Archive for the 'Breastfeeding' Category

Is Baby Weaning or Is It a Nursing Strike?

by Nancy Mohrbacher, IBCLC

Your baby has been nursing well for months, then suddenly begins refusing the breast. What does it mean? Is there something wrong with your milk? Is baby sick? Is baby ready to wean?

When a baby refuses to breastfeed, it may not be because he or she is ready to wean. If the baby is younger than a year and has not been eating much solid food or drinking from a cup, the most likely cause is a nursing strike.

A nursing strike is a baby’s way of communicating that something is wrong, and many babies who go “on strike” are obviously unhappy about it. Some nursing strikes come on suddenly, others more gradually. But a nursing strike does not have to mean the end of breastfeeding. If a mother encourages her baby to continue breastfeeding, a nursing strike usually lasts between two and four days, although some last longer. With lots of patience and persistence it is almost always possible to convince the baby to go back to nursing, which offers many benefits to both mother and baby.

POSSIBLE CAUSES OF A NURSING STRIKE

Sometimes the cause of a nursing strike is obvious, but other times, the mother may never discover the reason. Some common causes include:

  • mouth pain from teething, injury, cold sore, or a fungus, such as thrush,
  • an ear infection, which may cause pressure or pain while nursing,
  • pain while being held in the nursing position, perhaps due to an injection or an injury,
  • a cold or stuffy nose that makes breathing difficult while nursing,
  • too many bottles, overuse of a pacifier, or frequent thumbsucking, which may also lead to a reduced milk supply,
  • regular distractions and interruptions while nursing,
  • a strong reaction to a baby’s bite,
  • yelling or arguing while nursing,
  • overstimulation, stress, or tension from an overly full schedule or an upset in the home,
  • an unusually long separation from mother,
  • a major change in routine, such as moving or traveling,
  • limiting and/or rigidly scheduling feedings,
  • repeatedly putting off the baby when she wants to nurse or leaving her often to cry.

Becki Hallowell from Guam discovered on the third day of six- month-old Todd’s nursing strike that “we had all the usual causes and then some. We all had bad colds. (Todd’s was the worst.) We were all very tired and in a new situation with extra stresses. Todd’s grandparents, whom we hadn’t seen in a year, were visiting us for a month. During their visit, Grandpa ended up in the hospital. There had also been two deaths in our family within a week of each other only a few days before. Todd had been biting me due to teething, and I had reacted strongly.”

Other, less common causes of a nursing strike include: sensitivity to a food or drug the mother or baby has ingested (including vitamin or mineral supplements and fluoride drops), creams or ointments applied to the mother’s nipples, change in the taste of the mother’s milk due to a breast infection, and a reaction to a new product (such as a soap, shampoo, or laundry detergent) the mother has used on her body or her clothing. Iowa mother Carol Strait had to play detective to find the reason for her two-and-a-half month old daughter’s nursing strike. “My first clue was that Christie always seemed fussier and wouldn’t nurse when we went somewhere. This was because I had just showered and applied spray deodorant. I’m not sure what ingredients in the spray were responsible. My big problem was easily solved by simply switching from a spray to a solid stick deodorant.”

Naturally not all babies will respond to all of these possible causes by refusing to nurse. Some babies are more sensitive than others, and different babies will display a wide range of reactions to the same thing. For example, one baby with an ear infection might continue nursing well, while a second baby becomes fussy at the breast, and a third baby refuses the breast altogether.

AN UNHAPPY TIME FOR EVERYONE,

No matter what its cause, a nursing strike is upsetting for everyone. The baby may be unhappy and difficult to calm. The mother may feel frustrated and upset and worry that her baby is rejecting her. She also may feel guilty, believing that her baby’s refusal to nurse means she has done something wrong.

Anne Monroe from North Carolina, whose daughter Meghan went on a five-day nursing strike at eight months, “felt terrible grief and rejection during the strike.” Victoria Schnaufer from Pennsylvania, who weathered a ten-day nursing strike with her son Jonathan, says, “Until Jonathan went through a nursing strike at eleven months, I had no idea how emotionally stressful and physically draining this challenging breastfeeding situation could be. By the third or fourth day I was extremely frustrated and was becoming angry.” Carol Strait found her mind racing when two-and-a-half month old Christie began refusing the breast. “A thousand thoughts ran through my mind–I must be eating the wrong foods, maybe she was teething, I was probably too nervous (what nursing mother wouldn’t be nervous when her new baby suddenly refused to nurse?), perhaps she was weaning herself–and even the fearful thought that she didn’t like me!”

There are also physical considerations. As the baby misses feedings, the mother will soon become uncomfortable as her breasts fill up with milk. If her breasts become engorged, she will be at risk for a plugged duct or breast infection. And the baby still needs nourishment. Worries about how to feed the baby can add to the mother’s upset.

KEEPING MOTHER AND BABY COMFORTABLE

While the mother is trying to persuade her baby to take the breast, she will probably need to express her milk about as often as her baby had been nursing. This will keep her comfortable, prevent plugged ducts, and provide her baby with the milk he or she needs.

Expressing milk by hand or with a small breast pump is a learned skill that takes practice to master. If a mother whose baby is on strike is having difficulty expressing her milk, another option is to rent a full-size electric breast pump (available at many medical supply houses and drug stores). The full-size electric pump does not depend upon skill or practice to be effective, because its suction- and-release mechanism automatically mimics the suck of a breastfeeding baby. A double-pumping attachment is available with this type of pump that allows both breasts to be pumped at the same time, cutting pumping time in half.

Then the mother needs to decide how to give her expressed milk to her baby. Most mothers think of bottles first, but it may make it easier to convince a baby to go back to breastfeeding if bottles and pacifiers are avoided during a nursing strike. Artificial nipples satisfy the baby’s urge to suck, decreasing the desire to nurse. In some hospitals in Africa, bottles are never used. Even premature and ill babies are fed from small cups. If the baby is already drinking from a cup, try offering the expressed milk in that. Other feeding methods include spoon, eyedropper, and feeding syringe. Using a different feeding method may be messy at first, but with patience and practice, a baby will usually master it quickly.

The mother also may be concerned about whether her baby is getting enough milk. To set her mind at ease, she can keep track of her baby’s wet diapers. At least six to eight wet cloth diapers per day–five to six disposables–indicate that the baby is receiving enough fluid.

GETTING BABY BACK TO THE BREAST

Patience and persistence are the keys to getting a baby back to the breast. But if either mother or baby become frustrated when the breast is offered, it is time to stop and try again later. Attempts to breastfeed should be kept as pleasant as possible, so that the baby will associate nursing with positive feelings.

The following time-tested suggestions have helped many mothers overcome a nursing strike.

  • Try nursing when the baby is asleep or very sleepy, such as during the night or while napping. Many babies who refuse to nurse when they are awake will nurse when they are sleepy.
  • Vary nursing positions. Some babies will refuse to nurse in one position but take the breast in another.
  • Nurse when in motion. Some babies are more likely to nurse when rocking or walking rather than sitting or standing still.
  • Nurse in an environment that is free from distractions. Some babies, especially babies older than three months or so, may be easily distracted. Turn off the radio and television, and try nursing in a quiet, darkened room.
  • Give the baby extra attention and skin-to-skin contact. Focused attention and extra touching are comforting to both mother and baby. When offering the breast, whenever possible undress to the waist and clothe the baby in just a diaper. A baby sling or carrier can help keep the baby close between attempts to nurse. Taking warm baths together can also be soothing. Sleeping together provides extra closeness and also provides more opportunities to nurse while the baby is sleeping.

Sharon Stauffer from Ontario, Canada, “realized that I had been very busy with a new responsibility and had not given a lot of attention lately to my baby. Ten-month-old Sheldon is usually a very contented child, willing to play nicely by himself, so I unconsciously ignored him. He became more irritable and demanding and he stopped nursing. When I understood what the problem was I immediately laid aside all my other work and for two days played with him and held him a lot. After a while, he let me cuddle him again, and then he nursed while he was asleep. Finally, after three days, he nursed while he was awake and more often, as he had before.”

Monica McMaken from Arizona, whose son Ryan had a stuffy nose and went on strike at two months, found two suggestions especially helpful. “First, I nursed Ryan while he was sleeping, but if he woke up he would stop. Second, I tried nursing him while walking up and down the hall. If I sat down he would stop nursing. My arms sure were sore, but I was so happy to have my baby nursing again.”

Viola Marshall from British Columbia, Canada, blamed her son Keegan’s nursing strike on the three-to-four-hour schedule recommended by the hospital. Keegan spent many hours crying while Viola watched the clock. With the benefit of hindsight she wondered, “How many hours could have been saved for us both if I had given up the schedule!” The most helpful advice came from her husband, “who convinced me to nurse Keegan when he wanted, and not to use ‘fillers’ like apple juice in a bottle or a pacifier in between our scheduled nursings. Nothing changed overnight; it took three days of devoting myself totally to Keegan and trying to nurse him whenever he cried. The first two days he refused to nurse during the day, and I manually expressed my milk, feeding it to him by cup and spoon. Fortunately, he nursed willingly and happily in his sleep. Once Keegan’s nursing strike was over and the schedule was forgotten, nursing became less tense, more comfortable for both of us, and the time never became important again.”

Lee Roversi from Connecticut, who had been feeling overwhelmed by her son Sky’s “seemingly constant need to nurse,” had a change of heart when his erupting eye teeth made nursing painful for him and he went on strike. “We spent the next two days in almost constant touch– holding, reading, cuddling, bathing together, rocking. Thankfully, he would nurse in his sleep during the night and that, along with hand- expressing some of my milk, kept my breasts from becoming uncomfortably full. When his strike ended and he asked again for ‘nanas’ I knew that I had regained my perspective. All else could wait–indefinitely–while I treasured the moment.”

