Breastfeeding

by Rosemary Romberg

The following material is based on the findings and philosophy of La Leche League. This is an international organization which is devoted to breastfeeding.

Charcoal3280-tmb * A collection of charcoal drawings by me available for use as breastfeeding resource material. Click Here for the gallery.

La Leche League groups hold regular meetings, usually once a month. Many La Leche League groups hold both daytime and evening meetings. Usually La Leche League meetings are just for women because some new mothers may feel uncomfortable nursing in front of men that they do not know. Occasionally La Leche League groups hold special Father’s Nights meetings for interested couples. La Leche League meetings are informal, enjoyable, and an invaluable source of information and help if problems or questions arise. Most of the women attending are either pregnant or have nursing babies. However, any woman who is interested in learning about breastfeeding (such as a nurse, childbirth educator, or someone planning a future pregnancy) is welcome to attend. Your childbirth instructor, doctor, midwife, hospital, clinic, or birth center will probably be able to put you in touch with your local La Leche League group. Sometimes newspapers and telephone directories provide La Leche League information. In the United States La Leche League has a toll free number: 800-LA-LECHE (9 a.m.- 3 p.m. Central time) which can refer you to local groups or answer other concerns. Their central website is http://www.llli.org/ . This website includes references to a multitude of other websites and resources as well.

La Leche League is backed by an advisory board of medical professionals who have thoroughly researched and approved all of their findings. Often medical schools teach future doctors very little about breastfeeding. You may encounter doctors whose attitudes and advice are in disagreement with La Leche League’s philosophies (for example: advising that nursing babies be fed on rigid schedules or supplemented with formula.) However, be assured that all of the following information about breastfeeding has been thoroughly medically researched and approved. Usually local La Leche League groups can direct you to doctors and other health care providers who are strongly supportive of breastfeeding according to their principles.

La Leche League’s philosophy is based on total mothering and is centered on putting the baby’s needs first. This includes nursing the baby whenever he/she is hungry rather than by a strict schedule, not using bottles, starting solids around the middle of the first year, and weaning the baby when he/she is ready to give up nursing (which can be as early as 8 or 9 months for some babies, or as late as age 3 or 4 years for others.)

As an expectant Mother, especially if this is your first baby, you probably feel overwhelmed with so many new things to learn. You probably are not sure about many choices you may make. Perhaps La Leche League philosophy sounds exactly the way you would like to mother your baby. Or possibly some of these ideas may not appeal to you even though you do want to breastfeed. You are most welcome to attend La Leche League meetings, even if you do not wish to do everything according to their philosophy. Many women approach La Leche League with the attitude of “I’ll take from it what I need.” However, be open to the strong likelihood that your ideas and desires may change considerably once the baby becomes a reality and you grow into the mothering role.

Breastfeeding offers many wonderful advantages over bottle feeding for both you and your baby, several of which are discussed in the following paragraphs. This can help encourage you in your commitment to breastfeeding and can be a valuable resource if others, out of curiosity or criticism, question your decision. Finally, although breastfeeding is a rewarding, pleasurable experience for most mothers and babies, the first few weeks of the baby’s life are almost always challenging and frustrating. If you find yourself struggling through bouts of nipple soreness, breast engorgement, or simply adjusting to the needs of the new baby, reviewing for yourself the many advantages of breastfeeding can help you bring the experience into a positive light.

ADVANTAGES OF BREASTFEEDINGNursing mom

Breastfeeding is better for the mother physically:

1. Usually nursing mothers recover more quickly from giving birth. The baby’s suckling stimulates the uterus to contract and return to its non-pregnant state. Therefore, there is usually less postpartum bleeding than there would have been if she had not nursed. Therefore the mother is less likely to become anemic.

2. Regular menstrual periods often do not resume for several months for the mother who totally breastfeeds. For many women menstruation does not resume until solids are introduced or supplementary bottles are given, although how long the baby goes between feedings or whether or not the baby is given a pacifier are other factors in this. The delay in resumption of normal menstruation is another safeguard against anemia from blood loss.

