BREASTFEEDING
CONTENT
Benefits of breastfeeding
Nutrition for the breastfeeding mom
Alcohol and medications
Taking care of yourself
Personal hygiene
Breast care
Breast Problems
Sore Nipples
Plugged Ducts
Mastitis
Pumping
Setting up & using the pump
Cleaning the pump
Collecting, storing & transporting breastmilk
Breastfeeding
The premature baby
When should I feed my baby
Latching-on
Feeding positions
Length of feeding
Burping
Removing the baby from the breast
Supplemental feeding
Is my baby getting enough
Stools
Sleeping through the night
Weaning
Call the doctor if…
BENEFITS OF BREASTFEEDING
1. Mother’s milk is easily digested.
2. Mother’s milk contains extra defenses against infection. Each mom makes milk specific for her baby.
3. Breastfeeding allows you to experience a comfortable closeness to your baby.
4. Breastfeeding may be less stressful for the baby than bottle-feeding.
NUTRITION FOR THE BREASTFEEDING MOM
1. Drink plenty of fluids and water to help in milk production.
a. You should drink 6-8 glasses of water a day
b. It is helpful to drink a glass of water or juice every time you sit down to pump or breastfeed your baby
c. Be sure to drink enough to satisfy your thirst
d. Avoid coffee, tea or alcohol as they make you lose more fluid than you gain.
2. Eat a well-balanced diet.
a. Your body will naturally feel hunger for the extra calories you need—about 500-700 more calories per day than during your pregnancy
b. Include selections from each of the following groups:
Food Group / Requirement / What is considered a cup or ounceFruits / 2 cups/day / 1 cup of fruit
½ cup of dried fruit
Vegetables / 3 cups/day / 1 cup raw or cooked vegetables or juice
2 cups crisp raw leafy vegetables
Grains (Starch) / 8 ounces/day / 1 slice of bread
1 ounce ready-to-eat cereal
½ cup cooked pasta, rice, cereal
Meat & Beans (Protein) / 6½ ounces/day / 1 ounce meat, poultry, fish
¼ cup cooked dry beans
½ ounce nuts
1 egg
1 Tablespoon peanut butter
Milk (Dairy) / 3 cups/day / 1 cup milk
1½ ounces of cheese
8 ounces of yogurt
2 ounces processed cheese
c. Eat more dark-green and orange vegetables and cooked dried beans.
d. Make your ‘Grain’ choices whole-grain (e.g., whole wheat, brown rice) instead of refined grains (e.g., white bread or rice)
e. Choose low-fat or lean meats and poultry
f. Choose low-fat or fat-free milk, yogurt & cheese (e.g. 1% milk, skim milk, 2% cheese
g. These requirements are for the average breastfeeding moth. You may need more or less. Please check with you doctor to make sure you are getting enough and are losing the weight you gained during your pregnancy.)
3. Avoid “empty calories.” Foods that fill you up but do not give you much nutrition, such as: pizza, ice cream, hot dogs, potato chips, soda, cookies and candy.
4. Prenatal vitamins can be continued as long as you are breastfeeding or expressing milk.
5. There are no particular foods breastfeeding mothers must eat or must avoid eating unless they disagree with you or your baby.
6. A small amount of caffeine won’t harm your baby but do try to drink nutritional drinks whenever possible (e.g., juice, water, milk).
ALCOHOL AND MEDICATIONS
1. Alcohol crosses into breast milk. The effect of alcohol on your baby seems to be related to how much the mother drinks, but no amount is known to be safe.
a. Remember: alcohol may make you lose more fluid than you gain.
2. Almost all medications will pass into your breast milk. Most medications ordered by your doctor are safe to take and will not affect your baby.
a. Any medication you can take during a pregnancy is safe to take while you are breastfeeding
b. Take pain medicine just before pumping to decrease the effects of it on your baby and make you comfortable.
3. Please tell us about any medications or herbs you are taking.
a. Please list them on the label of the bottles of breast milk you bring into the NICU.
4. Street drugs are never safe and may cause harm if passed on in your breast milk.
5. Nicotine does go through your milk. It may decrease your milk supply and slow your let-down reflex.
a. Avoid smoking one hour prior to pumping, while you’re pumping or while you’re holding the baby
b. If you must smoke, smoke after breastfeeding or pumping and never around your baby
c. The less you smoke the better it is for your baby.
6. Limit your intake of caffeine to 1-2 times a day because it may cause your infant to be irritable and/or have trouble sleeping. Caffeine is found in soft drinks, coffee, tea, and chocolate.
TAKING CARE OF YOURSELF
1. It’s natural to feel tired and need extra rest after delivering a baby. Fatigue and stress may decrease your milk supply.
2. Relax and rest whenever possible. If possible, take a pillow along in the car and rest on your trips to and from the hospital.
3. Ask family and friends to help out with chores and other children at home so you can rest.
4. Remember you’re a new mom and need about 4-6 weeks to recover.
5. Ask friends or family to fix healthy snacks for you to take to the hospital while visiting (cheese, raisins, peanut butter crackers, fruits & vegetables).
PESONAL HYGIENE
1. Premature and sick babies can get an infection easily.
2. Shower daily. Use a gentle soap on your skin.
3. Wash your breasts with water only. Avoid soap on your nipple area as it may cause the nipple area to become dry and cracked.
4. Wear a clean bra daily (if you wear one). If one is worn, it should be comfortable and supportive. The bra should not feel tight against your breasts.
BREAST CARE
1. Wash your hands before expressing milk.
2. Change your breast pads often but especially when they become damp.
3. After pumping or feeding, allow your nipple to air dry before closing the bra, if you’re wearing one.
4. Nipple creams are not necessary unless you are experiencing nipple soreness. If you think you need a cream, talk with the lactation consultant or your baby’s nurse during a visit to the NICU.
