Breastfeeding

WITH SUCCESS
TABLE OF CONTENTS

Chapter 1 Chapter 4
The Value of Breastfeeding . . . . . . . . . . . . . . . . 1 Fitting Breastfeeding into Your Lifestyle . . . . . 23
For Your Baby: Breastfeeding and Breast Milk . 1 Breastfeeding in Public . . . . . . . . . . . . . . . . . . . . . 23
For the Mother: Breastfeeding . . . . . . . . . . . . . . . . 1 Leaking Breasts. . . . . . . . . . . . . . . . . . . . . . . . . . . 23
For Fathers, Mothers, and Families: Diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
For the Environment . . . . . . . . . . . . . . . . . . . . . . . . 2 Returning to Work or School . . . . . . . . . . . . . . . . 24
Baby-Friendly Breastfeeding Services . . . . . . . . . . 2 Breastfeeding for the First Year and Beyond . . . 25
A Perfect Match . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Weaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Birth Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Chapter 2
Getting Breastfeeding Started. . . . . . . . . . . . . . 3 Chapter 5
Getting to Know Your Baby . . . . . . . . . . . . . . . . . . 3 Frequently Asked Questions . . . . . . . . . . . . . . 27
Breastfeed Early. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Breastfeed Often . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Chapter 6
Breastfeed Well . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Your Breastfed Baby at Home . . . . . . . . . . . . . . . . 5 Kaiser Permanente Breastfeeding Clinics and
Breastfeeding Holds . . . . . . . . . . . . . . . . . . . . . . . . 6 Lactation Consultants . . . . . . . . . . . . . . . . . . . . 31
Latch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Kaiser Permanente Health Education
Milk Supply. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Departments . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
How to Tell Baby Is Getting Enough to Eat . . . . . . 8 Baby-Friendly USA . . . . . . . . . . . . . . . . . . . . . . . . 31
Feeding Patterns for Breastfed Babies. . . . . . . . 12 Breast Pumps and Supplies . . . . . . . . . . . . . . . . . 31
Diet and Breastfeeding Websites . . . . . . . . . . . . 31
Chapter 3 WIC (Women, Infants and Children). . . . . . . . . . . 31
Breastfeeding Challenges. . . . . . . . . . . . . . . . 15 Lactation Websites. . . . . . . . . . . . . . . . . . . . . . . . 32
Breast Engorgement . . . . . . . . . . . . . . . . . . . . . . . 15 Milk Banks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
When Breastfeeding Hurts . . . . . . . . . . . . . . . . . . 15 La Leche League . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Breast Milk Hand Expression. . . . . . . . . . . . . . . . 17 Recommended Reading . . . . . . . . . . . . . . . . . . . . 32
Breast Pumps and Pumping . . . . . . . . . . . . . . . . . 18
Introducing a Bottle to Your Breastfed Baby. . . . 20 Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Congratulations on the birth of your baby and your decision to breastfeed.

Breast milk is considered the gold standard for all newborns. By breastfeeding you
will be giving your baby the very best nutrition possible.

i
 The American Academy of Pediatrics recognizes
that breastfeeding is important for optimal infant
and child health and development….Breastfeeding
has advantages for infants, mothers, families, and
society. These advantages include health, nutritional,
immunologic, developmental, psychologic, social,
economic, and environmental benefits….
From American Academy of Pediatrics (AAP) website
(aap.org/healthtopics/breastfeeding.cfm), March 2009.

ii
CHAPTER 1 The Value of Breastfeeding

Breastfeeding, or nursing, can benefit the baby, the • bacterial meningitis,

mother, the father, families, and the environment • leukemia and other childhood cancers,
in many ways.
• multiple sclerosis and juvenile rheumatoid
arthritis, and
For Your Baby: Breastfeeding and • SIDS (Sudden Infant Death Syndrome).
Breast Milk
Breastfeeding helps your baby bond and be close to you.
While breastfeeding may not seem the right choice
Breast milk: for every parent, it is the best choice for every baby.
• Is always ready to feed your baby and at the right Amy Spangler, from cover of video,
temperature Through Their Eyes: Breastfeeding, the Gift for Life, 1997

• Gives antibodies to strengthen the immune system

• Gives good cholesterol and other types of fat for
your baby’s growing brain and nervous system
For the Mother: Breastfeeding
• Promotes bonding and attachment, calmness,
• Promotes clear vision
self-esteem, and confidence in mothering
• Promotes healthy jaws and teeth and lowers the
• Produces the naturally soothing hormones
risk of cavities
oxytocin and prolactin (the hormones of
• Supports your child’s intelligence. (A clinical “motherly love”)
study shows infants who were breastfed for the
• Helps your body recover from pregnancy, labor,
first 6 months of life test 11 IQ points higher
and birth
than formula-fed babies.)
• Helps your uterus contract after birth, lessening
Breastfeeding reduces the risk of infections and the chance of bleeding and anemia
promotes healthy bacteria in the digestive system,
• Lowers the risk of breast cancer. The longer you
which can result in:
breastfeed, the lower your risk.
• fewer colds and ear infections
• Lowers your chance of ovarian cancer
• fewer bladder infections
• May protect you against osteoporosis in later life
• fewer visits to the baby’s physician and less
• May help you lose weight, by burning calories to
chance of needing to go to the hospital
make milk (about 500 calories a day).
• less constipation and diarrhea.
Breastfeeding may reduce the risk of: For Fathers, Mothers, and Families:
• asthma and allergies, Breastfeeding
• eczema, • Makes for healthier mother and baby, and fewer
• obesity in infancy and childhood, missed days from work
• diabetes and high blood pressure, • Produces less offensive-smelling diapers
• high cholesterol later in life, • Is free! Artificial baby milk/formula is expensive.
• colitis and Crohn’s disease,

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For the Environment mother produces for her preterm baby is different
from what she produces when her baby is full term.
Breastfeeding means that there is no:
The milk your body makes during the baby’s first days
• overgrazing of land by cattle; is different from the milk that your body makes two
• use of chemical fertilizers to grow the soy for weeks later. As the baby’s needs change, so does the
formula; milk. Babies breastfed at 1 to 2 years of age receive
• packaging and transportation of the product; immunities just right for their age. This is true even
• use of water and fuel for mixing the product, if the baby is taking food and breastfeeding only two
heating it, and for cleaning bottles and nipples; to three times a day. Breast milk is the perfect food
and for your breastfed baby at all ages and stages.
• trash from cans, bottles, and cartons.
TABLE 1
How Does Formula Compare to Breast Milk?
Baby-Friendly Breastfeeding Services breast milk formula
While you are in the hospital, our health care staff 4 4 water
will help you and your baby learn to breastfeed. protein
4 4
Many Kaiser Permanente Southern California
4 4 carbohydrates
hospitals are now designated as “Baby Friendly”
by the World Health Organization and the United 4 4 vitamins
Nations Children’s Fund. It is a global program that 4 4 minerals
recognizes hospitals and birthing centers that offer fats
4 4
an optimal level of care for breastfeeding.
4 4 lipids
Kaiser Permanente promotes pregnancy and breast- 4 enzymes
feeding education. We believe good health begins 4 growth factors
with breastfeeding. You will receive clear information hormones
4
to help you make a fully informed choice as to how
4 anti-viruses
to feed your baby. Our health care staff will support
you when you have made that choice. 4 anti-parasites
4 anti-bacteria

A Perfect Match 4 anti-allergies

Your breast milk is a perfect match for your breastfed Breast milk and formula are similar in some ways . . .
baby. It changes as your baby grows. The milk a but where formula ends, breast milk is still providing!

Cost of Infant Feeding for 1 Year (Estimated)*

Breast milk, fed at the breast FREE
• Nursing bra (OPTIONAL) $14 and up
• Nursing pump rental (OPTIONAL) FREE (depending on medical facility or organization)
$107–395
• Manual nursing pump (OPTIONAL) $21–61
• Electric double nursing pump (OPTIONAL) $72–320

Formula Daily Cost Yearly Cost

• Powdered (12.5 oz. can) $5.76 $2,105.40
• Concentrated (13 fl. oz.) $6.08 $2,219.20
• Ready-to-Use (32 fl. oz.) $6.72 $2,452.80
*Enfamil purchased in Southern California in 2014.
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CHAPTER 2 Getting Breastfeeding Started

Labor and birth are rewarding, yet can be challenging down if baby is too warm. This is unique and only
and painful. Studies show that when labor progresses mothers can do this with their hormones. This will
without pain medications, the mother’s body produces help the baby’s body temperature be more stable,
hormones that help her cope and play a significant help even out the baby’s blood sugar, and start the
role in mother–baby bonding. These hormones also bonding process.
promote early breastfeeding. Medications that relieve
pain during labor, birth, and cesarean birth (C-section) Note: If the mother cannot hold her baby skin-to-skin
may affect the production of these hormones. There- during the first hour after birth, it is helpful for the
fore, any amount of time spent during labor without other parent or partner to hold the baby skin-to-skin.
medications may benefit mother, baby, and breast- This is good for the bonding process, but you should
feeding. Coping with pain and suffering are not the be careful that the baby does not get too warm.
same. Only you can weigh the benefits and drawbacks
of each and decide what is best for you and your baby. Breastfeed Early
Whatever you choose, you and your baby can still have
a rewarding and successful breastfeeding experience. Breastfeeding ideally begins during the first one or
two hours after birth. Babies held skin-to-skin will
often move themselves toward the breast and latch,
Getting to Know Your Baby many times with little or no help. When babies are
allowed to breastfeed early, they tend to breastfeed
Attachment and Bonding at Birth
better. Breastfeeding early and often helps mother to
Skin-to-skin care is when you hold your baby, dressed
make more milk, sooner.
only in a diaper on your bare chest. Skin-to-skin care
shortly after birth and beyond helps reduce the stress Colostrum—“newborn milk”
the newborn may feel from labor and birth. Babies At the first feedings, your baby may breastfeed actively
held skin-to-skin cry less, breastfeed better, and or your baby may prefer just to lick your nipple and
attach more strongly with parents. After your baby nuzzle your breast. Both are normal and perfectly okay.
is born, your childbirth team will place your baby The milk your baby gets from these early feedings is
on your chest and will give you time alone to get to called colostrum and is very important for the baby’s
know each other. This is a special time for bonding immune system. Colostrum is the first milk for the
and attachment. You may wish to quickly introduce baby; it is a rich, thick, yellowish milk. Your baby
your baby to friends and family. After that, they will only needs small amounts of colostrum at this time.
be asked to allow you time alone with your baby for If the baby doesn’t latch on right away, ask your nurse
this special time shortly after birth. to show you how to hand express drops that you can
put on the baby’s tongue. Your baby will enjoy the
Another benefit of skin-to-skin contact is that within sweet taste of your first milk. See pages 19 and 28 for
about one hour after birth, most babies will begin more information on colostrum.
searching for the breast without any help. They will
explore the mother’s chest, they will move to the
breast and often will latch on to the breast perfectly Breastfeed Often
on their own.
Newborn babies feed very often. Sometimes they
When mother does skin-to-skin contact, her body like to eat every half-hour, other times they will wait
temperature will go up to warm a cold baby and go longer between feedings. As long as your baby feeds

Babies thrive on exclusive breastfeeding.

