Breastfeeding is best for your baby because: Breast milk is easy to digest and provides nutrients in the amounts your baby needs. It changes as your baby grows. Breast milk helps protect your baby from illness and infections. Breastfeeding may help prevent food allergies. Breastfeeding is less costly and more convenient than formula. Breast milk is always ready and at the right temperature. Almost all women can breastfeed. Support from family and friends will help make breastfeeding successful. If you choose not to breastfeed at some point, commercial iron-fortified infant formula is recommended.

Breastfeeding Positions

Start by getting yourself in a comfortable position. Your may prefer to sit up, or lie on your side. Try holding your baby in different breastfeeding positions to find which is best for both of you. Some positions are:

Cradle Hold

Many mothers find this the most comfortable position. Sit with good support for your back. Cradle your baby in your arm with the baby's head in the bend of your elbow. Support your baby's body with your arm. Use your other hand to support your breast. Cuddle your baby close, facing your breast, with your baby's tummy and knees touching your abdomen.

Football Hold

Hold your baby at your side, resting on your arm. Use a pillow to support your arm and to raise the baby to the level of your breast. Hold your baby's head in the palm of your hand, with your baby's legs tucked by your side.

Lying Down

Lie on your side, supporting your back and head with pillows. Turn your baby on to his or her side to face you, with the baby's mouth at your nipple. Bring your baby to your breast, with the babyÕs tummy and knees touching your abdomen. Place a rolled towel or a small rolled blanket behind your baby to prevent the baby from rolling onto his or her back.

You may need help finding a comfortable position at first. If you have had a Caesarean birth, lying down to breastfeed may be more comfortable. If you are nursing twins at the same time, the football hold may be the easiest.

How to Position Your Baby Onto the Breast

Positioning your baby properly onto the breast is important for you to comfortably breastfeed, and for your baby to get a good feeding of breast milk. The following describes how to correctly do this:

1. Hold your baby close to your body, facing your breast, so that you are tummy-to-tummy.
2. Support your breast with your free hand. Lightly cup your breast in your hand, by holding your fingers underneath and your thumb on top. Do not squeeze or pinch your breast.
3. Brush your nipple against your baby's lips until the mouth opens wide like a yawn. Quickly bring your baby to your breast. When your baby feels your nipple on his or her tongue, the baby's lips will close over the areola (dark area around your nipple). Make sure your baby takes as much of the areola as possible into his or her mouth. This is called "latching on". You want your baby to breastfeed, not nipple-feed. If your baby is sucking only on the nipple, then your nipple will hurt and get sore, and your baby will get less milk. If the baby has latched onto the breast properly, you will feel pressure but the sucking will not hurt or pinch you.
4. If your baby is not correctly latched on, remove the baby from your breast by slipping your little finger in the corner of your baby's mouth to break the suction. If you pull the baby off your breast without first breaking the suction your nipple will get sore.
5. If needed, repeat steps 3 and 4 until your baby is properly latched onto the breast.

Establishing Breastfeeding

Adjusting to Breastfeeding

You may feel a tingling in your breasts when your baby starts to suck and the milk flows through small ducts to the tip of your nipple. This is called "let-down". Sometimes hearing your baby cry, or just thinking about your baby will trigger the let-down of your milk.

Your baby's first milk is called "colostrum". It is clear and yellowish. It appears a few weeks before the baby is born, and for the first few days of your baby's life. Colostrum is rich in protein and vitamins and helps protect your baby from infection.

During the first few days you may feel abdominal cramps when your baby sucks. These contractions mean your uterus is going back to its pre-pregnancy shape.

When your baby is two to six days old you will begin to produce milk which looks thin and bluish at the start of a feeding. This is normal. A creamier milk comes at the end of your baby's feeding.

While you are nursing, milk may flow from the breast not being nursed. Press a cloth or towel against the breast to stop the flow. If your breasts leak between feedings, use nursing pads to absorb the milk.

How Often Should My Baby Breastfeed?

Let your baby decide how often and how much to nurse. Every baby is different. Do not expect to follow a strict time table. Feed your baby whenever he or she is hungry. Learn to know your own baby's hunger cues. Signs of hunger may include sucking, smacking lips, searching with an open mouth, putting a fist in the mouth, or crying. Some feedings may be close together while others may be further apart. A newborn will feed anywhere from 8 to 14 times in 24 hours. Frequent nursing will help establish your milk supply.

