frequently asked questions
Our counselors helped us put together a list of the topics that seem to be on the minds of most of the nursing mothers whom they counsel. If you don't find the answer to your questions, try the troubleshooting link at left, or call the hotline to be referred to a counselor.
how can I get breastfeeding off to a good start?
- Attend a prenatal breastfeeding class.
- Limit visitors and visiting times when you are in the hospital, as well as in the early postpartum days after you return home.
- Spend as much time skin-to-skin with your baby as possible, starting as soon after birth as you can.
- Start breastfeeding as soon after baby’s birth as you can.
- Nurse your baby a minimum of 8–12 times in 24 hours.
- Avoid bottles and pacifiers until breastfeeding is well established (usually about 4 weeks).
- Attend a parent support and/or breastfeeding support group.
- Don’t hesitate to seek help if you encounter challenges.
how can I build an abundant milk supply?
Your milk supply is established during the first several weeks of your baby’s life. The amount you breastfeed in the early postpartum days helps determine the amount of milk you will have as your baby grows older.
- Help baby get a good latch
- Breastfeed frequently (8–12 or more times in 24 hours)
- Spend lots of time skin-to-skin
- If you are separated from your baby, pump 8–12 times in 24 hours
- Milk supply can be adversely affected by alcohol, cigarettes, over-the-counter cold remedies, antihistamines, decongestants, and hormone-based contraceptives.
how often should I feed my baby?
Babies need to eat a minimum of 8–12 (or more) times in 24 hours. Newborns will often feed more frequently, as will older babies who are sick, teething or experiencing a “growth spurt.”
Feed your baby whenever she shows signs of hunger. Babies often “cluster feed,” wanting to nurse several times in a short period, then taking a longer break until the next feed. Newborns often cluster feed all night long, while older babies tend to cluster feed in the evenings.
Occasionally, an older baby will be a very efficient breastfeeder and/or the mother has a fast flow of milk. In this case, the baby may feed less frequently than other babies (because she ingests more volume per feed). This is OK, as long as baby is gaining adequate weight and eliminating in a normal pattern.
how do I know when my baby is hungry?
Watch your baby for these early signs of hunger:
- Sucks her hand
- Licks her lips
- Moves and stretches her arms
- Opens her mouth
- Turns her head from side to side
- Turns her head toward your head or chest
Don’t wait until your baby cries before offering your breast. A crying baby is has a hard time latching.
how long should each breastfeeding session last?
The length of each breastfeeding session can vary, depending on baby’s age, hunger level, and individual nursing style. Generally speaking, newborns will feed anywhere from 5–40 minutes (occasionally even longer), while older babies tend to finish in a shorter time. Let your baby decide how long he wants to breastfeed. Start on one breast. When baby slows down or stops, lift him onto your chest for a quick break (or burp him), and then offer the other breast. He may or may not decide to feed some more.
how do I know when my baby is full?
Let baby decide when she is full. Watch for these signs:
- Sucking slows down or stops
- You no longer hear swallowing
- Baby’s arms and hands relax
- Baby lets go of the breast, and does not attempt to latch again
If you believe your baby is finished, lift her onto your chest and wait several minutes to see if she reinitiates feeding.
how much breastmilk does my baby need?
The amount of breastmilk a baby takes depends on her age. A newborn’s stomach is very small, and is not ready to digest a large volume of milk.
- Day 1 = about 1 teaspoon per feeding
- Day 3 = about 1 tablespoon per feeding
- Day 10 = about 2 oz. per feeding
- 1 month+ = about 2–3 oz. per feeding
Baby’s intake does not increase very much after 1 month of age, even though her weight continues to increase. The average intake for a 1–6 month old is about 25 oz per day, and the normal range is 19–30 oz per day. At about 6 months, when baby starts solids, her milk intake gradually decreases.
how do I know my baby is getting enough milk?
Watch baby’s weight gain, as well as how many diapers he has.
Most babies lose weight in the first several days of life. After Day 5, baby should be gaining weight, and be back at his birth weight by Day 10–14. Baby should gain about 1 oz. a day (5–7 oz./week) until 3 months, and 2–3 oz per week up to 6 months.