Breastfeeding in Public

by Nancy Mohrbacher, IBCLC

Despite decades of research proving that “breast is best,” we still live in a bottle-feeding society. As many nursing mothers discover, everything from hospital feeding schedules to weight gain charts are based on artificial feeding as the norm. Another reflection of this bottle-feeding bias is the current debate on breastfeeding in public sparked by the new Florida law stating that a woman who breastfeeds in public cannot be charged under any obscenity, lewdness or public nudity laws. No one thinks twice about giving a baby a bottle in public. Yet many women worry about offending others by breastfeeding.

These social pressures convince some women not to try breastfeeding at all. They imagine that breastfeeding will relegate them to the back bedroom at family gatherings, to breastfeeding in toilet stalls in restaurants, and keep them at home with their babies when they would rather be at the beach or at the ball game. No mother wants to feel that she is doing something socially unacceptable by feeding her baby.

Although a 1986 public opinion survey found that only 14% of Americans feel uncomfortable seeing a woman breastfeed in public, mothers still worry. Yet despite these worries, most women do breastfeed–some for a short time, but others for months and even years. With experience, these mothers find ways to make breastfeeding a normal part of their everyday lives, even in a society like ours that approves of breastfeeding in theory but not always in reality.

NURSING DISCREETLY

In most parts of the world no one gives a second thought to the sight of a nursing mother, whether she is discreet or not. In our society, however, some people object to breastfeeding in public–even when it’s done discreetly. Some confuse breastfeeding with excretion, since bodily fluids are involved. They believe women should breastfeed in the bathroom. Yet few adults would dream of eating their lunch in a public restroom. The smell and the second-hand smoke make them unappetizing places to dine, for adults and babies alike. Others object to breastfeeding in public because they confuse breastfeeding with sex, since breasts are associated with sexual foreplay. Yet exposed and semi-exposed breasts have become standard fare on beaches, in movies, and in advertising. It seems odd that the slight exposure involved in discreet breastfeeding would be perceived as scandalous. Yet because of this vocal minority, most women prefer to draw the least possible attention to themselves and their babies by breastfeeding discreetly.

Although at first most mothers feel nervous about breastfeeding in public, with a little preparation and practice, discreet nursing quickly becomes second nature. A mother can learn to nurse her baby so discreetly that only another nursing mother knows for sure. Most onlookers assume her baby is sleeping in her arms.

One easy way to prepare before venturing out is by nursing in front of a mirror at home. A new breastfeeding mother may also feel more at ease if she practices inconspicuous nursing with the baby’s father or a friend as a critic.

Mothers have discovered many helpful tricks, such as using a baby blanket as a cover-up. Some mothers drape the blanket over their shoulder to cover the baby, while others wrap the baby in the blanket and pull the corner up over their breast. This allows the mother to see her baby, which can make latching on easier, and it doesn’t cover the baby’s head and face, which bothers some babies.

The mother’s choice of clothing can also make discreet breastfeeding easier. Two-piece outfits allow a mother to lift her clothing from the bottom, with the baby’s body covering any exposed skin. Unbuttoning blouses from the bottom up, rather than from the top down, gives the least exposure. Jackets, cardigan sweaters, and overblouses also provide extra coverage. Although special clothing is not necessary, nursing fashions are also available with special openings and panels to make discreet nursing even easier. These include one-piece dresses for casual or dressy occasions, blouses, tops, nightgowns, and bras. To receive a free directory of companies that sell nursing fashions, send a stamped self-addressed envelope to: The Association for Breastfeeding Fashions, P.O. Box 4378, Sunland CA 91041.

Baby slings can also make breastfeeding in public easier. Unlike baby carriers that hold babies upright, baby slings consist of soft fabric that allows the baby to be carried in a variety of positions, including the nursing position, with padding at the mother’s shoulder for comfort. Many mothers find nursing a baby in a sling the height of ease and modesty, because they simply pull up the extra fabric to cover the baby. This allows them to nurse their babies while walking through the shopping mall (or anywhere else) with no one the wiser.

FINDING A PRIVATE PLACE

Even mothers who are usually comfortable breastfeeding in public may sometimes prefer more privacy. Perhaps the baby is tired or fussy and needs more quiet to settle down or the mother feels she would be more relaxed without a crowd around. How much privacy a mother wants will vary. One mother may ask for a seat at the back of a restaurant out of direct view rather than in the front, while another mother may opt for the restroom. At a shopping mall, one mother may look for a bench off to the side, while another will seek out a lounge or a clothing fitting room, which provides privacy without the bathroom smell.

Family gatherings may present a challenge if family members are unsupportive or hostile toward breastfeeding. In a situation like this, a mother may feel that she has no choice but to withdraw to the bedroom to nurse her baby.

My personal experience is, however, that attitudes can change. Some families just need time to adjust. I was the first in three generations to breastfeed, and although my mother and grandmother were supportive of breastfeeding, I was nervous about how they would react at our family’s holiday gathering. When I arrived with husband and newborn, my mother asked me to please nurse in the back bedroom so that my younger brothers, (two grown men, both of whom were married) wouldn’t “see anything.” To keep the peace, I decided to comply, but with the extra excitement and stimulation of the crowd, the baby wanted to nurse more often than usual, and I found herself spending most of my time in the back bedroom. In frustration, I finally decided to throw a baby blanket over my baby while I nursed so as not to offend, and I spent the rest of the evening with her family. After a few more family gatherings using the blanket, I began nursing without it and no one seemed to notice. Years later, when her brothers and their friends began bringing their babies to her parents’ home, she heard her parents tell them, “You don’t have to go in the other room. Stay in here with us and breastfeed. We’re used to it.”

CHANGING THE CULTURAL NORM

This familiarity with breastfeeding is the key to changing our cultural norm. Once breastfeeding becomes a natural and expected part of everyday life, breastfeeding in public will cease to be an issue. Girls and boys will grow up seeing mothers breastfeed and think of it as the natural process it is. Rather than giving bottles to their baby dolls while playing house, they will offer to nurse instead.

Early this year a significant step was taken in making breastfeeding a more common sight when the Florida legislature passed a bill guaranteeing a woman’s right to breastfeed in public. Florida Representative Miguel De Grandy, the main sponsor of the bill, was inspired to file the bill after reading an article in the Miami Herald by columnist Michelle Genz, who was criticized by a security guard while breastfeeding her four-month-old son at a shopping mall. Many Florida women came out in support of the bill, including the daughter of Florida Governor Lawton Chiles, Rhea Chiles MacKinnon, who nursed her baby at a House committee meeting while lobbying for the bill’s passage.

After he signed the bill into Florida law, Governor Chiles said, “It’s not a shameful act that ought to be hidden behind closed doors. It’s a time of bonding and nurturing between a mother and her baby. We know breastfeeding ought to be encouraged.” Rep. De Grandy said that since filing the bill he has heard from dozens of women who had also experienced harrassment for breastfeeding in public, either at shopping malls or at restaurants. De Grandy says, “Now they can say, ‘I’m sorry, it’s the law.’”

Dad and the Breastfeeding Baby

by Nancy Mohrbacher, IBCLC

For most couples, the weeks and months after the birth of a baby are some of the most joyful and stressful times of their lives. Along with the miraculous wonder of staring into a newborn’s eyes, comes the fatigue of sleepless nights and the emotional vulnerability of changing roles and shifting relationships.

During this time of transitions, breastfeeding affects family dynamics. Although many couples choose breastfeeding in part for the “closeness” it brings, they are often unprepared for the intensity of this physical link between mother and baby. Nursing is more than feeding; it is an act of intimacy. Breastfeeding hormones relax the mother and heighten her sensitivity to her child, evoking an intense desire to respond to his cries. The nursing baby experiences his mother through all five of his senses, finding security and comfort as well as milk at his mother’s breasts.

Since the new father lacks this intense physical link and natural source of comfort, what does this mean to his relationship with his baby? In recent studies, fathers of breastfeeding babies report feelings of frustration and inadequacy because they were unable to easily comfort their babies during their wives’ absence. When they realized their relationship with their baby was different from their wives’, they felt a sense of loss. Even so, the fathers continued to support breastfeeding because of its many health and emotional benefits. Those who wanted to be most actively involved with their babies reassured themselves that this difference “wouldn’t last forever” and found other ways to be involved in their babies’ care. Rather than attempting to duplicate the breastfeeding relationship, they found that they could develop their own unique relationship with their children.

In some fathers, though, feelings of frustration and inadequacy cause them to back off and become even less involved in their baby’s care, leading to resentment and jealousy at their wives’ absorption with the baby. Some fathers perceive the mother-baby bond as a threat.

What should a couple do if the new father begins to develop feelings of resentment or jealousy? In her book, Mothering and Fathering: The Gender Differences in Parenting, Tine Thevenin writes:

“The adjustment that comes with having a child takes effort and understanding. Instead of allowing misunderstandings about each other’s feelings to create a rift, I would suggest that both partners explore and acknowledge their own–and each other’s–emotional responses, while at the same time adopting an attitude of, ‘How can I be of greatest help in our relationship and our family?’”

No matter how his baby is fed, each new father has an important choice to make. Will he allow himself to feel left out and become a bystander in his baby’s care? Or will he take an active role in developing a positive relationship with his baby?

The relationship between father and child is intimately linked to the emotional health of the whole family. The couples’ relationship will be affected, as well as the mother’s ability to meet her own needs. When a mother has confidence in the father’s good relationship with their baby, she will feel freer to take the time she needs for herself. And when she sees her baby and his father happy together, it makes her feel even better about her partner.

WHAT ABOUT BOTTLES?

Although feeding is one way to interact with a baby, many couples have found that giving bottles doesn’t guarantee closeness. Julie Stock, mother of three, discovered this when she walked in on her husband absent-mindedly feeding their firstborn a bottle with his eyes glued to the football game on television. She and her husband decided to forgo bottles with her next two children and later came to the conclusion that during their babyhood “my husband actually felt closer to the two children who didn’t get bottles, because he had to invest more of himself and be more creative during their time together.”

