Breastfeeding

Your baby should feed 10 or more times in twenty-four hours. More is fine!  It is natural and healthy for your baby to suck and eat very frequently to increase and maintain your milk production.  In the first few days after birth, your baby will want to be at the breast a lot! This is perfect- your baby has a job to do: that is to get your milk to increase, and that is how they do it! During the first few weeks of life, an awake baby is usually a hungry baby. Do not wait until your baby is crying to feed him. Start getting ready to feed as soon as your baby is stirring or awake.  If your baby is still sleeping after 3 hours, gently attempt to wake your baby by undressing her (leave her diaper on) and your chest for the feeding session. This is called skin-to-skin contact.

If your baby has not eaten in six hours or is excessively sleepy after the first 24 hours following birth, contact Kaiser Permanente at 1-866-454-8855 to connect with an Advice Nurse.

One handy tool to help you track that is found in the, “Your Journey Home” booklet that you were given in the hospital. There is a chart that allows you to track the number of feedings, poops and pees in a 24 hour period.  On pages 18, 19 and 20 of the booklet, you will find charts to use for days 1-14. To make it even easier- just know that you will feed your baby 10 or more times in every 24 hours. In the first few days, baby is sucking lots to build the many connections needed for milk production in your breasts, and to get the laxative effect of your colostrum (the first kind of milk in your breasts) to move the first poop (meconium) out of baby’s bowels. This frequent sucking also increases your milk supply. In a few more days, baby will be sucking due to hunger and the milk will be ready!

A newborn eats less than 1/4 ounce (5-7ml, or an amount about the size of a quarter) in the entire first 24 hours of life. In the second 24 hours, your baby eats about that much per feeding, regardless of your baby’s size at birth. Around 3-4 days after delivery, you should notice your milk increasing in amount; your breasts will feel heavier.  Here are some signs from La Leche League’s book, “The Womanly Art of Breastfeeding” (pg 110) to help you know that both you and your baby are doing well:

• Weight gain – All babies lose weight at first. Baby should be back to birth weight by 2 weeks of age
• Diapers – By the middle of the first week, baby should have at least three poops the size of the space your fingers make when you use your thumb and forefinger to make the “okay” sign, every day (24 hours)
• Your Breasts – Your nipples are comfortable, you have a milk release (you feel a tingle, might have milk drip, and might hear baby swallow) after 1 minute or less of nursing, and your breasts are noticeably softer by the end of the feeding
• Baby’s nursing behavior – Look for open eyes when the feeding starts, periods of slow (about one per second) sucks with periodic pauses, and finishing within a half hour at most
• How Baby acts between feedings – Look for baby falling gently asleep toward the end of the nursing (or being contented for at least a while before he nurses again), limp hands, and an unworried expression most of the time
• What doesn’t matter – How many minutes on each breast- instead just finish the first breast first, or whether baby falls asleep at the breast at the end of a feeding

If you do not notice these signs by the 4th day of life, please contact Kaiser Permanente at 1-866-454-8855 to speak with an Advice Nurse.

Other reasons to call the 1-866-454-8855 number:

• After you are home from the hospital, baby has not pooped in 24 hours, during the first month of life
• Baby falls asleep immediately at the breast (have you tried skin-to-skin?) but is still hungry when removed
• Baby is increasingly frantic at the breast
• Baby is less active and alert, is more lethargic or sleepier, or is awake less often

By the third day of life your baby should have 3 or more wet diapers every 24 hours. Your baby’s poop (stool) will be turning from the blackish-tarry meconium stool to yellowish by the 3rd day of life. Baby should have a minimum of 3 loose, yellow stools, (each the size of the space your fingers make when you use your thumb and forefinger to make the “okay” sign) every 24 hours from about the 4th day of life through 6 weeks of age. Loose or watery stools after every feeding are considered normal breast milk stools and are not a cause for concern.

Start with skin-to-skin contact. Babies placed skin-to-skin cry less, interact more, stay warmer, are more likely to breastfeed longer, and have improved neurodevelopmental (brain) organization. All of this can help your baby to breastfeed better.  Partners are also encouraged to hold baby skin-to-skin which can be a great way to calm baby.

To have skin-to-skin contact with your baby, undress baby down to his/her diaper and place on your bare chest.  You may place a blanket over both of you if it’s cool in the room. Baby may crawl close to the nipple, lick the nipple, and use their hands to touch the breast before actually latching and suckling. This is normal behavior and actually produces hormones that help mom to relax, and the colostrum or milk start to flow; so do not use mittens on your baby’s hands!