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8 to 12 times in 24 hours, this should not be a problem. • Crying with hunger cues. Baby is saying, “I’m
For the first few days, some babies are sleepy and you really hungry. My tummy hurts; you need to
may need to wake them to feed. After the first few feed me NOW!”
days, most babies will begin to wake on their own for
feedings when they are hungry. After the milk supply Here are some resources for baby-led latching:
is established, many babies may begin to stretch out • breastfeedingusa.org/content/article/baby-
their feedings a bit. led-latch-how-awaken-your-babys-
Frequent feeding is good for your baby and good for breastfeeding-instincts
your milk supply. Frequent breastfeeding: • ameda.com
• Establishes and increases milk supply. “Your Baby Knows How to Latch On” (video)

• Eases the change from colostrum feedings to • breastfeedingmadesimple.com

mature milk, keeping breasts from feeling too full.
• Prevents the baby from losing too much weight Breastfeed Well
during the first days after birth. Some weight
loss is normal for all babies. When a baby is breastfeeding well, you will notice
long sucks with frequent swallows. By day 3, you
• Prevents jaundice in the newborn caused from should notice a lot of swallowing as the feeding
low milk intake. begins, with fewer swallows as the feeding goes on.
Hunger Cues Let your baby feed for as long as he or she wants. If
Baby-Led Latching your baby is actively sucking and you hear swallowing,
let the baby finish. This may take 10 to 30 minutes,
Watch your baby for signs of hunger instead of depending on the feeding and the baby.
watching the clock. Remember, crying is a late sign
of hunger. When your baby finishes the first breast, place your
Early signs of hunger, or feeding, cues are: baby on your chest and give the baby a chance to burp.
When the baby is ready, he or she will begin to search
• licking or smacking their lips; for the breast again. During the early days, it is a
• opening and closing their mouth; good idea to encourage your baby to feed from both
• sucking on their tongues, hands, blankets, your breasts. When babies get a little older, some babies
neck; are satisfied after feeding on one breast, while other
babies like both breasts, and even both breasts twice.
• searching with their mouth for something to
Let your baby breastfeed until content and satisfied.
suck on; and
• putting their fingers or hands in their mouth. Nursing your baby is very calming. No matter how
rushed or busy you are, try to slow down, spend time
Think of your baby’s feeding cues this way: with your baby, and enjoy the special time feeding
• Opening and closing mouth, licking lips. Baby is your baby. Be still, relax, and recuperate. Know that
saying, “mmmmm, a little milk right now would you are spending time doing the best thing for your
be nice.” baby. Notice how relaxed you feel while you are
breastfeeding. Your glands release special hormones
• Sucking on hands, blankets, fingers, etc. Baby is
that help you rest and relax during feedings.
saying, “I’m getting hungry; please feed me.”

A newborn baby has only three demands. They are warmth in the arms of its mother, food from
her breast, and security in the knowledge of her presence. Breastfeeding satisfies all three.
Grantly Dick-Read (1890–1959)
Expert on natural childbirth movement.

4
 Your Breastfed Baby at Home
Tips for Mother’s Helpers Feeding Station
Family and friends can be a good source of Many mothers find it helpful to create a special place
help and support for new mothers. During where they breastfeed. Choose a place where you will
the early weeks, the baby’s father, or other be comfortable for many feedings a day. A comfortable
parent, grandparents, family members, and chair, couch, or your bed can all work. Many mothers
friends all play a key role in helping the new enjoy a foot stool to put their feet on when sitting on
family to be strong and healthy. By “mothering” a chair or couch. Gather all the items you will want
the new mother, family will help her grow in to have within reach: pillows, something to drink,
her new role and recuperate faster and resume a snack, diapers, baby wipes, telephone, channel
normal activities when she is ready. Some of changer, and anything else you might need to be
the things family and friends can do to help in comfortable.
the early days after the baby is born are:
Get the baby. Remember, newborn babies feed often
• Protect the new family’s privacy. Too
(8, 10, 12 times in 24 hours). During the early days,
many visitors can exhaust new parents,
have lots of skin-to-skin contact with your baby. Your
making it difficult to meet the needs of
body temperature will go up or down as needed to
the new baby 24 hours a day.
keep your baby at just the right temperature. Drape
• Be positive and supportive of the new a blanket over you and baby if you or the baby feels
mother’s desire to give her baby the very chilly or the room is cool. Babies who are too warm
best. during feeding tend to fall asleep before they finish
• Prepare snacks and meals for the family. eating.
• Shop, do laundry, dishes, and cleaning. Position mother and baby for comfort.
• Take toddlers to the park, older children • Get comfortable.
to school, or just stay at their home to
• Get the baby organized—awake and ready to
provide support and assistance.
feed.
• Hold the baby while the new mother naps,
• Tummy to tummy, with shoulders and hips
showers, or enjoys some one-on-one time
supported at mother’s body.
with other children.
• Baby’s ear, shoulder, and hip should be in a
• Be creative. You can find lots of ways to
straight line.
support the new mother and her baby as
they establish breastfeeding. • Baby should be at breast level. Use pillows,
if needed, to support your arms so you can
support the baby. The baby’s nose should be
Note: Often new mothers are encouraged to opposite the mother’s nipple when positioned
pump their breasts to provide bottles of breast correctly.
milk to the baby while they sleep. This may
not be a good idea during the early weeks as
it can get in the way of a good start to breast-
feeding. Help the mother rest when the baby
sleeps during the day, and the nights will be
easier to manage for everyone.

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Breastfeeding Holds
Here are some positions in which you can hold your
baby while breastfeeding. You can choose the one(s) Cradle hold
that make you and your baby feel most comfortable.
No matter which one you choose, make sure your
baby’s mouth is near your nipple and he or she doesn’t
have to turn his or her head to breastfeed. For most
positions, your baby should be on his or her side with
his or her whole body facing yours. This helps the
baby to properly latch on to the nipple. Try using
pillows under your arms, elbows, neck, or back, or
under the baby for support.

Cross cradle or
This position is a commonly used position
that is comfortable for most mothers. Hold
transitional
your baby with his or her head on your fore-
hold
arm and the whole body facing yours.

Side-lying position

This position is good for mothers just learning

to breastfeed in the early days or weeks of the
baby’s life, for premature babies, or for babies
who are having problems latching on. Hold
your baby along the opposite arm from the
breast you are using. Support the baby’s head
with the palm of your hand at the base of his
or her neck. This position allows the mother to rest while
the baby nurses. It is useful for mothers who
had a cesarean birth (C-section). Lie on your
side with your baby facing you. Pull the baby
close and guide his or her mouth to your
nipple.
Used with permission. womenshealth.gov.

6
 • The mother’s nipple should be deep in the baby’s
mouth, resting just in front of the beginning of
the soft palate; usually about 1 to 1½ inches of
nipple and areola are in the baby’s mouth. (You
can feel how far back this is in your mouth by

running your tongue along the roof of your
mouth until you feel it turn from hard to soft.)
Clutch or
If you feel the baby’s gums moving on the
“football” hold
nipple, the nipple is not far enough back.
• The baby’s chin and cheeks should be touching
the breast. The nose should be near the breast
but not pushing into the breast.
• A deep latch feels better for the mother and
allows the baby to get milk out more easily.

This position is good for mothers with large

breasts, inverted nipples, or who had a cesarean
birth. Hold your baby at your side, lying on
his or her back, with his or her head at the
level of your nipple. Support the baby’s head
with the palm of your hand at the base of his
or her head.

Latch
A good latch is important for the baby to be able to
get lots of milk from the mother’s breasts. A good
latch also makes breastfeeding comfortable for the
mother. When latching the baby, be sure the baby
takes enough of the nipple and areola into the mouth.
• The mother’s nipple should be placed just Here are other ways to help the baby latch onto the
below the baby’s nose. Gently touch the area nipple:
between the nose and the upper lip with your
• Gently shape your breast with your hand so it
nipple. This will stimulate baby to open wide,
better fits your baby’s mouth.
commonly called the “rooting reflex.”
• The baby needs to open her mouth wide to
• When the baby opens wide, the mother can hug
get the nipple deep in her mouth and her lips
the baby close by pressing the baby’s chin into
back around your areola. Do not allow her to
her breast. This will help the baby to latch
“nibble” her way onto your nipple.
deeply.
• Lips Open. The baby’s lips need to be open
• Shallow latch may also feel like pinching or
wide like a yawn. If your baby’s upper lip seems
biting. When the nipple touches the baby’s
to be tucked in and pulling on the nipple, pull
bottom lip, the baby may latch to the nipple
up on her top lip a little to flare her upper lip
only, causing the shallow latch.