If the father will be giving bottles, such as when the mother is out for a few hours or if he will be caring for the baby when she goes back to work, it is best to wait until the baby is about a month old before introducing them in order to avoid nipple confusion. Most babies find it confusing to switch back and forth between the breast and artificial nipples during the early weeks while they are just learning to breastfeed. If a baby becomes nipple confused, he may try to nurse the breast like a bottle, causing sore nipples, or he may refuse the breast. Once a baby has been breastfeeding well for three to four weeks, nipple confusion is much less likely to develop.

In Becoming a Father William Sears, MD, pediatrician and father of eight, writes:

“I discourage supplemental bottles especially during the first month because of the risk of disturbing the breastfeeding harmony that mother and baby are working so hard to establish. Instead I encourage fathers to understand, respect, and support the uniqueness of the breastfeeding relationship….In the meantime, supplemental nourishment from dad should go to the mother.”

WHAT FATHERS CAN DO

There are many other ways a father can develop a positive relationship with his breastfeeding baby. First, be aware that mixed feelings about fatherhood are normal. And if a baby obviously prefers mother and is unresponsive to a father at first, it may feel frustrating and discouraging. But even if this happens, it is important to continue to work at the relationship. Some babies take a while to warm up to their fathers’ overtures. Sensitivity and patience go a long way to building closeness.

One way to show sensitivity to a baby is by being aware of and responding to her cues. Notice what happens when you talk to her. Tiny babies have a short attention span and are easily overstimulated. If she turns away, seems uninterested, pensive, or drowsy, just hold her close or try again later. Eye contact, reaching out, or smiling may mean that she’s ready to interact. Just like adults, each baby is a person with preferences. She may like some ways of touching, holding, and playing and not others. If she likes what you’re doing, keep it up and try it again another time. If she does not respond or seems upset, try something else.

Dr. Sears confesses in his book, Becoming a Father, that he didn’t learn how to be a fully involved father until his sixth child. In this book he shares his insights about how he became close to his breastfeeding baby and gives tips for others. His suggestions for fathers and babies younger than three months (the age that many fathers find particularly challenging) include a lot of touching and holding, which he feels helps a father and baby “feel right” together. Some of these early activities include:

  • the “neck nestle,” in which the baby nestles her head against the front of the father’s neck;
  • the “warm fuzzy,” in which the father drapes the infant, skin-to-skin over his chest with the baby’s ear over his heartbeat;
  • various holds that the father can use to comfort his baby;
  • bathing together;
  • wearing the baby in a carrier or sling;
  • infant massage.

HOW MOTHER CAN HELP

The mother’s role in encouraging a strong father-child relationship is one that is very difficult for many new mothers to carry out. During the time when nature programs her to protect her baby at all costs, she needs to overcome her natural inclination to hover while the father cares for the baby. She needs to keep quiet when she feels the urge to comment on or criticize the father’s efforts. (Does it really matter if the baby’s shirt is on backwards and his diaper is a little loose at first?) She needs to step back and let the father-child relationship develop without her. The more of a perfectionist the mother is, the more difficult this can be.

Ginny Rossi, a first-time mother, tells how she helped encourage her husband and son to become close:

We started off slow. During the early weeks my husband would sit next to us while we nursed, touching and caressing Marco, and afterwards he would do the burping. Eventually, after burping, Marco began to fall asleep on his dad’s chest and got used to being close to him. After some weeks of this, Marco was more willing to be comforted by his dad.

Now that Marco is eight months old, my husband is able to take him for a couple of hours every day, and they both look forward to their time together. Not only does it make me happy to see them enjoying each other so much, but this gives me a needed break, which helps me feel better about full-time motherhood. I am convinced that their closeness today stems from their early time together.

In this age of equal partnership between the sexes, one of the lessons of pregnancy, childbirth, and breastfeeding is that sharing an equal commitment to parenthood does not mean fulfilling the same roles. A baby does not need two mothers. Baby stands to benefit most when mother is most fully mother and father is most fully father. During a breastfeeding baby’s early weeks and months this may mean that the relationship between mother and baby is more intense. But a newborn needs his father, and this need grows as he grows. With father and baby, just as with any relationship, greater investment brings greater rewards.

Plugged Ducts, Breast Infections, and Mastitis

by Nancy Mohrbacher, IBCLC

Some women breastfeed without problems. Obviously breastfeeding is a process that tends to work, or the human race would not have survived until this century. But if a breastfeeding problem does arise, information and support are available to help overcome it, almost always without sacrificing breastfeeding in the process.

A plugged duct or breast infection, also known as mastitis, is one breastfeeding problem some nursing mothers encounter. Often it starts small, just a sore spot or lump in one breast. It may go away on its own, without doing anything special. Or it may not. The pain may worsen, and instead of staying confined to a small area, the soreness may spread through the breast, making breastfeeding painful and leaving the mother feeling feverish and ill.

In most cases, a mother can treat and heal a plugged duct or breast infections on her own. But whether a mother handles it herself or consults her doctor and receives medication, continuing to breastfeed is nearly always best for her and her baby.

PLUGGED DUCT OR BREAST INFECTION?

The difference between a plugged duct and breast infection is usually one of degree. A plugged duct refers to a sore or tender spot or lump in the breast not accompanied by a fever. This happens because a milk duct is not draining properly and has become inflamed. Pressure builds up behind the plug, causing inflammation in the surrounding tissues. This is also sometimes referred to as “caking,” and it usually occurs in only one breast.

If the soreness or lump is accompanied by a fever and/or flu-like symptoms (feeling tired and achy or run-down), it is called a breast infection. Other symptoms, such as nausea and vomiting, may also occur with a breast infection. A breastfeeding mother will sometimes develop a breast infection when other members of the family suffer from colds or the flu. Like a plugged duct, a breast infection usually occurs in only one breast.

TREATMENT IS THE SAME

Whether breast soreness is caused by a plugged duct or a breast infection, the treatment is the same: apply heat, breastfeed often on the affected side, and rest.

Applying heat increases the circulation to the sore area, speeding healing. Some mothers use a heating pad or baby-sized hot water bottle. It can also help to gently massage the area. While applying heat, gently massage the area and remove any dried milk secretions on the nipple by soaking it with plain water. One easy way to do this is to soak and massage your breast while lying on your side in a warm bath or while standing in a warm shower. When massaging, gently press on the lump using the palm of your hand and all your fingers in a gentle but firm circular motion, working toward the nipple. To help loosen the plug, breastfeed the baby or express some milk right after treating the sore area with warmth and massage.

Frequent nursing will keep the breast from becoming overly full and keep the milk flowing freely. As long as the breast is tender or warm to the touch, encourage the baby to nurse at least every two hours, including during the night, nursing on the affected side first.

Rest is the third crucial part of the treatment. Often a plugged duct or breast infection is the first sign that a mother is trying to do too much and is becoming overly tired. If possible, clear your schedule and go to bed with the baby until you’re feeling better. If that’s not possible, at the very least eliminate all extra activities and spend an extra hour or two relaxing with the baby at the breast and your feet up.

There are also other things that can help speed healing. First, loosen any tight clothing, especially your bra. Second, check the baby’s position and latch-on. Make sure when the baby latches on to the breast, she is facing the breast (so she doesn’t have to turn her head to nurse) and opens her mouth wide (like a yawn) so that she gets a big mouthful of the breast in her mouth. As she is going on to the breast, pull her in close. Good positioning and latch-on enable the baby to drain all the milk ducts more effectively at every feeding. Third, try different nursing positions. If you usually nurse sitting up, try nursing lying down or in the football hold for a couple of feedings. Some suggest positioning the baby so her nose or chin point in the direction of the plug.

WHEN TO CONTACT THE DOCTOR

By following these measures most mothers feel better within twenty-four hours. But if this doesn’t happen–if the fever persists or the symptoms worsen–contact your doctor, who may prescribe an antibiotic.

With some types of breast infection, a doctor should be contacted without delay. For example, if both breasts are affected, the nipple looks infected, if there is any pus or blood in the milk, if there are red streaks near the sore area, or if the symptoms came on suddenly and severely, these are signs of a bacterial breast infection and it should be checked by a doctor immediately.

Even if an antibiotic is necessary, continuing to breastfeed is best for you and your baby. Most antibiotics are compatible with breastfeeding. Babies are prescribed antibiotics when ill, and the baby would receive far less of the antibiotic through his mother’s milk than he would if he were receiving a treatment dose. If your doctor is not sure that the antibiotic is compatible with breastfeeding, check with the baby’s doctor. If the drug is questionable, ask the doctor to prescribe an antibiotic that is compatible with breastfeeding. If an antibiotic is prescribed, be sure to take it for the whole course of treatment.

POSSIBLE CAUSES

Knowing the reason for the plugged duct or breast infection can be reassuring and can help prevent it from happening again. The most common causes of a plugged duct or breast infection are: missed or shortened feedings, consistent pressure on the breast, and poor latch-on or positioning.

Anything that postpones nursing or reduces a baby’s time at the breast can result in overly full or engorged breasts and increase the risk of mastitis. For example, if a mother limits feeding times, she may cut nursings short before the baby has a chance to soften the breast, leaving her uncomfortably full. Giving supplementary bottles, whether of water, juice, formula or her own milk, can increase the time between nursings. Overuse of a pacifier can also contribute to this problem, because the baby spends less time at the breast. Busy schedules around holidays and vacations may mean nursings are postponed. Also, if the mother is beginning work or school outside the home, changes in routine may cause nursings to be postponed or eliminated. In this case, the mother may need to express her milk (or express it more often) while she is away from her baby.