3. Along with menstruation, ovulation frequently does not resume for several months for the mother who totally breastfeeds. Therefore breastfeeding has some value as a natural contraceptive. It can be used along with natural family planning methods such as checking ones temperature and/or cervical mucus to determine the time of ovulation.

Although breastfeeding often delays ovulation, it does not prevent it. It is possible to become pregnant while breastfeeding, and some women may ovulate before they have their first menstrual period after giving birth. (There is some speculation that breastfeeding is of greater value in preventing ovulation among women in underdeveloped countries where the diet is poor than it is for women in more affluent settings who eat a more nutritious and varied diet.) If you do not wish to have another baby right away and do not choose to follow natural family planning you should use another form of contraception. Do not try to depend on breastfeeding alone to prevent pregnancy.

4. The weight that is gained during pregnancy, above that which comprises the baby, placenta, water, and immediate blood loss after birth, provides a reserve supply for the increased calories and nutritional demands during breastfeeding. Nursing mothers need approximately 500 extra calories per day, varying of course with the size and growth rate of the baby and whether any other formula, juice, or solid foods are being given. Because of the extra calorie requirements for breastfeeding, nursing mothers are often able to return to their pre-pregnant weight within the first few months after birth while following a normal diet.

If you need to lose additional weight, there are highly nutritious, successful reducing diets which can be followed by nursing mothers. (A severe restriction in calories would not be advisable because of the importance of maintaining adequate nutrition to produce milk.) Weight Watchers has a weight loss program that is specifically designed for the needs of nursing mothers.

5. Some studies have indicated that nursing mothers are less likely to develop breast cancer than are women who have given birth but have never breastfed.

6. There is a natural hormone called prolactin which is released by the body while the mother is nursing her baby. Prolactin is a natural tranquilizer. Its release can make one feel sleepy or generally relaxed and peaceful. Prolactin is a chemical which strongly influences natural mothering behavior. In scientific experiments prolactin has been injected into male, or young, non-pregnant female animals who have then demonstrated motherly behavior towards other young animals. Therefore, there is a scientific, chemical basis to the idea that breastfeeding is associated with “natural mothering.”

Mom sleeping with baby    Because of the effects of prolactin, the nursing mother is likely to be more relaxed and in tune with the needs of her baby. She will probably get more rest (especially if she sleeps with her baby as well) and is less likely to have postpartum depression.

Breastfeeding offers many other practical advantages:

1. Breastfeeding is economical. Formula, bottles, and other paraphernalia associated with bottle feeding all cost money. (This, of course means profits for big businesses which is why magazines are often full of ads for baby bottles and formula while breastfeeding information may be scarce. No one makes any money from breast milk since our own bodies produce it!)

If a bottle feeding mother were to be given all of her baby’s formula and equipment free for the first year or several months of his/her life, this would be considered a fantastic gift! Yet you get this automatically when you breastfeed.

2. The mechanical chores that are necessary to bottle feed, such as sterilizing bottles and equipment and mixing and heating formula can be tiring and bothersome. None of this is necessary when you breastfeed.

3. The breastfed baby can be taken places easily with hardly any extra equipment. Bottle    feeding requires that you take bottles, formula, and other equipment with you whenever the baby goes anywhere. Also one can run out of formula, clean bottles, or bottle liners, but breast milk is always readily available.

Nursing mom

4. Breast milk is super-convenient. Formula can be too cold or too hot, or it can spoil. The baby can become frantic with hunger while the parents are attempting to adjust the bottle to the correct temperature. Breast milk never spoils (as long as it’s directly from the breast, and is always the correct temperature). One’s milk supply never entirely runs out and is available immediately for the baby’s needs.

5. Bottle feeding can only take place safely when the luxuries of civilization are available. One must have safe running water, a regular source of fuel for heat (such as electricity or gas), a stove, a refrigerator, stores that sell formula, a car or other vehicle to get to the store, and money to purchase it. In developed countries we take such things for granted, but attempts to bottle feed in underdeveloped countries have often resulted in severe health problems and death to many unfortunate children.

