— Breastfeed your baby on demand with no restriction to timing or duration
— Get the best latch possible. Make sure the baby has enough nipple tissue in its mouth and you hear audible swallowing. Wake your baby for feedings if he/she is sleeping too long
— When possible, breastfeed in a quiet relaxed atmosphere. Some babies won’t settle down and nurse if  there’s too much activity
— Once your baby is no longer drinking on his own, use compression to increase the flow

Hold the baby in one arm. Hold the breast with the other, thumb on one side of the breast, your fingers on the other,    fairly far back from the nipple
Watch for the baby’s drinking. The baby gets a substantial amount of milk when he/she is drinking with an OPEN-PAUSE-CLOSE (the pause is not a pause between sucks. It’s during one suck;)
When the baby is nibbling or no longer drinking with the OPEN-PAUSE- CLOSE type of suck, compress the breast. Not so hard that it hurts. The baby should start drinking again with the OPEN-PAUSE-CLOSE type of suck.
-When your baby no longer drinks even with compression, switch sides and repeat the process. Keep going back and forth until the baby does not drink even with compression
-Prior to feedings try warm compresses to the breast for 5-10 min or
gently massage the outer and lower aspect of the breast with the knuckles of your hand.
-Express each breast manually or mechanically for 5 minutes after feedings to increase nipple stimulation and empty as much as possible.
-Express your breasts when separated from your baby or if your baby has had an ineffective feeding. Looking at pictures of your baby, smelling it’s blanket or visualizing your baby at the breast will help your milk let down.

References: Davis, Marie,The Lactation Consultants Clinical Practice Manual 1998.
Newman, Jack; The Ultimate Breastfeeding Book of Answers; Prima Publishin,2000
Lawrence Ruth, Breastfeeding: A Guide for the Medical Profession Mosby 1999

Nutrition for the Breastfeeding Mother

There is no special diet for a breastfeeding mother. Mothers around the world consume various foods and spices. Major nutrients and minerals are provided at a stable level in breast milk at the expense of the mother’s nutrient stores. Thus breastfeeding greatly increase your requirements for most nutrients. The breastfeeding mother may utilize an extra 400-500 calories per day. Consuming fewer than 1500 calories per day has been shown to decrease breast milk volume. A well-balanced, varied diet which includes generous intake of vegetables, whole-grain breads and cereals, calcium-rich dairy products and protein foods such as lean meats, some fish and legumes can help supply needed nutrients.

Let the United States Department of Agriculture’s (USDA) Food Pyramid be your guide in choosing high quality foods that supply needed nutrients without excessive calories. The goal is optimal nutritious intake.
Try to plan three meals and two healthy snacks per day by incorporating the following suggested numbers of servings from the food guide pyramid as follows:

General Nutrition Guidelines

• Drink to thirst. Helpful hint: your urine should be the color of a manila folder; if it is dark in color such as the color of apple juice, you need to increase the amount of fluid you’re drinking.
• There is no need to avoid specific foods unless you notice your baby is often fussy after a particular food. On rare occasions, a baby may be sensitive to a particular food eaten by the mother. These may include dairy products, soy, peanuts, eggs, wheat, corn, citrus, seafood and caffeine. In high-risk allergic families, mothers may be advised to avoid certain allergens.
• Limit caffeinated beverages (coffee, tea, herbal tea, soft drinks) to two servings per day. Herbal teas should be used with caution because some have been documented to cause problems in the baby. The FDA does not regulate herbs.
• Avoid or limit artificial sweeteners. The effect on breastmilk and babies is unclear. Aspartame in moderation is presumed safe.
• Avoid or limit alcohol. Alcohol passes freely into breastmilk. It is suggested that breastfeeding be delayed 2-3 hours after consuming alcohol or breastfeed prior to consuming to minimize exposure.
• Avoid fad or crash diets and diet medications. Weight-loss should be no more than ½ to 1 pound per week.
•  Young mothers and mothers of multiples (twins etc.) have higher nutrient and caloric requirements. Vegetarians may need supplements, such as vitamin B12.
• Aim for at least 1200mg of calcium per day (1500mg if under age 18). Calcium sources include dairy products, dark green leafy vegetables, legumes and calcium fortified soy milk, tofu or juices
• Fish and seafood are excellent sources of omega-3 fatty acids.  However, according to FDA advisories, it is unsafe to consume high mercury containing fish such as: shark, swordfish, king mackerel, and tilefish during pregnancy or breastfeeding. Check with your state department regarding fish-eating limits for local rivers, lakes, and streams.