Sometimes, though, it is the baby who changes the nursing pattern, either by starting to sleep through the night or breastfeeding more often during one part of the day and less often at other times. A baby who is teething or has an ear infection or cold may also cut nursings short or refuse to nurse altogether due to discomfort. Some babies simply go longer than usual between feedings yet still have a healthy weight gain and thrive. Eventually, the mother’s milk supply will adjust to the baby’s pattern, but until it does she may need to express her milk whenever she begins to feel full.

Consistent pressure on the breast is another common cause of a plugged duct or breast infection. Any consistent or sustained pressure on any part of the breast can restrict the flow of milk and cause inflammation. Possibilities include: a tight bra or one that does not support well; a tight bathing suit; a baby carrier, heavy purse, or diaper bag with straps that put pressure on the breasts; thick breast pads or breast shells that cause a bra to be too tight; pressure on the breasts from sleeping on your stomach; the baby resting on your breasts; and pressing down on the breasts during feedings.

Another common cause is poor latch-on or positioning. If the baby is not latching on well–if she is grasping the breast near the end of the nipple rather than further back on the areola–she may not be milking the breast effectively, causing the breast to become overly full or the ducts to be emptied unevenly. Poor positioning and latch-on can also cause sore nipples, which may result in postponed feedings.

Other, less common causes include: a baby with a weak suck, who is not able to empty the breast (the baby would also gain weight slowly), fatigue, stress, and/or anemia in the mother, an overabundant milk supply, nipple damage, use of a nipple shield (worn over the nipples during feedings), and breast abnormalities.

BREASTFEEDING CAN AND SHOULD CONTINUE

At one time it was standard procedure to recommend weaning with a breast infection. But experience has shown that a breast infection clears up more quickly when the breast is not allowed to become overly full, and there is less risk of it developing into an abscess. Also, even temporary weaning is a hardship when a mother is not feeling well. As for the baby, antibodies in the mothers’ milk protect the baby from any bacteria.

In almost all cases, the best thing a mother with a plugged duct or breast infection can do for her and her baby is to keep nursing.

When a Nursing Mother Gets Sick

by Nancy Mohrbacher, IBCLC

When a mother gets sick, the whole household may be disrupted. And when the mother is also breastfeeding, she not only has her own health problems to contend with, but she may worry about how her illness or her medication will affect her nursing baby.

BREAST IS STILL BEST

Even during the mother’s illness, both mother and baby almost always benefit from continuing to breastfeed. When a nursing mother is exposed to an illness, her body begins producing specific antibodies to protect her breastfeeding baby from it. By the time the mother begins to feel sick, her baby has already been exposed to her illness. Continuing to breastfeed helps a baby fend off the mother’s illness, and if he does get sick, he almost always has a milder case, due to the antibodies and other immune factors he receives from his mother’s milk. By washing her hands regularly and limiting face-to-face contact with her baby, a mother can further decrease her baby’s chances of catching her illness.

Continuing to breastfeed also has advantages for the mother. She can conserve her strength by tucking the baby into bed with her and breastfeeding lying down when the baby gets hungry. If she must care for her baby alone, she is also spared the necessity of buying or preparing formula. Breastfeeding also adds to a mother’s feeling of normalcy through a difficult time, and it may be the one way she can contribute to her baby’s well-being when she can do little else for him.

On the other hand, abrupt weaning during an illness can compound a mother’s physical problems by causing uncomfortable breast fullness, engorgement, or even a breast infection. Sudden weaning can also be emotionally difficult, because in addition to being a method of feeding, breastfeeding is also a way of giving and receiving love. Abrupt weaning can also be difficult for a baby. If his familiar source of nourishment and comfort is suddenly taken away, the baby may be difficult to console, disrupting the household even more. Also, weaning will deprive the baby of the mother’s antibodies and immune factors that protect him from illness. There is also the chance that the baby will have an adverse reaction to the formula.

Breastfeeding can continue through most illnesses: colds, the flu, infections, food poisoning, measles, rubella, Lyme disease, chickenpox, cholera, typhoid fever, parasites (such as giardia and malaria), leprosy, hepatitis, even cancer, if chemotherapy is not used. Many mothers have also breastfed through chronic illnesses, such as arthritis, asthma, diabetes, lupus, cystic fibrosis, multiple sclerosis, epilepsy, and thyroid disease.

THE RARE EXCEPTIONS

Although breastfeeding can continue through most illnesses, there are exceptions. Chickenpox or measles do not usually interefere with breastfeeding, but when the mother contracts either of them within five days before childbirth, some doctors recommend that mother and baby be separated at birth to minimize the chances that the baby will become infected. (About half of babies will develop a mild case of these diseases despite the separation.) Both chickenpox and measles are potentially more serious for the newborn than they are for the older baby. Despite the separation, the mother can provide her milk for her baby until they are reunited.

Tuberculosis is another illness that may preclude breastfeeding, depending upon the mother’s condition. If the mother is allowed to be with her baby, she may be able to breastfeed. But if her tuberculosis is active in the lungs and can be transmitted by close nose-and-mouth contact, she will probably be separated from her baby until treatment has rendered her noninfectious. In countries where tuberculosis is prevalent, many women breastfeed without incident.

Herpes sores do not affect breastfeeding unless they are near or on the mother’s nipple. In this case, the mother can express her milk from the breast with the sore, discarding the milk until the sore has healed, and the baby can nurse from the other breast in the meantime. If a herpes sore develops anywhere else on the mother’s body, she will need to keep it covered when handling her baby and to wash her hands often to minimize the chances of infecting her baby. Cold sores in the mouth are a type of herpes, too, so the mother with a cold sore should wash her hands regularly and avoid kissing her baby until her sore is healed.

HIV and breastfeeding is a controversial topic. Research indicates that HIV can be transmitted by breastfeeding, so the World Health Organization and the US Centers for Disease Control currently recommend that mothers testing HIV-positive not breastfeed where safe alternatives are available. In order to make an informed choice, mothers need to discuss the pros and cons of breastfeeding with their families and health-care providers, weighing what is known about the benefits of breastfeeding and human milk and the risks of infant formula against the unknown risks of breastfeeding with HIV.

MEDICATIONS

The overwhelming majority of prescription and over-the-counter medications are compatible with breastfeeding, even though small amounts of the drug may pass into the mother’s milk. Most medical authorities agree that the benefits of breastfeeding far outweigh any risks to the baby from the drug. Cheston Berlin, Jr., head of the American Academy of Pediatrics’ Committee on Nutrition and contributor to the Academy’s guidelines for doctors on drugs and breastfeeding, wrote in 1989:

Drug therapy of the mother should rarely interrupt breastfeeding. A supportive approach by the pediatrician buttressed by available data can reassure nursing mothers that they can safely nurse while giving themselves necessary therapy, and everyone wins.

Before a nursing mother begins taking a drug, she should always consult with a doctor first, preferably her baby’s doctor, because he or she probably knows more about the drug’s effects on the baby. When evaluating the drug, the doctor will need to take into account the baby’s age, weight, medical history, and how much mother’s milk the baby is getting, as a baby receiving other foods will receive less of the drug than an exclusively breastfed baby. Some drugs that are considered compatible with breastfeeding for the mother of an older nursing baby are not the best choice for the mother of a premature, ill, or newborn baby.

Usually a drug that is given to babies is a good choice for a breastfeeding mother, because the amount the baby would receive through the mother’s milk is far less than he would receive if he were given the drug directly. Also, a time-tested drug that many breastfeeding mothers have taken over the years is usually a wiser choice than a new drug.

If a nursing mother is told that a particular drug that has been prescribed for her is incompatible with breastfeeding and she is not ready to wean, she has several choices. First, she can tell her doctor that she would like to continue breastfeeding. She can also ask:

Why does the doctor think the drug is unsafe? Is there research indicating this, or is the doctor’s recommendation based on an absence of research or personal opinion?

What do the reports in the medical literature say about the drug, and would it be helpful to obtain more information? Lactation consultants and La Leche League Leaders may have resources on hand on medications and breastfeeding and can also tap into La Leche League’s network of information. Also available is La Leche League International’s Center for Breastfeeding Information, which offers current and reliable reference texts on drugs and breastfeeding, as well as a comprehensive collection of articles from professional journals. This service can be used by the general public for a small fee. (Call 847-519-7730 8 am to 5 pm Central Time.)

Is there a more compatible drug that would allow for continued breastfeeding? When one drug is questionable, there are usually time-tested alternatives available. Second, the mother can get another opinion. Doctors differ in their attitudes about drugs and breastfeeding. Some doctors believe that breastfeeding mothers should not take any drug, despite objective research to the contrary. Other doctors make certain exceptions but are extremely conservative. Reasons for this include concerns about legal liability and an ignorance of the health risks of artificial feeding and abrupt weaning. Also, some doctors rely on written resources provided by the drug companies, which tend to take an overly cautious approach based more on fear of litigation than an objective weighing of the benefits of breastfeeding with the risks of the drug. When seeking a second opinion, ask a lactation consultant or a La Leche League Leader if she knows of any doctors in the area who are knowledgeable about breastfeeding.

If a nursing mother must take a drug that is not compatible with breastfeeding, she still has the option of temporarily weaning her baby and going back to breastfeeding after the drug treatment ends. To do this, she can pump and discard her milk about as often as her baby was nursing in order to minimize her own discomfort and keep up her milk supply. When all feedings must be replaced with pumping, the easiest and most effective type of breast pump to use is an automatic double pump, either a rental pump or the Medela Pump In Style or Hollister Purely Yours. Double pumping allows the mother to pump both breasts at the same time, cutting pumping time in half.

If returning to breastfeeding is not possible (for example, the mother with cancer, who will be on chemotherapy for an extended time), the best alternative may be to wean as gradually as time allows, giving the baby lots of extra love, cuddling, and attention and pumping or expressing milk whenever the mother’s breasts feel overly full so that her milk supply can decrease slowly and comfortably.

