Breastfeeding

Overview

Breastfeeding is one of the best ways to ensure your baby’s health and development. It’s a convenient, cost-effective, natural way to feed your baby.

Breastfeeding is widely recommended as the best way of feeding infants by leading health organizations, including, among others:

  • The American Academy of Pediatrics
  • The American Academy of Family Physicians
  • The American College of Obstetricians and Gynecologists
  • The American Dietetic Association
  • The American College of Nurse-Midwives
  • The U.S. Department of Health and Human Services, Office on Women’s Health

Healthy mothers should consider breastfeeding exclusively (no formula) for the first six months of life and, if possible, continue until the baby is one year old and beyond. Ideally, solid foods should only be introduced after six months of age.

While most new mothers breastfeed in the weeks following birth (called the early postpartum period), less than 15 percent continue to nurse exclusively through six months. The likelihood of breastfeeding is even lower among African-American women, as well as women with lower levels of education.

Initiatives to educate new mothers and their partners, health care professionals and employers about the clear, long-lasting health benefits of breastfeeding for both mom and baby are ongoing. Changes to routine maternity unit practices, including “rooming in” policies, which allow mom and baby to stay together in the hospital, are increasingly common and help support mothers who wish to breastfeed. Healthy People 2020, a national prevention initiative to improve the health of all Americans, set forth goals to increase breastfeeding rates.

Healthy People 2020 Goals

2020 Target

In early postpartum

81.9%

At six months

60.6%

At one year

34.1%

 

Diagnosis

Breastfeeding is a natural and rewarding process; however, it can be harder than it looks. If you have trouble breastfeeding, contact your health care provider or consult a lactation consultant or counselor. Breastfeeding challenges are often easily overcome with some support and, occasionally, treatment, so don’t give up.

What’s a Lactation Consultant?

Lactation consultants are professionals who are trained to help mothers who want to breastfeed their babies. Most hospitals and clinics have lactation consultants on staff to help new moms learn to nurse. They can provide encouragement and assist moms and babies with latching difficulties, painful nursing and other issues that may interfere with efforts to breastfeed. To find a lactation counselor near you, visit the La Leche League’s website: http://www.llli.org.

Common Complications with Breastfeeding

There are several problems new mothers may experience when breastfeeding, including:

  • Sore or cracked nipples. This occurs most often because the baby is not “latching on” to your breast correctly.
  • Engorgement. When your breasts are engorged, they become swollen, hard and sore. They may become so full that the nipple flattens into the areola (the dark skin around the nipple). This can lead to plugged ducts or a breast infection.
  • Plugged milk ducts. These are common during breastfeeding and occur when the milk is not properly drained. The affected milk duct feels like a tender lump in the breast and can become inflamed and red; however, there are usually no other symptoms.
  • Mastitis. Also called breast infection, mastitis is often accompanied by a fever, chills and/or other flu-like symptoms. Less common than other complications, mastitis is caused by bacteria on your skin or by bacteria from your baby’s mouth that enters the breast through cracked skin. The affected breast may be red or have red streaks and may be painful and swollen.
  • Thrush (yeast infection). Also less common than other breastfeeding complications, thrush may be suspected if you suddenly get sore nipples after several weeks of successful, pain-free nursing. Other signs include pink, flaky, shiny, itchy or cracked nipples. You may experience shooting pains deep in the breast during or after feedings if the yeast has gotten into the ductal tissue of the breast.

Treatment

There are ways to treat or prevent problems that may develop because of breastfeeding. Even if you begin to have symptoms like sore nipples or other issues, it’s important not to give up before speaking with your health care professional or lactation consultant—or even a friend who has successfully breastfed her children. Here are some treatment options for the most common breastfeeding symptoms.

Sore Nipples

To treat or prevent sore, cracked nipples:

  • Make sure your baby is sucking properly. The baby’s mouth should take your nipple and as much of the areola (darker area around the nipple) as possible. If it hurts, you may need to reposition and start again. Be careful not to pull the baby away from the breast quickly; instead gently interrupt the suction by placing a finger in his/her mouth.
  • Offer the less sore nipple first, as the baby may suck more vigorously at first.
  • Let your nipples air dry between feedings. You may want to expose them to sunlight briefly.
  • Rub a small amount of breast milk or a breast cream that contains lanolin and water to soothe the area after a feeding. Your milk will help heal cracks and kill bacteria, which could lead to an infection.
  • Change wet nursing pads frequently. Use of washable cotton pads may cause less irritation than synthetic (i.e. plastic) backed pads.
  • Wash your nipples daily with warm water and pat dry. Avoid using soap, which can remove natural oils.
  • If you have an open crack in the skin, it may be better to nurse from the other breast temporarily, but be sure to pump the sore side until it heals a bit and isn’t sore.

