Chapter I
Starting Out Successfully
This self learning module is designed to guide you in assisting mothers who are just starting to breastfeed. You will learn the best time to initiate breastfeeding and how to assist the mother in positioning her baby and the correct latch-on at the breast.
Your role in assisting the new breastfeeding mother and her baby get off to a good start is essential to her breastfeeding success.
Proceed through this self instructional module at your own pace. Complete the post-test after you have finished.
Learning objectives:
At the completion of this self learning module the learner will be able to:
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Determine the most opportune time for the first feeding |
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Instruct mothers in several positions for breastfeeding |
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Assess mothers and their infants for correct breastfeeding technique |
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Assist the breastfeeding mother after a cesarean |
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Advise mothers about nutrition during lactation |
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Provide pertinent discharge instructions |
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Advise mothers about medications taken during lactation |
Understanding the basics
Understanding the basics about the anatomy of the breast and the hormones that control lactation provides a background for the recommendations that will follow about positioning, latch-on and timing of feedings.
Alveoli and the duct system
The breast consists of grape-like clusters of alveoli that are lined with milk producing cells. An individual alveolus is a muscular sack similar to a miniature uterus.
Several groups of alveoli are attached to ductules. Ductules merge with larger ducts and milk is carried toward the nipple. For many years we believed that just under the edge of the areola were lactiferous sinuses, or widened areas in the ducts, where breastmilk collects. Recent research using sonograms of the breast has shown this not to be the case. There is, however, a significant amount of branching of the ducts that occurs in the area under the areola.
It is important for the breastfeeding infant’s mouth to cover all or most of the areola. During each suck-relax cycle breastmilk is then stripped from the ducts and the baby receives a bolus of milk.
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Diagram
of the anatomy of the breast
Tail of Spence
Breast tissue may extend up into the mother’s axilla. This is called the Tail of Spence. This area may produce milk and cause the mother some discomfort as the milk comes-in. The Tail of Spence has ducts that mingle with the normal drainage pattern of the breast and it will empty with some massage to the area.
If there is isolated tissue without ducts attaching it to the breast (supernumerary tissue), it may become full but will not empty. Mothers can apply ice to the area several times a day and assist this area to "dry up". The rest of the breast tissue will produce milk normally.
Hormones of Lactation
There are several hormones involved in the production of breastmilk and in the let-down (milk ejection reflex). The most important of these are oxytocin and prolactin. Both are produced by the pituitary gland and released into the mother’s bloodstream when the infant nurses at the breast.
Prolactin signals milk production. It is a slow acting hormone, working over 24 - 48 hours.
Oxytocin stimulates the let-down reflex and is a quick acting hormone. The release of milk occurs within 3 - 5 minutes of the time the baby goes to breast. Most mothers have 2 - 4 bursts of oxytocin during a feeding session.
First feedings
You play a vital role in helping a mother learn to breastfeed and your influence is very important!
You can provide two essential elements: encouragement and information. Both are essential.
New mothers need encouragement
Mothers need to know that you value breastfeeding and breastmilk. Comments highlighting the emotional benefits of breastfeeding and the health benefits for both mother and baby, spoken at the right moment, can have a big impact on mothers.
An optimistic but realistic approach seems to work best.
It is important to acknowledge that a mother may experience difficulties during the initiation of breastfeeding but that they are often short-lived. Patience and persistence are needed to work through these problems. Once breastfeeding is well established, mothers will be glad they followed through.
New mothers need information
Mothers need accurate, "mother friendly" information. In addition to the verbal instruction you give, encourage mothers to read breastfeeding books that can be purchased at local bookstores or obtained at a local library. Brochures given to breastfeeding mothers should be selected carefully.
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Review
educational materials carefully
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Breastfeeding Assessment
Make a quick observation of both mother and infant to determine any conditions that may impact on the initiation of breastfeeding.