When baby is 5 days old, he should have 5 wet diapers and 3 poopy diapers per 24 hours. The urine should be clear or very pale yellow, and the poop should be bright yellow and soft, like mustard.
By 6–8 weeks, baby will continue to have at least 5 wet diapers, but he may have fewer poopy diapers.
how do I know that my baby is latched on well?
- Baby’s mouth is open very wide.
- Her chin is pushed in against the breast .
- Both of her lips are curled out.
- You can see more of your areola above baby’s top lip than below her bottom lip.
- Her cheeks are rounded, not dimpled or sucked in.
- You can see her chin drop, which means she has a mouthful of milk.
- You can hear her swallow (it sounds like a soft “kuh”).
- You do not hear any clicking or smacking sounds.
- She takes long, rhythmic sucks, and you can see her upper jaw and ear move.
- You feel a strong tug while breastfeeding, but do not feel pain.
signs that breastfeeding is not going well…time to ask for help!
- Baby continues to have difficulty latching on and is not feeding well.
- Baby’s urine is dark and scanty and/or baby’s poop has not changed to yellow by day 5.
- Baby continues to loose weight after Day 4–5. Or, baby hasn’t regained birthweight by Day 10–14.
- Baby is very sleepy and/or is difficult to rouse (even after time spent skin-to-skin).
- Mom’s milk production has not increased by Day 5.
- Ongoing breastfeeding pain or discomfort.
- Cracks or sores on nipples haven’t healed within 3–5 days.
- Breasts are painful with hard, tender or red area.
- Mom has flu-like symptoms (chills, fever over 100ºF, aches, pains, enormous fatigue).
why do babies wake so often at night?
Newborns wake up approximately every 2 hours around the clock, whether they are fed by breast or bottle. There are several reasons why it’s important for babies to wake up at night.
Newborns’ tummies are tiny and can’t take in very much at each feeding. Babies must eat frequently, even at night, to get enough calories to sustain their rapid growth rate. As they get bigger, babies can drink more at one time and don’t have to wake as often to eat.
Young babies wake easily because they dream a lot. For infants, dreaming is a vital part of normal brain development. When babies dream, blood flows to their brains and neural connections are made. Dreaming is so important for newborns that they may spend up to 30 minutes dreaming before they fall into deep sleep. Babies, like adults, are more likely to wake up when they are dreaming than when they are deeply asleep. If something happens while they are dreaming (i.e. the phone rings, or they are put down into a bassinet), they will probably rouse. It’s simple to tell when a baby is dreaming; her eyelids flutter and her mouth and body twitch. Parents can help their baby stay asleep after breastfeeding by holding them and waiting until all signs of dreaming have stopped before putting them down. By the time baby is 3–4 months old, she will spend less time dreaming, and more time in deep sleep.
Young babies wake frequently to stay safe and comfortable. It can take a little time for babies to coordinate their brains, lungs and muscles. If they sleep too deeply, they may get too hot, or too cold, or they may not wake when they need to move their muscles or to get a little more air. After the first 6 weeks, most babies will settle down and sleep for 3–4 hour stretches. As they get older and their bodies mature, they will sleep even longer. Many babies will sleep most of the night around 6–9 months of age.
While it makes perfect sense for babies to wake frequently throughout the night, it can be very challenging for parents. Rest assured that the sleep deprivation you experience now is directly supporting the health and development of your wonderful baby. Take good care of yourself by eating well, getting a little exercise, relaxing whenever possible, talking to other parents, and letting others help you as much as possible. Believe it or not, this too shall pass!
(Adapted from www.secretsofbabybehavior.com)
do I have to eat a special diet while I am nursing?
Nursing mothers do not need to follow a special diet or eat certain foods to produce high-quality milk. The nutritional composition of breastmilk is not affected by the foods a mother eats. The normal healthy diet recommended for an average adult should meet the needs of most breastfeeding woman (see myplate.gov for guidelines).
Vegetarianism is fully compatible with breastfeeding. Mothers who follow a vegan diet, however, must be sure to supplement their diet with additional Vitamin B12.