Nipple soreness and chapping should go away within several days. If it doesn’t, you should contact your health care provider or lactation consultant.

Engorgement

If your breasts are engorged (overly full), breastfeed frequently to help empty your breasts and relieve fullness and pain. If this is too painful, try to manually express some milk to provide a natural, soothing lubricant. This may also make it easier for the baby to latch on to the nipple. To ease engorgement, take a warm shower or apply warm compresses for a few minutes before breastfeeding. If your baby is not latching on well, use a pump to reduce engorgement and help your milk flow. Use cool compresses between feedings to reduce swelling.

Plugged Milk Duct

This is a common problem for many breastfeeding mothers. Treatment may include: getting extra sleep or rest; applying heat compresses or taking a hot shower; massaging the blocked milk duct toward the nipple during nursing; and breastfeeding from the affected breast to help loosen the plug. Applying cool compresses to your breasts after feeding may also help.

Mastitis

If you suspect mastitis, or a breast infection, you should consult your health care provider right away. He/she will prescribe antibiotics and may recommend an analgesic to relieve the pain. Hot showers or compresses before breastfeeding can help by increasing circulation to the affected area.

In most cases, you can continue nursing through breastfeeding problems, even an infection. Emptying your breasts frequently can often reduce inflammation and relieve the problem.

Prevention 

Breastfeeding is a unique experience for each woman and her baby. You may not experience the same (or any) breastfeeding symptoms a friend had, while you may have more trouble getting started than your mother did (or not). Many difficulties associated with breastfeeding can be minimized. The benefits of staying committed, whenever possible, to breastfeeding always pay off.

Here are a few tips to further explain why breastfeeding is valuable to you and your baby’s health now and in the future, as well as how to prevent complications.