(A full discussion of these issues can be found in Chapter II "Overcoming Breastfeeding Difficulties")
Mothers’ assessment
Look for:
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Nipple shape:
erect, flat or inverted |
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Areola flexibility
and elasticity |
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Surgical scars
on the breast or areola |
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Shape of the
breasts |
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Size and symmetry
of the breasts |
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Spacing of the
breasts |
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Engorgement |
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Nipples that
are cracked, blistered, abraded or otherwise damaged |
Infants’ assessment
Look for:
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Short frenulum
or heart shaped tongue |
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Alertness and
hunger cues |
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Signs of jaundice |
Getting it right from the start
There are three important points in insuring a successful start to breastfeeding.
1. Begin breastfeeding during the first hour or so after birth when the baby first shows interest
The first breastfeeding should be as soon after the delivery as the baby shows interest. Babies go through several stages during the first hour after birth that help prepare for breastfeeding. They locate the breast by sight, smell and feel. Breastfeeding will progress more normally if mothers and their babies are left uninterrupted in skin to skin contact for the first hour, or so, after birth.
Any medical procedures or care for the mother that needs to be carried out should be grouped together and done as unobtrusively as possible.
2. Make sure the positioning and latch-on are correct
The baby should be positioned so he is directly facing the breast with as much of the nipple and areola in his mouth as possible.
3. The baby should be fed at least eight times each 24 hours for 15 - 30 minutes or more
The baby should be encouraged to feed frequently, around the clock. Feedings average 8-12 each 24 hours during the first several weeks.
Next, let's discuss each of these points individually.
Timing
During the first hour or two after birth the suck reflex is easily stimulated. Encourage the mother to take advantage of this instinct to suck by providing ample skin to skin contact and by offering the breast during this time.
| The first breastfeeding should be as soon after delivery as the baby shows interest |
Mothers who have had a cesarean delivery need not delay breastfeeding. If mother and baby are stable, the best time to begin breastfeeding maybe while the mother still has pain relief from regional anesthesia.
The baby is "primed" to begin feeding during the first few hours after birth. Allow the baby and mother unlimited skin-to-skin contact and allow breastfeeding to unfold naturally. Often the first feeding goes well, then the baby goes into a "sleepy" phase which may last for several days, where establishing breastfeeding is more difficult. Mothers should take advantage of this early quiet-alert state and be encouraged by success at the first feeding.
The baby may spend a great deal of time licking and nuzzling the nipple and areola before actually latching on. This is all good preparation for the first feeding. It allows the baby time to "get acquainted" to the nipple and encourages the mother’s nipple to become erect.
During these first hours, there are several predictable stages that babies go through preparing to feed.
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Stages of readiness for the first feeding Relaxation
0 -15 minutes after birth Awakening
10 - 30 minutes after birth Activity
15 - 30 minutes after birth Crawling
20 - 40 minutes after birth Resting 25-45
minutes after birth Locating the breast
30 - 45 minutes after birth Suckling
40 - 60 minutes after birth Sleeping
60 - 75 minutes after birth |
Timing of subsequent feedings
Instruct mothers to observe their infant’s states and take advantage of the alertness and readiness of the quiet alert state. Infants in deep sleep cannot be aroused to feed. Infants in light sleep might be brought up to quiet alert with stimulation. The best way to work "with" the baby is to watch for the characteristics of each state.
| Infant states | |
| Deep sleep | No movement, regular breathing |
| Light sleep | Facial expression, REM (rapid eye movement under closed eyelids) irregular breathing, 30 minutes cycles |
| Drowsy | Waking up for falling asleep, twilight |
| Quiet alert | Eyes open and bright, gazing, mirror parent's expressions. The "latchable" state |
| Active alert | Movement, looking, making sounds |
| Crying | Hungry, lonely, too hot or too cold, need comfort |
Feed the baby during the "latachable" state, the quiet alert state.
Positioning
There are several good positions for breastfeeding.