Your baby will have periods of rapid growth ("growth spurts") around two weeks, six weeks, three months of age and later. During these growth spurts your baby may want to feed more often; sometimes every hour! This does not mean your milk volume has decreased or that your milk is poor quality. The more your baby nurses, the more milk you produce. Your breast milk increases to meet your baby's needs.

How Long Should a Feeding Be?

Let your baby decide how long to nurse. Some babies finish a feeding quickly; others want to suck longer. When your baby has had enough milk, he or she may let go of your breast, stop sucking or fall asleep. Babies seem to know just how much is enough.

Let your baby finish nursing on one breast before changing to the other. The "hind" milk at the end of the feeding has more fat. This will help your baby feel full for longer. Your baby might nurse from both breasts at each feeding or only one. Alternate which breast is offered first. A safety pin on your bra strap will remind you which breast to start with for the next feeding.

Does My Baby Need to Burp?

Your baby may burp once or twice during and after a feeding, or not at all. If you need to burp your baby, hold your baby against your shoulder or face down on your lap. Pat or rub your baby's back gently.

Is Breast Milk All My Baby Needs? What About Vitamins?

Breast milk is the only food your baby needs for the first four to six months of life as it provides all the nutrients your baby needs - except for vitamin D.

Exclusively breastfed babies need a vitamin D supplement from birth. The recommended amount is 400 I.U. per day. You should continue to use vitamin D supplements until your baby is drinking 200 mL (seven ounces) of formula or drinking 500 mL (two cups) of whole milk. Both of these milks have vitamin D added.

In areas where the water is fluoridated, supplementation with fluoride is not necessary. If your water is not fluoridated, discuss the need for supplements with your public health nurse, dental hygienist, doctor or dentist.

How Often Should My Baby Have a Bowel Movement?

In the first weeks after birth, your baby might have several bowel movements daily. They are often soft and watery, and might be yellow, brown or dark green in colour.

Later, when babies are older than six weeks, they may go a few days without a bowel movement. This is normal too, as long as the stools are very large and soft.

Breastfed babies are rarely constipated. Constipation means dry, hard stools which are difficult or painful to pass.

Breastfeeding While Away From Home

Many mothers breastfeed their babies when they are away from home. Some women feel comfortable nursing anywhere, others do not. Do what feels most comfortable to you. Talk to friends or family for support and ideas. Remember, breastfeeding is the best and most natural choice in the world.

A two piece outfit with a loose top works well for breastfeeding. The top is lifted from the bottom and will keep your breasts covered. A small blanket or shawl over your shoulder can cover your breasts and your feeding baby. If you feel comfortable and confident nursing your baby, others will be at ease.

If you prefer to nurse privately, your baby can be fed in mothers rooms or change rooms in department stores. As well, some malls and restaurants provide special nursing areas in the women's washroom.

Breastfeeding and Special Concerns

If you have Sore or Cracked Nipples

These suggestions should help heal your cracked or sore nipples:

• Make sure your baby latches onto the breast properly. Most sore or cracked nipples can be prevented by a correct positioning or latch. If you need help, contact a lactation consultant or public health nurse.
• Begin nursing first with the breast that is less sore.
• Apply a light coating of expressed breast milk on your nipples after a feeding. This helps to heal cracked nipples.
• Air dry your nipples after feedings.
• Avoid nursing pads made with plastic.
• Between feedings, use ice or a cold wet towel on the sore area of the nipple to help ease the pain.

If Your Breasts Swell Painfully (Engorgement)

Engorgement means very full, heavy, sore breasts. Engorgement usually happens two to five days after the baby's birth. It usually happens when milk is not taken out of the breasts often enough or in large enough quantities. By following the steps to take care of engorgement, it can be gone in a day or two.

Engorgement can be prevented by latching baby correctly to your breast so that the breast can be emptied. You should not feel pain when nursing. Feed your baby 8 to 12 times in 24 hours. Do not use bottles or soothers. Pump milk from your breast (using a pump or your hands) only if you miss a feeding.