BREAST PROBLEMS
1. Sore Nipples
a. Proper positioning of your baby on the breast can lessen sore nipples
b. Allow breast milk to air dry on your nipples for 10—15 minutes after pumping or breastfeeding
c. Change nursing pads as soon as they become damp
d. Some mothers get relief from sore nipples by placing warm moist tea bags on their nipples after nursing for 5—10 minutes at least 4 times a day
e. Do not pull your off the breast—break the suction, then remove your baby from your breast
f. Call your doctor if you have severe nipple pain with redness and/or white patches on the nipple.
2. Plugged Ducts
a. The presence of a lump in your breast can be a sign of a plugged duct.
b. Plugged ducts can lead to or mastitis (breast infection)
c. Follow these steps to correct plugged ducts:
· Apply a warm moist pack to area
· Massage area toward the nipple
· Breastfeed or pump frequently, starting on the affected side, and massage breast during nursing as well. Do not skip feedings or pumping
· Call your doctor for plugged ducts that do not get better within a few days.
3. Mastitis
a. Breast may be red, hot and tender. Mastitis is not as localized as plugged ducts.
b. You also may have flu-like symptoms (increased temperature, joint aches, headache, or nausea).
c. Call your doctor if you think you have mastitis. He may need to order an antibiotic.
d. Empty breast frequently by feeding or pumping
e. Apply warm, moist compress before and during pumping.
f. Get as much rest as possible.
g. Most important factors to relieve mastitis:
· Frequent are nursing or pumping
· Warm moist compresses
· Bed rest.
PUMPING
1. Begin pumping as soon as possible after birth—preferably within the 1st 24 6 hours.
a. Your 1st attempt at pumping should be viewed as a practice session with you learning how to set-up and use the pump
b. Pump regularly, at least 8 times each day
c. Frequent nursing is the best way to maintain or increase your milk supply
d. Using a breast pump is a temporary substitute until your baby can breastfeed on a regular basis.
2. Wash your hands before handling your breasts or breast pump pieces that touch the milk.
3. Massage each breast 2—3 minutes before beginning to pump.
a. Move both hands in small circular strokes from the outer areas of the breast (under your arms) to just behind the areola (dark area round nipple)
b. Work each breast in a clockwise direction until you have massaged the entire breast surface
c. Your breast may feel lumpy
d. DO NOT Rush! Make yourself comfortable during pumping; try listening to relaxing music.
4. Drink a glass of water while you’re pumping.
5. Things to help with the “let-down” reflex:
a. Take a warm shower or apply warm cloths to your breasts before pumping
b. Look at your baby’s picture or talk to your baby while pumping
c. Call the NICU to check on your baby before starting to pump
d. Close your eyes and imagine holding your baby in your arms.
6. Pump 1st thing in the morning and every 2—3 hours during the day.
7. Pump at least 15 minutes or 2 minutes after the last drops of milk, whichever is greater, on each breast each time you pump.
a. Massage your breasts paying particular attention to any area that is tender or feels lumpy
b. Once your milk has stopped flowing, pump an additional 2 minutes
c. It’s important to empty your breasts. The last drops of milk are high in fat & calories which can help your baby to grow.
8. Pump the last thing before going to bed at night.
a. You can allow 5 hours between nighttime pumping; if breast fullness happens, you may need to pump sooner than 5 hours
b. As your baby begins to nurse and gets closer to going home, you may need to pump more frequently at night to meet your baby’s schedule.
9. If you plan on pumping when you visit your baby please bring your breast pump kit with you, we will not be able to provide you with another kit.
10. Electric Pumps
a. Recommended for use by mothers who have sick or preterm babies. You need an electric, hospital-grade pump to maintain an adequate milk supply for a NICU baby
b. Breast pumps may be rented. A list of rental companies can be found on the Community Resource List.
c. If you are WIC-Qualified, WIC will provide an electric pump for home use while your baby is in the NICU. Contact the WIC office for an appointment soon after your baby is born and admitted to the NICU.
d. Check with your insurance company; some companies will cover the cost of renting an electric pump.
11. Hand Expression
a. Place your hand on your breast at the edge of the areola, with your thumb above, the other fingers below the areola. Press on breast toward your chest, then squeeze the breast by rolling your thumb and fingers forward. Repeat this action in a rhythmic motion
b. Milk will come out in small spurts.
c. Move hand around your breast several times to reach all the milk ducts
d. Place the collecting container between your index finger and nipple to avoid milk running over your finger; hold container with your other hand. Express until milk no longer streams from your breast.
e. Breasts empty in about 20 minutes.
12. Hand Pump Expression
a. Hand pump expression is not recommended for frequent pumping or to establish a milk supply.
b. Use a hand pump as a temporary method of pumping when you are occasional separated from your baby or if an electric pump cannot be quickly obtained
c. Types of pumps available are the cylinder-shaped pump and the battery-operated motor pump
d. Cylinder-shaped pump:
· Sold under several brand names
· Nipple and areola positioned in breast shield. Suction is created by mother extending and releasing outer cylinder in a forward-backward motion while holding shield of inner cylinder over breast
· Sometimes hard on breast tissue with long-term use
e. Battery-operated pump:
· Available under several names
· Breast shield is placed on the breast and pump is turned on
· Mother pushes button on side of pump in push-release-push-release rhythm.
SETTING UP & USING THE PUMP
1. Wash your hands before expressing or pumping your breasts.
2. Do not touch the inside of the bottles when you are setting up and attaching the kit.
3. Make sure all parts of the kit are firmly put together.
4. With the pump turned off, place the breast shield over your breasts; the nipple should be in the center of the opening of the breast shield.