Web sites of interest:  www.cdc.gov/foodsafety ;  www.nal.usda.gov   (National Agricultural Library);
www.ods.od.nih.gov  (Office of Dietary Supplements-National Institute of Health);
www.foodallergynetwork.net   ;  www.ewg.org    (Environmental Working Group);
www.iBreastfeeding.com (Thomas Hale Publishing)

References:
Becker, Genevieve. “Nutrition for Lactating Women”, Core Curriculum for Lactation Consultant Practice, Walker, Marsha. Jones and Bartlett Pub.2005
Cadwell, Karin and Turner-Maffei, Cindy, Pocket Guide for Lactation Management, Jones and Bartlett Pub.2008.
Walker, Marsha; Martens, Patricia; and Mannel, Rebecca. Core Curriculum for Lactation Consultant Practice Manual, 2nd Ed.,  Jones and Bartlett Pub2008 
Riordan, Jan. Breastfeeding and Human Lactation 3 rd Ed., Jones and Bartlett Pub 2005
Medications and Mother’s Milk, 13th Ed.Amarillo, Pharmasoft Pub.2008
Lauwers, Judith and Shinskie, Debbie. Counseling the Nursing Mother, 3rd Ed., Sudbury, Jones and Bartlett Pub.2000.
Riordan, Jan, Breastfeeding and Human Lactation, 3rd ed. Jones&Bartlett Pub.2005

OVER-SUPPLY (OVERACTIVE LET-DOWN) SYNDROME

References:
Riordan, J.  Breastfeeding and Human Lactation.  Jones & Bartlett, 2005
Martin, C., The Nursing Mother’s Problem Solver, Fireside, 2000.
Davis, M., The Lactation Consultants Clinical Practice Manual, 1st Ed., 1998.

MANAGEMENT OF PLUGGED MILK DUCTS

References:

Riordan, J., Auerback, K, Breastfeeding and Human Lactation, Jones & Bartlett, 3rd edition, pp. 248-250, 2005.

Lawrence, R.J., Breastfeeding: A Guide for the Medical Profession, Mosby, 4th edition, 1994.

Davis, M., The Lactation Consultants Clinical Practice Manual, 1st Ed., 1998.

WEANING THE INFANT

What is it?                   The process of weaning is the cessation of breastfeeding done either gradually or abruptly. Gradual weaning is generally easier on both mother and baby especially in the early months or if your baby is nursing frequently. Weaning over a period of 2 weeks or more allows you to avoid engorgement as you slowly reduce your milk production and to observe your baby’s tolerance for formula before your milk is gone.

When should I wean?
Weaning can occur at any time during the breastfeeding relationship. Although extended breastfeeding is recommended, any amount of breastmilk is beneficial to your baby. You may wean when you decide the time is right or perhaps you may prefer to wait until you r baby decides he/she is no longer interested in nursing

How do I wean?           Infants over 6 months should be weaned to a cup rather than a bottle
Replace breastfeeding with iron fortified formula if your baby is under 1 year old
Before you start, stock up on breast pads. Many women leak when they’re weaning and they may continue to leak a bit for up to a year
You may wish to evaluate your baby’s tolerance to formula before you loose your milk by exclusively formula feeding your baby for several days while pumping your milk during that time
Signs and symptoms of formula intolerance include: “Bouts of crying, a lot of gas, increased spitting up or vomiting, body rashes, redness around the rectum and frequent watery stools that may be green, mucousy or bloody. Wheezing and stuffy nose can be an allergic reaction.”1
           Gradual weaning:
Start by replacing a day or evening nursing session with formula. If you observe   no adverse reaction to formula and your breasts are tolerating the decrease, replace a second feeding with formula in a few days and continue the process until your baby is exclusively formula fed.
Abrupt weaning:

