires immediate attention by a lactation consultant. Sometimes the answer is simple. If your baby has been crying hard, it may help to cuddle and perhaps burp her to calm her down first. If your breasts are overly full, your baby may not be able to get her mouth around your breast -- if that's the case, just squeeze out a few drops of milk first, to soften the breast.
You can nurse discreetly by covering your baby and breast with a small blanket, or by nursing in a baby sling. Wear two piece garments, and always lift your shirt up from the bottom instead of down from the top. Turn your back when your baby first latches on. You will be surprised at how few people notice you -- except for other nursing mothers.
Remember that breastfeeding is something to be proud of, not be ashamed of. You are using your breasts for their intended purpose: to feed and nurture your child.
Sleep near your baby and nurse lying down. If you don't have to sit up or stand up, your body will get more rest, even if you are awake when you nurse. Avoid turning on the light, as this also disrupts your sleep
There are many positions to nurse lying down: a) on your back, with your baby cradled under your arm, making sure his chest is against the side of your chest; b) on your side, with your baby's head resting on top of your bent elbow; c) on your side, with your top breast leaning into your baby's mouth; d) on your side with your lower breast supported by your bent elbow. It may take a little practice but stick with it.
If you choose to share a bed with your baby, it is important to know how to do this safely:
Your baby can sleep in a bassinet at the side or your bed, preferably high enough so that you don't have to bend over. Or, put your mattress on the floor; your baby can sleep on the floor next to your mattress, on a crib mattress, a camping mat or a yoga mat.
You can start by telling them all the benefits they will get from your breastfeeding: You and your partner may get more rest (if you sleep near your baby and nurse lying down). You or your partner will miss less work because your baby will be healthier. Your baby is less likely to be crying from colic. Unlike formula, breastmilk won't stain clothing, in case of spit-ups. The stools of breastfed babies do not smell as bad as those from formula-fed babies. Your chance of pre-menopausal breast cancer or ovarian cancer may be lower, which will please those who love you. Remind your family that your baby will get health benefits that will last his whole life. You can help family feel more comfortable by following guidelines for nursing in public, above.
Sometimes, family members want to be supportive, but say things that can shake your confidence. That is often because they know only about bottle feeding, and are comparing you to the only thing they know. If they think your baby is eating too often, for example, you may have to tell them that breastfed babies eat more often because breastmilk is so easy to digest. If your baby is gaining weight well, you can assure them that your baby is eating just fine. If they think your baby likes a bottle better, you can tell them that bottles work by gravity so it's easier to drink from bottles -- but a bottle can never replace the warmth of your breast, and can never replace your own valuable milk.
Remove the baby and say firmly, "no." He will learn within a couple of days or less.
Don't assume your baby is ready to wean or is personally rejecting you. A "nursing strike" can be common, and is typically sudden in onset. Although there is no specific known cause, there are several possibilities.
Nursing strikes may be related to changes in mom's smell -- if your periods are returning, or if you have started using a different perfume, deodorant or soap. You can try going back to your previous products; if your periods are coming back, your baby should adjust with a little time.
Another cause may be that your baby is getting more distracted with other things. Try a change in position, and nurse in a quiet place, or when the baby is sleepy.
Sometimes efforts to train your baby to sleep through the night, or other separations, can cause a decrease in milk supply and result in a loss of interest in nursing. Keep frequent, skin-to-skin contact with the baby, even if he won't nurse. If the nursing strike lasts more than a day or two, keep pumping to maintain your milk supply, and offer the milk in a cup.
Finally, stuffy noses can make it hard for babies to breathe and nurse at the same time. Other illnesses, like an ear infection or a mouth infection, may result in a loss of appetite or make nursing difficult for your baby. If you're concerned your baby could be sick, consider a phone call or visit to her doctor.
A baby who wants to nurse for comfort will likely get the satisfaction he seeks more quickly from the warmth of his mother's breast than from a pacifier. Comfort sucking will help your body to make more milk. Many mothers find that they do not make enough milk if they use a pacifier. If your baby is awake and alert, making movements with his mouth, or sucking his fist, he is probably hungry and needs to nurse. Using a pacifier may mask the early signs of hunger. Feeding at the earliest signs of hunger is important for establishing a good milk supply. In addition, sucking on a pacifier requires different muscle skills than sucking on a breast, so using a pacifier may make it hard for your baby to learn how to suck on the breast.
The breast is not a substitute for a pacifier. In many countries, pacifiers are called "dummies" because they are substitutes for the breast. Bottle fed babies seem to have a need for pacifiers because they don't receive the comfort of the breast.