  • Breastfeeding offers a wide range of health benefits and reduces the risk of certain illnesses for both mom and baby.
    • Breast milk has antibodies that bolster you baby’s natural immunity to fight common childhood infections, including diarrhea, ear infections, respiratory infections and bacterial meningitis. It can also lower the risk of some chronic illness (e.g., juvenile diabetes, some childhood cancers, irritable bowel syndrome/colitis, overweight and obesity). Because breastfed babies tend to be healthier, they have fewer:
      • Illnesses (less severe and shorter)
      • Sick care visits
      • Hospitalizations
    • Breastfeeding helps moms recover from pregnancy and childbirth and can reduce the likelihood of certain cancers (e.g., breast, ovarian) and osteoporosis.
  • Before starting to breastfeed, talk with your health care provider about any prescription or over-the-counter medications or herbs you are taking, just in case these can pass into your milk and harm your baby.
  • Limit alcohol and caffeine, which can easily pass into your milk. The effect of alcohol is related to the amount you consume. It’s OK to have the occasional beer or glass of wine (one glass or less a day). Time feedings so they occur two hours later, so the alcohol is no longer in your system.
  • Avoid certain kinds of fish and shellfish that contain high levels of mercury. These include shark, swordfish, king mackerel and tilefish. You can safely eat up to 12 ounces (two servings) per week of fish low in mercury, which include shrimp, canned light tuna, salmon, pollock, clams, haddock, trout and catfish.
  • Get plenty of rest and eat a well-balanced diet. As a new mom, you are probably feeling overly tired and may not be eating as well as you should be. This can lower your resistance to illness, making breast infections more likely.
  • Some women experience problems when breastfeeding, such as sore or cracked nipples, engorgement or blocked milk ducts, especially during the first four weeks. There are preventive steps you can take to limit their occurrence and reduce the likelihood of breast infections that may develop as a result. Here are some helpful tips:
    • Breastfeed frequently for your baby’s health and to help empty your breasts.
    • Check your baby’s position and the way he/she is latched on to your breast. If he/she is not latched on properly, nursing may hurt, and your breasts will be overly tender and sore.
    • Let your nipples air dry between feedings.
    • Wash your nipples daily with warm water. Avoid using soap on the nipple area or lotion that may contain alcohol, because both can dry the skin.
    • Manually express some milk on your nipples to provide a natural moisturizer or use a breast cream that contains lanolin and water to soothe the area.
    • Don’t skip feedings. Frequent breastfeeding is the most important thing you can do to protect your breast milk supply when with your baby. Frequently pumping when separated from your baby is equally important.
  • Facts to Know
    1. Breastfeeding is highly recommended. The American Academy of Pediatrics (AAP) and other leading health organizations strongly recommend exclusive breastfeeding (with no formula or solid foods) for the baby’s first six months of life. Breastfeeding should ideally continue through the first year of life or beyond.
    2. Breast milk is preferred for all infants, including premature and sick newborns, with few exceptions, according to the AAP. Human milk is rich in nutrients and easier to digest.
    3. Breastfed infants are healthier. They have fewer deaths during the first year and experience fewer and shorter illnesses than formula-fed babies.
    4. The health benefits add up. The longer you breastfeed, the greater the health benefits for you and your baby.
    5. Supply will meet demandMany mothers worry about whether their babies are getting enough milk. Your milk supply will respond to your baby’s needs—the more your baby suckles, the more milk will be produced.
    6. Breastfeed early. Try breastfeeding within the first hour of giving birth. This is an important time to bond with your baby and learn breastfeeding techniques from a lactation consultant or nurse on staff.
    7. Some new mothers experience difficulties breastfeeding. In fact, many mothers report problems during the first few weeks, such as sore nipples, breast pain or swelling. If problems persist, talk with your health care provider or ask to be referred to a lactation consultant. The good news is that most of these problems can be resolved with patience, practice or treatment.
    8. Working mothers can and should continue breastfeeding. More and more new mothers are returning to work and plan to continue breastfeeding. Make sure to speak with your employer or human resources manager before returning so you can discuss the logistics of pumping at work. Find out if there is a private room you can use and how you will fit pumping breaks into your schedule. Know your rights. Many states have laws that require employers to set up a space for you and/or allow unpaid or paid time to accommodate pumping breaks.
    9. In some cases, breastfeeding is not recommended. For example, mothers with certain health conditions can pass illnesses on to the baby through breast milk. These include:• Human immunodeficiency virus (HIV)
      • T-cell leukemia virus type 1
      • Active, untreated tuberculosisMothers who use illicit drugs, drink excessive amounts of alcohol or are taking prescribed chemotherapy or radiation therapies for cancer also should not breastfeed their babies. If you have a herpes lesion (sore) on your breast, you should not breastfeed.Women who have had breast reduction surgery or breast implants may not be able to breastfeed because of the impact these surgeries can have on milk production.
    10. Breastfeeding has economic benefits. Mothers of breastfed babies tend to have fewer missed work days and shorter absences because breastfed babies are better able to fight off infection and are sick less often. Companies incur fewer insurance claims for infant illnesses. Breastfeeding saves families money because it’s a lot less expensive than formula.
    11. Health BenefitsHealth Benefits for Mom and BabyThere are compelling reasons to breastfeed—and both you and your baby benefit.For Your Baby…
      • Breast milk provides just the right balance of nutrients for optimal growth and development.
      • Breast milk has antibodies that help protect your baby from common childhood illnesses and infections, such as bacterial meningitis, diarrhea, ear infections and certain respiratory infections. This natural immunity—or ability to fight off infection—means breast-fed babies have fewer:
        • Illnesses (less severe and shorter)
        • Visits to the pediatric provider
        • Hospitalizations
      • Research shows that breastfeeding also reduces newborns’ and infants’ risk for developing chronic diseases, such as celiac disease, inflammatory bowel disease, and some childhood cancers. There is some conflicting evidence that breastfeeding may reduce the risk for allergies and asthma.
      • Breastfed babies are at lower risk for sudden infant death syndrome (SIDS), the leading cause of death among infants one month to one year old.
      • Breast milk may offer protection against overweight/obesity years later in childhood and possibly adulthood, too. At one year of age, breastfed babies have significantly less fat than those who are fed formula.
      • Breastfed babies may have a lower risk of developing cardiovascular disease in adulthood.
      • Breast milk may protect against the development of type 2 diabetes later in life.
      • Breast milk may offer neurodevelopmental advantages and improve cognitive development.

      For You…

      • Breastfeeding releases a hormone called oxytocin that helps the uterus return to its normal size and reduces post-birth bleeding.
      • It also burns extra calories (up to 500 calories per day), making it easier for you to shed those pregnancy pounds.
      • Breastfeeding can deepen the emotional bond between you and your baby. Such physical contact helps your baby feel secure and warm and eases his/her transition from the womb.
      • Nursing can delay the return of regular periods, although you still need to use birth control.
      • Thereis growing evidence that certain cancers (breast, uterine and ovarian cancer) occur less often in women who breastfeed. A recent study found that breastfeeding may protect women at increased risk of breast cancer due to delayed childbirth.
      • Data from the Nurses’ Health Study shows that breastfeeding for a total of two or more years may help prevent coronary artery disease.
      • Breastfeeding may also reduce the risk of osteoporosis.
      • Breastfeeding can help prevent post-partum depression

      Breastfeeding saves time and money. There are no bottles to sterilize or formula to mix or warm. In fact, families save an estimated $1,000 to $2,000 on formula per year. In addition, mothers who breastfeed pay fewer out-of-pocket health care costs and take fewer sick days because breast-fed babies are healthier and tend not to need as many visits to their pediatric provider.