7
 out. If her bottom lip is tucked in and pulling Milk Supply
in on the nipple, pull down on her chin. If this
Establishing a good milk supply occurs during the
doesn’t work right away, stop and try again.
first 2 to 3 weeks of breastfeeding. Newborn babies
• Breaking Suction. Place a clean finger inside breastfeed often, usually 8, 10, 12, or more times in
the baby’s mouth (between the gums) and slide 24 hours. Babies should be allowed to feed whenever
your nipple out, or with your finger in the they show early feeding cues. Don’t wait until the
baby’s mouth press down on the lower gum to baby cries to feed. Crying with hunger cues means
break suction before taking the baby off your your baby is very hungry.
breast. Do not get into a “tug of war” over your
nipple with the baby. Feed your baby on the first breast for as long as the
baby is actively sucking with swallows. Watch the baby
• If the latch hurts, break suction and try again.
for signs that show that the baby is ready to change
Note: In the early weeks and months, as your baby sides (falling asleep, no longer swallowing, coming
is learning to breastfeed, avoid bottles and pacifiers. off the breast and going back on many times). Gently
When your baby is breastfeeding well, 3 to 4 weeks squeezing your breast and/or stimulating the baby to
after birth, having the father or other family mem- suck if sleepy may help the baby do a better job of
ber offer a bottle of breast milk or a pacifier once in finishing to feed.
a while should not get in the way of feeding at the
Allow the baby to “finish” the first breast. This is
breast or you making milk.
important because the baby gets the first milk, called
foremilk, and the later milk, called hind milk. The
Tips for Mother’s Helpers hind milk is important because it contains more fat
During the early days many mothers need help and calories than the foremilk. This will help baby
with positioning the baby at their breast and feel fuller and is needed for growth and development.
latching on. You can:
Give the baby a chance to burp. Offer the second
• Ask if there is anything you can do to help.
breast if the baby still seems hungry.
• Make sure the mother has drinks and
snacks while she is feeding the baby. Once the milk supply is established (after the first
Breastfeeding mothers get very thirsty week) some babies only feed from one breast per
during feedings and often get hungry too. feeding. If the baby has been gaining weight; is having
at least 6 wet diapers and 2 to 3 loose, yellow stools
• If the mother looks to be in pain, offer
every day; and is not interested in feeding from the
suggestions for relief if you know of any
second breast, it is okay.
or offer to make an appointment with a
lactation consultant if there is no improve- Always start on the opposite breast at each feeding. If
ment after a day or two. Phone numbers your baby starts one feeding on the right breast, the
for lactation consultants are listed in next feeding should start on the left breast.
Chapter 6.

For more information about positioning and latch-on,

How to Tell Baby Is Getting Enough
refer to these websites: to Eat
• ameda.com. Latch-on video. To tell if your baby is getting enough milk, watch for
these signs:
• breastfeeding.com
• Baby is sucking with swallows.
• drjacknewman.com. Many good video clips
on baby-led latching as well as guided latching - Birth to day 3—Bursts of sucking 6 to 20 sucks
using the cross cradle hold. or more, followed by a pause. Baby will not
swallow with every suck. After resting for a
• kellymom.com
8
 • Milk may drip from one breast while the baby
Questions About Breastfeeding: feeds on the other breast.
• Are you concerned that breastfeeding
• Baby’s urine and stool output increases from day
may be a problem for you?
1 to 5.
• Are you concerned that your nipples are
• Average weight gain of 1 ounce per day after day
too small, too flat, too big, or not right
5. All babies lose a little weight the first 3 to 5
for breastfeeding?
days of life.
• Have you had breast surgery and are
• Baby should be happy and content after most
worried it may keep you from
feedings.
breastfeeding?
• Do you have a health problem that may Your Breastfeeding Relationship and Newborn
affect your breastfeeding? Changes Day to Day
As your baby adjusts to life outside the womb and
If you have concerns about being able to
develops a breastfeeding relationship with you, watch
breastfeed for any reason, talk about them
as your newborn changes each day:
with your physician or midwife.
Call your lactation consultant before your Day 1: Your baby will be placed skin-to-skin shortly
baby is born to discuss your concerns. after birth for the first feeding. Babies are often alert
for the first 2 hours after birth and this helps them to
want to nurse for the first time. After breastfeeding
minute or so, the baby will start another burst for the first time, most newborns will be sleepy for
of sucking. Baby will usually feed for 10 to 30 several hours. This is normal. Expect your baby to
minutes on each breast. feed at least 5 to 6 feedings, and then start feeding
- Day 3 and beyond—Continues bursts of 6 to 8 to 12 times per day.
20 sucks, followed by a pause. Baby should
begin swallowing every 1 to 3 sucks. There will Day 2: Your baby will start to wake up and want
be frequent swallows at the beginning of the to feed more often, especially at night. Frequent
feeding, with gradual slowing after 5 to 10 min- feedings help you make more milk. Feed your baby
utes. Some babies will be finished on the breast whenever they show hunger signs, such as mouthing,
at this time. Others may respond to a renewed rooting, lip smacking and sucking, about 8 to 12 times
flow at the breast and will begin sucking again. every 24 hours.
Baby will usually spend 10 to 30 minutes on Day 3 and beyond: Each day your baby will become
each breast. more awake and alert as well as have fussy times, often
 ote: After a few months, babies get more
N at night. Babies suck for comfort and for hunger. As
efficient and spend a shorter amount of time at you get to know your baby, you will be able to tell
the breast. the difference between cries of distress and hunger
• Breasts feel full and heavy before baby feeds and signs. When you see hunger signs, feed your baby
softer after baby finishes feeding. soon. If your baby is fussy and not showing hunger
signs, he or she may be sleepy, overstimulated, hot
• Some mothers, especially in the early months, or cold, bored, or lonely. Your baby may have a wet
may feel a sensation of the milk ejection reflex, diaper that is burning his or her skin or may feel
or the milk “letting down.” This can range from sick. Putting your baby to breast will meet the baby’s
a warm or tingling sensation to a somewhat needs of hunger and may also comfort and calm some
painful tightening in the breast. Other moms of the baby’s needs. As you learn about your baby’s
may not feel this at all. If you don’t feel it, watch needs, you feel more confident in your parenting.
your baby to see that he or she swallows regularly.

9
Use this chart during the first week of feeding. Circle the time you begin each breastfeeding. Check off a circle for
each wet diaper and each bowel movement.
Babies need to breastfeed often, at least 8 times every 24 hours. The number of wet diapers and stools will increase
over the first week. At first the stools will be black, tarry, and sticky. By about day 3, the stools will become less
sticky and will be green or brown. By day 5, the stool should turn to a mustard yellow color and be liquid and seedy.

TABLE 2
Breastfeeding Log

Day 1 goals: 8–12 feedings, 1 wet diaper, 1 bowel movement

Feedings: a.m. 1 2 3 4 5 6 7 8 9 10 11 12

Supplements:

Feedings: p.m. 1 2 3 4 5 6 7 8 9 10 11 12

wet diaper: m

bowel movement: m

Day 2 goals: 8–12 feedings, 2 wet diapers, 2 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 10 11 12

Supplements:

Feedings: p.m. 1 2 3 4 5 6 7 8 9 10 11 12

wet diapers: m m

bowel movements: m m

Day 3 goals: 8–12 feedings, 3 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 10 11 12

Supplements:

Feedings: p.m. 1 2 3 4 5 6 7 8 9 10 11 12

wet diapers: m m m

bowel movements: m m m

10
Day 4 goals: 8–12 feedings, 4 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 10 11 12

Supplements:

Feedings: p.m. 1 2 3 4 5 6 7 8 9 10 11 12

wet diapers: m m m m

bowel movements: m m m

Day 5 goals: 8–12 feedings, 5–6 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 10 11 12

Supplements:

Feedings: p.m. 1 2 3 4 5 6 7 8 9 10 11 12

wet diapers: m m m m m m

bowel movements: m m m

Day 6 goals: 8–12 feedings, 6–8 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 10 11 12

Supplements:

Feedings: p.m. 1 2 3 4 5 6 7 8 9 10 11 12

wet diapers: m m m m m m m m

bowel movements: m m m

Day 7 goals: 8–12 feedings, 6–8 wet diapers, 3 bowel movements

Feedings: a.m. 1 2 3 4 5 6 7 8 9 10 11 12

Supplements:

Feedings: p.m. 1 2 3 4 5 6 7 8 9 10 11 12

wet diapers: m m m m m m m m

bowel movements: m m m

11
Night Feedings 1. Start doing breast massage and compressions.
Babies feed often during the night. During the first Gently squeeze your breast and hold until you
1 to 2 weeks, babies often feed more during the night hear swallows then release the breast. Repeat as
than they do during the day. It is very important that needed watching your baby for increased
new parents rest whenever their baby sleeps so that interest in feeding and increased swallowing.
the night feedings will be more manageable and less 2. Dress your baby in a diaper only during feedings.
difficult. This stage passes as the baby gets older. You Add a light blanket as needed over the baby if she
can try to wake baby more often during the day to help wakes and is actively sucking with swallowing.
the baby transition to better night sleeping, but this
will be a gradual change over the first days and weeks. 3. Stretch the baby’s arms slowly up toward the head
and down again.
Sleepy Babies
4. Rub your baby’s feet, head, and/or back to stimu-
Many babies are sleepy in the first few days after late him.
birth. If your baby sleeps more than 3 hours, gently
wake your baby up to feed. Watch for early signs of If none of this works, try to wake the baby again
hunger (for example, licking the lips, putting hands in an hour or so. If the baby skips more than two
and fingers to the mouth, moving arms and legs to feedings, express your milk manually or with a breast
get your attention). A sleeping baby with rapid eye pump and feed your baby using a dropper, soft cup,
movement under the eyelids is a sign that he or she or a syringe. Using a bottle too early can cause nipple
may be starting to get hungry. confusion. Try breastfeeding again at the next feeding.
Tips to wake a sleepy baby: Contact a lactation consultant or your baby’s physician
1. U
 ndress baby down to just a diaper before feeding if this behavior continues for more than two feedings
time. in a row, you notice a decrease in urine output, or
the problem lasts for more than one day.
2. H
 old the baby close (skin-to-skin) with the baby’s
head on your chest, tummy on your tummy, or
heart to heart. Feeding Patterns for Breastfed
3. Gently massage the baby’s back, arms, and legs. Babies
4. S troke your baby’s cheeks, lips, and mouth with One Breast per Feeding or Both
your finger. Babies all have their own unique pattern of feeding.
5. Change the baby’s diaper. Some babies like to feed from one breast per feeding.
Other babies like to feed from one breast, wait 10
6. Talk or sing to your baby.
minutes, and then feed from the other breast. Still
7. Walk your fingers up and down the baby’s back. other babies like to feed from one breast then the
8. H
 and express your milk onto your baby’s lips to other breast, then back to the first breast, three sides
taste and smell. per feeding. Some babies eat a lot during the morning,
nap well in the afternoon, and then feed a lot during
9. Tickle your baby’s chin.
the evening hours. Other babies like to feed less in
10. With the baby sitting in your lap, gently lean the the morning then eat all afternoon.
baby back and then bring the baby to a sitting
position. Do this several times. Feeding patterns change over time. What your baby
is doing this month may be very different next
Some babies fall asleep after only a few minutes of
month and the month after. Follow your baby’s lead.
feeding. If your baby is falling asleep at the breast
Feed your baby when hungry, and keep an eye on
during the first week without feeding for very long or
the number of diaper changes you are doing. Weight
swallowing very much, try these tips for waking your
checks will also help reassure you that your baby is
baby to finish feeding:
getting enough to eat.

12
Cluster Feedings 6. Feed yourself. If you are not very hungry, try to
Babies feed often for lots of reasons. Cluster feeding snack several times a day. Fresh fruit, whole-grain
is common in the early weeks for most babies. Once crackers, and nuts all make good healthy snacks.
or twice a day, your baby may want to feed from both 7. Rest. The demands of taking care of a new baby
breasts two or three times in a row, or have 2 to 3 are high. Try to nap in the morning and afternoon
feedings in a very short period of time. This is normal when the baby is sleeping during the early weeks
and is the baby’s way of getting the milk at the end after birth and whenever you can as the baby gets
of the feeding that has more fat and calories. Think older.
of this as dessert for your baby. After a cluster of
frequent feedings, most babies will sleep their longest 8. Pump after or between feedings for 10 to 20
stretch of the day. minutes for extra stimulation.
• Visualize lots of milk flowing, while massaging
Growth Spurts
your breasts before you begin and again halfway
When babies are getting ready to have a growth spurt, through the pumping session.
they need more milk. The baby will take in more milk
by feeding more often for a day or two and then go • Try to relax. Avoid staring at the bottles and
back to a more normal routine. Frequent breastfeed- getting stressed at the milk flow. Relax, read,
ing gives them more milk for them to grow. It does listen to music, watch TV, or visit with a friend
not mean your milk has dried up or that your milk while pumping.
is inadequate in any way. Your baby’s first growth • If you have tried all of these suggestions for 2 to
spurt may occur when he or she is about 6 days old, 3 days and still feel your milk supply is too low,
again at about 2 to 3 weeks, then occur every several call your lactation consultant to discuss other
weeks over the first year or so. Just relax and enjoy possible causes and solutions.
these days, knowing that your body will take care of
the baby’s needs. If you become concerned, count
the baby’s diapers. If there are lots of diaper changes,
your baby is getting plenty to eat.
If you feel your milk supply is low, try these steps to
increase production.
1. Put warm, moist towels on your breasts for 10 to
15 minutes before feedings. This can help your
milk to begin flowing; it is often referred to as
“letdown.”
2. Feed your baby at least every 8 to 12 times in
24 hours. If your baby seems hungry more often,
breastfeed more often to meet your baby’s needs.
3. Latch the baby deeply so that the baby’s mouth is
open wide covering the nipple and 1 inch or more
of areola.
4. Listen for the baby to swallow frequently.
5. Drink enough fluids, at least 1 glass of water every
time you feed the baby and more if you are still
thirsty.

13
 NOTES
How to tell if you’re making enough milk
for your baby
If you are worried you are not making enough
milk for your baby, use this checklist:
o Keep your baby close and feed whenever
the baby shows signs of hunger.
o Count diapers. After day 5, look for 6 (or
more) heavy wet diapers every 24 hours
and 3 or more loose yellow stools. Some
babies may have a bowel movement with
every feeding. This is okay too.
o Look at your baby. Is the baby getting
bigger? Are the clothes getting tighter? Is
the baby gaining weight? If so, your baby
is getting enough milk.
o Is the baby content after most feedings?
All babies have some fussy times; this is
normal, but the baby should be content
most of the time.
o Is the baby having a growth spurt? These
usually last only 1 to 2 days when the baby
feeds often.
o Have you been very busy lately, missing
feedings at times? Sometimes a fussy baby
is telling the mother to slow down and
spend a little more time cuddling and
breastfeeding and enjoying him or her.

14
CHAPTER 3 Breastfeeding Challenges

Breast Engorgement your breasts for 10 to 15 minutes. This will help

reduce the engorgement further. (Bags of frozen
For the first week after the birth of your baby, your
peas work well.) Make sure you have a cloth layer
body is going through many changes. One of these
between your breasts and the ice packs.
changes is the beginning of breast milk production.
Two to five days after birth many women notice breast 7. I buprofen or acetaminophen may help reduce the
fullness, while others experience breast engorgement. pain. Ibuprofen may help reduce the swelling.
You may continue to breastfeed while taking these
Difference Between Breast Fullness and medications.
Breast Engorgement
8. If there is no improvement after 24 to 48 hours,
Breast fullness is related to the beginning of milk
contact your lactation consultant for advice. If you
production. This is sometimes referred to as “the milk
get a fever above 100.4°F, notice redness or warmth
has come in.” Breast fullness rarely causes a baby to
in one area, or feel ill, it could mean you have an
have trouble latching on and breastfeeding. When
infection. If a lactation consultant is not available,
the baby has finished feeding, the breast usually feels
you should see your primary care physician or go
softer, lighter, and more comfortable.
to Urgent Care.
Breast engorgement is when the breasts are hard to the
touch, swollen, and painful. While the breast is hard
and swollen, the baby may have trouble latching and can- When Breastfeeding Hurts
not drain the milk from the breast well. Some mothers Sore Nipples
get a slight fever (below 100°F) for a short time. If breastfeeding is painful and hurts, this could mean
that there is something wrong. Blisters, scabs, cracks,
To prevent engorgement, breastfeed early, breastfeed
or bleeding are not normal when breastfeeding and
often, breastfeed well, and breastfeed exclusively. are signs that there is a problem. Read the following
How to Treat Breast Engorgement information and see a lactation consultant right away.
1. Breastfeed often, at least every 2 to 3 hours. Do Early Days of Breastfeeding
not limit your baby’s time at the breast. Many women experience some nipple tenderness dur-
2. Avoid the use of pacifiers, bottles of formula, or water ing the early days of breastfeeding. This is usually
(unless recommended by your baby’s physician). a sign that baby is not latching correctly. Review the
3. If your breasts are not leaking, you may use warm, information in Chapter 2 on the correct latch, look
moist compresses on your breasts for 5 minutes at the videos on the Internet, and ask for help. If you
before each feeding. Massaging your breasts will don’t get relief, call a lactation consultant in your area
also help drain the milk better. and schedule an appointment; a lactation consultation
can help.
4. Warm showers are helpful as well. While in the
shower, massage your breasts to help soften them. Pain Management
5. If the baby is unable to latch, unable to soften the To treat your pain until you can get help, follow
breast when feeding, or has less than 5 wet diapers these steps:
in 24 hours, you will need to express your milk • Begin each feeding on the least sore breast. If
by hand (see pages 17–20 for more information) both breasts are sore, put a warm, wet washcloth
or use an electric breast pump. Use the milk you on the breast and use gentle massage (going from
express to feed your baby. the chest wall toward the nipple) to start the
6. If your breasts are still hard after breastfeeding flow of milk.
or expressing your milk, apply ice compresses to
15
 • If necessary, breastfeed more often (every 1 to under the skin or it may be a red, firm, and tender
2 hours) and for shorter periods of time (10 to area near the nipple.
15 minutes or until the breast is soft). • Causes
• Express a small amount of milk or colostrum - missed feedings,
onto the sore area after the feeding. Air-dry your - the baby’s first sleeping through the night,
nipples after feedings.
- wearing an underwire bra, a bra that is too
• Pure lanolin cream can help protect nipple tissue. tight, or not properly fitted, and
Do not use vitamin E or other creams or oils.
- doing too much in one day or feeling stressed.
• Gel pads can provide relief and protection.
They can be cooled and, like lanolin, will keep • Treatment
your nipples moist. Gel pads are available where - Breastfeed the baby often, starting with the
breastfeeding supplies are sold. See Chapter 6. sore side first.
- Position the baby’s nose toward the plugged
• Avoid soap on nipples when breastfeeding; just duct while breastfeeding and change positions
rinse with water during your daily shower. often.
If breastfeeding is too painful, pump your breasts - Apply warm, moist compresses 5 to 6 times a day
every 2 to 3 hours for about 15 to 20 minutes on for 10 to 15 minutes just before breastfeeding.
each breast, or longer if the milk is still flowing. An - Massage the breast just in front of the tender
electric breast pump is the easiest, most effective area to help the milk to begin flowing. Once
pump for this use. See Chapter 6 for pump resources there is milk flow, use some deep pressure
at your medical center. You can feed your expressed massage just behind the tender area while
milk to your baby until your nipples heal and you feeding, working fingers toward the nipple to
can see a lactation consultant for help. Don’t quit help move the plugged milk toward the nipple
breastfeeding because it hurts; get help. and out.
Sore nipples after pain-free breastfeeding for - Drink extra fluids and eat healthy foods.
1 week or more - Wear a soft bra that doesn’t dig into the breast
Sore nipples can occur after the first week for several or don’t wear a bra.
reasons. The first thing to check is the latch, to make
• Prevention
sure it is still correct. Thrush (a fungal infection many
- Pump your breasts to keep them soft if you
babies get in their mouths that may require medication),
miss a feeding or your baby sleeps all night and
teething, or a new pregnancy can also affect your
you are uncomfortably full.
nipples. If your nipples become sore, call your lacta-
tion consultant. She will help you find the cause so - Try not to overdo it. You are still recovering
that you can solve the problem as quickly as possible from giving birth.
and get you back to pain-free breastfeeding again. Most plugged milk ducts are released within 24 to
Sore Breasts 48 hours. If there is no improvement or if you begin
Your breasts can be sore for a number of reasons. running a fever over 101°F or you feel sick as if you
Engorgement, plugged ducts, and mastitis (breast are coming down with the flu, see your health care
infection). If you are having breast pain, try the professional or go to Urgent Care for treatment.
suggestions given below. If the pain is severe or you
have no relief within 24 hours, contact your lactation
Mastitis
consultant or health care professional.
Mastitis is an infection of your breast tissues, not
Plugged milk ducts your milk supply. It is safe and important to con-
When a milk duct is not draining well, it can become tinue breastfeeding.
blocked or plugged. It often feels like a lump or pea