Women sometimes believe they must avoid certain foods (such as beans, broccoli, garlic, onions) to prevent gas or colic in their babies. The components in foods that cause gas in the mother, however, do not pass into breastmilk. Most women find they are able to enjoy a wide variety of foods with little or no affect on their babies. If a mother suspects a particular food is causing a problem, she can omit that food for a week and then reintroduce it.
Average weight loss during lactation is one to two pounds a month for a mother with a healthy diet and normal physical activity. If the mother’s intake exceeds her needs, she will gain weight while lactating. Well-nourished, healthy women can safely lose up to one pound per week with no adverse affect on milk production. Caloric intake for breastfeeding women should not go below 1800 calories per day.
(Adapted from Counseling the Nursing Mother, J. Lauwers and A. Swisher)
can I have a glass of wine or beer?
An occasional drink, or regular light drinking (one or fewer drinks per day), has not been found to be harmful to breastfeeding babies. Alcohol passes freely into mother’s milk, peaking about 30–60 minutes after consumption, and also passes freely out of a mother’s milk at a rate of approximately 2 hours per drink consumed. There is no need to “pump and dump” breastmilk after drinking alcohol. It is safe to nurse when the effects of the alcohol have worn off and you feel normal again.
The effects of alcohol on the breastfeeding baby are directly related to the amount consumed by the mother. Babies of women who consistently drink moderately to heavily (defined as 2 or more drinks per day) may exhibit drowsiness, weakness, decrease in linear growth and slow weight gain. Excessive alcohol consumption can also limit parental effectiveness and result in life-threatening conditions for the infant.
(Adapted from Counseling the Nursing Mother, J. Lauwers and A. Swisher)
can I have caffeinated beverages?
In general, very little caffeine passes into breastmilk. Mothers only need to eliminate or limit their caffeine consumption if their baby shows a negative response. A baby who is being overstimulated by caffeine may be wakeful, hyperactive, unusually fussy and/or colicky. Newborns and preterm babies are more sensitive to caffeine due to their immature digestive systems. If a mother suspects that her baby is reacting to caffeine, she should remove it from her diet for 2 weeks and then assess whether the symptoms have improved.
(Adapted from Counseling the Nursing Mother, J. Lauwers and A. Swisher)
will exercise affect my breastmilk?
Exercise is energizing, reduces stress, and is an important contributor to Mom’s overall emotional and physical well-being. Studies show that exercise, even vigorous activity like running, does NOT affect milk production, or composition. Likewise, exercise does NOT change the taste of breastmilk, so there is no need to avoid nursing right after a workout. Exercising four to six times per week, beginning four to eight weeks postpartum is safe for most women. Breastfeeding women may find that they are more thirsty than they were before they had a baby. When exercising, be sure to drink enough to satisfy your thirst.
when can I give my baby a pacifier/bottle?
Unless medically indicated, it’s best to avoid pacifiers and bottles until breastfeeding is well established, typically 4–6 weeks.
Giving a pacifier to a newborn may decrease the amount of time she spends suckling at the breast, resulting in lower milk intake for baby. Less time at the breast in the early postpartum period also means decreased nipple stimulation, which can compromise mom’s developing milk supply. Additionally, the way a baby sucks on a pacifier (mouth closed tight, tongue pressing to roof of the mouth) is different from the way she needs to suckle on the breast (mouth open wide, tongue extending past the gumline). Older babies who already know how to breastfeed can usually switch between breast and pacifier without a problem. But a newborn who tries to breastfeed “pacifier-style” may have difficulty latching properly, causing a lot of nipple damage in the process. If your newborn needs “pacifying,” try holding her skin-to-skin as much as possible. Snuggle her close so that she can hear your heartbeat and smell your special smell…you’ll probably discover that Mommy is the most effective “pacifier” of all!
Even if your goal is to combine breast and bottle feeding, it is important to breastfeed exclusively for the first 4 weeks. Introducing a bottle early-on can complicate breastfeeding for the same reasons that pacifiers do, including possible breast refusal, ineffective breastfeeding and suckling changes that cause sore nipples. Moreover, giving frequent bottles during the first month gives your body the message that it doesn’t need to make as much milk. Your milk supply (established during the first 4–6 weeks of baby’s life) is based on how many times and how well-drained your breasts are per day. If milk is not removed (because baby is full from a bottle), then your breasts become calibrated to produce a smaller amount of milk. Once your breasts reach this “set point” for milk production, it can be difficult to increase the milk supply. Breastfeeding exclusively for the first 4-6 weeks helps calibrate your breasts to make a bountiful amount, and then you can choose to bottle feed without worrying about compromising your overall milk supply.
