Who should I call for breastfeeding help?
	Who is eligible for a WIC breastpump?
	When will my milk come in?
	How often and how long should I feed my baby?
	Does my baby need bottles?
	What if I don't have enough milk or my baby is gaining weight poorly?
	How do I know if my baby is getting enough milk?
	Why does my baby want to nurse all the time?
	What diet should I follow while breastfeeding?
	Are there foods to avoid while breastfeeding?
	What about breastpumps?
	I'm a tense person. How can I relax better during nursing?
	When should I wean my baby?

Who should I call for breastfeeding help?	[top]
For breastfeeding help call Mon-Fri 8am-4pm (352) 392-6911 ext.227 or 1-800-494-2543 ext. 259 or E-mail us with your questions: tanners@obgyn.ufl.edu Susie Tanner BA, IBCLC, Breastfeeding Coordinator In case of an after hours or weekend emergency please call your doctor or the mother baby unit at the hospital where you had your baby
Who is eligible for a WIC breastpump?	[top]
Most women, in normal circumstances can establish and maintain breastfeeding without using a breastpump. We recommend that mothers exclusively breastfeed their full term healthy babies for at least three to four weeks before giving bottles. If you plan to combine breast and bottle feeding, it is important to first establish your breastmilk supply and feel comfortable breastfeeding. If you are having difficulty with breastfeeding please call us for help, you may qualify for a pump. For breastfeeding mothers who are returning to work or school we have hand pumps to help you maintain your milk supply while separated from your baby. We loan electric breast pumps at no charge to over 120 North Central Florida WIC families with medical need every year. Common reasons that we loan pumps include: premature baby, mother or baby hospitalized, mother of twins or triplets, infant with slow weight gain or failure to thrive, or mother is on a medication incompatible with breastfeeding. Call us for an appointment to discuss your situation.
When will my milk come in?	[top]
Mature milk production begins about 30 hours after delivery, but may not be evident for two to five days. Timing varies depending on your baby's ability to latch-on properly and how frequently and effectively your baby sucks. Generally, the more babies you have had, the sooner your milk "comes in." Keep in mind that until mature milk is present, your baby is receiving rich colostrum "starter milk," which has three times the protein of mature milk and is just right for meeting your baby's needs during those first few days.
How often and how long should I feed my baby?	[top]
Babies need to be nursed as often as they indicate a desire to breastfeed. Watch for your baby's cues. Rooting, brushing a hand across his face, or making little sucking motions are all indications that it is time to breastfeed. Babies will demonstrate feeding cues for up to 30 minutes before they start crying. Crying can cause your baby to have an uncoordinated suck, making it more difficult to initiate feeding. Most babies need to breastfeed at least 8 to 12 times in 24 hours for the first few weeks. Once you and your baby are synchronized, the frequency and duration of feedings per day will decrease. This process takes about six weeks, just about the length of time it takes for you to completely recover physically from the birth process! Breastfeed as long as your baby wants to on the first breast; your baby will let you know when he is finished, either by spontaneously coming off the breast or by drowsily moving into non-nutritive "nursing." You can burp the baby and offer the other breast. If your baby takes it, fine; if not, that's fine too. There aren't any "rules" about having to take both breasts at a feeding. The next time the baby is ready to feed, you can offer the side baby finished on or didn't take. Keep in mind that sometimes babies love to be put to the breast simply for closeness and comfort, not because they are necessarily hungry. Generally speaking, most babies will breastfeed every 2 to 3 hours for 5 to 15 minutes per breast.
Does my baby need bottles?	[top]
Giving your baby supplemental or "relief" bottles in the early days may lead to nipple confusion/preference and can adversely affect your milk supply. Unless you are advised to do so for a medical reason, you should not give a breastfeeding baby bottles of water or formula for the first 3 to 4 weeks. If supplementation is necessary, it can be done with a small medicine spoon or a cup. Giving bottles every day or every other day so your baby "gets used to taking a bottle" is not necessary. After the first few weeks, giving baby a bottle of expressed breast milk periodically, when it is convenient for both of you, is all you need to do. If your baby balks at taking a bottle, you can always feed him using a small cup or a medicine spoon.