The American Academy Pediatrics issued a recommendation in 2005 recommending that infants use pacifiers at bedtime in order to prevent Sudden Infant Death Syndrome. They emphasize that this should not begin until after breastfeeding is well established, so it does not apply to the newborn period. The AAP recommendation has been controversial, and many experts do not believe there is sufficient evidence to warrant this widespread recommendation.
Breastfeeding is still the healthiest way to feed your baby, even if you smoke. If you can't quit smoking, limit your smoking to outdoors and away from your baby. Children who live with smokers have higher rates of ear infections and sudden infant death syndrome (SIDS) and breastfeeding can help reduce the risk of these conditions.
If you want to quit, a nicotine patch is probably safer than either nicotine gum and smoking. It's safest to feed then smoke, rather than smoke before or during a feed.
Be aware that smoking can also lower your milk supply.
Quitting smoking is best for your health and that of your child, regardless of how you feed your child.
Small amounts of alcohol are considered acceptable -- one drink a day or less, on average. If possible, time your drink so that your baby will not need to nurse for about 2 hours after your drink (feed, then drink). Do not drink more than one drink between feeds. Avoid alcohol if your child is having any problems feeding, or is not gaining weight well.
Most medications are safe in breastfeeding but a few are not. Sometimes doctors are not completely familiar with the most current information on medications and breastfeeding, so it does not hurt to double check your doctor's advice, especially if you are advised to stop breastfeeding.
The American Academy of Pediatrics has published guidelines on which medications are safe, and can be found at the bottom of its statement, available at http://www.aap.org/policy/0063.html. Inside the statement, there are tables of drugs you can click on. You need to know the generic name of the drug you are looking for (ask your pharmacist or doctor's office). This list does not include all medications -- just because a drug has not been reviewed does not mean it is safe or unsafe; it only means you must look elsewhere to find out. The list is updated every few years, most recently in 2001. A drug which is "contraindicated" is not safe.
The most authoritative guide to medications and breastfeeding is Medications and Mother's Milk, by Thomas Hale, which also includes the AAP ratings for each drug listed, and includes drugs that have not yet been reviewed by AAP. Your doctor and hospital should have access to this book, which is available in paperback from ibreastfeeding.com (which is quicker) or from Amazon.com.
Yes. You can have a couple cups of coffee a day, and this is considered safe.
Yes. Breastmilk from mothers with silicone implants actually has less silicone in it than formula and cow's milk. However, bear in mind that breast surgery can sometimes affect the anatomy of the breast, so your baby should be followed closely at first to make sure your are physically able to make enough milk.
Breast surgery can sometimes affect the anatomy of the breast, so you and your baby should be followed closely at first to make sure you are physically able to make enough milk. It's a good idea to see a lactation consultant early. Sometimes women who have had breast surgery need to supplement with formula.
No. Your body will make the perfect milk for your baby no matter what. For your own health, of course, it is best to eat a balanced diet regardless of how you feed your baby. Nursing mothers need to drink plenty of fluids, enough so that you are never feeling thirsty. This may mean 2-3 liters (quarts) a day. Your doctor may recommend that you continue to take your prenatal vitamins while you are nursing. Some doctors recommend that mothers avoid peanuts during pregnancy and breastfeeding if allergies or asthma run in the family, as avoiding peanuts may help prevent the development of peanut allergy in your baby.
You do not need to drink cow's milk in order to make breastmilk.
Yes. Breastfeeding is 98% effective in preventing pregnancy in the first 6 months if you meet the following conditions: your menstrual periods have not yet resumed, your baby is getting no other food or drink besides breastmilk, your baby does not go longer than 6 hours without feeding, your baby nurses at least 8 times a day.
Since birth control pills with estrogen can lower your milk supply, they are best avoided while you are nursing.
If you will be working more than 3 to 4 hours at a stretch, you will need to pump at work to maintain your milk supply. If possible, it is best to be able to bring your baby to work to breastfeed rather than pump. If you are pumping, you may find that your baby will suddenly want to nurse during the night, even if he used to sleep through the night before -- do not be alarmed. Your baby is only making up for time away from you, and this means you may need to pump less during the day. It is often easiest for working moms to sleep near their babies.
If you need to pump more than once a day, you should use a double electric pump. If you are only pumping once a day, you may be able to use a single electric pump or hand pump. These are general guidelines; there is no "right" pump for everyone, and some pumps may give you a better let-down than others. Avoid "bicycle horn" hand pumps. Some hand pumps are more efficient than others. Reliable brands of pumps include Medela, Ameda, and Avent.