Although in rare cases a mother may have to wean her baby due to illness or medication, it is almost always possible to continue breastfeeding. Even during illness, mother and baby benefit in countless ways from nursing’s closeness and comfort.

Handling Night Nursings

by Nancy Mohrbacher, IBCLC

Of all the advantages of breastfeeding, many mothers are most grateful for the ease nursing brings to night feedings. With no preparation or waiting time, baby is calmed immediately and siblings’ sleep is not disturbed. If mother keeps baby close at night, she may not even have to get out of bed to nurse. With some practice, a mother can learn to nurse lying down, allowing her to sleep while baby breastfeeds. Once a mother finds ways to manage night feedings so that she awakens feeling rested, the question of when the baby will sleep through the night becomes far less significant.

When considering what might work best for your family, start by being open-minded and looking carefully at your own situation. Family and friends are always glad to offer their opinions and ideas, but what works well for one family may feel totally wrong to another. The best approach is one in which all family members’ needs are met. But no one approach will be right for all families at all times. Also, be willing to experiment with different approaches. After allowing some time for adjustment, if one approach doesn’t feel right, try another.

Keeping Baby Close

If sleep is a top priority, think first about sleeping arrangements that give mother easy access to baby. Many families opt to have their newborns sleep in a bassinet, cradle, or crib next to their bed during the early months.
Other families choose a “sidecar” arrangement, with the crib pushed firmly against the parents’ bed and the side rail removed so that the opening faces the parents’ bed. For maximum comfort and safety, the crib mattress is set at bed level and there are no crevices between crib and bed. To eliminate crevices, tuck a quilt or blanket between crib and bed. The sidecar makes night feedings easy because no one has to get out of bed for nursing. Baby can come into the parents’ bed to nurse with a minimum of fuss and be returned to the crib whenever desired.

Another set-up that has worked well for some families is to have baby sleep on a mattress or pallet on the floor next to the parents’ bed, with mother going down to the baby’s bed for nursings and returning to the big bed at other times.

Sleeping Together

Some families choose to bring baby into their bed for all or part of the night, with the mother rolling on her side to nurse whenever the baby is hungry. Like the sidecar, once baby is in bed with mother, no one has to get up to nurse. When mother and baby sleep together there is so little effort required for night feedings that many mothers never fully awaken during feedings and have no idea by morning whether or how often the baby nursed. Also, the baby may never even have to cry; as soon as the baby begins to root or squirm at the mother’s side, the baby can be put to breast.

Most families find that for comfortable co-family sleeping they need at least a queen-size bed. When a queen-size bed is not available, some families push together twin or double beds for more space. To prevent baby from rolling out of bed, the bed can be pushed against the wall or bed rails used.

Many parents hesitate to try sleeping with their babies, even though it may mean more sleep for everyone, because it is frowned upon by many in our culture. When considering this option, it may help to know that mothers and babies have been sleeping together since time immemorial in other cultures and in our own until the last 100 years. It has only been since the Industrial Revolution that some “experts” began recommending against co-family sleeping. And even after 100 years of such recommendations, surveys show that most parents in the U.S. sleep with their babies and young children at least occasionally.

Two of the most common reasons parents are cautioned against sleeping with their babies are fear of rolling over on the baby and concerns about starting a bad habit. While it is true that a parent should never sleep with a baby if he or she has been drinking heavily or is taking drugs that impair functioning, rolling over on a baby is not a danger under average circumstances. Adults maintain some awareness during sleep, which is why we don’t roll out of bed at night. Parents who sleep with their baby find that they are sensitive to their baby’s presence in their bed and that their baby, even as a newborn, is perfectly capable of rousing them if necessary.

On the issue of bad habits and dependency, William Sears, MD, pediatrician and father of eight, writes in his book, Nighttime Parenting:

How often have you heard ‘But the baby will get to enjoy it; he’ll become so dependent that he’ll never want to leave your bed’? Yes, of course, the baby will enjoy it….Yes, he will temporarily seem dependent and not want to leave your bed. This is a natural consequence of the feeling of rightness….You are not encouraging dependency when you sleep with your baby. You are responding to a need and teaching your child about trust. Your child will not grow up to be less independent because he slept in your bed. In my experience children who are given open access to the family bed in infancy become more secure and independent in the long run.

The answer to the oft-asked question, “But when will he sleep in his own bed?” varies from family to family and child to child and is much the same as the answer to the question, “When will he stop nursing?” When parent or child feels the time is right, both weaning and moving the child to his own bed can be accomplished gradually and with love by finding and substituting positive new alternatives for old routines.

Recent research has found that there also may be health benefits to sharing sleep with babies. The National Institutes of Health have recently awarded a $1 million award to sleep researcher, James McKenna, and his team, whose preliminary studies have found that sharing sleep with their mothers seems to help babies regulate their breathing and heart rate during the night, which may help prevent Sudden Infant Death Syndrome (SIDS). McKenna notes that Hong Kong, Japan, and Pakistan, where mothers and babies customarily sleep together, have lower incidences of SIDS than the U.S., Canada, New Zealand, and Great Britain, where mothers and babies sleep apart.

Sleeping Apart

Due to personal preferences and individual situations, many parents choose to sleep apart from their babies. When mother and baby sleep in different rooms and the mother chooses not to bring the baby into her bed to nurse, there are still ways to get more sleep. For example, setting up an adult-sized bed or putting a mattress on the floor in the baby’s room would enable the mother to nurse lying down and get some sleep until she decides to return to her own bed. This is a more restful alternative than staying awake through each feeding.
When mother and baby sleep apart, another challenge is keeping baby asleep while transfering him from arms to bed. Some babies settle themselves easily when put down, but others wake immediately when moved. For this second type of baby, Dr. Sears suggests nursing through the initial period of light sleep, which he says is usually about twenty minutes, until baby enters a deep sleep (when he feels like he’s melting into your arms) before trying to put him down. Another time-tested suggestion is to wrap baby in a blanket during nursings and leave him in the blanket when putting him down, so that the warm blanket spares him the shock of the cooler sheets.

The early months of parenting are exhausting under the best of circumstances. It is well worth it for each family to give some time and thought to approaches that will help them get the most rest while meeting their baby’s needs at night. The question of “when will the baby sleep through the night?” probably assumed the proportions it has because of the inconvenience of nighttime bottle feeding–getting up with the baby into what may be a chilly house, waiting while the bottle warms, fighting sleep, and being fearful that baby or bottle may be dropped. When a nursing mother takes full advantage of the natural convenience of breastfeeding, this issue loses much of its significance, allowing her to fully enjoy her baby at his current state of growth and development.

Can There Be Breastfeeding After Weaning

by Nancy Mohrbacher, IBCLC

Many women are surprised to hear that it is possible to begin breastfeeding again after a baby has weaned. Although this is now considered unusual, it was once commonplace in our society and in other parts of the world. Called relactation, this is the process of rebuilding a mother’s milk supply after it has been reduced or has completely dried up. Mothers often consider relactation when breastfeeding has been interrupted before mother and baby are ready to wean.

REASONS AND OUTCOMES

The most common reasons women give for wanting to resume breastfeeding are the nutritional and emotional benefits it offers the baby and the closeness it brings to the mother-baby relationship. In a survey of 366 women who relactated, most women reported not being as concerned with the amount of milk they produced as they were with having the opportunity to nurture their babies through breastfeeding. Although some mothers made the decision to relactate based on their babies’ intolerance to formula or other health problems, most women were more concerned with the effect breastfeeding had on their relationship with their babies.

The majority of mothers were able to successfully relactate. More than half of the women surveyed established a full milk supply within a month. It took another one-quarter of the mothers more than a month to fully relactate. The remaining mothers breastfed with supplements until the child weaned. Women who attempted relactation within two months of childbirth reported greater milk production than those who attempted it later on.

GETTING STARTED

In order to relactate, a mother needs to accomplish several tasks:

  • teach the baby to nurse effectively at the breast (if he isn’t already),
  • stimulate her breasts to produce milk,
  • make sure the baby receives adequate nourishment while she is increasing her milk supply,
  • and

  • arrange for necessary help and support for the entire family during the process.

Relactation can consume most of a mother’s time and energy for about two weeks, so any mother who is thinking about relactating should carefully consider her own feelings and her family situation, including any other commitments she may have. If a mother is motivated and willing to take the time, relactation is definitely possible. It can help to have the kind of mother-to-mother support that a lactation consultant or La Leche League Leader can provide.

A nursing baby is the most effective way of stimulating milk production, and because milk supply is based on supply and demand, the more often the baby nurses, the more milk there will be. If you still has some milk and the baby is willing to nurse for comfort as well as for nourishment, put baby to the breast at least every two to three hours for at least fifteen to twenty minutes per breast and gradually decreasing the amount of supplement the baby receives.

When a baby won’t nurse often or long enough or he is not sucking well, some mothers find a breast pump helpful in stimulating milk production. This often leads to a baby staying at the breast longer because the milk supply is more plentiful. The most effective type of breast pump is the full-size electric model that can be rented from some pharmacies and medical supply houses. Hand expression can also help increase milk supply.

A device called a nursing supplementer is another way to teach the baby to nurse, stimulate the breasts, and provide the baby with nourishment all at once. It allows the baby to receive expressed mother’s milk or formula while nursing at the breast. It allows a baby to receive the supplement through a small, flexible tube that is taped or held in place at the mother’s nipple. One type of nursing supplementer, the Supplemental Nursing System (SNS) by Medela, which holds the supplement in a plastic bottle suspended from a cord around the mother’s neck and uses three sizes of tubing. Milk flow is regulated by the size of the tubing used and the height of the uspplemental bottle in relation to the mother’s nipple. The higher the bottle, the faster the supplement flows; the lower the bottle, the slower it flows. To find a Medela retailer near you, call Medela at 1-800-TELLYOU. Its current cost is $43.40.