In the event of a power failure, traffic jam, personal financial difficulties, or natural disaster such as a flood or earthquake, bottle feeding can become a catastrophe while breastfeeding can continue normally. Families who enjoy camping trips especially appreciate the ease and convenience of breastfeeding.

Breastfeeding offers many specific advantages to the baby:

Nursing mom

1. In general breasted babies tend to be happier, more agreeable babies. This is due to the continual close contact with the mother’s body and because mother’s milk agrees more completely with the baby’s system.

However, even breastfeeding is not a total guarantee that the baby won’t be fussy – and a continually fussy baby can make life extremely challenging! No one knows for sure what physical or emotional discomforts can cause some babies to be persistently fussy, but the continued comfort and reassurance afforded by a nursing relationship can particularly help soothe the problems of the fussy baby.

2. Breastfed babies smell better. Their spit up does not have an unpleasant odor and does not stain clothing the way formula does. Babies that are only consuming breast milk produce stools that are normally yellowish, fairly liquid in consistency, and have a mild, sweet odor. Breastfed babies do not need to be bathed very often. If you use cloth diapers, the soiled diapers of a totally breastfed baby do not need to be rinsed out before washing or being sent to the diaper service. The loose, mild, breastfed stool quickly dissolves in the pre-wash cycle, is rinsed away by the washing machine, and the diapers come out clean.

3. Breast milk has been proven to be nutritionally superior for the baby. Even formula companies often state in their advertising that their product is second best to mother’s milk.

— Breast milk is raw milk. This preserves important nutrients and immunities which are destroyed by pasteurization and subsequent heating.

–Totally* breastfed babies are less likely to develop allergies, especially if solid food and supplementary formula, milk, or juices are not introduced during the first several months of life. (*Commercial baby cereals have added iron which may cause constipation, even if the baby is breastfed.)

— Because breast milk agrees completely with the baby’s system, breastfed babies are less likely to develop future digestive upsets. Formula, especially if it is based on cow’s milk, forms larger curds in the stomach which is more difficult for a baby to digest.

— Breastfed babies are never constipated. Constipation refers to a hard, dry stool that is difficult to pass. The stool of a breastfed baby is loose and runny, resembling yellow cottage cheese or Dijon mustard. Some breasted babies soil their diapers several times a day (which is the normal pattern for most newborns). Some babies go once a day. Some babies may go several days or a week or more between stools. This is normal, as long as the baby is nursing well and is otherwise healthy. Going several days between passing a stool is not in itself constipation.

— Breast milk gives the baby a supply of natural immunities from the mother’s body. For this reason, breastfed babies are less likely to become ill.

— As a rule breastfed babies tend not to need solids until around the middle of the first year. Breast milk contains all of the nutrients a baby needs, except for being low in iron. Babies are born with a natural supply of iron which starts to not be enough by around 4-6 months even though he/she does get some iron through breast milk. The introduction of solids at this time will provide the extra iron that the baby needs as he/she continues to grow.

Occasionally a very large, hungry baby may be more content if solids are introduced at around 3-4 months. Sometimes a premature baby, with a less Babyadequate iron reserve might also need solids at around this time. But most doctors today agree that babies get little use from solids during the early weeks of life.

(Normal hand to mouth activity, in which babies grasp objects and put them in their mouths, commonly begins at around 6 months of age. This suggests that this is the correct age for solid food to be introduced. In many parts of the world the mother doesn’t sit her baby down with a spoon and baby food. The baby simply starts feeding himself as he gets older.)

Sometimes a perfectly healthy breasted baby will refuse to take any interest in solid food at age 6 months or older. A baby like this can thrive perfectly well on breast milk for a year or more as long as iron supplements are given. (A simple blood test can determine the baby’s exact iron level. Based on this you and your baby’s health care provider can make the appropriate decision about iron supplementation.)