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"Beginners"
positions Cross cradle hold Football hold |
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"Advanced"
positions Cradle hold Side-lying position |
Start by helping the mother get comfortable with good back support, pillows, a footstool or whatever assistance she needs to provide support for her back, shoulders and elbows.
No matter which position is used, these three principles apply. They facilitate a deeper latch-on, improved milk transfer from mother to baby, reduced tension on the nipple and prevent soreness.
1. Position the baby at breast height. The baby should be horizontal above the mother's waist. Several pillows may be needed to support the baby and the mother's arms comfortably.
3. Roll the baby on his side "chest to chest" so that he is in direct contact with the mothers upper abdomen.
3. Position the baby so he is directly in front of the breast and "nose to nipple". The baby should have to "reach" up slightly to take the nipple in his mouth.
"Beginners" Positions
The cross-cradle hold and the football hold usually work best for new mothers because the baby’s head is held in the mother’s hand. The mother has good control when she brings the baby’s head to the breast. Encourage these two positions for the first couple of weeks until breastfeeding is going well.
Cross cradle hold
The baby is supported by the mother's opposite forearm with his head in her hand. She should hold the baby’s head behind the ears. This gives good control of the head and does not stimulate the reflex that causes the head to arch back. Mom’s often mistake this for breast refusal or that the baby doesn’t "like her".
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This position is especially useful with the newborn or for beginning to breastfeed the premature infant.
Remember, look for the straight line from the baby's ear to his shoulder to his hip. Check that the baby is horizontal above the mother's waist with the hips and legs comfortably flexed.
Football hold
The body of the baby is to the side of the mother. Instruct the mother to support her baby's body with pillows and hold his head in her hand. Once the baby is latched-on, the mother may be more comfortable with a folded towel or small pillow to give her hand support. The baby’s head gets heavy to hold after awhile.
This position usually works best with infants with short frenulum, receding chin or short tongue. It is also usually the position of choice for mothers who have had a cesarean section as the weight of the baby is not on their abdomen.
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Note
how the baby's bottom is placed against the sofa
and his feet are
going up.
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"Advanced" Positions
The cradle hold and side-lying positions will give the mother more flexibility as breastfeeding becomes easier. Encourage her to try these positions when she has reliably achieved a good latch-on.
Cradle hold
The mother holds the baby with his head in the bend of her elbow or on her forearm. She supports his body with her forearm and hand. The baby's body should be straight. Look for an imaginary line from the ear, to the shoulder, to the hips.
The baby's hips should be flexed and legs tucked snugly around the mother’s waist.
The mother’s other hand is free to support the breast. Have her position her fingers below and thumb on top of the breast, well behind the areola.
Babies can breathe easily even when the nose is touching the breast. However, mothers are frequently concerned. Position the baby so his chin and nose are gently touching the breast.
Instruct the mother to pull the baby’s hips closer, or slide the baby up an inch or two to bring the nose away from the breast enough to relieve the mother’s concerns.
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Side Lying
The mother lies flat in bed on her side. Use pillows to support the mother’s back, head and upper leg. Pillow support to the baby’s back helps to hold him in position. The baby lies in bed facing his mother and she nurses on the lower breast.
Instruct the mother to shift her shoulders and nurse on upper breast. Or she can roll over holding the baby to her chest and reposition the baby to nurse on other breast.
Note the
pillows at the baby's back and between the legs and at the back of
the mother 
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Check the positioning No matter which position the mother chooses to hold her baby, look for:
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Latch-on
Regardless of the position in which the mother holds the baby, the way he latches-on to the breast is the same.
Instruct the mother to offer the breast using a "U" hold when holding the baby in a cradle or cross-cradle hold. She should hold the breast in a "C" hold when holding the baby in a football position.
"C" hold |
"U" hold |
Slight compression of the areola into an oval or "sandwich" in either the "C" or the "U" hold assures the baby will achieve a deeper latch-on. The oval areola will fit nicely into the baby’s open mouth.
