Breastfeeding may be natural, but it’s perfectly OK to have questions and concerns as a new mom—or a veteran mom new to nursing! We got chatty with Jessica Madden, MD, certified lactation consultant and medical director at Aeroflow Breastpumps, to get the ins and outs of breastfeeding success.
I get the feeling breastfeeding should be easy. How will I know if I am doing it correctly?
Women get that impression for two main reasons: Other women do not often share how common it is for breastfeeding to be challenging, especially in the beginning, and secondly, videos, photos, social media posts, etc., that we see depicting beautiful and peaceful breastfeeding mother/baby dyads do not reflect the early postpartum period!
Signs that breastfeeding is going well include a lack of significant pain, audible suckling, your baby seeming relaxed and content during and after feeding, and the establishment of a good milk supply. An adequate milk supply can be identified by your baby having lots of wet and dirty diapers, that he seems satisfied after eating and no longer shows signs of hunger, and he has good weight gain. Breastfed newborns should regain their birth weight within a week or two after birth and then gain approximately 1 ounce per day.
Are there signals to show my baby is getting enough milk?
It’s normal for infants to feed every 1 to 3 hours, both day and night. Frequent feedings during the first few weeks of life are essential for the production of hormones that are needed for the establishment of a good milk supply.
It can be difficult to gauge how much milk your baby drinks at the breast. For full-term babies, falling asleep at the breast can be a sign that they are finished feeding. However, preterm babies, and even those who are just a little before their due date (early-term, or 37 to 38 weeks’ gestation), can fall asleep at the breast even if they are not full. Babies who are born before their due date, who tend to be “sleepy” at the breast, will often start to feed again if you wake them up. In addition to looking for the signs of a well-established milk supply, I recommend that all mothers of premature and early-term babies work with a lactation consultant until a good supply has been established.
It’s also important to note that breastfeeding newborn babies should not be expected to sleep through the night! Your body secretes the largest amount of prolactin, the main hormone involved in milk production, in the middle of the night. Thus, nighttime feedings are important in boosting and maintaining mothers’ milk flows. Trying to put a newborn baby (less than one month of age) onto a strict breastfeeding schedule can lead to a significant decrease in one’s supply.
What can I do about sore nipples?
Sore nipples are common and up to 90 percent of breastfeeding moms experience some degree of nipple soreness early on. Treatments for sore nipples include warm, moist heat, nipple ointments and creams, and hydrogel pads. Breast massage and wearing comfortable bras can also help.
Persistent nipple pain can be a sign that your baby is not latching on correctly. This can be a result of baby’s latch being too shallow, a tongue-tie, and/or too much suction being present as your baby comes off of your breast. The best way to troubleshoot a painful latch is by working with a lactation specialist. Nipple shields, which are thin, silicone sleeves that fit over the nipple/areolar region, can be used as a temporary tool to help with problematic latches. It’s very important to have a professional help you choose nipple shields that are the correct size for your breasts. Some women with large breasts actually need smaller-sized nipple shields and vice versa. In addition, some moms may find that certain brands of shields work better than others. Sore nipples can sometimes improve if different nursing positions are used as well. “Laid-back,” or reclined breastfeeding, is increasingly being used to promote maternal comfort and proper latching.
Any tips for getting past shyness of feeding in front of other people—especially those unsupportive of nursing?
It’s really important to be patient with yourself and your baby as you bond with each other and learn how to breastfeed. Like learning any new skill, it’s best to practice without an audience around. The first few postpartum weeks often involve countless hours of being topless and having “skin-to-skin” time with your baby between breastfeeding sessions. This is not the optimal time to have lots of visitors and/or prolonged visits with family and friends.
Once breastfeeding is well-established, I’d recommend starting to feed around supportive loved ones first. This is also a good time to practice with nursing apparel and cover-ups to see which ones are the most comfortable for you and your baby as you prepare for how you will comfortably nurse in public.
I started pumping and have noticed one breast produces more milk. Does that mean my baby isn’t getting enough sustenance on the other side?
I had the exact same question when I had my oldest baby and started pumping; my right breast always produced less milk than my left. I blamed myself for somehow “messing up” and causing this, but I now know that it’s actually very common for one breast to produce more milk than another. One way to balance things out is to try to start feeding your baby on the lower-producing breast first and/or more often. Some moms are also able to pump on the lower-producing side while their baby feeds on the higher-producing side, with an improvement in supply. The reality, however, is that a lot of breastfeeding women have asymmetrically-sized breasts until they wean. It’s one of those things that you sometimes just have to get used to experiencing as a nursing mom!
How should I store breast milk?
