Feeding your baby should be a happy, pleasant time. Your decision to breast or bottle-feed is a personal choice between you and your partner, and it should be made realistically, taking your desires, expectations, and lifestyle into consideration. Do not allow others to make you feel guilty about your decision. Whichever method you choose and are comfortable with, be assured that your baby will receive proper nutrition and the warm feelings of love and security that are so closely associated with the act of feeding.
Hopefully, the following discussions of breast and bottle-feeding will help you in your decision.
Almost every woman is physically able to breastfeed her baby, no matter what size her breasts are. The key to your success in breastfeeding depends greatly on your desire to nurse, as well as the encouragement you receive from those around you. Because your partner’s support is vital, the decision to breastfeed should be a mutual one.
- Breast milk is the perfect food for babies. It is rapidly and easily digested, and it generally causes few digestive upsets.
- There are virtually no allergies to breast milk.
- Breast-fed babies have a lower incidence of allergies, respiratory and intestinal disease, dental problems, and colic.
- Colostrum and breast milk contain antibodies that initially protect the baby against illness/infection.
- Breastfeeding saves time, work, and money, since there is no preparation or purchase. Breast milk is always there—fresh, warm, and ready to drink.
- Night feedings are more convenient, because you do not have to prepare a bottle.
- During an emergency or major disaster, a baby can continue to receive an uncontaminated food supply.
- Breastfeeding encourages close physical contact, which is necessary for the baby’s development and also for maternal satisfaction.
- Nipple stimulation by the nursing infant causes the uterus to contract. These contractions help prevent postpartum hemorrhage, and they help the uterus return to its pre- pregnant size more rapidly.
- Diapers of breast-fed babies are more pleasant to change, since the stools of breast-fed babies usually do not have an offensive odor.
- When breast milk is spit up, it does not leave an unpleasant odor.
- Breastfeeding uses calories and helps to burn the extra fat that was stored during pregnancy.
- The sucking associated with nursing promotes the baby’s good facial development.
- The mother is more tied down and needs to be with her baby during feeding times. If the baby does not learn to take an occasional bottle, it is very difficult for the mother to have an afternoon or evening out.
- The mother cannot be on a strict diet to lose weight. Proper nutrition and adequate calories are necessary for the mother while she is breastfeeding.
Physiology and Anatomy of Milk Production
During pregnancy, your breasts have undergone changes in preparation for breastfeeding. They have enlarged as high levels of hormones develop a systematic network of milk-producing glands (alveoli) and milk ducts. Your areola have become wider and darker, and your nipples have become larger, darker, and more erectile.
Sometime during your pregnancy you may have noticed a thick, yellowish discharge from your nipples. This is called colostrum. It is a high-protein, high-fat substance that, following delivery, will nourish your baby until your milk comes in. It is also important because of the early immunity against illness that it provides your baby. When your breast milk does come in, its normal appearance is thin and watery—much like skim milk.
Milk is produced and released from the breasts by hormonal effects. After birth, the sharp decrease of the hormones that maintained your pregnancy signals the alveoli or milk glands to begin producing milk. Also involved with milk production is the hormone prolactin, which is secreted by your pituitary gland each time your baby nurses. Its main function is to stimulate the alveoli or milk glands to produce milk. It is important to nurse frequently, because as your baby nurses, more prolactin will be secreted, and more milk will be produced.
Getting the milk from the alveoli through the ducts to the storage sinuses or reservoirs is a complex physiological and emotional process that is referred to as the let-down reflex. When your baby sucks, it sends sensory messages to your hypothalamus in the brain. These sucking messages are joined in the hypothalamus with your thoughts and emotions. The hypothalamus then stimulates the pituitary gland to produce another hormone, oxytocin. Its function is to cause the tiny muscles surrounding the alveoli, or milk glands, to contract, thus squeezing the milk into the milk ducts and on into the storage sinuses or reservoirs, where it is readily available for your baby.
The hypothalamus is most effective in initiating the let-down reflex when you are generally relaxed, positive, and quiet. Factors such as tension, fatigue, anger, anxiety, or even excitement, can cause interference with the let-down reflex. Because this process is a reflex action that is affected by emotion, just thinking about your baby or hearing her/his cry may initiate the reflex.