What if I don't have enough milk or my baby is gaining weight poorly?	[top]
Most delays in milk production result from an upset in the supply and demand balance. Avoid giving supplemental bottles. Temporarily postpone your other commitments to focus your energies toward establishing a breastfeeding routine with your baby. Try: Take your baby to bed with you. Nap- and night-nursing are time-tested remedies for enhancing a baby's weight gain. Remember the law of supply and demand, and increase the frequency of feedings to at least one every two to three hours. Wake your baby during the day if baby sleeps more than three hours. Even a sleepy baby will nestle at your breast and stimulate milk production. Look at, caress, and groom your baby while breastfeeding. These maternal behaviors stimulate milk production. Undress your baby before feeding to allow skin-to-skin contact. This action may help awaken sleepy babies and stimulate less-enthusiastic nursers. Watch for your baby's feeding cues and capitalize on the times when baby seems ready to eat. Don't try to wake your baby from a deep sleep; wait until he is in a light sleep or drowsy state. Try "switch-nursing" to encourage more enthusiastic breastfeeding if your baby seems to fall asleep quickly. Also called the "burp and switch" method, switch-nursing allows your baby to feed on the first breast until the suck diminishes and baby's eyes begin to close. Take the baby off your breast, burp and latch-on the other breast. When sucking diminishes, take baby off, burp and switch again so baby nurses at least twice on both sides. Double-nursing is another effective method for increasing the volume and fat content. Feed your baby until baby is content; keep baby upright instead of putting baby down to sleep; burp baby well, and 10 to 20 minutes later, breastfeed a second time. Be sure to keep baby upright for 10 to 20 minutes after a feeding to allow the trapped air bubbles to be burped up, leaving room for a "topping off." Above all, relax during breastfeeding to permit an effective milk ejection reflex. Seek the support of breastfeeding and mothering organizations such as the La Leche League or contact a lactation consultant.
How do I know if my baby is getting enough milk?	[top]
After the first month or so, you will intuitively know that your baby has been satisfied by his heavier look and weight. In the first few weeks, it is not as easy to tell, particularly for first-time mothers. Here are some signs to look for: Your baby will have six to eight wet cloth diapers (four to five disposable diapers) and two to five (or more) bowel movements every 24 hours. The color of the stools can vary from yellow to tan with a mustard-like consistency. Urine should be pale yellow to almost clear in color. Your breasts may feel full before a feeding, less full after. You may leak between feedings or leak on one side while feeding on the other. You will feel your baby sucking vigorously and hear him swallowing. Many mothers (though not all) feel a tingly or pinchy sensation with the milk ejection reflex. Often baby will drift off to sleep at the breast, a good indication that he is satisfied. Sometimes a baby will seem satisfied at the breast, but when put down, will start to fuss and root again. This behavior is not necessarily an indication that your milk supply is inadequate. Your baby may simply enjoy being held and cuddled, and not want to give it up for a crib or an infant seat. Using a baby sling or front baby carrier during the day will keep him cuddled next to you while you go about your daily routine.
Why does my baby want to nurse all the time?	[top]
Your baby will breastfeed more frequently in response to sudden growth spurts. Babies can grow as much as 1/2 inch in a 24-hour period. No wonder they need to breastfeed frequently for several days! Breastfeed as frequently as your baby indicates a desire. Your milk supply will soon catch up to the increased need. Giving bottles of formula at this time will only sabotage the natural supply and demand cycle, and you will be unable to catch up with your baby's needs. Some babies love to be held and nursed frequently as a way of helping them to adjust to life outside the womb. In fact, the first three to four months of life for all babies is a transition from the womb to the world. During "increased appetite" days, set aside other commitments to focus your energies on your baby. Sleep when your baby sleeps to recharge your system after these high-need periods. "Wearing" your baby in a sling or front carrier may be helpful. Just as a toddler needs a periodic hug and kiss to make the world right again, a newborn may need to be cuddled and even nursed for a while. As babies get older, they learn other ways of self-comforting, and breastfeeding sessions generally become shorter and less frequent.