"C" hold compressed into sandwich |
"U" hold compressed into sandwich |
The mothers fingers should be well behind the areola in either position. Discourage the use of the "cigarette hold", because it is more difficult to keep the fingers back behind the edges of the areola.
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Exercise:
Blow up a balloon.
Open your mouth wide and place your lips on the balloon as if
you were "latching-on, leaving a lipstick print. Then compress
the balloon as a mother would compress her areola using a "C"
hold. Place your lips on the balloon again leaving another lipstick
print. See how much wider your lip print is when the balloon
is compressed or "sandwiched". This is how much more
of the areola the baby can get in his mouth when the areola
is compressed for latch-on. |
Tricks of the Trade
Checking the hand position Mothers sometimes have difficulty remembering which hand position to use when: the "C" hold or the "U" hold. Instruct her to put her thumb near her baby’s nose and her fingers by her baby’s chin. This will automatically rotate her hand to the correct position. |
Stroke the baby's chin or tickle his lips up and down with the nipple to stimulate him to open his mouth WIDE like a yawn. The baby’s tongue will come forward over the lower gums.
Quickly pull the baby to the breast as the baby’s tongue scoops the nipple and areola in. The mother should not lean foreword to put the breast in the baby’s mouth; rather, pull the baby to the breast. The nipple and most of the areola (more of the lower part of the areola than the upper part) should be in the baby's mouth.
Bring the Baby to the Breast - Not the Breast to the Baby
Drawing downward from the nose, stroke the baby's lips and chin or tickle his lips up down with the nipple to stimulate him to open his mouth WIDE like a yawn. The baby’s tongue will come forward over the lower gums.
Allow the infant’s head to drop back slightly so his chin and lower lip will contact the outer edge of the areola first. Aiming the nipple at the roof of the infant’s mouth, quickly pull the baby to the breast as the baby’s tongue scoops the nipple and areola in. The mother should not lean foreword to put the breast in the baby’s mouth; rather, pull the baby to the breast. The nipple and most of the areola (more of the lower part of the areola than the upper part) should be in the baby's mouth.
| Infant's chin and lower lip contact the breast first, on the outer edge of the areola | Notice the wide mouth, the flanged lips and the asymmetrical latch-on (more from the bottom of the areola than the top) |
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Support the infant’s head at the nape of the neck. Pressure on the occiput (top of the head) can cause arching. A mother may assume that the baby is rejecting the breast when it is simply a reflex, unrelated to breastfeeding, that has been stimulated.
Look for a wide open "V" (greater than 140O) where the baby's mouth covers the breast. A narrow "V" (less than 140O) indicates the baby has not latched-on well. He should be removed and reattached with a better latch-on.
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These illustrations are of a 60O angle, 90O angle and a 140O angle. You are probably most familiar with a 90O square corner. The baby’s mouth should be open about as wide as this 140O angle. |
You can carefully pull down the corner of the baby’s mouth to visualize the tongue forward over the lower gums and troughed around the nipple. If it is not, he should be removed and reattached with a better latch-on.
Both upper and lower lips should be flanged out and cheeks plump. Dimpling, hollow cheeks, clicking or popping sounds indicate the baby is not properly latched-on. He should be removed and reattached with a better latch-on.
The infant should compress the milk reservoirs with each suck. This ensures an adequate breastmilk intake. Sucking just on the nipple will not provide intake and will make the mother very sore.
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Check the latch-on
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Tricks of
the Trade Tips to improve the latch-on Check the latch-on. If it is poor, break the suction and try again. If it is a marginal latch-on, you may be able to improve it without removing the baby from the breast. Pull down gently on the baby’s chin and hold it while he continues to suck several times. This will allow him to pull more of the nipple and areola into his mouth. It will also roll-out the lower lip into a better position. Check the latch-on again. It should be wider and the mother should report that it feels better. If it is improved, teach the father (or other support person) how to do this. If it is not improved, remove the baby from the breast and try the latch-on again.