You should pump as often as your baby would nurse. You need to be relaxed, so that your milk will let down -- this can be harder with a pump than with your baby. A bathroom is not the best place to pump, but is often the only option for many women. You should have a place to refrigerate your milk, and a sink to rinse out your pump and wash your hands. You should check out the situation well before your baby is born; do not hesitate to ask your employer to help. Tell your employer that nursing mothers miss less work because their babies are healthier.
Some women find that thinking of their baby helps with let-down -- a photo of your baby, or something that smells like your baby can help. Other women prefer to think of a peaceful or serene place. A warm drink can also help you relax and let-down. Massaging your breasts or applying a warm compress to your breast can also help.
It's a good idea to freeze a supply of breastmilk. However, leave your pump in the box until your baby is at least 3-4 weeks old, when your baby should start being introduced to a bottle. Make sure you feel comfortable using your pump before you go back to work. Don't feel like you should pump every day during your maternity leave.
You can build up a good supply of milk to freeze by pumping in the morning, when you typically make the most milk. Nurse one side and pump the other when you first wake up. Use your baby to stimulate your let-down reflex. Or, pump during your baby's morning nap.
Milk can be stored in plastic or glass bottles, or in nursing bags, such as the kind used for feeding formula, or in special storage bags made just for storing breastmilk. All containers should be labeled with the date the milk was expressed. At room temperature, breastmilk will be good for four hours. In the refrigerator, milk will be good for 3 to 5 days. In a cooler with blue ice, it will be good for 24 hours. On a shelf in the freezer, milk will be good for 3 months. (In the freezer door, milk will not last this long.) Milk separates within a few hours, with the fat rising to the top; if you see the milk separate, it does not mean the milk has gone bad, but you will need to shake it gently before use.
Nurser bags should be placed upright. If the milk is to be frozen, the bag should then be placed in an airtight container, such as a ziplock freezer bag, which will help prevent the bag from breaking. Do not fill bags or bottles to the top, as milk expands when frozen. Thaw milk overnight in a refrigerator, or under warm water; never microwave, as "hot spots" can burn baby's mouth. Use the oldest milk first.
Storage amounts: 2-3 oz for a baby up to 2 weeks old; 3-5 oz for a baby up to 2 months old; 4-6 oz for a baby 2-4 months old; 5-8 oz for a baby 4-6 months old. (Do not be alarmed if you do not get this much outÑthat is very common. You can combine smaller amounts in one storage container before freezing it, but don't pour liquid milk onto frozen milk, as it might thaw.)
This is very common because pumps are not nearly as effective as your baby in removing milk. You may need to supplement your baby while you're at work with frozen breastmilk or formula. But don't despair. Keep pumping to maintain your milk supply, and nurse as often as you can when at home. Your baby may want to start nursing at night more often ("reverse cycle feeding"). Nurse your baby when you are home; use bottles only when you are apart.
Probably at about 3- 4 weeks, you can begin to train your baby to use a bottle by having another person give a bottle of pumped milk about twice a week. It is important not to introduce a bottle too early, before baby has learned how to breastfeed. On the other hand, do not wait until you're back at work to try a bottle for the first time-- some older babies will refuse a bottle altogether. Have your baby practice a couple of times a week in the weeks before going back to work. If your baby is old enough, she may prefer a cup or sippy cup.
Breastmilk is especially important for premature babies, who need it to help their brains and eyes develop, as well as to prevent infections. However, a very early baby may have a hard time learning to suckle. If your baby was born before 34 weeks (6 weeks early), she will need to be fed in the hospital by a special feeding tube. In this case, you should pump as soon as possible, at least 8 times a day, to establish your milk supply, and maintain it until your baby is big enough to suckle. It is best to get professional advice from a lactation consultant as soon as possible.
If your baby is just a little early (35-37 weeks, or 3-5 weeks early), she may still need help learning to nurse. For any baby born before 37 weeks, it is best to see a certified lactation consultant as early as possible after the first day of life. If your baby is having difficulty nursing, a lactation consultant is likely to suggest that your baby be fed without using a bottle -- cup, dropper, or finger feeding may be recommended.
Jaundice (yellow color to the skin) is common in newborns and is usually normal, but can sometimes be a sign of serious illness. It can also be a sign that a baby is not nursing well. It does not usually mean that your baby needs to take formula. Be evaluated as soon as you can by a certified lactation consultant. Make sure you and your baby's doctor keep a close eye on your baby's wet diapers and stools, as well as his weight gain. Frequent nursing can help the jaundice resolve more quickly, provided there is audible swallowing, which indicates that the baby is actually getting the milk. A lactation consultant can evaluate whether your baby is nursing effectively.