• Before feeding from an engorged breast, you need to first soften the breast and nipple in order to have your baby latch on.
• To soften the breast apply warm moist heat (use towels, clean diapers or take a shower) to your breast for two to five minutes. Massage the breast gently with a circular motion. Start under your arm and move towards the nipple.
• Hand express or pump enough milk from the breast so the baby can latch onto the nipple.
• Between feedings apply cold towels to your breasts for comfort. Wear a supportive bra.
• If you need to, take a medication such as acetaminophen (for example, Tylenol) for pain 20 minutes before feeding.
• Call your public health nurse or a lactation consultant for information or help.

Mastitis

Mastitis is a red, lumpy, painful area on your breast. It may appear with fever, chills and other flu-like symptoms. Symptoms are sudden. Mastitis might be caused by a clogged milk duct. If it is left untreated, an abscess can develop. If you have these symptoms:

• The best treatment is to keep nursing your baby as often as possible. Start with the sore breast first. The milk is perfectly safe for the baby.
• Take a warm shower or use a warm wet towel before breastfeeding to help the milk flow. Gently massage the sore area with your finger tips while the breast is warm.
• Rest is important. You may need a day of bed rest. Drink plenty of fluids.

• Call your public health nurse, a lactation consultant and/or your doctor. Sometimes an antibiotic in needed.

If Your Baby is Premature

Premature babies are small and might and might not be strong enough to suck very long. Your might have to feed your baby expressed milk. Express your milk as soon as possible after birth and the nurses will feed your baby with a tube. Your breast milk is the best food for your premature baby. The first milk from the breast (colostrum) is especially suited to the needs of your premature baby. Talk to your doctor about when to try breastfeeding.

If breastfeeding is supplemented with formula, breastfeed first and then give the bottle. Gradually decrease the amount of formula used as your baby becomes stronger and better at nursing.

When You Cannot Breastfeed

Sometimes things make it difficult or impossible to continue breastfeeding. If this happens to you, do not worry. Formula-feeding can be a good substitute for breastfeeding. What is most important to the emotional health of your baby is your love, cuddling and caressing.

Expressed Breast Milk

Bottles or soothers are not recommended for the first four to five weeks while breastfeeding is being established. The sucking action used for breastfeeding is different from that used for bottles or soothers. Your baby may become confused and reject the breast if you introduce a bottle or soother too early.

After nursing is well established, you may wish to give your baby a bottle of expressed milk when you cannot be with your baby for a feeding. This may be for an evening or daily if you return to work. Your baby will still get the benefits of breast milk and you will keep up your milk supply.

Health Canada recommends you sterilize all bottles and equipment used for feeding the baby for the first three or four months of life. To sterilize: put clean equipment on a rack or cloth in a large pot and cover with water. Boil rapidly for five minutes and allow to cool. Remove all equipment with sterile tongs. Disposable plastic liners do not require sterilization.

How to Hand Express Breast Milk

It takes practice to express breast milk by hand. Once you know how, you will be able to express milk anywhere with little equipment. Here are some guidelines:

1. Wash your hands.
2. Put a clean wide-mouth container under your breast.
3. Massage your breasts gently to stimulate milk release.
4. Lightly cup the breast with your hand, placing your thumb above and forefinger near the edge of the areola. (If your areola is very large, place your fingers about one inch behind the nipple on the areola).
5. Press in toward your chest wall. Gently squeeze your thumb and forefinger together applying only enough pressure to release the milk.
6. Keep repeating step 5 while moving your hand around the breast. This will shift the position of your thumb and forefinger all around the edge of the areola. Remember you are trying to duplicate the action of your baby's mouth pressing on the milk ducts.
   If your milk does not flow at first, massage your breast again. It might take a few minutes longer for the let-down than when you are nursing. It takes practice to become skilled at expressing breast milk. Try to be relaxed and not rushed.

Manual, battery or electric breast pumps can also be used to express milk. Electric pumps can be rented from some hospitals, drugstores, and lactation consultants.