Jars of prepared baby foods, or dehydrated baby foods and cereals purchased at the supermarket can be quite convenient. However, they are the equivalent of canned food. As an alternative or supplement to commercial baby foods, many mothers choose to make their own with a baby food grinder, blender, or food processor. Home made baby food can be made up in large quantities and kept in the freezer until used.

  Breastfeeding offers many advantages for the infant’s psychological well-being:

— The baby begins life relating to a person (mother) instead of an object (bottle). Through the nursing relationship the baby learns the value of a strong, one-to-one, interpersonal relationship. When the baby is breastfed, he or she is always fed by the same person (mother), while the bottle fed baby is often fed by different people during different feedings. In a day and age of fickle relationships and rampant divorce, this may be of greater significance than we realize.

— The baby learns to love by relating to the warmth and closeness of the mother’s body. Breastfeeding can only be accomplished by holding the baby close. A close rapport and communication develops between the mother and her nursing baby. You can bottle feed and still be a warm, loving mother, but most people would agree that it’s “not the same.”

Where does the father fit in when the mother is nursing the baby?Dad and baby

Some fathers are highly enthusiastic about breastfeeding and are able to give their wife/partner considerable support and encouragement. Other fathers may be non-committal about the matters leaving the decision about how to feed the baby entirely up to her. Often fathers who have experienced the chores and hassle of preparing bottles for a previous baby tend to especially appreciate the ease and convenience of breastfeeding.

However, it is not uncommon for some men to feel jealous or hesitant about their wife’s/partner’s choice to breastfeed. If he has only thought of his wife’s partner’s breasts in a sexual context, he may initially have some difficulty about accepting their dual purpose in nourishing and comforting the baby. Also, some fathers especially want to be actively involved with their babies and may feel left out if the mother is breastfeeding because he cannot feed the baby. However, babies do many things besides eat. A daddy can bathe, dress, play with and cuddle the baby, and need not feel left out just because only the mother can feed the baby.

Many fathers who start out feeling ambivalent about their wife’s/partner’s breastfeeding become greatly enthusiastic as time goes by. Many men find this a time when they appreciate their wife/partner more deeply as she is fully expressing her femininity and motherliness by nurturing the baby with her own body.

COMMON MISCONCEPTIONS ABOUT BREASTFEEDING:

Mom with small babyUnfortunately a lot of old wives tales and general misinformation abounds about breastfeeding. People may be simply curious, have little knowledge, and might make strange comments. People intending to be helpful may give faulty advice. Sometimes women who were not successful with nursing their own babies can feel painfully disappointed and therefore may try to undermine the success of others. Even some medical people can be seriously misinformed about breastfeeding and will give faulty advice. Sadly, some misinformation can lead a mother to give up nursing her baby when she truly wanted to continue.

Hopefully if these misconceptions can be answered with facts, this can be a valuable tool in establishing a successful nursing relationship:

1. “Some women cannot nurse because they just don’t have any milk.”

The inability to lactate (produce milk) is extremely rare. Occasionally a woman, (particularly from previous generations who gave birth when breastfeeding was not as encouraged as it is today), may say: “But I tried to nurse my baby, and there just wasn’t any milk there!” Possibly she was unaware that only colostrum is produced for the first 2-3 days after birth before true (i.e. mature) milk starts to come in. (Colostrum, by the way, is extremely valuable for the baby as it is full of vital nutrients and natural immunities.)

There may be some rare diseases or glandular deficiencies that strongly inhibit lactation, but usually that would also interfere with the ability to become pregnant.  Sometimes an inadequate diet or certain drugs such as antihistamines or birth control pills containing estrogen can result in an insufficient milk supply. Also, previous breast surgery such as breast reduction may interfere with the ability to produce milk.

More often, however, our mental states can have a profound and curious effect on our body’s processes. Some mothers who for whatever reasons have no interest in breastfeeding will experience little or no breast growth or nipple sensitivity during pregnancy, never have colostrum, and little or no milk ever gets produced after the baby is born. Lack of desire to breastfeed can cause the body to respond accordingly, while strong desire to breastfeed is almost always associated with breastfeeding success.