Avoid giving your baby a pacifier or bottle, which can satisfy her need to suck for comfort. Use a nursing supplementer, spoon, cup, or eyedropper, so she’ll be more likely to accept the breast for comfort, which will further stimulate your milk supply. If you prefer to supplement with a bottle, hold the bottle close to your breast so your baby becomes comfortable in that position and begins to associate skin-to-skin contact with feedings. To encourage your baby to nurse as much as possible, offer her the breast before, after and in between supplementary feedings.

PERSISTENCE PAYS OFF

Not all babies are eager and willing to take the breast at the first offering, but this is not an accurate predictor of how breastfeeding will go. Mothers in the survey who were relactating due to an untimely weaning reported that only 39% of their babies nursed well on the first attempt, 32% were ambivalent at first, and 28% refused the breast. But within a week of consistent trying, 54% of these babies took the breast well, and by ten days the number rose to 74%. The baby’s age and previous breastfeeding eperience also had some influence on whether relactation was successful. Babies younger than three months and those who had previously breastfed tended to be more willing. However, the most crucial factors in persuading babies to take the breast were time, patience, and persistence.

The transition will be smoother if you make sure breastfeeding is a relaxing and positive for you and your baby. Never insist on nursing if the baby is resistant. Good times to attempt nursing are when the baby is not too hungry, when the baby is asleep or relaxed. Certain environments may be more conducive to nursing. Try nursing your baby in a darkened room or a place free from distractions, or while bathing in the tub, rocking in a rocking chair or walking. If a nursing supplementer is not being used, dripping milk or formula on your breast may help motivate baby to latch on. Also, spending time each day just touching is comforting to both mother and baby and may make a baby more willing to nurse. Cuddle and stroke your baby, carry him snuggled close in a baby carrier or sling, and take baths and sleep together.

TRACKING PROGRESS

As the mother’s milk supply increases over time, the baby will need less supplement. Some babies begin leaving supplement in the nursing supplementer or bottle, letting the mother know it is time to cut back accordingly. But more commonly, mothers need to take the initiative and gradually reduce the amount herself as she notices signs of increasing milk supply, such as feelings of fullness in her breasts or the tingling of milk let-down. Decreasing the supplement by a half ounce per feeding per day works well for some babies.

Changing from one feeding method to another is difficult for some babies. A baby should never be stressed by hunger during relactation and formula should never be diluted. To be make sure your baby is receiving enough nourishment, keep a written journal tracking factors that show your baby’s progress:

  • Frequency and length of breastfeedings. Most babies need to nurse at least eight to ten times per day. Nursing even more often for comfort will accelerate this process.
  • Your baby’s reaction to breastfeeding. Does he suck actively? Is he happy to take the breast?
  • The amount of supplement offered and how it was given. This will provide a record of decreasing supplement and increasing milk supply.
  • Number of wet diapers and stools per day. Baby should have at least six wet diapers and at least two stools a day. Fewer stools may be normal in a baby older than six weeks. Expect stools to change in consistency and become less formed as mother’s milk becomes a greater part of the baby’s diet. Fewer than six wet diapers are a sign that more supplements may be needed.
  • Weight gain and growth. Check your baby’s weight weekly. Baby should be gaining at least four to eight ounces a week. If weight gain is less, more supplements may be needed.

IS IT WORTH IT?

In hindsight, three-quarters of the 366 women surveyed felt relactation had been a positive experience. However, the amount of milk they produced was unrelated to their feelings of success. Time and again they emphasized that breastfeeding is as much nurturing at the breast as it is nutrition from the breast. One mother said she did it “for the sheer joy of holding him close–if not fed by the breast at least at the breast.”

Overall, the women felt the most compelling reason for attempting relactation is the mother’s desire to breastfeed. One mother said, “I would suggest she decide what she honestly wants and do it and not listen to [those who say] ‘wait til your next one.’” Or, as another said: “Breastfeeding to me is a beautiful and natural way of feeding your baby, and I feel that everyone should have the chance to experience it.”

Breastfeeding with Silicone Breast Implants: Are There Risks?

by Nancy Mohrbacher, IBCLC

My own silicone breast implant was inserted twenty years ago. Since then I have breastfed three children, and during the past nine years La Leche League International has referred calls and letters to me from women from all over the world who want to be put in touch with someone who has breastfed with implants. Prior to 1990, most questions related to milk supply. Now these women’s main concern is whether their babies might be harmed by silicone leaking into their milk.

Since 1990, the media has given prominent and sensational coverage to possible health risks of breast implants. In addition to possible health risks to women with implants, recent reports have raised questions about whether exposure to implants during pregnancy and breastfeeding may put their children at risk to serious health problems. There is little research on these issues and none of it is conclusive, but some doctors and women’s groups are suggesting that breastfeeding mothers with implants wean their babies and pregnant women with implants choose artificial feeding instead.

The JAMA Study

On January 19, 1994, the Journal of the American Medical Association (JAMA) published a study of eleven children with chronic gastrointestinal disorders who were born to women with silicone breast implants. Their symptoms included abdominal pain, vomiting, difficulty in swallowing or poor weight gain. Eight of these children had been breastfed and three had been artificially fed. Six of the eight breastfed children (which were from four families) were found to have reduced esophageal motility, or a reduction in the normal wave-like motion of the esophagus that moves food toward the stomach. This reduced esophageal motility was not found in the three artificially fed children or in the 20 children with chronic gastrointestinal disorders in the control group whose mothers did not have silicone breast implants. Abnormal esophageal motility is seen in several disorders, including scleroderma, an autoimmune disease that has been linked to women with silicone breast implants in lawsuits.

The authors of this study, Drs. Jeremiah J. Levine and Norman T. Ilowite, concluded that:

Although these results will need to be verified by larger studies, it is possible that substances leaking from the implant or immunologic factors may be transmitted through breast milk and taken up across the immature intestinal barrier of the breastfeeding infant.1

In an editorial appearing in the same issue of JAMA, pediatrician Jonathan A. Flick, MD, commented:

The American Medical Association’s Council on Scientific Affairs has estimated that it will be many years before controlled trials determine if silicone gel breast implants are associated with an increase in immune disorders among the recipients themselves. The benefits of breastfeeding, including the infant’s reduced susceptibility to infectious diseases and promotion of maternal-infant bonding, are well established, while the potential adverse effects reported by Levine and Ilowite among breastfed children of silicone implant recipients are yet to be confirmed….For now, it would appear that breast, whether augmented or not, is still best.2

The FDA Response and Others

The US Food and Drug Administration (FDA) quickly responded to this study in its January 21, 2022 Talk Paper:

FDA believes that the study is inconclusive and preliminary, and further studies are needed…The [FDA] views this study with interest, but the limitations of the study design including, for example, the small size of the study and selection bias, limit conclusions that can be drawn from it…..3

Also as a response to this study and after consultation with the FDA, the Human Milk Banking Association of North America (HMBANA) issued an addendum to its guidelines on March 8, 1994:

Although the paper in question does not offer conclusive proof of an association between silicone implants and reduced esophageal motility, the [HMBANA] has an obligation to provide the safest product possible to its recipient infants….It is recommended that mothers with silicone breast implants not be accepted as donors.4

According to HMBANA’s Director, Lois Arnold, MPH, IBCLC, this change in guidelines should not be taken to mean that women with breast implants should not breastfeed or that a cause-and-effect relationship has been proven between health problems in children and breastfeeding with silicone breast implants. According to Arnold, it was “a defensive measure” to insure that public confidence remains high in the safety of milk from human milk banks.

Silicone in the Milk?

Levine and Ilowite suggest in their study that if a connection exists between breastfeeding with silicone breast implants and health problems in children, it may be due to “substances leaking” into mother’s milk. To determine whether silicone implants are compatible with breastfeeding, the same questions can be asked that are used to determine a drug’s compatibility with breastfeeding.

Does it pass into the milk? In order to pass into the milk, a molecule must be small enough to fit through the water-filled pores in the lining of the mother’s alveoli, which “permit the movement of molecules of less than 200 molecular weight.”5 Some drugs, such as heparin, do not pass into mother’s milk, because their molecular weight is greater than 200. The type of silicone used in implants (active ingredient: polydimethylsiloxanes) has a molecular weight of 14,000 to 21,000,6 making it extremely unlikely that the molecules could fit through this membrane and pass into the milk.

Silicone is also insoluble in water, further decreasing the likelihood that it could pass into the milk. According to Philip O. Anderson in Clinical Pharmacy, in order for drug transfer to take place, the molecules must be soluble in water. “Larger…molecules must dissolve in the outer lipid membrane of the epithelial cells, diffuse across the aqueous interior of the cell, dissolve in and pass through the opposite cell membrane, and then pass into the milk.”7

Jack Northington, an analytical chemist at a California lab, developed a test for silicone in human milk and has used it to test the milk of women whose implants have ruptured, those most likely to have silicone in their milk. However, he has yet to find any silicone in milk. Northington considers the test a waste of money, explaining that “in theory [silicone] shouldn’t be there, and in practice we haven’t found it.”

If it is in the milk, would it be absorbed by the baby? Some drugs, such as insulin, are destroyed by the baby’s digestive system. Other drugs, such as some laxatives, are not absorbed and pass through a baby’s digestive system unchanged. Last year, when Betty Crase, manager of La Leche League International’s Breastfeeding Reference Library & Database, polled selected members of La Leche League International’s Health Advisory Council, their opinion was that ingested silicone would pass through a baby’s digestive system unchanged. If silicone is not absorbed, it would pose no danger to the nursing baby.

Mylicon drops, which contain the same polymer as silicone breast implants, are given to colicky babies as a gas-reducer and work by coating the digestive system.