Occasionally there is a baby who reacts to a tug on his chin by closing his mouth tighter. Do not use this technique with this type of baby. |
Feeding "on cue"
The baby should be encouraged to feed frequently around the clock during the first several weeks
Discourage requests to feed the baby
in the nursery during the night.
Encourage rooming-in and instruct mothers to feed when the baby seems
to show interest.
It is very important to breastfeed around-the-clock. This stimulates a good milk supply, prevents engorgement and nipple confusion.
The baby should be breastfed every 1 ½ - 3 hours "on request" (or more often if necessary). The first several weeks is the time the mother (with the help of her baby’s sucking) "sets" her milk supply. Vigorous stimulation helps the mom bring in a bountiful milk supply that will set the stage for an ample supply in the following months. If for any reason the baby is not stimulating the mother well, she should be instructed to use a breast pump.
Instruct mothers to be aware of hunger cues.
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Newborns normally feed 8 to 12 times in 24 hours. Some babies cluster their feedings and then sleep for longer intervals at other times. If the baby doesn't wake for feeding within 3 hours during daytime hours, he may need to be awakened.
The baby should be allowed to determine the length of the feedings. Some babies prefer to feed on both breasts at each feeding. Allow 15 to 30 minutes at each breast. Alternate the breast on which the feeding is started.
Other babies prefer to feed on one breast at each feeding. Allow 20 to 30 minutes for these babies. Feed from the opposite breast at the next feeding.
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Foremilk & Hindmilk After milk has "come-in"
and mature milk is present in the breast, the milk will change over
the feeding. The milk released at the beginning of the feeding (foremilk)
is lower in fat content and calories. As the feeding progresses
and the let-down reflexes occur, more fat is released into the milk.
Hindmilk (the milk from the end of the feeding) is higher in fat
content and calories. |
Whether infants feed from both breasts or only one at each feeding, they need to nurse long enough to obtain foremilk and the hindmilk. That will ensure adequate weight gain. Remind the mother that if she needs to move the baby from the breast, she needs to break the suction by putting her finger between the baby's gums.
Reassure mothers it is normal for newborns to nurse 8 - 12 times or more per day. The feedings will gradually space out as the baby grows.
Instruct mothers that colostrum is present for the first 2 - 3 days in sufficient quantities to satisfy the baby's needs. Mature milk comes in on the third to fifth day (rarely up to 10 days). Extra water or formula is usually unnecessary and often leads to engorgement, nipple confusion and lack of confidence in the breastfeeding mother.
A mother may be concerned about her baby's weight loss and her milk supply. It is common for a baby to lose 7-10 % of his body weight in the first 2 - 3 days while the milk is coming in. Frequent nursing during this time brings the milk in sooner, and increases the baby's intake thereby minimizing his weight loss.
If the baby loses more than 10% of his birth weight and supplementation is medically indicated, refer to the Self Learning Module on Alternative Feeding Methods to supplement the baby without comprising breastfeeding.
Sleepy babies
Newborns are often very sleepy and a new parent’s biggest challenge is to wake the baby for feedings and to keep the baby awake for a full feeding. If the baby drifts off to sleep at the breast, parents should be instructed to wake him up. Babies who doze at the breast may "snack" at the breast rather than getting a full "meal". They will be hungry again very soon.
There are several techniques you can teach parents. Some work better on certain babies than others. When one becomes ineffective, try another.
1. Undress the baby to his diaper so he is not so cozy. When babies are in skin-to-skin contact with their mothers, the mother will provide plenty of "radiant heat". (You may need to wait until the baby is 24 hours old and can maintain a stable body temperature)
2. Rub and massage the
baby in various spots
Top of the head
Bottom of the feet
Up and down the spine
Up and down the arm
Rub the baby’s belly above
the umbilicus
Squeeze the baby’s palm rhythmically
3. Change the position of the baby, from cradle hold to football hold and back again when he stops sucking (called "switch nursing"). Use each breast two times.