Milk production works on a supply and demand basis. The amount of milk that is produced responds directly to the amount of suckling that the baby does. For this reason, most mothers of twins can readily produce enough milk for two babies. (Mothers of triplets have totally and successfully breasted.. When wet-nursing – one woman hired to nurse another woman’s baby – was common, there have been instances on record of women wet-nursing as many as seven babies!)

Sometimes uninformed mothers can get into a vicious circle of thinking that they don’t have enough milk, giving the baby a bottle of formula, and consequently producing less milk because the baby is taking formula. This can lead to weaning before the mother wished to wean.

Breast milk is also digested much more quickly and thoroughly than cow’s milk. Therefore, the formula fed baby may be more likely to go 3-4 hours between feedings before being hungry again, while the breasted baby may want to nurse again as early as 1 ½ to 2 hours after the last feeding. If the nursing mother does not understand this, she may be led to believe that the baby isn’t getting enough because he/she is hungry again so soon.

Sometimes a mother has plenty of milk, but the milk is not letting down. Normally when a baby begins to nurse the suckling stimulates a let down reflex which causes the milk to flow out of the breasts. Most nursing mothers readily recognize this as a tingling sensation in the breasts. Sometimes emotional factors can inhibit the let down reflex, and consequently the baby does not get enough milk. In most cases, taking whatever steps are necessary to resolve the emotional tension will solve this problem.

2. “Only women with large breasts can nurse their babies.”

All breasts of normally functioning adult women are equipped with the same milk producing glands and ducts. Varying sizes of different women’s breasts is almost entirely due to fat cells. Therefore this has no effect on the ability to produce milk. Some women have very little breast development except when they are pregnant or lactating, and yet they successfully nurse their babies. Even women with silicone implants and women who have had some types of breast reduction surgery can nurse their babies.

3. “Nursing mothers need a special diet and cannot eat certain foods.”

Women have nursed their babies since the human race began. Women nurse their babies in all parts of the world while following a wide variety of diets. Milk production will be successful as long as the food is nutritious and adequate. Eating a lot of junk food or following an extremely restricted reducing diet can cause the milk supply to diminish and will adversely affect the mother’s energy level.

Occasionally a baby may have a fussy or allergic reaction to a food in the mother’s diet which affected the milk. Some babies, particularly very young babies, seem to be particularly sensitive to such things. In general, if a food upsets the mother it may also upset the baby.

Rarely a baby will have inherited a number of allergies and be so sensitive that the mother must follow an extremely restricted diet while she is nursing her baby. The highly allergic child is especially benefited if he/she starts out with only mother’s milk, so most mothers are glad to make such a sacrifice.

Most nursing mothers find that they can eat anything, even questionable foods such as chocolate, fresh fruit, dried beans, spices, onions, and garlic, with no effect on the baby.

4. “If you get sick, you must wean the baby.”

If the mother gets the flu, colds, and most minor illnesses, these apparently do not adversely affect the milk or the baby. Usually the nursing baby stays healthy despite the fact that the mother is sick. The baby gets antibodies to the illness through the mother’s milk. When a mother is sick, it is far easier to lie down and tuck the baby into bed next to her,  than be up attempting other household tasks.

Weaning is necessary if the mother has a serious illness that is so contagious that she should not be in contact with the baby at all such as tuberculosis or whooping cough. (Once adequate medication has begun and the mother has begun to recover, breastfeeding can be resumed.) Maternal AIDS is believed to be another contraindication to breastfeeding as infection through her milk could result, although simple physical contact with her baby would not put him/her in danger. (Today there is considerable medical debate as to the advisability of breastfeeding if the mother has aids, especially in parts of the world where formula is not easily available. Many articles about this can be found on La Leche League’s website.)