If it is absorbed by the baby, what are safe levels? Neither normal nor safe levels of silicone have yet been established. Many people are surprised to learn that nearly everyone has silicone in his or her body. We ingest silicone compounds through cosmetics (such as lipstick), over-the-counter drugs (such as antacids), and the coating on fresh fruits and vegetables. Silicone is also used to lubricate syringes and to make silicone nipples for baby bottles and pacifiers.

Most drugs are considered compatible with breastfeeding, because the benefits of breastfeeding far outweigh the risks of a small amount of drug reaching the baby. For the same reason, silicone implants should also be considered compatible with breastfeeding.

Asking the Right Questions

Everyone agrees that more research is needed into the health effects of silicone breast implants on mothers and their babies. However, studies that focus on children with health problems, such as the one recently reported through Reuters new service in the popular press by Dr. Andrew Campbell of the Center for Immune, Environmental and Toxic Disorders in Houston as well as the JAMA study, paint a distorted picture. What we really need to know is if these health problems occur more often in children of mothers with implants or if they occur at the same rate as in children of mothers without implants. Until we have this information, we cannot know if there is a cause-and-effect relationship. And if a link is established between implants and health problems in children, we need to know if silicone exposure in utero is the cause or if breastfeeding plays a part. If further research shows that silicone compromises a baby’s immune system during pregnancy, the immunities in breastfeeding may prove to be even more important to these babies than to others.

Advising women to artificially feed their babies in the meantime is no solution. Scientific evidence exists that artificial feeding can be hazardous to babies’ health. It is common knowledge that artificially fed babies have greater morbidity and mortality than breastfed babies, and preliminary studies now indicate that the health benefits of breastfeeding may last a lifetime. Artificial feeding contributes to insulin-dependent diabetes, Crohn’s disease, celiac disease, ulcerative colitis, and some childhood cancers, as well as food allergies and chronic liver diseases.8 Unlike the concerns raised about breastfeeding with silicone breast implants, the health risks of artificial feeding are well-documented.

Until there is scientific proof to the contrary, I believe the benefits of breastfeeding with silicone breast implants still outweigh the risks and these women should be encouraged to breastfeed.

Footnotes

  1. Levine J.J. and N.T. Ilowite. “Sclerodermalike Esophageal Disease in Children Breast-fed by Mothers with Silicone Breast Implants.” JAMA 1994, 271:213-16.
  2. Flick, J.A. “Silicone Implants and Esophageal Dysmotility: Are Breast-fed Infants at Risk?” JAMA 1994, 271:240-41.
  3. FDA Talk Paper, “Study of Children Breastfed by Women with Breast Implants.” Food and Drug Administration, U.S. Department of Health and Human Services, T94-6, January 21, 1994.
  4. Addendum, Human Milk Banking Association of North America, P.O. Box 370464, Hartford, CT 06137-0464 USA, March 8, 1994.
  5. Lawrence, R. Breastfeeding: A Guide for the Medical Profession, 3rd ed. St. Louis: Mosby, 1989, p. 259.
  6. McEvoy, G, ed.. American Hospital Formulary Service Drug Information, Bethesda, MD: American Society of Hospital Pharmacists, 1992, p. 1720.
  7. Anderson, P.O. “Drug Use during Breast-feeding.” Clin Pharmacy 1991, 10:595.
  8. Cunningham, A.S., D.B. Jelliffe and E.F. P. Jelliffe. “Breast-feeding and Health Inthe 1980s: A Global Epidemiologic Review.” J Pediatr 1991, 118(5):659-66.

Breastfeeding Right from the Start

by Nancy Mohrbacher, IBCLC

You may envision breastfeeding as a Madonna-like experience, with you and your baby snuggled close as she contentedly nurses at your breast. In reality, breastfeeding doesn’t always start out so smoothly. It might take several tries before your newborn learns to take the breast into her mouth, and you may be unprepared for how often she wants to nurse in the beginning. But knowing what to expect should ease you through those early breastfeeding days and help you handle difficulties if they occur. Breastfeeding is natural, but it is also a learned art. Knowing what’s normal and what to expect can make the early days and weeks easier and more enjoyable. It can also give you the confidence to know when breastfeeding is going well and the knowledge to decide if and when you need help.

First Feedings

Ideally breastfeeding begins within the first hour or two after birth, when babies tend to be most alert and eager to nurse. During the first few days, while a baby gets colostrum (the first milk) and before the mother’s milk supply increases, he may want to nurse often and for long stretches, even hours at a time. Although many mothers are told to limit early feedings to prevent sore nipples, studies show that this does not help. Also, nursing long and often in the early days lessens breast engorgement in the mother.

The colostrum, or first milk, contains high concentrations of antibodies to boost baby’s immune system. Colostrum also has a laxative effect, which stimulates babies to pass stools more quickly. That’s why long and frequent feedings in the first few days have been found to help prevent jaundice. Newborn jaundice is caused by a build-up of bilirubin, a by-product of the breakdown of the extra red blood cells present at birth. The more stools the baby passes early on, the less jaundiced they become.

Although many newborns nurse long and avidly during their first days, some babies to want to nurse less often or for shorter periods. Some babies are uninterested in nursing or sleepy during their first few days. Even if baby seems uninterested in breastfeeding, encourage him to nurse at least every couple of hours. If he is sleepy, watch his cues, and try stimulating him to nurse when he is in light sleep (eyes moving under eyelids) or beginning to stir. Try rubbing her feet jiggling her a little, talking to her or rubbing her back.

When your milk supply becomes more plentiful on the third or fourth day, a baby’s nursing pattern may change. The baby who was nursing for long stretches may finish more quickly because he’s getting more milk sooner. Babies who were less eager to nurse may now become more interested. Also, look for more wet diapers and bowel movements. Rather than the one or two wet diapers that are normal during the first few days, once the milk increases expect at least five to six wet disposable diapers and at least three to four stools per day.

Your breasts may become uncomfortably full when your milk increases. Called engorgement, this condition is caused by extra blood rushing to the breasts and will subside within days as long as you continue to nurse frequently. It might also help to take a warm shower, apply heat before nursings, cold between nursings and gently massage your breasts.

Sometimes engorement causes the nipple to flatten out, which makes it difficult for babies to take the breast into their mouth. If this happens, hand-express or pump enough milk to soften the nipple and areola before you offer your baby the breast, which will relieve some of the fullness and make it easier for her to nurse.

Follow Baby’s Cues

Your milk supply is based on supply and demand, so the more you nurse, the more milk you produce. To ensure your milk supply keeps up with your baby’s changing needs, follow his cues as to how often and long to breastfeed.

Many babies go through growth spurts when they need to nurse much more often. After at most a few days, these extra nursings will stimulate your milk supply to step up to meet your baby’s needs and he’ll return to his normal nursing pattern. Growth spurts usually occur at about two weeks, six weeks, three months and six months.

As long as baby nurses actively, switch breasts when your baby has finished with the first one. Human milk increases in fat as the baby nurses, so letting baby “finish the first breast first” insures that baby receives the right balance of fluid and fat. Switching breasts too soon or limiting feeding times can cause a baby to fill up on the watery foremilk at the beginning of a nursing without getting the high-calorie hindmilk that comes at the end. A baby getting too much foremilk and not enough hindmilk may not gain weight well, may be colicky or gassy, and may have green stools.

If you wonder whether your baby is getting enough milk, keep in mind that during the newborn period most babies need to nurse at least eight to twelve times a day. But this doesn’t mean that feedings will be spaced every two to three hours. Newborns tend to “cluster” nurse, or bunch feedings together during one part of the day, often the evening. It is best to ignore the length of time between feedings and keep track instead of whether the number of feedings every 24 hours falls within this 8-12 range. If a baby nurses fewer than eight times per day, this may be a baby who needs to be wakened and stimulated to feed more often.

Many newborns are also night owls, so their long sleep period may not come until the sun rises. There is a wide range of normal nursing patterns, from babies who nurse every half hour for part of the day and every hour-and-a-half for forty to sixty minutes for another part of the day to babies who nurse every four hours for ten minutes. As long as a baby has at least five to six wet disposable diapers and at least three to four stools each day (fewer stools may be normal for a baby older than six weeks) and is gaining at least four to seven ounces a week (at least a pound per month), a mother can be sure her baby is getting enough milk.

Latching On

A good latch-on is critical during the early weeks because it makes breastfeeding most comfortable for mother and allows the baby to get the most milk for his efforts. When a baby goes onto the breast, he needs to take the breast deeply into his mouth, bypassing the nipple and latching on to the darker area around the nipple. The milk sinuses (where the milk ducts widen) are located about an inch behind the nipple.