16
Mastitis may follow a plugged milk duct or may Breast Milk Hand Expression
appear suddenly with no warning. Symptoms are the
Expressing breast milk by hand has many advantages:
same as the flu: fever, chills, and body aches. Also,
there is usually a red, swollen, hot, painful area on • Natural; no pump needed
the breast. Usually it is only on one side. • Can relieve breast engorgement
• Causes • Increase milk supply
- cracked or otherwise damaged nipples,
• Can be used to give milk to newborns who may
- baby not feeding well or often enough,
be having trouble breastfeeding.
- overtired mother, and
- untreated plugged milk duct. Hand expression does take a little practice. Here are
• Treatment some tips to increase milk flow:
- Heat. Apply warm moist compresses and place • Sit up and lean forward a little—gravity helps.
them on your breasts for 10 to 15 minutes before • Apply a warm, moist wash cloth to the breasts
feeding or pumping. (Fill a clean, disposable for a few minutes. It can help relax milk ducts
diaper with warm tap water and place it over and help the milk letdown.
your breast. It can be used over and over again.)
• Gently massage the breast with hands or a soft
- Rest. Go to bed. Take the baby with you for towel.
frequent feedings. When baby is ready to sleep,
put the baby in his or her bed. Make sure to • Place fingers on opposite sides of your breast,
drink a lot of fluids and eat healthy foods. This about an inch away from your areola with
is very important or your symptoms may get thumb on top and fingers on bottom in the
worse. If you have other children at home, shape of a “C.”
arrange for someone to care for them while you • Press back toward chest.
get better. • Compress fingers toward each other, drawing
- Breastfeed often to keep your breasts soft. If slightly toward the nipple but not sliding skin.
your baby cannot, or will not, breastfeed enough, • Release pressure, relax hand.
use a breast pump to keep your breast well
drained. • Repeat the Press-Compress-Relax pattern several
times.
- Pain relief. Ibuprofen medicine may relieve
your pain. You do not need a prescription. • Don’t expect anything right away; relax and the
Follow the package instructions or follow your milk will come.
physician’s instructions. • Shift hand to a different part of the breast to
- If your symptoms are severe or last for more move milk from other ducts.
than 24 hours, call for a same-day appointment • For newborn colostrum, collect drops on a clean
with your primary care physician or go to plastic spoon or clean medicine cup.
Urgent Care. You may need to take antibiotics. • For mature milk, express milk into a clean cup
If so, take them for the full 10-day course and or large bowl.
continue to breastfeed.
• Prevention
- Latch well. A good latch solves most breast-
feeding problems. A video on hand expression can be viewed at
- Breastfeed often. http://newborns.stanford.edu/breastfeeding/
- Rest as much as possible, especially the first handexpression.html
6 weeks.
- Treat plugged milk ducts right away.
- Continue breastfeeding.
17
TABLE 3
Ways to Express Your Milk

Small electric, Double pump, Hospital

Manual Hand
If you plan to battery-operated electric grade electric
pump Expression
pump (to purchase) pump (rental)
Pump for the occasional supple-
mental bottle
4 4

Pump at least once per day 4 4

Return to work 4

Relieve engorgement 4

Milk for newborns 4

Increase milk supply 4 4

Establish milk supply
(baby is not latching)
4

Baby in NICU
(premature or sick baby)
4

Breast Pumps and Pumping Using a Breast Pump to Start Your Milk Supply
Many women need to use a breast pump to get their
Here are some resources for breast pumps:
milk supply going until the baby is able to breastfeed
• Many Kaiser Permanente facilities have breast well. Most women switch over to breastfeeding once
pumps available for rent and/or purchase. See the problems are resolved. Be sure to stay in contact
Chapter 6 for pump options at your medical with your lactation consultant so she can guide you
center. through the process of moving from pumping to
• You can call Medela® at 1-800-435-8316 or visit breastfeeding. Some reasons you may need to pump
their website at medela.com or Ameda at for a while are that the:
(866) 99-AMEDA (1-866-992-6332) or visit • baby is not able to maintain latch and breastfeed
their website at ameda.com for a breast pump well,
dealer located near you.
• baby has mouth or suckling problems that may
• Recommended hand pumps for purchase: keep him or her from breastfeeding well,
Ameda, Medela, and Philips AVENT
• baby is in the NICU because he or she has
(avent.com).
special needs, or
• Recommended electric pumps for purchase:
• mother’s nipples are too large for baby to take
Ameda, Medela, and Lansinoh (lansinoh.com).
them into his or her mouth.
Battery-operated and small electric pumps are
not as efficient as the large electric breast pumps Even though your baby cannot breastfeed right away,
available for rent. you can start giving your baby the best food possible
• If you are unsure about what pump to use, ask by using an electric breast pump. After your baby’s
your lactation consultant at your local medical birth, your hormones that control milk making are
center. at high levels. If the milk stays in the breast too long,

18
the hormone levels drop and milk production stops. minutes at a time. If you are pumping one breast
By using an electric breast pump on a regular basis at a time, it may be helpful to change sides, back
(8 to 10 times a day), you will help to keep the lacta- and forth, whenever your milk flow slows.
tion hormones high for milk production. • Hand expression is often very effective during
Your nurse or lactation consultant will help you to the first days after giving birth. If little milk is
get pumping started while you are in the hospital and flowing at first, try both hand expression and
will help guide you in the steps needed for you to pumping to increase the milk flow.
keep pumping once you are home from the hospital. • During the first 2 days after birth, you have
As you make more milk and your baby is able to colostrum. Colostrum is the first milk, or new-
drink the milk you have pumped, the lactation con- born milk. It is concentrated and has the right
sultants will help you and baby learn to breastfeed. amount of nutrients and immune factors for
your baby. Do not be alarmed if there are only
To prepare to express/pump your milk, follow these small amounts; this is normal. Every drop is
steps: important for your baby.
• If you are expressing milk for a premature baby
or for a baby who is sick, your physician may • Milk volume will increase when your baby is
have recommended you store milk in sterile about 3 to 5 days old. Pump even when there
containers. For the well baby, clean bottles or is little or no milk coming, as this stimulation
milk storage bags can be used. will help your milk supply later and will prevent
engorgement from occurring.
• Apply warm, moist heat to your breasts for
about 5 to 10 minutes before expressing milk
to help your milk ducts relax and the milk to
let-down and flow better. Follow this with 1 to A good pump should be able to relieve breasts
2 minutes of breast massage. (Once you are used of some milk and of stimulating production.
to expressing your milk and you have a good It should be clean, contamination free, easy to
flow of milk, you can skip this step.) use and not cause pain or discomfort.
Ruth Lawrence, MD
• Set the pressure on your pump to the lowest From her book, Breastfeeding: A Guide for the
pressure. Turn the pressure up to your comfort Medical Profession
level. To find your comfort level, turn the suction
up to the point where it hurts, then turn it down
slightly. Pumping should not hurt. If it hurts, turn Storage of Breast Milk
it down a little more. Be sure to label any bottles of milk that will be stored
Follow this procedure for expressing your milk: with the date and time you pumped it as well as
• If your baby is in the NICU, begin pumping any other information you feel will be important.
within 2 hours after birth, if possible. Breast milk stored for a period of time will separate.
• If your baby cannot latch on after several attempts, The fatty portion of the milk will float on the top.
begin pumping to provide breast milk for your The amount of fat will vary depending on when you
baby until your baby latches on well. pump, how long you pump, and the time of day the
milk was expressed. Shake gently to mix the milk
• Pump often; 8 to 10 pumping sessions in 24 hours
back together before giving it to your baby.
will help you establish a good milk supply. Try to
space your pumping sessions throughout the day Breast Pump Cleaning and Care Instructions
with at least one pumping session at night. Keeping the parts of your breast pump clean is
• Pump your breasts for about 15 minutes, both at important to prevent a bacterial infection, which
the same time or one at a time, or until no milk could make your baby sick.
flows for 2 minutes. Pump no more than 30