A mother should not nurse if she has to take medication that would be dangerous to the baby. Whenever you must take medication and are nursing your baby, make sure your doctor knows that you are breastfeeding. Unfortunately, not all doctors are well informed about the needs of nursing babies or which medications would harm them. Some doctors will routinely prescribe weaning for any medication, while occasionally women have been told to continue nursing when a medication has been harmful to her baby. If necessary, La Leche League’s medical resources can provide you with specific information about a particular medication or other situation.

Usually if one type of medication would be harmful, another medication or alternative treatment can be followed instead. If you must take medication that would not be good for the baby, you can express your milk for a few days, throw the medicated milk away, and resume nursing when you are no longer taking it. Only if you must take a potentially harmful medication for a long period of time would it be, regretfully, necessary to wean the baby.

5. “If you get a breast infection, you must wean.”

Breast infections are due to old milk that has not been drained out of the breast.  A bra that is too tight or an injury to the breast, inept attempts at hand expressing ones milk, or even lying wrong on one’s breast while sleeping can result in a breast infection. Some women find that they are more prone to breast infections if they are over exerting and trying to do too much too soon after giving birth.

A general achy feeling, and one area of the breast that is sore are indicatons of a breast infection. The let down sensation may be painful in the infected breast, particularly if the baby is nursing on the side that is not sore. The infection, however, does not affect the milk, and the infected breast should be kept as empty as possible, by nursing the baby or carefully expressing the milk. Weaning is the very worst thing that one can do for a breast infection, as this would cause the breast to become painfully engorged with milk which would greatly complicate the condition.

Breast infections must usually be treated with antibiotics such as penicillin. Contact your health care provider immediately if you have a breast infection as he/she must prescribe the medication. (Some health care providers will simply listen to you describe the symptoms and prescribe the medicine over the phone.) Ordinarily the antibiotic will not affect the baby. In a minority of cases the baby may have a bad reaction to the antibiotic. Usually changing to a different antibiotic will solve the problem. If this does not work, it will be necessary to express the milk for a few days (to keep your milk supply in and keep the breast drained) and resume nursing when you quit taking the medication.

6. “You should wash and follow special procedures before each nursing.”

Reasonable personal cleanliness such as a shower or bath every day or two is sufficient. Soap or alcohol are drying and can contribute to nipple soreness. Because baby bottles and nipples must be carefully sterilized, some people think that a similar procedure is necessary for the mother’s nipples. This is not necessary because mother’s milk coming directly from the breast into the baby’s mouth has no opportunity to come into contact with germs and is essentially sterile.

Some special procedures are advised if the mother is troubled by nipple soreness. Preparations such as lanolin, coconut oil or vitamin E oil can be applied to the nipples prior to nursing the baby if your nipples are sore. Lanolin should not be used if you are allergic to wool. Commercially prepared nursing creams are usually less advisable because they contain perfumes which can be irritating and can affect the baby.

Women with fair, sensitive skin are usually more prone to nipple soreness than are women with darker skin pigmentation. Sometimes nipple soreness can be related to incorrect positioning of the baby’s mouth on the nipple. Or if the baby has “thrush” – a whitish, yeast type infection in his/her mouth which should be treated with anti-fungal medication – this can cause sore nipples. Nipple soreness normally goes away after the first few days after birth, although sometimes it can take weeks to entirely subside.

7. “Nervous women cannot nurse.”

Women with all sorts of different temperaments have successfully nursed their babies. Sometimes women who tried to nurse and were unsuccessful may say such things as “I can’t nurse because I’m too nervous.” as an excuse.

As was previously discussed, occasionally emotional tension can inhibit the let down reflex, but this problem can almost always be resolved for the woman who truly wants to nurse. Many women who are ordinarily high strung find that they are more relaxed during the time that they are nursing their babies. The natural hormone, prolactin, produced by one’s system while nursing, acts as a natural tranquilizer and eases tension.

8. “If you have a Cesarean, you should not nurse.”

Many, many women who have had Cesarean deliveries have successfully nursed their babies. The Cesarean mother is recovering from major surgery, but she will undoubtedly get more rest by nursing than if she is busy fixing bottles and formula.