It's normal for babies to lose some weight in the first two or three days, because babies are born with a little extra fluid in their bodies. After that, your baby should be gaining 1/2 an ounce to an ounce a day, at the minimum, as your milk comes in.
All breastfed babies should be weighed about 2 days after going home. If the weight gain does not seem adequate at that visit, she should be weighed again on the same scale 1-2 days later. If the weight gain is truly inadequate, you should plan to get help from a certified lactation consultant right away -- within the next couple days. You should also discuss it with your doctor.
In the meantime, do away with a pacifier if you are using one. Make sure you have proper positioning (see sore nipples). Nurse as often as you can -- at least 10 times a day. Sleep near your baby and nurse lying down if you can -- this allows more time at the breast. Be aware that tobacco, alcohol, birth control pills, and pseudoephedrine (found in Sudafed and other cold medicines) can lower your milk supply, so avoid these substances if your baby is not gaining well. See our tips, Making Milk is Easy -- 10 Steps to Make Plenty of Milk.
As twins and triplets are often born early, breastfeeding is particularly important for the development of their brains and nervous systems, and to prevent serious infections and complications. Plan to get help from a lactation consultant right away, in the hospital. Also, pick a pediatrician in advance - find someone who is especially supportive or knowledgeable about breastfeeding.
If your babies are small or premature, they may need help learning to breastfeed. Triplets are usually born prematurely enough that they need to spend time in a special care nursery after they are born, and this is often the case for twins, too. Babies too premature to nurse on their own may be fed breastmilk by a tube, while mom pumps 8-12 times a day to supply their milk, using a hospital-grade double-electric pump. Pumping may be tiring, but be assured that it is only temporary, and that this is "special care" that only you can provide! The milk of mothers of premature babies is special: your body adapts to having early babies by making milk that gives them just what they need Once they are medically stable, very small babies can be kept warm by being held next to their parents¹ skin, a practice known as "kangaroo care." Small babies may be put to breast to help them learn how to suckle, even though they may get most of their nourishment through the tube. It is not unusual for very small babies to need supplements in the beginning for medical reasons.
Caring for multiples is challenging, no matter how you feed them. Before your babies come home, do as much as you can in advance: line up a network of family or friends to bring meals, do household chores, and provide support: consider arranging a schedule in advance, assigning people to certain days of the week. Plan to have diaper-changing areas in all the spaces in your home where you spend the most time. This may just mean a towel on the floor, with diapers and wipes nearby.
Many parents of multiples find it helpful to feed the babies at the same time. If one baby is hungry, wake the other baby or babies to feed as well. If you have triplets, you may encounter the situation where all three babies are hungry at once: this is where it helps to have some pumped milk available and extra help. With breastfeeding, unlike bottle feeding, you can feed two babies at once, after a little practice. A wrap-around pillow will make feeding much easier, and you can buy a pillow specifically made for feeding two babies at once. Plan to sleep near your babies, and learn how to nurse lying down, so that you can get plenty of rest. This may also take a little practice, especially if your babies are very small. As long as your babies can suck and swallow effectively, you should be able to make plenty of milk. You may need to drink more so that you will not feel thirsty-- you may want to keep sports bottles all around your home.
Finally, talk to other parents of multiples, even before your babies are born. There are many support groups, such as Triplets, Moms, and More. Visit Consumersgroup.com for a list of local groups in this state.
There is a growing body of evidence showing the benefits of sleeping near the baby, rather than in a separate room. In the hospital, it has been shown that newborns who room-in with their mothers sleep more and cry less, and that mothers get the same amount of sleep whether they leave the baby in the nursery or keep the baby with them.
Sleeping near the baby facilitates breastfeeding at the earliest signs of hunger, thus helping build milk supply. Parents should be advised to continue this practice, even after they leave the hospital.
Bedsharing in particular, has been shown to promote breastfeeding.The American Academy of Pediatrics recommends that infants sleep in the same room as their parent(s), but advises against bedsharing.
However, the Academy of Breastfeeding Medicine finds that there is insufficient evidence to routinely discourage co-sleeping. The ABM defines co-sleepers as those "who remain close enough for each to detect and potentially act on the sensory stimuli of the other, and this includes an infant sleeping alongside a parent on a different piece of furniture or object," as well as an infant who shares a bed with the parent.
Data about bedsharing show that such babies learn to respond to mother's movements and breathing, and that mothers learn to respond to baby's early feeding cues. Babies who bedshare have been found to spend more time nursing than babies who don't and this helps build milk supply. In addition, nursing the baby in the sidelying position allows both parents to wake up more well-rested in the morning.