19
Follow these steps to care for your breast pump: Introducing a Bottle to Your
1. Wash your hands before you begin to use your Breastfed Baby
breast pump. Under normal circumstances, it is not advisable to
2. I f your pump kit does not come in a sterile con- pump, nor to give your baby a bottle, until your milk
tainer, such as a sealed plastic bag, sanitize your kit supply is established and your baby’s first growth
with boiling water (for 20 minutes) before you use spurt has passed. At that time, you may start pump-
it the first time. ing once a day for milk storage. Wait until your baby
3. A
 fter you use your pump, remove the tubing from is at least 3 or 4 weeks old before giving a bottle.
the milk collection container (leave the tubing Many mothers do not offer a bottle until 2 weeks
attached to the pump). Leave the motor running before they return to work. Your baby will usually
for 2 to 5 minutes to dry any moisture that has accept a bottle if not too hungry and if the bottle is
collected in the tubing. not forced. After your baby has had a bottle, offer a
bottle at least twice a week so that she will keep
4. T
 ake your pump collection kit apart completely
accepting it.
(even the valve that goes inside the bottle). Wash
all pump parts that come in contact with your To begin, think about having someone other than
milk with hot soapy water after each use. the breastfeeding mother give the first bottle. It may
5. Rinse well with clean water. be helpful for the father or grandparent, etc., to hold
the baby in a position other than the familiar breast-
6. Air-dry all the parts of the pump.
feeding position. Some mothers find it helpful if they
7. D
 o not store wet or damp parts in plastic bags are not even home. Your baby senses your presence,
between uses. can hear and smell you, and may refuse to accept the
8. I f you notice any discolorations in your tubing or bottle. Instead, take your pump and plan to be away
collection kit, those parts will need to be cleaned and during your baby’s feeding time. This gives you a
replaced. Contact the breast pump manufacturer chance to pump while your baby is learning to accept
or your lactation consultant. a bottle.

Preparing Milk for Feeding The best nipples on a bottle are ones that require the
Follow these tips to warm milk or thaw frozen milk baby to keep her mouth open wide while sucking.
for feedings: Do not allow your baby to suck only on the nipple tip.
• Never heat baby’s milk in a microwave or on the Babies take about 1 ounce of milk for every 2½
stove. pounds of body weight during a feeding. Start by
• Warm milk gently and slowly, placing the bottle offering the baby 2 ounces. Heat 1 more ounce if the
in a cup or bowl of warm water. baby is still hungry. Remember that milk that has
been warmed for a feeding must be thrown out at the
• Thaw frozen milk by placing it in the refrigerator
end of the feeding.
the night before if you know you will need it the
next day.
• Place a bottle of frozen milk in a mug of warm
water and allow it to thaw gradually.
• If the fatty portion of the milk has floated to the
top, mix the separated milk back together before
feeding it to the baby by gently swirling the
bottle.

20
TABLE 4
Storage Duration of Fresh Human Milk for Use with Healthy Full-Term Infants

Location Temperature Duration Comments

Room temper- Containers should be covered and kept as

Countertop, table ature (up to 6–8 hours cool as possible; covering the container with a
77°F or 25°C) cool towel may keep milk cooler.

5–39°F or Keep ice packs in contact with milk containers

Insulated cooler bag 24 hours
-15–4°C at all times; limit opening cooler bag.

Store milk in the back of the main body of

Refrigerator 39°F or 4°C 5 days
the refrigerator.

Freezer

Freezer compartment
5°F or -15°C 2 weeks
of a refrigerator

Store milk toward the back of the freezer,

where temperature is most constant. Milk
Freezer compartment stored for longer durations in the ranges listed
3–6 is safe, but some of the lipids in the milk
of refrigerator with 0°F or -18°C
months undergo degradation resulting in lower quality.
separate doors

Chest or upright deep 6–12

-4°F or -20°C
freezer months

Source: cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm

Reference: Academy of Breastfeeding Medicine (2004). Clinical Protocol Number #8: Human Milk Storage
Information for Home Use for Healthy Full Term Infants. Princeton Junction, New Jersey: Academy of Breastfeeding
Medicine.

21
NOTES

22
CHAPTER 4 Fitting Breastfeeding into Your Lifestyle

Before you know it, your baby will have grown past Diet
the newborn stage. Your life will get busy as you
You do not need to follow a special diet when you are
resume many of the activities you enjoyed before
breastfeeding. Follow these simple guidelines to feel
your baby was born. Thinking about your return to
good while you breastfeed:
work or school can be stressful for many mothers. If
planned well, you will be able to manage it all. • Keep taking your prenatal vitamins while
breastfeeding.
• Eat a wide variety of foods—lots of fresh fruit,
Breastfeeding in Public vegetables, whole grains, and an extra serving of
California state law (California Civil Code, Section protein.
43.3) states a mother may breastfeed her child in any • Drink lots of water. Some juice and limited
location, public or private, except the private home amounts of coffee, tea, and sodas with caffeine
or residence of another, where the mother and the may be okay, but don’t overdo them.
child are otherwise authorized to be present.
• Eat enough calories—about 500 calories extra
Some women find that wearing a loose-fitting top each day to support lactation (usually about
that can be unbuttoned or pulled up from the waist 2,200 to 2,800 calories per day). Go to
or covering up with a receiving blanket helps them choosemyplate.gov/pregnancy-breastfeeding.html
feel more at ease when they breastfeed in public. to create your own daily meal plan. You can
Others find that using a baby sling works well. If you enter your height, weight, due date/birth date,
need help or tips on how to breastfeed when you’re out and activity level to get suggestions just for
in public, ask your lactation consultant or educator you. If you have any special nutritional needs,
for assistance. be sure to discuss them with your physician or
lactation consultant.
Leaking Breasts • Drinking alcohol in limited amounts is safe
when breastfeeding. Remember that the alcohol
Many women find that when their breasts are very will filter into your milk, so small amounts (one
full or when they are away from the baby and miss drink or less) taken after feedings are usually best.
a feeding, their breasts will leak. Leaking is a signal
from your body that you should try to pump or • Human milk varies only slightly from mother
breastfeed soon. There are a few things you can do to to mother regardless of what you do or do not
prevent wet spots on your clothes. eat. The goal is to eat balanced, healthy, ener-
gizing meals so you and your baby can thrive.
• Apply direct pressure to your nipple when you
feel the milk is starting to flow. Refer to Chapter 6 for more information.
• Use cotton or disposable breast pads. Change
your pads often.
Exercise
• Avoid letting your breasts get overly full; you
will leak less. Many mothers are anxious to get back into shape and
want to begin an exercise program right away after
For most women, leaking becomes less of a problem
the baby is born. Wait until after your postpartum
after about 6 weeks when the hormones levels adjust
appointment and approval from your physician or
to breastfeeding.

23
midwife. When you are ready to start exercising, • Pumping not often enough and missing pump-
don’t let breastfeeding stop you. Many women walk, ing sessions can lead to engorgement and a de-
run, do yoga, go to the gym, or whatever else they creasing milk supply. Avoid letting your breasts
enjoy, while they are still breastfeeding. get overly full. Engorgement sends a signal to
your body to slow down milk production.
• Having the support of another breastfeeding
Returning to Work or School
mom will improve your success.
As you get ready to return to work or school, keep
these things in mind to support you as you keep Because breastfeeding is a relationship, babies connect
breastfeeding: breastfeeding with their mothers and will refuse to
take a bottle from mom. Have someone other than
• Federal law requires employers to provide
you give your baby a bottle 3 to 4 weeks before going
reasonable break time and a private location
back to work or school. This may take several times
(not a toilet stall) for nursing mothers to express
before your baby will accept the change to bottle
breast milk during the workday for one year after
feeding. Babies who will not take a bottle sometimes
the child’s birth. Plan ahead and talk with your
take a cup.
manager about a place to pump and let him or her
know you will be pumping 2 to 3 times per day. Returning to work or school is an adjustment for
• You will need a good quality electric double both of you. If your baby’s caregiver is close to work,
breast pump and a manual breast pump for you may want to try breastfeeding before and after
back up in case the electric pump breaks down. work, or on your lunch break. Try a practice day
Three to four weeks before returning to work, before returning to work to adapt your pumping
begin pumping after feedings when your breasts schedule or adjust for any challenges you did not
feel the most full. You will probably have more foresee. Pack your diaper bag and breast pump kit
milk volume in the morning than later in the the night before to make your mornings flow easier.
afternoon or evening. Pump 1 to 2 times per When you get to work, pump at the times you would
day to store milk in the freezer before you return usually feed your baby.
to work. You will be able to express ½ to 1 ounce
Some Kaiser Permanente facilities offer a Breastfeeding
or more each time you pump after feedings.
and Returning to Work class. Call your local health
• You will need 2 to 3 flexible pumping breaks at education department or your lactation consultant/
work. This will take about 20 minutes to allow educator. See Chapter 6.
time for pumping and cleaning your pump parts
(10 to 15 minutes to pump and 5 minutes to For tips on breastfeeding and returning to work, go
clean up). If there is no refrigerator at work, use to breastfeeding.com and
an insulated lunch bag with ice packs to keep http://www.womenshealth.gov/breastfeeding/
the milk cool for the day. Your breast milk can government-in-action/business-case-for-breastfeeding/
be stored in your refrigerator for use the next California Lactation Accommodation Law
day or the freezer for future use. California Labor Code Sections 1030–1033 state
• Ease your way back to work. Consider returning that any business shall provide an employee with a
to work mid-week, or work part time or half days reasonable break time and a location, other than a
to ease your transition away from your baby. bathroom, for you to express your milk. Make
• It will help to protect your milk supply by arrangements with your employer before returning to
pumping consistently at work the same time work to ensure a smooth transition back to work.
each day, and breastfeeding when you are at breastfeedla.org/resources/breastfeeding-laws
home with your baby. You may want to schedule
your pumping time in advance and block it out cdph.ca.gov/HealthInfo/healthyliving/childfamily/
on your calendar. Pages/CaliforniaLawsRelatedtoBreastfeeding.aspx

24
Breastfeeding for the First Year and
Beyond Support Groups

As the days, weeks, and months pass, you will no- Support groups have been proven to help
tice your breastfeeding will change. The American mothers to breastfeed longer. Find a sup-
Academy of Pediatrics recommends at least 1 year portive group that you enjoy and get to know
of breastfeeding and suggests that you continue for other breastfeeding mothers. Here are some
as long as you and the baby enjoy the relationship. ideas:
Your milk continues to be nutritious and is a healthy • Many Kaiser Permanente facilities have
addition to your baby’s diet for as long as you con- support groups for new families. Contact
tinue to breastfeed. You will make milk as long as your local lactation consultant for
your baby is drinking the milk. support group information at your local
medical center. See Chapter 6.
• WIC (Women, Infants and Children).
The American Academy of Pediatrics recom- Many WIC health and nutrition
mends that you breastfeed your baby for at programs have support groups for new
least 12 months, and thereafter for as long mothers. Ask your WIC worker if a
as mutually desired. You can breastfeed your support group is available in your area.
baby for over 1 year. See Chapter 6.