Also, here are some tips to position your baby to breastfeed:  Align baby’s ear, shoulder, and hip in straight line Place baby tummy to tummy with mom, nose to nipple. Hand express colostrum first and gently touch drops to baby’s mouth to entice him/her.  Touch your baby’s bottom lip with nipple and wait for baby to open his/her mouth wide.  Try not to force the nipple into the mouth. When mouth opens wide, lips flanged out, quickly bring baby to the breast, supporting neck and shoulders. Do not hold the baby’s head.  Allow the head to naturally tip back.  You will get the best latch if you can keep baby’s body turned in toward your chest, very close to you.

Some babies do better with the laid-back position for breastfeeding. In this position, you are reclining, or semi-reclined, supported on the bed or sofa with a pillow. Allow baby to bob his/her head, lick the breast, then gradually move toward the breast and self-latch. Of course you can help baby to get comfortable! You can use pillows under the baby, under your arms, and behind your back. Moms need to be comfortable, too!

If baby doesn’t feed well, or hasn’t eaten in 6 hours, contact Kaiser Permanente at 866-454-8855 to speak with an Advice Nurse.

It is important for your baby to latch regularly (at least every 1-3 hours) in order for you to keep producing milk.  This is usually done by placing the baby on your breast to suck and feed.

Sometimes babies have difficulty latching because they are premature, or had a more difficult birth experience. You will usually know if this is the case while you are still in the hospital and the staff will help you.

Another reason babies have a hard time latching well is when your breasts are very hard or engorged. Are your feet, legs, or hands still swollen from the IV fluids you received during your labor? If so, the extra fluid (edema) is in your breasts, too. Edema may appear early, or later, within 48-96 hours, often lasting 10-14 days.

One way to help baby to latch is to use “Reverse Pressure Softening” or RPS around the nipple:

• The firmer or more swollen the nipple area, the more time is needed to soften the nipple
  • RPS often forms temporary “dimples” or “pits”, but edema soon re-enters the pits after pressure is released.
  • If severe edema, lying flat on your back during RPS delays re-entry of swelling, allowing a longer window of time for latching.
  • Firmly but gently, press steadily on the areola, right at the nipple base.
  • Pressure should not be firm enough to cause pain. Avoid discomfort with less pressure for longer intervals.
  • Press inward toward the chest wall for a full 60 seconds or longer (10 minutes or more if needed).
• Any finger combination may be used. (See diagrams)
  • Mothers may find short nails with curved fingertips of both hands the most effective method.
  • One-handed methods are convenient if the other hand is busy.
  • Helper’s may find straight-fingers or two-thumb methods more convenient.
    • Use the flats of two thumbs or the first several fingers on each hand lengthwise above and below the nipple, creating a 1-2 inch long depression.
    • Continue to alternate in opposite quadrants, with repeated 2 minute periods of pressure, partially overlapping the first set of pits, to keep edema displaced from the entire area at the base of the nipple.
• After RPS, additional fingertip expression to further soften the areola is much easier, more comfortable and more productive. Creating a special niche for the chin often permits deeper latching.
• For engorgement, take a pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Avoid anti-inflammatory medication like aspirin.

If your baby absolutely cannot latch comfortably onto the nipple it is NOT the end of the world!  You will still be able to breastfeed. You and your baby may simply need some additional, temporary help.  If this is the case, you may need to protect and increase your milk supply by manually expressing or pumping regularly (10 or more times per day) and feeding your baby this breast milk by using a spoon, a syringe, or a cup.  If this is the case, please contact Kaiser Permanente at 866-454-8855 to speak with an Advice Nurse.

Many women experience some discomfort early in their breastfeeding experience, especially as you and your baby are learning proper positioning. If you see red areas, blood, or scabs on your nipple, please call Kaiser Permanente (below) right away so we can help you. You may continue to be uncomfortable while your nipples heal.  However, the discomfort should be present mostly at the beginning of a feeding session, and should improve once baby starts suckling. To help your nipples heal, you can use soap and water once a day if you have raw areas (this helps keep bacteria ‘down’), you can apply hand-expressed colostrum/breast milk to your nipples, air dry, and then use a small amount of lanolin. (Do not use lanolin if you are allergic to wool.)

It is important to work on adjusting your baby’s latch so that the sore nipples do not continue.  Try to focus on keeping baby’s body in close to you so that his/her body is completely facing you and the head is in line with the body.  If one position is not working for you (i.e. football hold), try another position (i.e. cross-cradle position).  Baby’s mouth should be directly in front of your nipple or the head should be slightly tilted upward.  Lips should be widely flared outward.  Be sure to wait until baby opens his/her mouth wide, or let baby attach to your breast on his own. If significant pain continues, contact Kaiser Permanente at 866-454-8855 to speak with an Advice Nurse for help with latch and positioning.