Having the baby sleep in a separate room from the mother, even with the a baby monitor, does not result in these benefits. Crying is a late sign of hunger, and it is important to feed the baby well before one can hear him crying down the hall. It is also hard to feed a crying baby.
If a mother shares a bed with her infant, if is important that she know how to do this safely:
Lactation consultants are health professionals have special training in breastfeeding--they are breastfeeding specialists. They are often nurses but their backgrounds may vary widely. They have training outside of what a typical nurse or doctor would get. Look for the initials IBCLC after their names. IBCLC stands for " International Board of Certified Lactation Consultants," which means they have passed a certification exam had a specified amount of training. These specialists can make a big difference.
There are also "certified lactation counselors", or "breastfeeding counselors." While these professionals may have also passed an exam, their training is not as rigorous. They may have excellent skills, but they may not necessarily have the training needed to address major problems like poor weight gain, or premature babies.
Your pediatrician or obstetrician's office may be able to refer you, and the hospital where you gave birth may be able to refer you also, and they can also be found in the Yellow Pages. You can also find one through ZipMilk, a tool developed by the Massachusetts Breastfeeding Coalition for locating breastfeeding resources. Many insurance companies will pay for lactation consultants, but often you have to pay up front, and be reimbursed later. Some hospitals provide free lactation services after discharge for moms and babies who delivered there. See Breastfeeding Support and Services, from the MBC Resource Guide.
If your baby isn't gaining weight well, see a certified lactation consultant as soon as possible. You should also be evaluated as soon as possible by a certified lactation consultant if your baby is not having at least 3 yellow stools a day once your milk comes in, if your baby is not latching on, or not latching on well, or if your baby loses more than 7 to 10% of his birthweight in the first two or three days.
For example, if your nipples are sore beyond the first few days, a lactation consultant or a lactation counselor help evaluate whether you have proper positioning. A La Leche League leader or even another experienced nursing mother can often help with things like positioning.
To find another experienced nursing mother, you can also call the Nursing Mother's Council at (617) 244-5102, or contact La Leche League at 1-(800)-LaLeche, or WIC at 1-(800)-942-1007, or check Breastfeeding Support and Services, from the MBC Resource Guide. On the web, check out ZipMilk and http://www.lalecheleague.org. Another, less personal source of support is http://www.breastfeeding.com, which has videos demonstrating breastfeeding in various situations as well as answers to many commonly asked questions.
Your hospital should have certified lactation consultants (IBCLCs) on staff who are available before, during, and after your stay, since any mother having difficulty breastfeeding should be promptly evaluated by a qualified professional. Your hospital should have a written policy on breastfeeding. It should encourage breastfeeding within an hour of birth and encourage you to sleep near your baby. The hospital staff, (not just the lactation consultants) should be qualified to show you how to position your baby properly and how to breastfeed. Your hospital should not offer pacifiers to nursing mothers, and should not give formula to nursing babies without a clear medical reason. If your baby needs supplements for a medical reason, your hospital should show you ways to give supplements without using a bottle.
Your hospital should not give you free formula, or formula-sponsored diaper bags at discharge. (Virtually all hospitals give out formula-advertising diaper bags because of financial agreements they have made with formula companies. If your hospital does this, it may help to protest in writing to hospital administrators and executives).
Your hospital can take steps to adopt the Baby-Friendly Hospital Initiative, which is considered one of the most effective models for promoting breastfeeding success. It was developed by the World Health Organization and UNICEF in 1991, and requires that hospitals implement Ten Steps in order to be designated Baby-Friendly. These steps, most of which are described above, are based on scientific evidence. Currently, Boston Medical Center is the only Baby-Friendly Hospital in Massachusetts.
Your obstetric provider should discuss feeding options with you early in your pregnancy, so that you can make an informed choice. Your provider should let you know that breastfeeding is important for your health, as well as for your baby's long term health. Your provider and your baby's provider should not have formula advertising in her office, nor offer sign-up sheets for "baby-clubs" with free or discounted formula. Find out what she knows about breastfeeding, and what resources she will have to help you. If you have difficulty breastfeeding, your provider should promptly refer you to qualified help, rather than tell you to stop breastfeeding.
If you need a medication, your provider should check an up-to-date safety profile on that medication, rather than simply telling you to stop breastfeeding. Your provider should have access to Thomas Hale's book, Medication and Mothers' Milk, and to the AAP list of medications, available at www.aap.org/policy/0063.html.
Your baby's health care provider will probably not be the same person who is providing your obstetric care, unless you have a family practitioner. Start the search for a pediatric care provider before your baby is born. It might help to ask experienced moms for recommendations.
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