 Wear a good fitting supportive bra
Avoid any nipple or breast stimulation
Use a mild analgesic such as ibuprofen or Tylenol for pain for discomfort
You may also apply ice packs to your breasts for comfort as needed
Abrupt weaning can also lead to “milk fever” with symptoms including    mild   fever, headache, achiness and fatigue often lasting 3-4 days. Is not the same as breast infection such as mastitis, which is distinguished by a reddened area of the breast in addition to flu-like symptoms. Milk fever resolves without treatment as opposed to mastitis which requires antibiotics. Consult your physician to rule out mastitis.
If you wish to avoid severe engorgement while weaning abruptly, nurse or express just       enough milk to keep you comfortable.

References:
1.Huggins K, Zeidrick, The Nursing Mother’s Guide to Weaning, Harvard common Press, 1994
2.Martin C, The Nursing Mother’s Problem Solver, Fireside, 2000

Breastfeeding and Gastric Bypass Information Sheet
Breastfeeding is encouraged and supported

Definition   
Gastric bypass surgery (Bariatric surgery, gastric bypass; Roux-en-Y gastric bypass) is used to cause significant weight loss. The surgery reduces the body's intake of calories. Calorie reduction is accomplished in two ways: the stomach is smaller and the small intestines are literally bypassed (skipped over) so that fewer calories are absorbed. Unfortunately, sometimes nutrients are lost as well.  Iron, folate, vitamin B-12, and calcium are the nutrients most affected. Since the gastric bypass diet does not provide enough vitamins and minerals on its own, most physicians recommend taking continuous mineral and vitamin supplements. Breastfeeding success is dependent on numerous individual factors. Such as previous successful breastfeeding history, length of time since surgery, current diet, weight loss, and other existing health conditions that may effect milk production.  There is an increased risk of nutritional deficiencies with the demands of breastfeeding. Careful monitoring of Mom and Baby are needed.
Frequent weight checks of the infant and possible blood tests for nutrition assessment may be needed.
Lactation Associated Risks:
            *Iron or vitamin B12 deficiencies (if they occur) can lead to anemia. B12 Deficiency (also known as pernicious anemia) is a disorder caused by inadequate adsorption of the vitamin, which leads to decreased production of red blood cells. Anemia in pregnancy may lead to infants born with sub optimal levels. Further depletion may occur if uncorrected and exclusively breastfeeding. Human milk content of B12 is approximately 1/3 that of the mother’s blood level. Signs of B12 deficiency, such as diarrhea, vomiting, constipation and poor weight gain may appear in the infant.
*Marginal or inadequate weight gain of the infant. Maternal fat malabsorption may result in low-fat and low caloric milk for the infant. Supplemental formula may be needed.

References:
WWW.todaysdietician.comjan2006pg47  ;
WWW.nlm.nih.gov/medlineplus
WWW.cnn.com/health/library

Breastfeeding Outlook ,2004 Issue 3

DIFFICULT LATCH

References:

Riordan, J., Auerback, K, Breastfeeding and Human Lactation, LLLI, Tips for Rousing a Sleepy Newborn, November 1997, Jones & Bartlett, 2nd edition, 1998.

Newman, Jack, Guide to Breastfeeding, Harper Collins Publishers, Ltd., 2000.

Newman, Jack, The Ultimate Breastfeeding Book of Answers, Prima Pub., © 2000.

Biancuzzo, Marie, Breastfeeding the Newborn:  Clinical Strategies, Mosby, 1999.

MASTITIS

Mastitis should be managed by your health care provider.

References:

Walker, Marsha, Rn, IBCLC, La Leche League International, Lactation Consultant Series Two, Unit 2, “Mastitis in Lactating Women,” 1999.

Walker, M., Care Plan for Mastitis, La Leche League International.

Riordan, J., Auerback, K, Breastfeeding and Human Lactation, Jones & Bartlett, 2nd edition, pp. 502-504.