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You may or may not notice the following sensations, which may be signs that the let-down reflex is occurring:
- Tingling, warmth, and/or tightening in your breasts
- Leaking of milk from the opposite breast
- Uterine contractions
Your milk production will begin two to four days after birth. Your breasts may feel larger, fuller, and more tender as your milk comes in. This temporary fullness is known as engorgement and is caused by increased blood flow to the breasts, swelling, and beginning milk production. Fullness may be more apparent in women with smaller or medium-sized breasts. Your breasts may feel full and lumpy. This lumpiness may also extend into the milk glands in your armpits.
Engorgement normally lasts 24–48 hours, and a well fitted nursing bra can provide comfort and support for your breasts. Nursing your baby frequently, every two hours, is the best treatment. Engorgement can be further relieved by hand-expressing milk to soften your areola so that the baby can latch on without causing more soreness. Do not become concerned that you have less milk when your breasts lose their fullness after engorgement. Your milk glands have now fully developed and milk production has become established.
Preparation for Breastfeeding
Preparation for breastfeeding begins during pregnancy. Following are some preparations that you may want to consider.
- Please refer to the recommended reading list in the back of this manual for suggested books about breastfeeding. Resource books are a good investment.
- Discuss your desire to breastfeed your baby with your partner and family. Partner and family support will help you to succeed.
- Talk to a friend who has breastfed successfully who is willing to be a resource to help with any problems that you may have and to share feelings about the breastfeeding process.
- Little nipple preparation is needed during pregnancy. Nipple toughening techniques such as rubbing, twisting, or massaging do little to prevent early breastfeeding soreness.
- Keep your nipples dry by wearing cotton bras. You may need to start wearing nursing pads as your breasts produce colostrum in late pregnancy. Keep your nipples dry by changing pads when they become damp.
- Expose your breasts frequently to the air, the friction of your clothing, and, if possible, the sunlight. Avoid using soap on your nipples when bathing. Wash them with clear water and gently pat them dry.
- Inverted nipples are important to identify during your pregnancy. Your baby may have a difficult time latching on properly if your nipples do not protrude enough. Check to see if one or both nipples appear inverted, folded in the center, or flat. Then, gently squeeze just behind your nipple with your finger and thumb and see how your nipples respond. If your nipple moves inward or flattens, you should begin steps to avoid nursing problems.
- Inverted nipples can be corrected with a special plastic breast shell worn inside your bra. Breast shells exert a steady but gentle pressure on the areola, causing your nipple to extend outward through the shell opening. Breast shells should ideally be worn from mid-pregnancy on. Start by wearing shells for a few hours each day and gradually work up to wearing them for most of the day. Let comfort be your guide.
- Breast shells can be easily cleaned with soap and water. Be sure to keep your nipples dry by allowing your skin to breathe regularly. Remove your breast shells for short periods or occasionally wear only the base part. Breast shells can be purchased at maternity shops or from local pharmacies.
- A nursing bra will help support your breasts, which will have enlarged during your pregnancy. You’ll most likely need a bra that is larger in cup and chest size than you have previously worn. If you are planning to breastfeed, the best time to be fitted with a nursing bra is between the 28th and 34th week. A good nursing bra should have cotton flaps and non-elastic straps. Since your rib cage will shrink after delivery, it is also important to have a couple rows of snaps so you can tighten your bra as necessary. Wear your nursing bra during pregnancy so that you can drop the flaps several times each day, allowing your nipples to be exposed to the air or friction of your clothing. After birth, as your milk comes in and your breasts become engorged, it is important to wear your nursing bra 24 hours a day for comfort and support.
Basic Information About Breastfeeding
Nursing as soon as possible after birth benefits both you and your baby. For the baby, it provides intimate contact with its mother, the nourishment of colostrum, and the stimulation of the sucking reflex. It provides you with a bonding experience with your baby.
Nursing is a learned skill for both you and your baby. It may take both of you from several days to several weeks to become proficient at it. Patience and persistence will be helpful during this period of mutual adjustment.
Demand and Supply
An ongoing demand schedule of feeding works best, since breastfeeding operates on the principal of demand and supply. The more your baby nurses, the more milk you will produce.
Frequency of Nursing
Newborns may initially want to nurse every 11/2–3 hours around the clock. Gradually, babies will establish their own feeding schedules.