Storing Breast Milk

Fresh breast milk can be stored in the refrigerator for 24 to 48 hours. For longer storage, you can freeze the milk in disposable bottle liners, sterile bottles, glass jars or freezer bags. To reduce waste, freeze in 60 - 120 mL (two to four ounce) portions. Breast milk can be frozen in layers. Completely cool freshly expressed breast milk before adding it to the previously frozen layer. Always mark the collection date on the container. Breast milk can be kept in a refrigerator freezer for up to 2 weeks; in a refrigerator with a separate freezer door for up to 3 months; or in a deep freezer for up to 6 months.

Warming Breast Milk

Thaw a container of frozen breast milk in the refrigerator or place the container in warm water. Since milk separates upon thawing, blend the fat particles by gently shaking the container.

Warm the container of milk for a few minutes in a pan of warm water. Before feeding your baby make sure that the milk is cool to touch by testing a few drops on your inside wrist or tongue. Throw out any leftover breast milk after your baby is finished feeding.

CAUTION: Microwaving breast milk may be dangerous and is not recommended. Babies mouths have been seriously burned due to uneven heating. Microwaving destroys nutrients in breast milk. If you choose to microwave, use only microwave safe containers and heat for a few seconds. Shake the bottle ten times then check the temperature before feeding your baby.

 

Giving a Bottle of Expressed Milk

Cuddle your baby close when giving a bottle. Another family member or friend can give the bottle of breast milk to your baby. This allows you to be away from your baby for short period of time. It also helps the baby learn to feel comfortable being held and fed by someone else.

It is normal for your baby's appetite to change from one feeding to the next. Your baby does not have to finish all the bottle at every feeding. Throw away any milk left in the bottle because germs from your baby's saliva might have entered the milk.

Baby bottle mouth or "nursing bottle syndrome" refers to tooth decay which can occur when your baby falls asleep sucking at the breast or on a bottle of expressed milk. As your baby falls asleep, the fluid pools around the teeth and decays the enamel. To prevent "nursing bottle syndrome":

• Take your baby off the breast if he or she falls asleep.
• Avoid putting your baby to bed with a bottle of breast milk.

When You Work Away From Home

You can continue to breastfeed even if you work outside your home. You could nurse before you leave for work, again when you get home and before bedtime. The baby can be given expressed breast milk or formula when you are not at home.

Here are some helpful tips:

• Start to express your milk and store it in your freezer a few weeks before returning to work.
• Express your milk at work and refrigerate it for the next day's feeding if you cannot go home during the day, or if your breasts are too full and uncomfortable.
• You can replace nursings when you will be away with a bottle or cup of formula and then breastfeed when you are with the baby. This is called partial weaning. See the weaning section for details.

Weaning From Breastfeeding

There is no "right" age to wean your baby. Try to continue breastfeeding for at least six months and, if possible, up to or beyond one year. If you are weaning your baby during the latter part of the first year, weaning may be done directly to a cup. Iron-fortified commercial formula is the recommended substitute for breast milk if you wean your baby before 9 to 12 months of age. After your baby is 9 to 12 months old, whole (homogenized) cow's milk can be introduced.

As your baby matures he or she will need to start eating solid foods. By four to six months of age, solid foods can be gradually introduced. For more information on introducing solid foods, contact the local Health Unit Office of your Regional Health Authority.

Gradual Weaning

This is the easiest on you and your baby. Begin by offering a bottle or cup instead of nursing at a mid-day feeding. Replace a breastfeeding no more than every two to three days. Slow down the weaning if your baby is adjusting poorly.

Partial Weaning

You can replace certain nursings with a bottle or cup and then breastfeed when you are with the baby. This works well for women who return to work, can't express, but want to continue breastfeeding. In a few days your body will adapt to produce breast milk at the times when you regularly feed.

Abrupt Weaning

Abrupt weaning means breastfeeding is stopped in a short period of time. It can be very hard for some babies to adjust to a sudden change in the way of feeding. The breasts can become engorged and very painful. If you have a choice, this method of weaning is not recommended.

Sharing Your Experiences

Now that you have experienced breastfeeding, you can encourage and help other new mothers. Share your experiences with them. Enjoy knowing that you are also helping their babies get the best possible start in life!

For help or information contact:

• Public Health Nurse at the local Health Unit Office of your Regional Health Authority
• Certified Lactation Consultant at the Health Unit Office or Hospital of your Regional Health Authority or in private practice
• LaLeche League International Breastfeeding Support and Advocacy Group