How the Breast Produces Milk

Milk production is a normal physiologic response to the childbearing experience. New studies shed light on milk delivery, the composition of milk and the anatomy of the lactating breast. This information can help new moms better understand their bodies and how they respond to breastfeeding.

After pregnancy, your breasts produce colostrum—a thick, yellowish fluid—that helps your newborn’s digestive system grow and function. Colostrum, often called “first milk” or “immune milk,” is rich in nutrients and infection fighting antibodies. While you may wonder whether you’re producing enough colostrum or milk for your baby in these first few days, keep in mind your baby’s stomach is only the size of a marble. Your mature milk supply typically “comes in” within five days of giving birth.

When you put your baby to your breast, your milk doesn’t automatically start to flow. Your body responds to your baby’s suckling patterns, which occur in two phases.

  • Non-nutritive phase: when the baby is first put to breast and starts suckling in a fast, light rhythm to stimulate the milk-ejection reflex. This reflex is also known as the let-down reflex. It is the “trigger” that starts your milk flowing and often doesn’t occur for a minute or so after the baby starts suckling (timing varies with each mom). This can be stimulated by your baby’s cry or if you are overdue for a feeding. When your milk lets down, you may feel a tingling or tightening sensation as it fills your breast.
  • Nutritive phase: after let-down occurs and your baby switches to a slower, deeper suck. This nutritive phase is when the baby actually drinks your breast milk.

Anatomy of the Lactating Breast

New research using ultrasound imaging reveals a number of key differences from the previously held understanding of the anatomy of the breast. These findings can help mothers understand how their infants obtain milk and provide insights for physicians and women considering breast augmentation or reduction surgery.

Key findings include:

  1. The average number of milk ducts per breast is lower than previously believed.
  2. There is an absence of lactiferous sinuses, which were previously believed to contain a significant amount of milk.
  3. Glandular tissue is found closer to the nipple.
  4. Ducts branch closer to the nipple.
  5. Subcutaneous fat is minimal at the base of the nipple.

The absence of lactiferous sinuses changes our understanding of the way in which the breast produces and delivers milk. For example, it’s thought that the lack of lactiferous sinuses is a reason why little milk is able to be expressed prior to milk ejection. Much more study needs to be done to further understand milk delivery.

The number of milk ducts also has implications for breast augmentation surgeons, since the loss of only a few ducts could seriously compromise a woman’s ability to breastfeed. The overlapping of fat and glandular tissue also suggests that it is very difficult to remove only fatty tissue from the breast. For more information about the anatomy of the breast

Using a Breast Pump

Breast pumps are designed to help:

  • Provide your baby with the health and nutritional advantages of breast milk while you’re away.
  • Empty the milk in your breast, which can guard against engorgement, blocked milk ducts and infection.
  • Stimulate your milk production.

If possible, you should pump every three hours that you are away from your baby. Make sure to clean the breast pump parts between uses.

Both hand and battery-operated pumps are available. Electric pumps simulate your baby’s sucking more effectively and are faster than hand pumps. Many pumps come with discreet carrying cases. The cost ranges from about $35 to $350. Be sure to research which brands and models provide the best performance, reliability and comfort. Also take into consideration the demands of your daily schedule. Many hospitals and clinics rent breast pumps, so you may want to ask your health care provider or a lactation counselor about these and which models would best fit your needs.

A Word about Milk Storage

  • After pumping, refrigerate, freeze or store your milk in a cooler.
  • Any container used to store milk should be clean and sterile. Glass containers and plastic bottles and storage bags that are labeled “bisphenol A (BPA)-free” are good choices.
  • Always label and note the date on the storage bag or container. Always use oldest dated milk first.
  • The following are some guidelines for freshly expressed breast milk storage from the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC):
    • At room temperature (66–72°F) for up to 10 hours
    • At 72–79°F for four to six hours
    • At 86–100°F for up to four hours
    • In a refrigerator (32–39°F) for up to eight days
    • In a freezer contained within a refrigerator for up to two weeks
    • In a self-contained freezer unit for three to four months
    • In a deep-freezer (0°F) for six to 12 months
  • Breast milk should be thawed slowly under warm running water and not in the microwave, which can reduce its nutrition.
  • Once the milk has been thawed it should not be refrozen.