Breast Feeding: Your Questions Answered
Frederick R. Jelovsek MD
and Marilyn Arnold RN
Popular Breast Feeding Question
Postpartum breast infection
I'm pregnant and thinking about breastfeeding
Does baby get anything before milk comes in?
Is baby latched well?
How can I tell if my baby is getting enough milk?
How often should I nurse?
How to prevent breast engorgement
What causes sore nipples?
When can I use a bottle or pacifier?
Baby's suddenly hungry
Breast lump while nursing
Going back to work while nursing
Storing breast milk
Can I nurse a premature baby in intensive care?
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Questions Answered
Postpartum mastitis (breast infection)
These signs and symptoms are characteristic of a postpartum mastitis, or infection of the ducts and glands of the breast. It usually happens within the 1st 3 or 4 weeks after delivery.
It takes about 3 days on antibiotics to feel better and about a week to totally clear. Continue nursing or pumping the breast. DON'T miss any of the antibiotics you are supposed to take.
The antibiotic will likely be one that covers staph and strep; usually a penecillin-like drug.
Somehow staph or strep bacteria that can cause this got on the nipple and got into the breast either through a cracked fissure in the nipple or one of the ducts when the baby breast feeds.
If it doesn't get treated promptly, it can cause a breast abscess. An abscess can get big and result in breast disfigurement if it needs to be surgically drained. If it is treated promptly with antibiotics, it almost always heals with no long term effect.
The baby can nurse as long as there is only milk and not pus coming from the nipple. The breasts do have to be drained of milk regularly along with the antibiotics to heal. If your temperature is not down within 36 hours of taking the antibiotics or if any pus drains, you need to be seen right away.
There is a good little book on breast feeding in our Woman's Diagnostic Cyber Store.
I'm pregnant and thinking about breastfeeding
Read about breastfeeding, go to a class, pick a pediatrician supportive of breastfeeding which will be easy to do because the American Academy of Pediatrics now recommends that babies be breastfed for one year. Research clearly shows that breastfed babies are healthier! And if you have flat or inverted nipples and are not at risk for premature labor, wear breastshells during your waking hours during the last trimester of your pregnancy.
Does baby get anything before milk comes in?
Yes, your breasts supply colostrum, a very concentrated milk full of antibodies. This colostrum acts as a laxative, helping clear meconium (black tarry stool) and bilirubin (which may make baby jaundiced or yellow) from your baby.
Is baby latched well?
When you feel good tugging and it doesn't hurt. If this isn't the case, your baby's gums probably aren't over the lactiferous sinuses where they need to be to compress the sinuses. These sinuses are back about an inch from the tip of the nipple. Make sure baby completely faces you, opens wide with tongue down before you quickly center nipple in baby's mouth. If it hurts, let dad or grandma pull down on baby's chin so baby's tongue comes down and cushions lower gum. But if it still hurts, remove baby from breast by putting your clean finger between baby's gums and start over. Laying baby on pillows and keeping baby's mouth right in front of your nipple helps too. And remember when you were pregnant, your baby was all flexed inside of you so now baby will feel more secure if he is curled up with both his knees touching you.
How can I tell if my baby is getting enough milk?
When your milk comes in (day three to day five after delivery) start counting wet diapers. Buy inexpensive diapers for the first week so you can easily tell if they are wet. If your baby has four to six wet diapers in a 24-hour period, you are supplying baby with a good amount of breast milk. Another sign that there is good milk transfer is your breasts soften with nursing.
How often should I nurse?
Daytime every two to three hours for at least 10-15 minutes on each breast. You may need to wake your baby (a diaper change and holding baby upright and talking to baby helps waken baby) during the day so your nights will be more restful. As baby's nutritional needs are better met during the day, baby will not wake as often during the night. Sometimes your breasts will be full during the night and baby may still be asleep so you will want to wake your baby and nurse. As baby gets older, feedings will space out.
How to prevent breast engorgement
You can significantly reduce your risk of engorgement by doing two things. First: before your milk comes in, nurse alot. Second: the day your milk comes in, nurse at least every two hours that day. As fast as your milk comes in, baby is taking it out which helps decrease possible engorgement.
What causes sore nipples?
When you are first learning to breastfeed, sore nipples are the result of poor positioning. They hurt because your baby's gums probably aren't over the lactiferous sinuses where they need to be to compress the sinuses. These sinuses are back about an inch from the tip of the nipple. Properly position baby's gums over the lactiferous sinuses where the milk is pooling, not the tip of the nipple where you have lots of nerve endings. Next, you can help the soreness by leaving colostrum or breastmilk on the nipple (unless you have inverted nipples) and airdrying the nipples. But the cause of the soreness is probably poor positioning. (Later soreness can be caused by thrush - a yeast infection - in which case both mother and baby need to be treated).
When can I use a bottle or pacifier?
It is best to wait a few weeks and let breastfeeding get a good start, build up a good milk supply and let baby get used to one kind of nipple. Then before baby is a month old you may have dad or grandma offer baby an occasional bottle, maybe when baby is a little sleepy and in a room where you usually don't breastfeed.
Baby's suddenly hungry
Babies have growth spurts, usually between 1-2 weeks old, at 6 weeks old, and 3 months old. Baby may want to nurse twice as often for 1-2 days during that time, and this extra stimulation will automatically increase mother's supply to match baby's demands.
Breast lump while nursing
Lumpy breasts can be normal when nursing but if you notice a particular lump it may be a plugged duct. Before nursing, use heat (warm shower or warm compress) and breast massage (gentle circular motion with fingertips from chest wall, over lump towards nipple) then nurse or pump. It is important to clear a plugged duct because it can lead to a breast infection. If the lump doesn't clear with this treatment or you develop flu-like symptoms, call the doctor.
Going back to work while nursing
If you have time and privacy at work, you may wish to pump your milk during those feeding times you will be away from baby. If you will not have the opportunity to pump at work, you may SLOWLY wean your baby from worktime feedings and only nurse before and after work or completely wean your baby. Whenever you wean, always do it slowly.
Storing breast milk
About 72 hours in the refrigerator, but after 48 hours there is some breakdown of the fats and proteins. For five days, refrigerated milk may be free of bacterial contamination. After that it should be disposed of. It is best to store in the back and higher shelves of the refrigerator. You may keep milk in the freezer for two weeks to six months depending on the type of freezer you have. Check with a lactation consultant or La Leche League about pumping, labeling and storing milk.
Can I nurse a premature baby in intensive care?
Your milk is tailor-made for your baby. If you have a premature baby your milk is higher in protein and gives baby extra protection against illness. And only you, no doctor or nurse who is caring for your baby in the intensive care unit, can supply this special protection. If you cannot put your baby to breast at first, you may pump your milk. Your nurse or lactation consultant will help you get started.
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