When the baby takes the breast deeply enough into his mouth to compress these milk sinuses during nursing, he is rewarded with more milk. Latching on closer to the tip of the nipple gives baby less milk and may also cause sore nipples. In most cases, if the baby latches on well, breastfeeding will not hurt the mother, no matter how long or often baby nurses. To help the baby latch on well:

  • Support the breast while the baby is going on to the breast and throughout the feeding with the breast held between thumb on one side and fingers on the other. Make sure fingers and thumb are well back from the nipple and surrounding area so they don’t get in baby’s way as he goes on to the breast. (Unless the mother has large breasts, she may not need to support her breast during feedings after the early weeks.)
  • Hold the baby so that he is approaching the from underneath (with his head angled slightly back) rather than straight on. If he is in the cradle hold, be sure his legs and hips are pulled in close to mother’s body.
  • Encourage the baby to open his mouth wide (like a yawn) by tickling his lips lightly with the nipple. If this doesn’t work, try again even more lightly. Keep lightly tickling until baby opens really wide.
  • As the baby opens wide, pull him far onto the breast–chin first–so that he takes the breast deeply into his mouth. The most comfortable latch for most mothers is off-center, with the baby’s lower jaw latched on as far from the base of the nipple as possible. Baby should lead with his chin, so that when he is latched on his chin is pressed into the breast but his nose is angled out to allow for breathing. If baby’s nose seems blocked by the breast, pull his body and feet in closer to mother. After the baby latches on, if breastfeeding hurts or is uncomfortable, don’t let him keep nursing this way. Break the suction gently by putting a finger between the baby’s gums, take him off, and try again. The baby’s mouth may need to be open wider or he may need to be pulled on farther (with more oomph!). Some babies latch on well at the first try while others take many tries before breastfeeding feels comfortable. With practice, getting a good latch-on becomes easier and more automatic, but it is well worth the time in the beginning to help baby learn to do it right.
  • Comfort is also important when choosing a nursing position. Depending on the size and shape of the mother’s breasts and the length of her arms and torso, one position may be easier than another. The best position is one that allows the mother to hold the baby close to the breast and relax without straining any muscles. In some positions, it may help to put pillows or cushions behind her back or under the baby to support his weight. The baby will find it easiest to breastfeed if he is directly facing the breast without having to turn his head to nurse and if his head, shoulders, and hips are in a straight line, not twisted or turned. The mother will be more comfortable if she brings the baby to the breast, not the breast to the baby.

Common breastfeeding positions include:

  • Cradle hold–With mother sitting up, baby lies on his side, across the mother’s lap, his whole body facing hers, with his head resting on her forearm near the crook of her arm and his body pulled in close. A pillow or cushion under baby may make this position more comfortable.
  • Cross cradle–Like the cradle above, but with the mother’s hands reversed–the mother supports her breast with the same-side hand and holds the baby upper back with the opposite hand. This puts a hand behind the baby’s head for better control. A pillow or cushion under baby makes this position easier.
  • Football hold–With mother sitting up, baby lies at mother’s side with his upper back resting along the mother’s forearm while she supports his neck with her hand. A pillow or cushion under the mother’s elbow can help support baby’s weight.
  • Lying down–Mother and baby lie on their sides facing one another with the baby’s feet pulled in close to the mother’s body. A pillow under the mother’s head and between her knees may make her more comfortable and a pillow or rolled blanket behind baby may help keep him in close. The baby’s head may rest on the mother’s arm or on the bed.

Take Care of Yourself

Breastfeeding will be easier if you make your needs a priority as well as your baby’s. Ask a friend or relative to help with household chores so you can nap when the baby naps and relax while nursing. Many mothers find that once they learn to get comfortable nursing lying down they can nap while breastfeeding.

Eat a well-balanced diet to keep up your energy and stay healthy. Although studies indicate that eating a less-than-ideal diet will not affect the quality or quantity of your milk, eating well will help you meet the physical demands of new motherhood. Contrary to popular belief, there are no foods that you must eat or avoid while breastfeeding. Most mothers can eat any food in moderation (even coffee, chocolate, and spicy foods!) without effect on their baby. The same principles of good nutrition apply to the nursing mother as to the rest of the family. As for fluids, the simple rule-of-thumb is drink to thirst.

Health experts advise nursing mothers to wait two months before trying to lose weight. This gives your body time to recover from birth. Plus most women lose weight naturally during this time. Breastfeeding seems to make it easier to shed extra pounds, mobilizing even the fat accumulated before pregnancy.

If after two months you want to lose weight, do so gradually. The body stores pesticides and other environmental contaminants in body fat, and when you lose weight too quicky–more than a pound a week–they can be released into your bloodstream and go into your milk. So its healthier for both you and your baby to take it slow.

Exercise is also compatible with breastfeeding. The real challenge for most new mothers is finding the time. But keep an open mind and be creative. For example, rather than trying to schedule regular time away from baby, some mothers find it easier to use exercise videos at home, join a mother-baby exercise class, or go for walks with baby.

Although learning to breastfeed requires an investment in time, it can simplify life with a baby in other ways. You’ll have the satisfaction of knowing that you’re providing your baby with the best possible nourishment, you won’t need to prepare bottles, and the closeness of nursing may comfort you as well as your baby. Soon you may find you and your baby have settled into a smooth nursing rhythm and resemble that Madonna-like image you once envisioned.

Choosing a Pro-Nursing Doctor for Your Baby

by Nancy Mohrbacher, IBCLC

During pregnancy, expectant parents tend to focus most of their attention on choosing the mother’s doctor and preparing for the birth. But choosing the baby’s doctor is just as important, especially when breastfeeding is the plan. While it may seem easiest to pick a doctor recommended by the obstetrician, the hospital, or friends and family, carefully selecting a doctor can make the difference between a good breastfeeding beginning and an untimely weaning.

Nearly all doctors today claim to be “for breastfeeding.” So families need to know more about a doctor than this in order to make an informed choice. While being supportive of breastfeeding is a plus, a truly “breastfeeding friendly” doctor encourages breastfeeding by putting in place breastfeeding friendly policies and practices. To find a doctor like this, a good place to begin is to talk to local La Leche League Leaders and lactation consultants for their suggestions. They quickly learn through personal experience and word of mouth which doctors are good with breastfeeding. After you’ve assembled a list of candidates, interview each, asking the following questions:

“Do you recommend bottles of water or formula routinely be given to newborns?” Water and formula are unnecessary for the full-term healthy newborn and can cause breastfeeding problems during the early weeks. Studies show that babies who are given water tend to lose more weight and have more severe jaundice.

Supplements can fill up a baby and make her less interested in nursing. A decrease in the time a baby spends at the breast can diminish a mother’s milk supply and cause her to become painfully engorged. Engorgement in turn will make it difficult for a baby to latch on to the breast.

Also, bottles given during the first few weeks can cause a baby to become “nipple confused,” causing either breast refusal or incorrect sucking.

If a doctor says that he or she recommends supplements “only when needed,” beware. If a baby is not nursing well, a bottle is not a solution. Instead, mother and baby need immediate help with nursing, and if the doctor is does not provide it, a mother should be referred to a lactation consultant or a La Leche League Leader.

If a doctor’s standing orders at the hospital include bottles but he or she agrees to make an exception, be sure to get this in writing and bring copies to the hospital when the baby is born. The nursing staff will follow a doctor’s usual orders unless the doctor instructs otherwise. If a baby is born in the middle of the night, it may be many hours (and bottles) until the doctor is contacted.

The most ideal breastfeeding start is one in which mother and baby are able to nurse early and often without restrictions, so another question to ask is how soon after birth the doctor believes nursing should begin and how he or she feels about rooming-in and feeding schedules in the hospital. A doctor who recommends nursing as soon as possible after birth and shows strong support for rooming-in and unrestricted nursing is probably a doctor who understands their importance to breastfeeding and to mother’s and baby’s health.

If you pick a doctor who is not on staff at the hospital where you plan to deliver, you can either request a doctor at the hospital before birth or the hospital will assign a doctor to the baby. You won’t need to interview the staff docts in depth, but ask about their policies in the hospital, such as if they give supplements and how they treat jaundice. Because a doctor’s practices have such a great impact on breastfeeding during the early days, it is worth making the effort to choose a doctor ahead of time, rather than leaving it to chance.

“How do you treat jaundice?” During the first week, more than half of all newborns develop jaundice, a buildup in the blood of excess bilirubin, which is the end product of oxygen-carrying cells. This buildup causes a baby to become yellowish in color. Bilirubin is processed by the liver, but newborns often produce more bilirubin than their immature livers can handle. In most cases, bilirubin levels decrease in a week or so, as the liver matures.

Many doctors still advise that nursing babies with jaundice be given formula, but recent research confirms that babies can safely continue breastfeeding without supplements. Depending upon the severity of the jaundice, treatment also may include the use of special lights (called phototherapy), but this needn’t affect breastfeeding.

When a baby develops a health problem, such as newborn jaundice, the doctor’s approach may have a profound effect on breastfeeding. Since about half of all newborns become jaundiced during their first week of life, it makes sense to ask before birth about a doctor’s standard treatment of jaundice.

“How do you determine whether a baby has low blood sugar?” When a baby is above or below a certain weight range, this could indicate low blood sugar, known as hypoglycemia. As a precaution, some doctors routinely recommend that all breastfeeding babies outside this weight range receive formula or sugar water supplements. But this may not be necessary. A blood sugar test can determine whether a baby has hypoglycemia.

If the doctor gives supplements according to a baby’s weight, ask if a blood sugar test can be done. If your baby does have low blood sugar, supplements can be given by eyedropper or cup to avoid nipple confusion.

“How do you handle slow weight gain?” Normal weight gain in a breastfeeding baby is an average of 4 to 8 ounces a week, or at least a pound a month for the first three months. (During the first month, weight gain should be counted from the lowest point, not birth weight.) If a baby’s weight gain falls below this, a doctor who understands breastfeeding will first look at how breastfeeding is being managed and see if changes can be made to increase a mother’s milk supply. For example, a baby who is nursing fewer than about ten times per day may need to nurse more often.

“Do you recommend a feeding schedule?” A doctor well-versed in breastfeeding usually realizes that there is a wide variation in nursing patterns among healthy babies. Sometimes a doctor who claims to be for nursing on cue will say, “But babies shouldn’t nurse more often than every X hours,” or “Don’t let the baby use the breast as a pacifier.” Most newborns, tend to cluster their feedings or bunch feedings together at certain times of the day, rather than nursing at regular intervals. Stretching out feeding times to meet arbitrary guidelines can interfere with a baby’s attempts to increase her mother’s milk supply by nursing more often during growth spurts.

In an ideal world, every baby’s doctor would understand good breastfeeding management, have standard practices that promote breastfeeding, and know how to treat health problems without compromising breastfeeding. But this ideal is not yet a reality. Until it is, parents need to take responsibility for selecting a doctor who will help them meet their breastfeeding goals.