(Adapted from Breastfeeding Made Simple, N. Mohrbacher and K. Kendall-Tackett)
can I let my partner give a bottle so I can get a good night’s sleep?
It is best to wait 4–6 weeks before introducing a bottle (see section on “When can I give my baby a pacifier/bottle?”). Once breastfeeding is well established, your partner can help with a feeding.
Giving formula (instead of expressed breastmilk) may affect your milk production. To maintain your milk supply you will need to pump or hand express an amount of breastmilk that is equal to the amount of formula your partner gives to baby.
Depending on your baby’s age and feeding patterns, it might not be realistic to expect that you will get a solid 6–8 hours of sleep, even if your partner gives a bottle in the middle of the night. When your breasts are used to nursing several times at night, they will get very full if you skip a feeding…you may have to get up to pump or breastfeed to relieve the engorgement.
Families find lots of ways to maximize their sleep time. Sharing a bedroom with baby makes it much easier for Mom to respond to baby’s feeding cues, and to get back to sleep quickly after nursing. Some families find that Mom gets more sleep in the long run if she goes to bed early while her partner gives a late evening bottle, or if the partner gets up early with the baby and lets Mom sleep in. Other families find that nighttime breastfeeding goes relatively smoothly, and Mom would rather have her partner take baby for a block of time during the day so that she can have some “me time” to nap or relax.
is breastfeeding supposed to hurt?
Breastfeeding causes many different sensations. It can sometimes be confusing to distinguish between what is normal and what is a problem.
Some common sensations that are normal include:
- General nipple tenderness: Most women experience this during the first week. It subsides as mother’s hormones stabilize and baby gets better at latching.
- Tingling or “pins and needles” at the beginning of a breastfeeding session: This is probably your “let down,”or milk-ejection reflex, when milk flows from the milk ducts down toward the nipple. Some women feel their let down, others do not.
- Strong tugging: This is a sign that baby is latched deeply and is drawing the nipple far back into her mouth.
- “Holy cow, this is weird!”: If you’ve never breastfed before, it may take several days to acclimate to the new experience.
- Uterine cramps: For the first several days, your uterus will contract when your baby suckles. This is a sign that your uterus is returning to its pre-pregnancy size.
Sensations that might indicate a problem include:
- Pinching, rubbing or biting pain that lasts throughout the feeding.
- Sharp pain that radiates through the breast.
- Hard lumps that are painful to the touch.
- Burning sensation in nipples during feedings, at the end of feedings or between feedings.
- Soreness or pain that does not improve after three days of consistently working to correct the cause.
Persistent or intense nipple soreness indicates that some adjustment needs to be made. Poor positioning or latch-on is the most common cause of sore nipples in the early weeks. Do not hesitate to seek help if you encounter challenges!
why is my baby falling asleep not long after latching?
Poor latch-on is the most common cause of newborns falling asleep quickly at the breast. If baby takes only the nipple or a small amount of breast into his mouth, the flow of milk will be slow, and not enough to keep him interested in continuing to suckle. Improving the latch (so that baby is taking a deep mouthful of breast tissue) is often all it takes to trigger active, effective suckling, which increases the milk flow, and keeps baby alert and interested at the breast.
Babies may also be “sleepy” at the breast if they had a difficult delivery, if they are preterm, if there is too much stimulation in their environment (light, sound, activity), or if they have a medical condition such as jaundice or infection.
Some sleepy babies must be “reminded” to wake and feed 8–12 times in 24 hours. To rouse your baby, change her diaper and remove her clothes. Place her on your bare chest with her head nestled between your breasts so that she can hear your heartbeat and smell your milk. Gently rub her back and the bottoms of her feet, talk to her and make eye contact. You can also circle her lips with your finger, and express milk onto her lips.