Surround yourself with supportive family and • La Leche League. La Leche League is
friends. a mother-to-mother information and
support organization for breastfeeding
Attend a support group. You’ll be glad you did. mothers. Call 1-800-La Leche (1-800-
525-3243) for the La Leche League
group information for your area. See
Chapter 6.
Weaning
• Community centers. Many community
Gradual weaning can be best for both mother and centers offer parent support groups and
baby. The weaning process begins when baby starts new mother groups. Call your local
solid foods at around 6 months of age. Over the community center to get information on
coming weeks or months, the baby will gradually what is available in your neighborhood.
eat more solid foods and breastfeed less. It can take
weeks, months, or years to completely wean your baby.
For a comfortable weaning, always wean gradually.
Never try to drop more than one breastfeeding a week.

Birth Control
You can get pregnant while breastfeeding. Be sure to
discuss birth control options with your health care
professional. They can guide you in choosing a safe
and effective method to use while you are breastfeeding.

25
NOTES

26
CHAPTER 5 Frequently Asked Questions

Q. H
 ow do I know if my baby is getting enough Q. W
 hy does my baby sleep so well during the
breast milk since I can’t tell how much he is day but stays awake at night?
drinking?
A. B
 abies wake during the night for feedings for
A. L
 ook at your baby. Listen and watch for swallows several months. If your baby is awake more than
during feeding. Expect occasional swallows the just for feeding, it may be that their sleep cycle is set
first 1 to 2 days with increasing swallowing after for being awake at night. During your pregnancy
day 3. Track the baby’s bowel movements and wet your baby’s sleep cycle was set by your activities.
diapers on the Breastfeeding Log form (Table 2). If you were active during the daytime hours, your
Feed your baby whenever he or she shows signs of baby was probably rocked to sleep all day. When
hunger and for as long as the baby desires. Babies you went to bed at night, the rocking stopped and
should breastfeed 8 to12 times in 24 hours. The your baby became more awake and alert. Some
number of wet and soiled diapers should increase ways to help your baby to be more wakeful during
every day until baby is 5 days old. After day 5, the day and sleep better at night are to expose your
you should see at least six really wet diapers and baby to more light during the day to help reset
at least two large yellow stools every day. After the baby’s internal clock. Keeping your baby close
feedings, your baby should be content and sleepy during the night may help your baby sleep better
most of the time. If this is not the case, call your as he or she feels more secure when somebody is
lactation consultant to discuss your concerns. close to him or her. Keep the lights low and limit
activity during the night to help teach your baby
that nighttime is for sleeping.
 owever, you should call your pediatrician if your
H
baby appears to have a loss of appetite during
feedings, has frequent or a lot of vomiting, rectal Q. M
 y baby is so gassy. Did I eat something that
temperature higher than 100.4ºF or underarm caused this?
temperature higher than 99.4ºF, and if your baby
A. P
 robably not. The colostrum the baby is eating
seems very irritable, sleeps most of the time, or is
the first few days acts like a laxative to help the
very restless or has trouble breathing.
baby pass the sticky first stools, called meconium.
After those first few days, some gas is normal for
Q. M
 y baby wants to suck all the time, even after everyone; it is part of the digestion process. If
he or she is fed. Should I use a pacifier? your baby is gassy, crying, and uncomfortable,
call your lactation consultant. She can probably
A. B
 abies are born with a very strong suck instinct.
help you find possible causes.
Sucking feels good to babies. They have been
sucking their fingers and toes since before they
were born. Newborns will suck on their hands Q. Should I give my baby formula, juice, or water?
to show you they are hungry, and they will suck
A. Th
 e American Academy of Pediatrics recommends
to help themselves go to sleep. During the first
your baby drink only human milk for the first
month, your baby should be put on your breast
6 months. Your pediatrician will guide you through
whenever they show signs of hunger, like sucking
this process. Breast milk should continue to be
on their hands. After 1 month of age you can
a major part of your baby’s diet for the first year.
introduce a pacifier but limit its use to times
Your baby should never need any formula when
when you are not available to breastfeed, like in
breastfeeding is going well.
the car or when you are in the shower.

27
Q. D
 oes breast milk change over time? your baby. See Chapter 3 for the section on
A. Y
 es. Milk changes according to your baby’s need. breast pumps to help you decide what type of
The milk changes as your baby grows, but it also pump you will need.
changes during the feeding.
S ome medical centers offer a class through your
 e milk in the first few days is called colostrum.
Th local Health Education Department about
Colostrum is like an energy drink for your baby, Returning to Work for breastfeeding mothers.
low in fat, high in protein, and easy to digest. Call your Health Education Department for class
It is the perfect food for your baby to learn how information. See Chapter 6.
to breastfeed. It is sweet and present in small
amounts so the baby doesn’t get overwhelmed Q. W
 hat does it mean that a baby can be “nipple
with too much milk flowing. By about the third confused”?
day the milk volume starts to increase. The more
the baby breastfeeds, the more milk there will be. A. S
 ucking is a natural instinct; breastfeeding is a
This milk has more water and fat than in the first learned skill. Sometimes if a baby gets a bottle too
two days, but it still has all the good colostrum early, he or she may have a hard time breastfeeding.
to keep your baby healthy. By the time your baby The bottle feels different in the baby’s mouth and
is about 2 weeks old, the colostrum is gone and the milk flows differently from the bottle than it
your baby is getting mature milk. does from the breast. While some babies can go
back and forth from breast to bottle, other babies
have trouble and can get quite frustrated. Also,
 uring the feedings, milk changes too. The
D when they do latch to the breast, they may suck
milk at the beginning of the feeding may appear incorrectly, making the nipples very sore. The
watery. This is because it has a lot of water to American Academy of Pediatrics recommends
quench the baby’s thirst. The milk toward the that you avoid bottle or pacifier nipples and only
end of the feeding is thicker, richer, and has a breastfeed for the first month of your baby’s life.
higher fat content. This milk helps your baby to After one month, babies can usually manage the
feel full and gain weight. This is why it is differences better.
important to let baby decide when the feeding is
finished. In that way, the baby gets just the right
kind of milks. Q. W
 hy is my baby so fussy?
A. A
 ll babies have times during the day when they are
restless and irritable. There can be many reasons
Q. Is it okay to only pump and bottle-feed my
for a baby to cry and be fussy and irritable. For
baby breast milk?
some babies, this is worse than others. If your
A. Th
 is is not recommended on a long-term basis; baby is fussy, try holding the baby skin-to-skin
however, it is better than the baby not getting any and just relax. If your baby is crying a lot and
breast milk and just getting formula. Call your passing a lot of gas, try burping the baby more
lactation consultant if you are having problems often. If nothing seems to soothe your baby, call
with breastfeeding. A baby who is latching well your lactation consultant and she will make other
can feed very quickly and effectively. suggestions that may help.

 fter you have been breastfeeding for about a

A
month, you can begin to pump and store breast
milk for use when you need to be away from

28
Q. D
 o I have to eat a special diet or avoid certain Q. M
 y family says I can’t take any medicines
foods while breastfeeding? when I’m breastfeeding. Is that true?
A. E
 very culture has different “rules” about what you A. M
 ost medications are safe to take when breast-
can and cannot eat when you are breastfeeding. feeding. Your lactation consultant has resources
You will get lots of advice from well-meaning on the safety of breastfeeding while taking
friends and family about your diet. There is no medications. If you are concerned about the use
food that causes every baby to be gassy, get a rash, of any medication you need to take while breast-
or spit up a lot. The best advice is to eat a variety feeding, call your lactation consultant for advice.
of foods you enjoy. Enjoy fruits and vegetables,
whole grains, protein foods like meats, eggs, and
beans on a regular basis. Try not to eat the same
foods all the time. If you feel that every time
you eat a certain food, your baby reacts badly in
any way, please call your lactation consultant for
advice.

Q. If I get a cold or have a fever, should I still

feed my baby?
A. A
 bsolutely. Keep breastfeeding. Before you even
know you are getting sick, your baby has been
exposed to your illness. Your body starts producing
antibodies to fight the illness before you have any
symptoms. These antibodies pass into your milk
for your baby. By breastfeeding, you pass these
antibodies to your baby to help protect him or her.