4. Change the baby’s diaper.
5. Do "baby sit-ups". Rock the baby from a sitting to lying position and back again. Rock gently back and forth until the baby's eyes open. Do not "jack-knife" the baby (force him forward).
6. Jiggle the nipple in the baby’s mouth (Make sure that this does not result in the baby sucking on just the tip of the nipple. If it does break the suction and re-attach the baby to the breast)
7. Talk to the baby
8. Try adjusting room lights up for stimulation or down so the baby can comfortably open his eyes.
9. Apply a cool washcloth to the baby's head, stomach or back. (Do not let the baby become chilled. Premature infants become chilled more easily than term infants.)
Remember !
Advice for the early feedings
Timing
The first breastfeeding should be as soon after the delivery as the baby shows interest, sometime during the first hour after birth.
Positioning
The baby should be positioned breast height, rolled so he is directly facing the breast and lined up with his nose at the nipple. The chin should be touching the breast
Latch-on
Check for flanged lips, the angle where the baby’s lips meet the breast of >140O, most of the areola in the baby’s mouth
Timing of subsequent feedings
The baby should nurse a minimum of eight times each 24 hours, 8-12 is normal frequency. Feedings are usually not evenly spaced. Watch for hunger cues. The baby should be encouraged to feed frequently around the clock during the first several weeks.
Breastfeeding twins (or more...)
Breastfeeding twins (or more...) can be as rewarding as it is challenging.. Many mothers find breastfeeding twins, after the adjustment phase is over, is much easier.
Suggestions for getting started:
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Feed the babies individually until they latch-on easily (this make several weeks) |
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Alternate the breast the babies feed on. The stronger of the babies will bring in a better milk supply for the weaker of the babies. |
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Mothers’ design systems that work for them and their babies. There
are no rules! |
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Suggestions
for positioning twins:
Double football hold |
Click here for diagrams and pictures of breastfeeding twins.
Suggestions for triplets:
Feed 2 babies simultaneously using the double football, parallel or the "V" hold, then feed the third baby on both breasts. Rotate the babies at the next feeding. Some mothers keep a chart to remember which baby should be where at the next feeding.
Or, mothers can breastfeed two babies and someone else can give a bottle (ideally containing pumped breastmilk) to the third baby. Rotate the babies so each baby breastfeeds two out of three feedings.
If the babies are not nursing well, use a hospital grade. breast pump to stimulate the milk supply. It is essential to establish an abundant milk supply in the first several weeks.
Mothers of multiples need encouragement. Once the adjustment period of the first few weeks is over, mothers tell us that it does not take more time to breastfeed, it is easier, it does promote more rest and it does promote better bonding with both/all of the babies.
If one or both/all of the babies are pre-term or in the Intensive Care Nursery, the mother will need to pump, and continue to pump until both/all of the babies are feeding at the breast.
Mothers will need help at home. Encourage her to plan for an extra help each day for the first several weeks, at least.
Provide resources
National Organization of Mothers of Twins Clubs, Inc 1-800-243-2276, www.nomotc.org/
Mothers of Supertwins 516-434-MOST, www.MOSTonline.org
Triplet connection 209-474-0885, 209-474-3073, www.tripletconnection.org
La Leche League 800-LaLeche, www.lalecheleague.org/
Twins Magazine 800-328-3211, www.twinsmagazine.com
Assessing Intake
Signs of adequate intake:
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The infant is satisfied for 1½ to 3 hours (and not more than 4 hours) |
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Mother's breasts seem emptier after feedings |
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The
infant has a minimum of: 1 wet diaper on day one 2 wet diapers on day two 3 wet diapers on day three 4 wet diapers on day four 5 wet diapers on day five 6 wet diapers on day six and beyond |
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The infant has light yellow urine (In the hospital, check the specific gravity if concerned). |
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The baby has at least one stool daily the first three days, then several stools daily. (Three to four stools daily is considered a good sign of adequate intake.) The stool should change from the thick, tarry meconium to yellow and "seedy" after the mother's milk comes-in |
If the baby does not meet these minimum requirements, do a further assessment to determine why. Breastfeeding difficulties should be addressed quickly. Babies can become dehydrated and lose unacceptable amounts of weight very quickly. It is commonly expected that babies will lose up to 7-10% of their birth weight within the first several days. Weight loss exceeding that, or other problems can usually be corrected if intervention is prompt. Refer problem situations to an experienced Lactation Consultant or other breastfeeding specialist before the problem becomes too complex.