Most babies will go through stages when they have a greater demand for nursing. These times are thought to correspond with growth spurts, which typically occur at about the ages of three weeks, six weeks, three months, and six months. To meet the demand for more milk during a growth spurt, we recommend that you nurse more frequently.
As you begin to nurse each time, get into a relaxed, comfortable position, either sitting or lying down. Pillows can be used to enhance your comfort by adding support to you or your baby. Sore nipples are usually prevented by correctly positioning your baby at your breast at each feeding. Hold your baby with her/his entire body facing you, stomach to stomach.
Attaching Baby to Breast
Before your baby attaches to your breast, relax and take a couple of slow, deep breaths. It is best to begin nursing when your baby is quiet and soothed rather than excited or frustrated. Always start with the breast that the baby fed from last. Hold your nipple with your thumb above and fingers below, and stroke the baby’s cheek with your nipple to stimulate the rooting reflex. This touching will instinctually cause the baby to turn towards the direction of the stimulus with mouth open. Center your nipple in baby’s mouth, encouraging the baby to grasp most of the areola in her/his mouth. Depress your breast by the baby’s nose to allow for free breathing.
Removing Baby from Breast
To remove your baby from your breast, insert your finger into the corner of the baby’s mouth to break the suction, and gently remove your breast. Never pull your nipple from the baby’s mouth; this is uncomfortable and will eventually cause nipple soreness.
You should burp your baby after nursing on each breast and more often if necessary. Burping can be done by holding your baby upright on your shoulder, laying your baby face down on your lap, or holding your baby in a sitting position on your lap. With the baby in a comfortable position, gently rub upward and/or pat your baby’s back to stimulate the release of air bubbles.
Length of Nursing
Have your baby nurse on both breasts at each feeding. The baby will get most of the milk in the first 10 minutes of nursing on each breast, though most newborns require 20–40 minutes for each feeding. Sore nipples usually result from improper positioning of the baby rather than from nursing too long.
Routine Breast Care
Expose your nipples to the air for at least 10–15 minutes following each feeding. Your nipples should be cleansed with clear water each day during your bath or shower.
For support and comfort, wear your nursing bra 24 hours each day during the early days of nursing and engorgement.
Although unnecessary, small amounts of A&D ointment may be applied to the areola and base of the nipple if you desire. These will not harm your baby but, if you prefer, wipe your nipples just prior to feeding.
You may leak excessively at first, because it takes approximately three weeks to equalize your milk supply with your baby’s demand. You may choose to wear nursing pads in your bra between feedings. Breast shells may be worn between feedings as well. Any milk that is collected in the shells should be discarded.
Assessing the Amount of Milk
Many new mothers are concerned about whether or not their baby is getting enough to eat. If your baby is gaining weight, has six to eight diapers in 24 hours, and is generally content and/or sleeping between feedings, your baby is getting enough breast milk.
Mother’s Diet and Rest While Nursing
A healthy, nutritious diet is vital while nursing. As a lactating woman, you will need approximately 2,000–2,500 calories per day, depending on your size and activity. In addition to a well-balanced diet, continue taking your prenatal vitamins and iron throughout the breastfeeding period. Take fluids according to your thirst.
Fatigue, tension, and excitement will interfere with nursing. Try to take frequent naps or rest periods during the early weeks after birth. Utilizing relaxation and positive visualization can be very helpful in stimulating the let-down reflex.
Medications while Nursing
Some medications (both prescription and over-the-counter) pass into breast milk and are absorbed into the baby’s blood stream from her/his intestinal tract. These may or may not be harmful to the baby. If you are breastfeeding, you should not take any medication without consulting either your physician, nurse midwife, or pediatrician first.
Contraception while Nursing
Nursing is NOT an effective form of contraception, so some form of birth control is necessary to prevent pregnancy. Birth control pills containing estrogen should not be taken since the hormones will pass through breast milk to the baby, and they may also decrease your milk supply. Please refer to the “Methods of Contraception” chapter for alternative methods of birth control.
Initially, most breast-fed infants do not require additional milk from bottles. Bottles in the early weeks after birth may actually interfere with nursing since they decrease your baby’s demand, which in turn decreases your milk supply. After three to four weeks, when your milk supply is established, a bottle a day of either expressed breast milk or formula should not interfere with your supply. Having your baby become familiar with the bottle is helpful if you are planning to return to work and/or if the father would like to actively participate in feeding. It also gives you the opportunity to be away from your baby during feeding time while you enjoy an afternoon or evening out.