Maternal Illness Fact Sheet

Can I breastfeed if I am sick?
Many mothers worry about nursing their infant if they are sick.  In almost all cases she should continue nursing her infant.  Many illnesses are contagious in the incubation stage; however by the time the mom knows she is sick the infant has already been exposed to the illness.  When a breastfeeding mother is sick, she builds antibodies against the illness and will pass these on to her baby through her breast milk.  Oftentimes, the baby may not get sick at all or will have a much less severe illness.
What is the treatment?  Good hand washing is the key to controlling the spread of most illnesses1.
The most common illnesses are colds and flu.  Assess for possible mastitis, as these symptoms can be the same as a flu-like illness.  The symptoms of mastitis are breast pain, hard, reddened area of the breast with fever and chills.  If you have these symptoms, you should speak with your doctor.  You may and should continue nursing.

Generally breastfeeding may continue with the following illnesses:

• Colds / Flu / Fever
• Most bacterial infections being treated by antibiotics2
• Rubella is contagious in the incubation stage.  It is transmitted to infant before symptoms appear in the mother.
• Measles and Mumps are contagious in the incubation stage.  It is transmitted before symptoms appear in the mother.
• Herpes Viruses :
• Herpes Simplex is contagious in the incubation stage and while lesions are draining.2,3  .  May continue breastfeeding if lesions are not on the breast/nipple.2,3
• Varicella- Zoster Chicken pox is contagious in incubation period.  It is transmitted to infant before symptoms appear in the mother.  Cover any open lesions that may come in contact with the baby.  Change dressing every feeding.  May continue breastfeeding if lesions are not on the breast/nipple.2,3
• Cytomegalovirus –Breastfeeding the full term infant is allowed. The virus can be inactivated for premature infants by freezing mother’s milk.
• Hepatitis A: May breastfeed as soon as  Mother receives gamma globulin
• Hepatitis B:  May breastfeed provided infant receives HBIG and first dose of hepatitis B vaccine.
• Hepatitis C:  May breastfeed if no co-infections such as HIV.  More controversial.
• Active TB:   May breastfeed after 2 or more weeks of treatment

Cannot breastfeed with the following illnesses/conditions:

• Active Cancer (Most treatments like surgery and Chemotherapy should not be postponed.)3
• AIDS or HIV Positive:  This virus may be transmitted through the breast milk.  Risks of postpartum transmission are yet to be determined.2,3
• Any life-threatening illness.
• Illegal drug use is never acceptable for a breastfeeding mother.

Recommendations:

• Contact your Primary Care Physician/Health Specialist in regards to particular diseases or acute/ chronic illnesses.
• Inform your PCP you are breastfeeding especially when medications are needed or prescribed.
• Get lots of rest and increase fluids to help maintain supply.
• Observe infants for changes in feeding patterns, voiding, stooling and sleeping and report any concerns to pediatrician.

Most moms report a decreased supply with and fever/flu like illness, with rest and fluids and frequent nursing this should recover.
www.CDC.org

Reference:

1 Core Curriculum  for Lactation Consultant Practice Manual, 2nd Ed. Walker, Marsha; Martens, Patricia; and Mannel, Rebecca. Jones and Bartlett Pub2008 
2Riordan, Jan. Breastfeeding and Human Lactation. 3 rd Ed; Jones and Bartlett Pub 2005
3Lawrence Ruth A. Breastfeeding: A Guide for the Medical Profession. 3rd edition. New York; C. V. Mosby, 1989
Cadwell, Karin and Turner-Maffei, Cindy, Pocket Guide for Lactation Management, Jones and Bartlett Pub.2008.

MEDICATION DURING BREASTFEEDING

References:
Hale, Medication and Mother’s Milk, 13th ed, Pharmasoft Publishing, 2008
Riordan J, Breastfeeding and Human lactation, 3rd ed, Jones and Bartlett, 2005
LaLeche League, The Breastfeeding Answer Book 3rd ed LaLeche League International 2003

Jaundice – Normal Newborn

References:

Riordan, J., Auerback, K, Breastfeeding and Human Lactation, Jones & Bartlett, Third Edition 2005
Lawrence, R.J., Breastfeeding: A Guide for the Medical Profession, Mosby, 5th Edition, 1999.
Elliot Hospital Parent Information Guide on Jaundice
Hale,T., and Hartmann, P., Textbook of Human Lactation, Hale, First Edition, 2007.`

Top of Page