Breastfeeding after a Cesarean birth
Mothers are commonly more uncomfortable and sleepy after a Cesarean delivery, however you can still help breastfeeding get off to a good start.
If both mother and baby are stable, the ideal time for the first feeding is during the first hour after birth. If regional anesthesia was used, the mother may wish to take advantage of this pain free time to put the baby to breast.
Encourage the mother to rest when she has the chance. Try to group necessary procedures (vital signs, medications, etc.) around her breastfeeding sessions to allow her periods of uninterrupted sleep.
Assist the mother to position the baby in the most comfortable way for her. Usually the football hold works best as it keeps the baby off the incision area.
The cradle hold or cross cradle hold, supporting the baby with lots of pillows and the mothers legs flexed, may also be comfortable.
Mothers may want to time pain medications so they receive maximum benefit from the analgesia with the minimum sedative affect on the baby. Taking pain medications after feedings will help reduce the amount of medication that baby receives through his mother's milk.
If necessary, reassure the mother that short term use of analgesics will not develop a dependency in the baby. It is important for her to be comfortable during her recovery period Being comfortable helps the let-down reflex and lets the milk flow more easily.
Nutrition during lactation
The breastfeeding mother needs to be aware of proper nutrition for breastfeeding. The recommended diet during breastfeeding is similar to that during pregnancy.
Although even women with poor diets produce good quality breastmilk, a balanced diet assures that the mother has the nutrients and calories needed for herself and for breastmilk production. A mothers may wish to continue taking prenatal vitamins during lactation. She may do so, but it is not necessary if her diet is adequate.
She should drink plenty of fluids to satisfy her thirst. It is not necessary to force fluids.
Caffeine containing beverages should be limited to 2 per day as caffeine passes into breastmilk. It is not eliminated well by the baby and can cause him to be wakeful and irritable.
Beverages containing alcohol should also be limited. Alcohol passes into breastmilk very quickly, but diminishes quickly also. Mothers who choose to drink alcoholic beverages should be counseled to limit their intake. If a mother wishes to limit the exposure to her infant from alcoholic beverages, she can consume alcohol just after feeding the baby. Most of the alcohol will be gone from her breastmilk by the next feeding.
Dietary restrictions while breastfeeding
Mothers who are vegetarian or who limit their intake of meat or other food groups, may run the risk on inadequate intake of vitamin B12. She needs to eat foods rich in vitamin B12 or to take a supplement since that is a nutrient commonly found in red meats. A mother who is not well versed in the diet she chooses should be referred to a registered dietician for counseling.
Mothers need not limit certain foods in an effort to avoid colic. Many babies are not sensitive to anything the mother eats. Others may become fussy 4 - 8 hours after certain foods are consumed.
Trial and error will determine if any particular foods cause a reaction. A food diary may help a mother identify the offending food or food group. Then that item can be eliminated from the diet temporarily. Sensitive babies generally outgrow this in three to four months.
Mothers may wish to avoid allergies in their infants by limiting foods to which there is a family history of allergies. Suggest she talk to her allergist or pediatrician about this. If she needs to limit one whole food group (e.g. dairy products) she needs nutritional counseling about replacement of those nutrients, especially calcium.