Adding Solid Foods
Breast milk will be your baby’s complete food until about four to six months of age, at which time most pediatricians recommend starting solid food. When solids are given, nurse your baby first to keep your milk supply from decreasing.
Expressing and Storing Breast Milk
At times, you may need to express milk from your breast for comfort, for separation from your baby for any reason, or for freezing the milk for later use. Breast milk can be expressed by hand or by using a breast pump. If you choose to express milk by hand, begin with clean hands and massage your breasts to stimulate the let-down reflex. When you have let-down, the milk can be expressed by placing your thumb and forefinger on the outer edges of the areola, and simultaneously pressing towards your back while squeezing gently. You are compressing the milk sinuses with your fingers just as your baby does with her/his sucking.
Various breast pumps may also be used. The best manual pump is the syringe or pistol type. Electric pumps are the most effective for mothers who need to pump over a long period of time. Electric pumps can be rented.
Breast milk should be stored in very clean plastic or glass containers, or disposable nurser bags. Regular plastic sandwich bags are unacceptable since they are not considered clean enough. After expressing the milk, tightly seal your container of breast milk and label it with the date of expression.
Fresh breast milk can be stored in the refrigerator for up to 24 hours. If your baby starts feeding from that milk, but does not finish it, you should discard the unused portion.
Breast milk may be kept frozen in a regular freezer for up to two weeks, or in a freezer at zero degrees Fahrenheit or colder for up to three months.
When using frozen breast milk, defrost only enough breast milk for one feeding. Breast milk should be defrosted under warm running water. Rotate the milk to mix it, because it may have separated during freezing. Using a microwave to thaw or heat breast milk is controversial since it may alter or destroy nutrients and/or cause hot spots. Once breast milk has been thawed, it can be kept for up to 24 hours in the refrigerator.
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- Breasts that are swollen, tender, and warm to the touch
- Wear a nursing bra 24 hours each day for comfort and support
- Nurse frequently using both breasts at each feeding
- Do breast massage and hand expression of milk to help clear milk ducts
- Apply heat to breasts or take a warm shower to help the let-down reflex
- Use ice packs to relieve discomfort and swelling between feedings
- Take Tylenol or aspirin every four hours to relieve discomfort
• Tenderness and pain around the nipple area or cracked nipples
- Nurse frequently for short periods, not more than every couple hours if possible; do not delay feedings
- Begin nursing on the least sore side at each feeding
- Express a small amount of milk or apply ice to nipple just before baby latches on
- Make sure your baby’s mouth grasps most of the areola so that adequate pressure is applied on the storage sinuses behind the nipple
- Do not let your baby bite or chew on your nipples
- Expose nipples to the air and sunshine if possible after nursing
- Change nursing pads when they become damp or wet
- Use pads that do not have plastic liners; wear cotton bras that allow adequate air circulation
- If you are using plastic breast shells, wash them daily; shells can encourage dripping, keep nipples moist, and actually promote soreness
- Keep your nipples dry
- Use only plain water (no soap) when cleansing your breasts and nipples; always pat them dry
- Apply dry heat to nipples briefly (such as the heat from a 40-watt light bulb or hair dryer)
- Acetaminophen (Tylenol) may be used for pain relief
Lack of Milk
- Baby has poor weight gain
- Baby has less than 6–8 wet diapers per day
- Baby’s urine is dark and concentrated
- Baby is unhappy and discontented
- Drink extra fluid
- Nurse baby more frequently
- Give no supplemental feedings until milk supply is established
- Get extra rest
- Use relaxation or deep relaxed breathing to encourage let-down reflex
- Milk leaking or spraying from breasts
- Apply pressure to nipple with heel of hand
- Wear nursing pads or milk cup in bra
- Nurse frequently
Mastitis (Breast Infection)
- Fever, flu-like symptoms
- Hard, warm, tender, or reddened area on breast
- Call doctor or nurse midwife and follow advice
- CONTINUE NURSING—this infection is not harmful to your baby
- Nurse with affected breast first to keep it empty
- Get extra rest
- Drink extra fluids
- Apply heat or moist warm pack to tender areas of breast
Bottle-feeding can also be a very special, intimate, loving time between you and your baby. Because holding and cuddling provides your baby with feelings of love, warmth, and security, it is important not to prop the bottle or set your baby in an infant seat instead of holding her/him while feeding. Propping the bottle can also be very dangerous, since babies can easily choke on or aspirate their formula. Talking softly, singing, and looking at your baby may enhance the pleasure of feeding time for both of you.