Women commonly feel disappointed or disconnected following a Cesarean birth, especially if the surgery was unexpected. Many such women have especially valued the satisfaction of successfully breastfeeding and have found that it reconnected them to their baby and restored their sense of joy over having given birth.

The Cesarean mother may be uncomfortable holding her baby on her lap to nurse and may be more comfortable lying down to nurse until her incision heals.

9. “If you have twins, you cannot nurse.”

Parents of twins   Because milk production works on a supply and demand basis, most women can produce enough milk to fully breastfeed twins. Some women have even fully breasted triplets. Breastfeeding twins is much easier and less expensive than preparing a double supply of bottles. Nursing mothers with twins sometimes do nurse both babies at the same time.

Twins will be twice as much work in any event. Extra help with housework and with older children is usually a necessity when the twins are babies. It is especially important that the nursing mother of twins eat an ample, nutritious diet to insure a plentiful milk supply

10. “You cannot nurse if you have a premature baby or if the baby has to stay in the hospital for a while before coming home.”

Many mothers of premature or otherwise hospitalized babies have been able to successfully nurse their babies. Different courses of action can be followed depending on the hospital’s policy and the condition of the baby

Some hospital nurseries have provisions so that the mother can scrub in sterile, go into the nursery and nurse the baby there on a regular basis.

Some doctors will allow an otherwise healthy baby that has reached a weight of between four and five lbs. to go home so that the mother can nurse regularly.

Some very tiny or sick babies are too weak to suck. In this case the mother can express her milk and bring it to the nursery so that it can be fed to the baby. A baby like this will probably be fed through a tube that goes directly down his/her nose and throat and into his/her stomach. Also usually hospitals provide special bottles with very soft “preemie” nipples. A baby that can suck can be fed in this manner if the mother is not nursing or cannot be there for every feeding.

While the medical profession is increasingly recognizing the benefits of breast milk, some hospital staff may not be open to either allowing the mother to nurse her hospitalized baby or to allowing her milk to be given to the baby. Even in a case like this the mother can continue to hand express her milk at home, for the purpose of keeping up her milk supply, and begin nursing when the baby finally does come home.

A premature baby needs all the help that he/she can get for a good start in life. Mother’s milk has many benefits such as natural immunities and easy digestibility that will give the premature baby a superior start. Some hospitals make special provisions to obtain mother’s milk for their premature babies, even if the babies’ own mothers are not planning to breastfeed, because of the nutritional superiority of breast milk.

11. “If you have the RH factor, you should not nurse.”

Many RH- mothers with RH+ babies have successfully breastfed without any problems. Today, few doctors even question whether the RH- mother should nurse. Since babies who suffer from a blood incompatibility almost always develop a highly dangerous type of jaundice, other concerns about breastfeeding and jaundice have been interrelated with the concerns about the RH factor.

12. “If the baby gets jaundice, the mother should not nurse.”

Most jaundice is normal. Normal physiologic jaundice usually appears 3-4 days after birth. It is said to occur in up to 70% of all newborns. Many cases of jaundice appear after the baby leaves the hospital or birth center. Sometimes the condition never gets recognized or formally treated, but it disappears of its own accord within a few days with no problems. If a baby is jaundiced his/her skin will appear yellowish – a condition more easily recognized in Caucasian babies than in African, Asian, or other dark skinned babies. The baby needs more red blood cells during prenatal life than it does after birth. Therefore the baby must break down and get rid of some of its red blood cells shortly after birth. Bilirubin is released into the baby’s system when these red blood cells are broken down. The yellow color appears because the baby cannot dispose of the red blood cells fast enough.