To keep a sleepy baby interested during a feeding, use breast compressions to keep the milk flowing (see http://www.breastfeedinginc.ca/content.php?pagename=doc-BC for instructions). Massage the crown of baby’s head gently in a circular motion. You can also switch breasts as soon as baby begins to lose interest in sucking. Burp baby or change her diaper between sides to keep interest high.
If your baby consistently does not wake to feed, falls asleep quickly when on the breast, or does not feed 8–12 times in 24 hours, he may not get the calories he needs to sustain growth. Seek help from a lactation consultant or your pediatrician if you have any concerns.
(Adapted from The Breastfeeding Answer Book, N. Mohrbacher, J. Stock)
why is my baby pulling off the breast?
Babies pull off the breast for many different reasons. Some of the most common ones include:
- Baby has not latched-on well and is trying to reposition her mouth on the breast.
- Baby is done nursing for the moment. She may or may not take more milk after taking a short break.
- Babies sometimes fuss, cry or pull off the breast when they need to burp.
- Some babies pull off the breast if Mom has a forceful let-down and/or a super-abundant milk supply. You may hear your baby choking, gasping or gulping before she pulls off. She might also clamp down on your nipple to try and control the flow. Other signs of a forceful let-down include excessive gas or spitting up.
- Some babies get impatient if Mom has a slow let-down or a low flow of milk. Baby will knead the breast, pull off and on the nipple and suck more rapidly to speed up the flow. Try compressing your breasts during feeding (see http://www.breastfeedinginc.ca/content.php?pagename=doc-BC for instructions) to increase the flow.
- Babies who are teething, ill, or have thrush or reflux may also pull off the breast.
(Adapted from www.kellymom.com)
why is my baby refusing my breast?
If a baby younger than a week old has been refusing the breast since birth, it is most often due to poor positioning and latch-on. It might also be a result of birth interventions (including aggressive suctioning) and medications. Be sure that baby has been checked for medical problems, such as cleft palate, short frenulum, injury or illness.
If baby began refusing the breast between the second and fourth day, it may be because the breast is engorged (which makes it more difficult for baby to latch), delayed or inhibited let-down, or a delay in mother’s milk “coming in.”
A baby who has received bottles may refuse the breast because he has become accustomed to a faster flow of milk. He may also have developed sucking patterns that make it difficult for him to remove milk from the breast.
Baby may also refuse the breast if Mom has a forceful let-down or an overabundant milk supply, both of which make it difficult for baby to cope with the amount of milk she gets during a feeding.
Older babies (4 months and up) are often highly distractible and will refuse the breast if they notice anything “interesting” (an older sibling, a dog barking) during a feeding. Babies 9 months and up are often “too busy” during the day to breastfeed, and nurse more frequently during the night to make up for it.
Some babies refuse the breast when they are overstimulated, upset or under stress. Changes in daily routine, traveling and increased tension in the family might contribute to baby’s refusal to nurse. Some sensitive babies will refuse the breast if Mom has started using a new cosmetic, soap, lotion, or laundry detergent that smells different from what baby is used to.
For strategies on how to coax a baby back onto the breast, see: www.kellymom.com/bf/concerns/baby/back-to-breast.html
(Adapted from The Breastfeeding Answer Book, N. Mohrbacher, J. Stock)
how long can i store my breastmilk?
Containers should be covered and kept as cool as possible; covering the container wiht a cool towel may keep milk cooler.
insulated cooler bag
5–39º F or -14–5ºC
Keep ice packs in contact with milk containers at all times, limit opening cooler bag.
39ºF or 4ºC
Store milk in the back of the main body of the refrigerator.
freezer compartment in refrigerator
5ºF or 15ºC
Store milk toward the back of the freezer, where temperature is most constant. Milk stored for longer durations in the ranges listed is safe, but some of the lipids in the milk undergo degradation resulting in lower quality.
freezer compartment of refrigerator with separate doors
0ºF or -18ºC
chest, upright, or deep-freezer
-4ºF or -20ºC
Reference: Academy of Breastfeeding Medicine. (2004) Clinical Protocol Number #8: Human Milk Storage Information for Home Use for Healthy Full Term Infants.