What diet should I follow while breastfeeding?	[top]
There are no "rules" to follow about your diet. A healthy, well-balanced diet, high in protein and complex carbohydrates, similar to the one you consumed during pregnancy, is all that is necessary. Because a lactating woman is extremely energy efficient, there is no need for extra calories. Drink water or other beverages when you are thirsty; eat when you are hungry. Lose weight by avoiding high calorie/low-nutrition snacks. Control your weight through regular exercise rather than crash diets, which can present health risks to both you and your nursing baby. If you must diet while breastfeeding, contact your lactation consultant, physician, a registered dietitian, your La Leche League leader, or the Nursing Mothers' Council for specifics.
Are there foods to avoid while breastfeeding?	[top]
Although you will get plenty of unsolicited advice about dietary restrictions while you are breastfeeding, there aren't any foods that a mother should routinely avoid, except alcohol and the myth that beer consumption promotes breast milk production is just that: a myth. Babies can be fussy and can have excess gas -- just because babies are fussy and babies have gas, is not because you had broccoli for dinner last night. Occasionally, a baby may be sensitive to something in the mother's diet. The most common sensitivities are to protein antigens that are found in cow's milk, soy, wheat, fish, corn, eggs and nuts. If you believe your baby is reacting to something in your diet, eliminate that food for two or three weeks, then try it again. Generally speaking, you should eat a healthy, well-balanced diet, with no restrictions. Any food (even chocolate!) in moderation is usually fine. If your baby continues to be usually fussy and gassy, contact a lactation consultant, registered dietitian or WIC nutritionist, your La Leche League leader or the Nursing Mothers' Council.
What about breastpumps?	[top]
Breastpumps are helpful in stimulating, maintaining and expressing milk in cases involving working mothers or mothers with engorged breasts, and premature or sick infants. Breastpumps are available in a variety of types, depending on your preferences and needs.
I'm a tense person. How can I relax better during nursing?	[top]
While the milk-producing hormone prolactin has a natural relaxing effect on the breastfeeding mother, sometimes additional help is needed. There are excellent audiotapes available that include special relaxation techniques that will help improve your milk ejection reflex. Setting up a special "breastfeeding station" in your home may help create an environment in which you can unwind. Select a comfortable chair (a big easy chair or rocking chair with arms is nice), and a footstool to raise your lap. Surround yourself with everything you might need: pillows, telephone, books, nutritious nibbles, juice, water and extra diapers. Try relaxing to soothing classical music or use the relaxation techniques you learned in your childbirth class. If you have a toddler who demands your attention, set up your nursing station on the floor or in the child's room. Include an assortment of pastime supplies, such as special toys, snacks, books and music.
When should I wean my baby?	[top]
Around the world, babies are breastfed an average of two to three years; there is, however, no "right" time to wean. Weaning is an individual decision for each mother and baby. Most babies will not show signs of wanting to wean before eight to nine months at the earliest. The American Academy of Pediatrics recommends breastfeeding exclusively for the first six months, gradually introducing new foods after that time. Breast milk for at least a year is preferred, using formula if you wean before that time. When you or your baby decides to wean, you should do so gradually to prevent the discomfort of engorgement and to help maintain your baby's sense of security. Dropping one feeding every few days and replacing it with formula or cow's milk (depending upon your baby's age), will allow your breasts to adjust to the decreased demand in comfort. Most mothers drop the late night or early morning feeding last as this feeding is often a special snuggle time with the baby.
Some information from breastfeeding.org	[top]