- Bottle-feeding allows the mother more freedom since another person can feed the baby.
- Many fathers enjoy feeding the baby and especially enjoy the physical contact and cuddling that is associated with feedings.
- The mother can diet strictly.
- It requires no advance preparation during pregnancy.
- Some babies do not tolerate formula well and have problems with gastric upset and constipation.
- Bowel movements and regurgitated milk may have an offensive odor.
- The temptation to prop bottles may be very dangerous to babies, and it deprives them of being held and cuddled.
- With bottle-feeding, you have the cost of the formula, bottles, and nipples.
- It requires time to prepare bottles
Even though you have not chosen to breastfeed, normal physiological processes occur after birth that begin milk production. As milk is coming in, your breasts will engorge and may feel very swollen, hard, tender, and uncomfortable. The discomfort generally lasts only for two or three days, after which your breasts will be softer and more comfortable. Sometimes women may leak milk for several weeks, however.
The following suggestions may help ease breast discomfort:
- Wear a good, supportive bra that fits snugly
- Avoid having the hot/warm water of your shower beat against your chest; turn your back to the water for the first week or so after birth
- Apply ice packs to engorged breasts
- Avoid breast and nipple stimulation
- Take Tylenol or aspirin every four hours as needed
- Wear breast pads inside bra to protect clothing from leakage
Types of Formula
Your pediatrician will recommend a formula for your baby that closely resembles your milk and is enriched with vitamins and usually iron. Formula tolerance varies with each baby. Occasionally, problems with a particular formula may require a change. Sometimes babies may actually be allergic to cow’s milk formula, and your doctor will recommend a soybean formula. Signs of allergies to cow’s milk formula may include rash, diarrhea, colic, or chronic cold symptoms.
Formulas come in the following forms:
- Ready-to-feed is the easiest but most expensive form to use; no mixing is required; the prepared formula may be poured directly into bottles
- Liquid concentrate comes in cans; to prepare, it is generally mixed with an equal amount of water
- Powdered formula is the least expensive type of formula; prescribed amounts of powder and water are mixed to make the formula
Bottles are prepared for a 24-hour period. After preparation, each type of formula may be kept up to 24 hours in the refrigerator. Bottles that are not used within 24 hours should be discarded. If your baby starts feeding from a bottle and does not finish it, discard the unused portion.
NOTE: Generally, as long as your water supply is approved for drinking, there is no need to sterilize water for making formula.
- Ten 8-ounce bottles (plastic, glass, or plastic nurser bottles and disposable liners)
- Caps and rings
- Bottles and nipple brushes
Cleansing the Bottles and Nipples
Sterilization of equipment is unnecessary. Rinse bottles and nipples after each feeding. Wash bottles and nipples in hot, soapy water. Bottle and nipple brushes help to remove milk residue. Rinse bottles and nipples thoroughly with hot water. Water should be squeezed through nipples to ensure cleanliness. Air dry.
Frequency of Feedings
The easiest way to feed your baby is on demand, which is usually about every two to four hours at first. Gradually, your baby will develop her/his own schedule for feedings.
Amount of Feedings
Initially, newborns will eat only small amounts of formula, about 1/4–1/2 ounce per feeding, and then they will gradually start eating larger amounts. You can consult with your pediatrician about exact amounts. Babies generally know when they have had enough to eat, and they will stop sucking. Do not force them to continue to eat.
You should burp your baby frequently during feedings. Burping can be done by holding your baby upright on your shoulder, laying your baby face down on your lap, or holding your baby in a sitting position on your lap. With the baby in a comfortable position, gently rub upward and/or pat your baby’s back to stimulate release of air bubbles.
Tips for Bottle-Feeding
- Always hold and cuddle your baby when feeding. NEVER prop the bottle.
- Hold the bottle so that the nipple completely fills with milk, thus reducing the amount of air that the baby takes in while sucking.
- The temperature of a bottle is dependent on your baby’s preferences; it may range from cold to warm. If you do heat bottles, avoid excessive heat and/or microwaving since this may alter or destroy the formula’s nutrients.