Pumped breast milk can go bad if it is not stored properly. According to the Academy of Breastfeeding Medicine (ABM), freshly expressed breast milk can be stored at room temperature for four to eight hours, on ice packs in a cooler for up to 24 hours, in a refrigerator for about five to eight days, in a regular freezer for six months, and in a deep freezer for up to 12 months. Pumped milk should be placed in storage bags or containers that are made specifically for breast milk and should always be labeled with the date and amount that was pumped. When storing milk, make sure that it is kept in the back of the refrigerator or freezer, where it will be kept coldest, and use the oldest milk first. Once frozen milk has been thawed in the refrigerator it should be used within 24 hours to prevent the growth of harmful bacteria. Lastly, thawed milk should not be refrozen, as there is not information in regards to the safety of refreezing previously thawed milk.
Can I drink alcohol while exclusively breastfeeding?
You can drink a small amount of alcohol without causing any harm to your baby. It’s definitely best to limit the amount you drink to one drink (i.e. 4 ounces of wine) at a time. The American College of Obstetricians and Gynecologists (ACOG) recommends that you wait at least two hours after having a single drink to breastfeed. If you feel tipsy or drunk, it’s best to refrain from breastfeeding, as this means that the levels of alcohol in your blood are too high to be safe for your baby. Too much alcohol interferes with babies’ sleep-wake cycles, feeding, and weight gain and growth. Long-term alcohol exposure negatively impacts brain and nerve development.
Is feeding impacted by surgery (augmentation/reduction/reconstruction)?
Yes, breast surgeries can affect breastfeeding. Fortunately, most mothers with a history of breast surgery can achieve at least a partial milk supply if they work in consultation with a lactation specialist. If you have had breast surgery, it can be helpful to meet with a lactation specialist while you are pregnant, so you can learn what to anticipate when you start breastfeeding. Nursing in the setting of previous breast surgery may include frequent pumping, the use of galactagogues (herbs and medications to increase milk supply), supplemental nursing systems, and/or donor breast milk.
Will introducing a bottle interfere with continuing to nurse?
This is a difficult question to answer as the jury is still out as to whether or not “nipple confusion” actually exists. Some babies are able to switch back and forth between feeding at the breast and by bottle without a problem, but there’s no real way to anticipate how a baby will do with this ahead of time. Some babies will seem to “prefer” the bottle as the milk might come out quicker and easier than at the breast. If this is the case, it can be helpful to experiment with different types of nipples. Some slower-flow nipples mimic the flow of breast milk from mothers’ breasts and can be helpful in these situations.
If your baby does not need to be supplemented via bottle for medical reasons, such as significant jaundice or low blood sugar levels, it’s best to wait until breastfeeding is well-established to begin to give pumped milk by bottle. Some newborns will refuse to take bottles of milk from their moms, so it’s often recommended that a baby’s father, or another caregiver, give the first bottle.
Should I stop breastfeeding if I am sick?
In most cases you should continue to breastfeed when you are sick. Breast milk contains helpful antibodies that pass from moms to babies to help to protect them from infections. There are only a few absolute contraindications to breastfeeding in the U.S. Infants should not receive breast milk if any of the following conditions exist:
• Baby is born with a metabolic condition called galactosemia. These babies cannot have any milk and will need to be formula fed for the long haul.
• Mother is using illicit street drugs, such as PCP or cocaine.
• Mother has any of the following viruses: human immunodeficiency virus (HIV), Ebola virus, or human T-lymphotropic virus type 1 or type 2 (HTLV 1/2).
Mothers who have coronavirus (COVID-19) are encouraged to breastfeed and/or provide pumped milk, as long as they are well able to do so. To date, there have been no reports of babies getting coronavirus from their moms’ milk. In order to prevent the spread to babies, the Centers for Disease Control and Prevention (CDC) recommends that breastfeeding mothers who have COVID-19 (or suspected COVID-19) do all of the following:
• Wash your hands or use an alcohol-based hand sanitizer before touching your baby.
• Wear a mask or cloth face covering while feeding your baby at the breast.
• Wash your hands before touching your pump or bottle parts and clean all parts after each use.
• If you are very ill, have a caregiver who is well feed your baby your pumped milk.
Where can I go to get more support?
Today’s moms are fortunate to have so many great options for breastfeeding support. Sources of support include family members and friends, lactation consultants, local La Leche League chapters, support groups for moms of newborns (both in-person and virtual), postpartum doulas, books, videos and the internet. One of my favorite breastfeeding internet sites is kellymom.com.
Every mother’s breastfeeding journey is unique. Breastfeeding can be difficult, easy, tiring, rewarding, beautiful, messy, exhausting, fulfilling, confusing, joyful, and challenging (and this might change day-to-day, or even hour-to-hour). Like so many other aspects of parenting, expectations of breastfeeding do not always meet the reality. Lastly, I remind all of the moms I work with that breastfeeding is not an “all or nothing” endeavor. There are great benefits to your baby receiving any breast milk at all, and your success (or lack of) in breastfeeding has no bearing on how good of a mom you are, or your long-term relationship with your baby.