This is called ‘engorgement’ and is can sometimes happen around 3-5 days after birth. This is usually your first sign that your milk supply is “increasing.”  You should continue to feed your baby whenever he/she wants, 10 or more times in 24 hours- or as frequently as every 1-3 hours. Some hand-expression of the milk right before you feed the baby will help to soften your nipple and make it easier for the baby to latch. But don’t worry! Women “breast” feed, not “nipple” feed; so baby will do fine. You can help by taking a warm shower and having the warm water on your back.  Massaging the breasts before or during a feeding can also help. After a feeding session, put a frozen bag of peas, or cool washcloths on your breasts. You may take a pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Avoid anti-inflammatory medication like aspirin.

If your baby cannot latch very well, please see above “What if my baby just won’t latch” for the helpful RPS technique.

While engorgement may be temporarily uncomfortable, it should not be persistently painful.  You should feel more comfortable and your breasts should be softer after your baby feeds.  If this is not happening, please contact Kaiser Permanente at 866-454-8855 to speak with an Advice Nurse so that we can help you.

You will start to produce ‘mature’ milk by day 4 of baby’s life.  Mature milk should look more like skim milk rather than the thicker, yellowish colostrum of the first few days.  At this point, your baby should be getting closer to a ping-pong ball amount of breast milk (1-2 ounces or 30-60ml) per feeding.  When you are breastfeeding, it is not important to know exactly how much your baby is getting from the breast.  You can tell that your baby is getting enough if:

• Your baby is able to sustain a rhythmic suck/swallow/pause motion for 10-20 minutes at a time.
• You can hear and/or see your baby swallowing.
• Your baby is content, sleepy, and limp following a feed.  This is often called a “milk coma”.
• Your breasts feel full prior to feeding and much softer afterwards.

It is normal for your baby to fall asleep at the breast after a sustained feeding for 10-20 minutes.  If he/she is falling asleep immediately after latching, your baby may be too warm and comfortable. Unwrap your baby and place skin-to-skin.  This will help wake baby and stimulate him/her to feed.  If feedings are taking 45-60 minutes at a time, pay close attention to whether your baby is spending this time actively sucking and swallowing or simply sleeping at the breast.  It is acceptable for your baby to fall asleep or pacify at the breast after 10-20 minutes of active feeding, but if you cannot tell whether baby is sucking/swallowing or if your baby tends to spend more time sleeping than feeding at the breast, contact Kaiser Permanente at 866-454-8855 to speak with an Advice Nurse for help. This pattern of not feeding can potentially lead to poor weight gain for your baby and a poor milk supply for you, and is fixable!

In the first few weeks of life, an awake baby is usually a hungry baby.  You may notice early hunger cues that indicate when your baby is ready to feed; such as rooting, bringing hands to mouth, wanting to suck, or smacking the mouth and lips.  It is best to always offer the breast when your baby is fussy.  Whether your baby is hungry, tired, or simply needs soothing, the breast is your “secret weapon”.  However, it is also important to remember that not all crying is due to hunger.  Crying is simply a sign of distress.  Your baby may have a dirty diaper or be tired.

It can be helpful to occasionally swaddle your baby after feeding to help him/her sleep.  You can also try other calming measures such as burping, skin-to-skin contact, rocking, walking, singing or talking softly.  Sometimes you may see more fussiness in the evening, or your infant may be cluster-feeding for hours or a couple days at a time.  This does not necessarily mean that your baby is not getting enough milk from you or needs formula. These frequent feeding sessions are what increases your milk supply as your baby grows. Check above under “Is my baby getting enough.”

Your partner is vital to helping you in many ways, but cannot make milk for your baby.  In the beginning, your partner can be most helpful by changing diapers, bringing baby to you to feed, soothing baby with skin-to-skin, and helping with household chores.  Once breastfeeding is well established, usually by about 6 weeks of age, your partner may feed the baby with a bottle of expressed breast milk when necessary.  It is important that you pump your breasts anytime your baby is fed by bottle.  Otherwise, your milk supply will gradually decrease or you may become engorged, which can lead to mastitis.  For this reason, it is usually easier for moms to breastfeed during the night, rather than having a partner feed the baby a bottle.  Breastfeeding typically takes less time than pumping, so you can get back to sleep quickly.

It is important to avoid pacifiers while your baby is learning to breastfeed. Feeding cues may be missed if pacifiers are used and some babies will be so satisfied with the pacifier that they “forget” to ask for the breast.  This can lead to poor weight gain in the first few weeks of life.  Pacifiers can also change the way your baby sucks, causing it to be more difficult for your baby to breastfeed successfully. We recommend waiting until at least 1 month of age before introducing a pacifier.