29
NOTES

30
CHAPTER 6 Resources

Kaiser Permanente Breastfeeding Breast Pumps and Supplies

Clinics and Lactation Consultants Contact your local Kaiser Permanente Medical Center.
Anaheim (714) 644-5604 Anaheim (714) 644-2708
Antelope Valley (661) 533-7600 Antelope Valley (661) 533-7600*
Bakersfield (661) 869-6438 Bakersfield (661) 869-6438
Baldwin Park (626) 851-6013 Baldwin Park (626) 851-5820
Downey (562) 461-6614 Downey (562) 461-6614
Fontana (888) 750-0036 Fontana (909) 427-4560*
Irvine (949) 932-5892 Irvine (949) 932-2707
Los Angeles (323) 783-7808 Los Angeles (323) 783-7808 or (323) 783-4345
(323) 783-4345
Orange (714) 748-2775
(323) 783-4472
Panorama City (818) 375-3018
Panorama City (818) 375-3340
Riverside (951) 353-4475*
Riverside (866) 883-0119
San Diego (619) 528-5153
San Diego (866) 940-2218
South Bay (310) 816-5440
South Bay (310) 517-4300
West Los Angeles (323) 857-4065*
West Los Angeles (323) 857-4121
Woodland Hills (818) 719-4305*
Woodland Hills (818) 719-2826
(818) 719-2255
* These Health Stores are open only from Monday to
Friday from 9 a.m. to 5 p.m.

Kaiser Permanente Health

Education Departments Diet and Breastfeeding Websites
For class information from your local Health • womenshealth.gov/breastfeeding
Education Department, go to kp.org/classes.
• wicworks.nal.usda.gov/breastfeeding

Baby-Friendly USA
WIC (Women, Infants and Children)
Baby-Friendly USA, Inc. is the accrediting body for
1-888-942-9675 (1-888-WIC-WORKS)
the Baby-Friendly Hospital Initiative in the United
States. cdph.ca.gov/programs/wicworks/

babyfriendlyusa.org WIC is a federally funded health and nutrition

program that helps low-income pregnant women,
new mothers, and young children under the age of
5 to eat well and stay healthy.

31
Lactation Websites La Leche League
• kp.org/pregnancy 1-800-525-3243
• breastfeedingmadesimple.com llli.org
• breastfeeding.com lalecheleaguescnv.org

• kellymom.com
• ameda.com—“Your Baby Knows How to Latch-on”
(video)
Recommended Reading
• drjacknewman.com—Many good video clips on
Eileen Behan, RD. Eat Well, Lose Weight While
latching babies
Breastfeeding.
• motherwear.com/br/bfguide.cfm
Kathleen Huggins, RN, MS. The Nursing Mother’s
• medelabreastfeedingus.com Companion.
• askdrsears.com Kathleen Huggins, RN. The Nursing Mother’s Guide
• lowmilksupply.org—Information and support for to Weaning.
breastfeeding mothers with low milk supply La Leche League International. The Womanly Art of
• bfar.org—For women who have had breast surgery Breastfeeding.
Nancy Mohrbacher and Kathleen Kendall-Tackett.
Breastfeeding Made Simple.
Jack Newman, MD. The Ultimate Book of Breast-
Milk Banks feeding Answers.
San Jose Milk Bank Gale Pryor. Nursing Mother, Working Mother.
A nonprofit organization that is one of the longest-
Amy Spangler, BSN, MN, IBCLC. Amy Spangler’s
running milk banks in the country.
Breastfeeding: A Parent’s Guide.
sanjosemilkbank.com/index.htm

Prolacta
A for-profit organization that specializes in engineering
human milk to control fat, calories, and nutrient
content of milk for very small preterm babies.
prolacta.com/

32
INDEX
American Academy of Breastfeeding ibuprofen, 15, 17
Pediatrics (AAP), ii, 25, 27, 28 Benefits of, 1–2 sore breast, 16–17
Attachment and bonding at Challenges, 15–20 mastitis, 16–17
birth, 3 breast engorgement, 15, 17, plugged milk ducts, 16
Skin-to-skin contact, 3, 5, 12, 19, 24 prevention, 17
28 breast fullness, 15 sore nipples, 15, 16, 28
Early, 3, 15 gel pads, 16
Baby-Friendly breastfeeding colostrum, 3, 16, 17, 19, 27, 28 new pregnancy, 16
services, 2, 31 Exclusively, 15 teething, 16
Behavior of baby Fitting into your lifestyle, 23–25
 thrush, 16
Fussy, 28 birth control, 25 Questions, 9, 27–29
Sleeping problems, 27 breastfeeding for the first Relationship, 9–10
Benefits of breastfeeding, 1–2 year and beyond, 25 Supplies
Birth control, 25 diet, 23, 29 bottles, 19, 20
Bra, 16 exercise, 23–24 breast pads, 23
Soft bra, 16 in public, 23 breast pump, 12, 17–20, 24, 28
Underwire bra, 16 leaking breasts, 23 electric breast pump, 15, 16,
Breast engorgement, 15, 17, 19, 24 returning to work or school, 18, 19, 24
Breast fullness, 15 20, 24 gel pads, 16
Electric breast pump, 15, 16, 18, support groups, 25 lanolin cream, 16
19, 24 weaning, 25 milk storage bags, 19
Hand express, 15–21 Holds, 6 Value of, 1–2
How to treat, 15 cradle hold, 6 Well, 4, 15
Infection, 15 clutch or “football” hold, 7 While sick, 29
Breast milk changes, 28 cross cradle or transitional
Breast milk hand expression, 17–20 hold, 6 California state law, 23, 24
Advantages, 17 side-lying position, 6 California Civil Code, Section

Press-compress-relax pattern, 17 In public, 23 43.3, 23
Procedure, 19 California Civil Code, 
California Labor Code,
Tips to increase milk flow, 17 Section 43.3, 23 Sections 1030–1033 (California
Breast pump, 12, 17–20, 24, 28 Latch, 7, 15, 17, 19, 28 Lactation Accommodation
Cleaning and care breaking suction, 8 Law), 24
instructions, 19–20 deep latch, 7 Cesarean birth (C-section), 3, 6, 7
Electric breast pump, 15, 16, lips open, 7 Colostrum, 3, 16, 17, 19, 27, 28
18, 19, 24 rooting reflex, 7 Definition, 3, 28
Hand pumps, 19 shallow latch, 7
Manual breast pump, 24 Log, 10–11 (Table 2), 27 Diet, 23, 29
Preparing milk for feeding, 20 Often, 3, 13, 15, 17 Alcohol, 23
Preparing to pump, 19 hunger (feeding) cues, 4, 8 Daily meal plan, 23
Procedure, 19 baby-led latching, 4
Resources for breast pumps, 18, 31 Pain, 3, 8, 15–17 Exercise, 23–24
Breastfed baby at home, 5 relief, 17
Feeding station, 5 acetaminophen, 15 Feeding patterns, 12–14
Introducing a bottle, 20, 24, 28 antibiotics, 17 Cluster feedings, 13
33
 Growth spurts, 13, 20 Lips open, 7 Skin-to-skin contact, 3, 5, 12, 28
One breast or both per Rooting reflex, 7 Sleep cycle, 27
feeding, 12 Shallow latch, 7 Sleepy babies, 4, 12
Formula, 2 (Table 1), 27, 28 Low milk supply, 13–14 Nipple confusion, 12
Enfamil, 2 Rapid eye movement, 12
Medications, 3, 29
Frequently asked questions, Tips to wake a sleepy baby, 12
Midwife, 9, 24
27–29 Stools, 10–11 (Table 2), 27
Milk ejection reflex, 9
Meconium, 27
See Milk let-down.
Gas, 27, 28 Storage duration of fresh human
Milk let-down, 9, 13, 17, 19
Meconium, 27 milk for use with healthy full-term
Milk supply, 8, 13–14, 17, 18, 19,
infants, 21 (Table 4)
21, 24
Hand expressed milk, 12, 15–21, Storage of breast milk, 19, 20, 21,
Establish, 18, 20
24 24, 28
Foremilk, 8
Process, 18, 20 Sucking, 9, 20, 27, 28
Hind milk, 8
Video, 18 Pacifier, 27, 28
Increase, 18
Ways to express your milk, 18 Swallows, 9, 12, 27
Low, 13–14
(Table 3) Supplies for breastfeeding, 19, 31
Milk volume, 18, 19, 24, 28
Hormones, lactation, 1, 3, 4, 19, 23 Bottles, 19, 20
Levels, 19, 23 Breast pads, 23
Neonatal intensive care unit
Oxytocin, 1 Breast pump, 12, 17–20, 24, 28
(NICU), 18, 19, 20
Prolactin, 1 Electric breast pump, 15, 16,
Newborn changes, 9–10
Hunger signs (cues), 4, 9–10, 27 18, 19, 24
Night feedings, 12, 27
Lip smacking and sucking, 4, 9, Gel pads, 16
27 Lanolin cream, 16
Pain management, 3, 15, 16, 17
Mouthing, 4, 9 Milk storage bags, 19
Plugged milk ducts, 16–17
Rooting, 9 Support groups, 25
Causes, 16
Community centers, 25
Prevention, 17
Infections, 1, 15, 16, 17 Kaiser Permanente, 25, 31
Treatment, 16–17
Bacterial, 19 La Leche League, 25, 32
Prenatal vitamins, 23
Mastitis, 16–17 WIC, 25, 31
Pump, 5, 18, 19, 20, 28
Thrush, 16
Tips for mother’s helpers, 5, 8
Resources, 31–32
Kaiser Permanente
Baby-Friendly USA, 31
Breastfeeding clinics and Videos, 4, 8, 15, 17, 32
Diet and breastfeeding
lactation consultants, 31
websites, 31
Breast pumps and supplies, 31 Weaning, 25
Kaiser Permanente, 31
Health education departments, Websites, 2, 4, 6, 8, 17, 18, 21, 23,
breastfeeding clinics and
24, 28, 31 24, 31–32
lactation consultants, 31
Support groups, 25
breast pumps and supplies, 31
health education
Lactation consultant, 8, 9, 12,
departments, 3, 24, 28, 31
13, 15, 16, 18, 19, 20, 23, 24,
Lactation websites, 32
25, 27, 28, 29
La Leche League, 25, 32
Latch, 7, 14, 16, 19, 28
Milk banks, 32
Breaking suction, 8
Recommended reading, 32
Deep latch, 7
WIC, 25, 31

34
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