Some pediatricians recommend avoiding peanuts during breastfeeding due to the increasing incidence of peanut allergies.
Recommended daily intake for breastfeeding mothers
Meat, poultry, fish, eggs, nuts and beans 2-3 servings
These foods are equivalent to one serving:
Eggs (1)
Fish (2-3 ounces)
Poultry (2-3 ounces)
Lean meat (2-3 ounces)
Legumes, dried beans, peas (1/2 cup)
Tofu (8 ounces)
Peanut butter (2 tablespoons)
Milk and milk products 2-3 servings
These foods are equivalent to one serving:
Milk (1 cup)
Cheese (1 1/2 ounces)
Yogurt (1 cup)
Fruits 2-4 servings
Whole fruit or melon wedge
Fruit juice (3/4 cup)
Canned fruit (½ cup)
Dried fruit (1/4 cup)
Vegetables 3-5 servings
Raw or cooked vegetables (½ cup)
Leafy raw vegetables (1 cup)
Vegetable juice (3/4 cup)
Grains - 6-11 servings
Whole grain breads, crackers (1 slice)
Cereals (1 ounce cold, 1/2 cup cooked)
Pasta, rice (1/2 cup)
Vitamin D Supplementation
Most pediatricians are now recommending Vitamin D supplements for breastfeeding babies. There have been enough cases of rickets in recent years to warrant supplementation for all babies.
Food Guide Pyramid
Use the guidelines in the Food Guide Pyramid to help mothers make healthy dietary choices.
Remember!
Recommendations for nutrition during lactation
A well balanced diet
is recommended during lactation
Breastfeeding mothers should drink to thirst
Mothers should limit caffeine and alcohol while
breastfeeding
Particular foods do not need to be eliminated
from the mother’s diet unless they are shown to cause a problem for her
baby.
Use of medications while breastfeeding
Mothers are concerned about medications that may pass into breastmilk. Most do, but most prescription and over-the-counter medications are safe for the breastfeeding mother, if taken in the usual dosage for short term or occasional use.
Instruct mothers to keep their use of all medications to a minimum while breastfeeding and to remind any physician prescribing medications that they are a breastfeeding mother.
There
are several considerations in recommending drug therapy during
breastfeeding
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There are several good reference books available to determine the safety of medications for breastfeeding mothers. Refer to one of them when questions arise.
References on medications
and breastfeeding
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Mothers taking most medications can safely breastfeed. In a few instances, breastfeeding needs to be temporarily interrupted while the mother uses a breast pump and discards the milk.
In rare cases, when the medication is contraindicated for breastfeeding and long term drug therapy is extremely important for the mother’s health, the infant must be weaned.
Analgesics may temporarily make babies sleepy while they are taken. Prescription analgesics should be tapered and discontinued as soon as the mother is comfortable. Over-the-counter analgesics are safe to take (avoid aspirin).
Decongestants and antihistamines may decrease breastmilk supply with repeated use.
Most antibiotics are safe for breastfeeding mothers.
Stool softeners are safe for breastfeeding mothers but laxatives may give infants colic and diarrhea.
Most anti-hypertensive, cardiovascular and antidepressant drugs seem to have no affect on the breastfeeding infant. Be sure to check a reference book about the specific drug and consult with the infant's pediatrician.
Street or recreational drugs are never appropriate for the breastfeeding mother.
Mothers should pump and discard their milk for 24 hours to several weeks after use of radioactive diagnostic compounds depending on which one was used. Consult a drug reference book to determine the time necessary to eliminate the drug.
Breastfeeding is contraindicated during therapy with chemotherapeutic drugs.
More detailed information regarding the safety of specific drugs during breastfeeding can be obtained from a reference book, pediatrician, pharmacist or experienced lactation consultant.
Remember !
Advice for mothers who need to take medications while breastfeeding
Most commonly used medications are safe
for the nursing infant in the usual