Try to wait until breastfeeding is well established, after about 6 weeks of age, to offer your baby a bottle.  There is no need to “teach” your baby to take a bottle by a certain age.  Start trying a bottle only when necessary.  Giving a bottle of formula or pre-pumped breast-milk in the first weeks may cause the following:

• Baby may lose interest in sucking at breast
• Baby may reject breast if given bottles while learning to breastfeed
• If formula is given when not medically necessary, baby may overeat formula, sleep too long and miss next session of breastfeeding
• Mom is more likely to become engorged, have a plugged duct, or get a breast infection

It is not usually necessary to pump in addition to breastfeeding, unless you have been instructed to do so by your physician or lactation consultant.  Your baby does the best job of emptying your breasts to produce the perfect amount of milk. Learning how to breastfeed is what you should focus on right now. If you need to pump for medical reasons, the hospital or lactation staff will teach you how. This usually requires an electric, hospital-grade pump.  The hand pump you received in the hospital is meant to be used once breastfeeding is well established and you are away from your baby on occasion. If you eventually need to return to work or school, we recommend that you do not start pumping until 1-2 weeks prior to your return date.   By then you will have learned how to breastfeed, and can learn the new system of pumping your breast milk.

When you are breastfeeding, it is normal to feel some lumpiness in your breasts that change before and after feedings. If the lump becomes a tender spot, is painful, or red on the surface of your skin, you may have a plugged milk duct. It’s important to take care of it right away to stop a breast infection from developing. Here are some ways to help a plugged duct:

• Apply a wet, warm wash cloth to the plugged duct area for 10 to 15 minutes before nursing.
• Look for dried milk secretions or a white clogged pore on your nipple. Lean over and soak your breast in a basin of warm water for about 10 minutes. Then gently try to remove the dried milk with a wet wash cloth.
• Breastfeed every 1 to 3 hours, or more.  This will help drain the breast and clear out the plugged duct, as well as give you a chance to bond with your baby.
• Begin each feeding session on the side with the plugged duct because the baby empties the first side better.
• Gently massage the breast just above the sore area while baby is nursing.
• If possible, increase the length of time you feed your baby, at least 20 minutes per side, and also offer the second breast at each feeding.
• Vary your nursing position from time to time to relieve the pressure on your nipples. Try sitting up, lying down, and switch between using the football hold, cradle hold, cross-cradle hold, and laid-back positions.
• Make sure your baby is properly positioned and you hear swallowing.
• Remove tight clothing or baby carriers. Find a well-fitting bra and use a carrier that does not squeeze the breast tissue.
• Be sure to get enough rest. Sleep when the baby sleeps. Get help with household chores or leave them undone until you feel better.
• Increase your fluid intake to 8 to 10 glasses in a 24-hour period and eat a healthy, balanced diet.
• If needed, take acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) to help relieve the pain.

If these suggestions do not relieve your discomfort or you have any questions, contact Kaiser Permanente at 866-454-8855 to speak with an Advice Nurse so that we can further assist you.

When a breastfeeding mom feels like she has “the flu”, it is probably an infection in her breast called “mastitis”. You might feel:

• An area of the breast that is red, sore, and hot to the touch.
• Flu-like symptoms—including chills, body aches, tiredness, and fever.

If you are breastfeeding and have any of these symptoms, contact your practitioner or lactation consultant right away. It’s important that the infection is treated immediately. You should feel better within 24 hours with quick and proper treatment. If you’re given pills (antibiotics), make sure that you completely finish all of the pills according to the schedule your practitioner has recommended, even if you feel like you’re completely well before the pills are all gone.

If your baby is healthy, it is not necessary to stop breastfeeding when you have a breast infection. Breastfeeding actually helps your breast to heal more quickly, and continues to provide your baby all of the best benefits.

In addition to seeing your practitioner and taking the medication as prescribed, all of the hints above, in “I feel a lump in my breast” will help with a breast infection (mastitis), too.

Contact Kaiser Permanente at 866-454-8855 to speak with an Advice Nurse if you need additional help.

Appointment and Advice Line: 1-866-454-8855

Breastfeeding support is available to you anytime, day or night. Get answers to your questions and if needed, schedule an appointment with a lactation specialist or pediatrician. Your call is handled by Kaiser Permanente nurses.

Newborn Care Center and Breastfeeding Stores

The supplies you want are available at the Breastfeeding Stores. You will find a variety of breast pumps for rent or purchase, bras, baby slings, and more:

• Antioch Medical Center – 925-813-3879
• Pleasanton Medical Offices – 925-847-5511
• Walnut Creek Medical Center – 925-295-5001

Breastfeeding Support Groups

You will find support and make new friends at these weekly two-hour groups facilitated by a lactation consultant. Share ideas and solutions for breastfeeding and learn about baby’s breastfeeding behaviors. Bring your baby!
No need for a referral or to pre-register, no fee members only.

Please call for room location, day, and time:

• Antioch Medical Center – 925-813-3879
• Pleasanton Medical Offices – 925-847-5511
• Walnut Creek Medical Center – 925-295-4368