If you are home and the baby looks very yellow, especially if his/her eyeballs are yellow, contact the baby’s doctor or health-care provider. They will probably want to take some blood from the baby’s heel to test for bilirubin count. Although most jaundice disappears readily by itself, very high bilirubin counts can result in brain damage. Babies with jaundice are often kept under special lights or in indirect sunlight which helps break down the bilirubin. Usually such babies are hospitalized for these treatments. Occasionally doctors have provided methods by which parents can place the baby under the special light or bright natural light at home. If the baby is hospitalized, in many cases the mother can remain with her baby and continue nursing him/her.

Some health care providers advise that the baby be given extra water to help flush the bilirubin out of his/her system. Others argue that this practice has been shown to increase the level of bilirubin. Today most authorities do agree that occasionally nursing alone provides the baby with ample amounts of fluid.

Premature babies, and very small full term babies frequently develop jaundice. The condition occurs fairly frequently in average sized babies (5-7 lbs.) and less commonly in large babies (weighing 8-9 lbs. or more.)

Jaundice that appears within the first two days after birth can indicate a blood incompatibility and can be life threatening, possibly requiring a blood exchange transfusion. The baby, however, can still be breastfed.

There is a rare type of jaundice that is caused by breast milk. This occurs approximately 10 days to 2 weeks after birth. In these rare cases a substance in the mother’s milk interferes with the baby’s ability to dispose of bilirubin. Many mothers have continued to nurse their babies under this circumstance, and although the baby will continue to appear yellowish, no harm to the baby results. In other cases, mothers have substituted formula for 2 or 3 days, hand expressed their milk in the meantime, and have then resumed nursing Even true breast milk jaundice is not a reason for weaning.

Because of this rare breast milk jaundice, some doctors in the past have routinely advised automatic weaning for all jaundiced babies. Today, increasing numbers of health care providers recognize the advantages of breastfeeding and realize that jaundiced babies usually can be nursed with no ill effects.

13. “When engorgement goes away the milk is gone.”

When the milk first comes in, about 3-4 days after giving birth, most nursing mothers experience engorgement. When this happens the breasts are suddenly very swollen and uncomfortable. This period of engorgement lasts about 2-3 days and then the swelling subsides. After that the mother still has just as much milk, but now her breasts are working more efficiently. Sometimes mothers have not understood this process and have thought that engorgement meant that they were full of “gallons” of milk which suddenly disappeared.

14. “Nursing ruins the shape of ones breasts.”

Occasionally some women, or their husbands or partners are hesitant about breastfeeding because they have heard that women can get saggy breasts due to nursing their babies. Actually it is pregnancy that changes the nature of the breasts. Also all people’s bodies become somewhat saggier due to the aging process.

A woman’s breasts normally become larger during pregnancy and nursing and return to their original size after weaning. A properly fitting bra should be worn during pregnancy and nursing, especially if your breasts are large. It is not necessary to wear a bra when you sleep, although some women find that this helps prevent leaking and becoming overly full with milk.

Sometimes people see pictures of primitive, tribal women in publications like National Geographic and these women have saggy, pendulous breasts. This appears to be due to heredity and to not wearing a bra. A woman may find that her breasts are not be as firm after she stops nursing her baby as they were before she ever became pregnant, but they aren’t anything like the ones in those types of pictures.

Even if breastfeeding were to have an effect on the shape of ones breasts, most women who want to nurse would consider the warm, close relationship with the baby, and the many other advantages afforded by breastfeeding more important. Breasts are not intended to be only decorations!

15. “When the baby gets teeth, it’s time to wean.”

Today, many nursing mothers are discovering that nursing an older baby or toddler offers many rewards and pleasures. Nursing the baby during the second half of the first year, or through the second or third year, is much easier and less demanding than it usually is when the baby is little. Although the baby is probably drinking from a cup and eating many other foods by this time, the nursing relationship can be a continued source of comfort and closeness for him/her.

The baby does have teeth by this time. Normally when a baby is really nursing, he/she does not bite. If she/he tries out her/his teeth, usually immediate scolding and taking the breast away will discourage her/him from doing it again. (The baby is probably just playing rather than seriously nursing if this happens.) By this time ones nipples are usually less sensitive anyway. Most babies will learn quickly not to bite while nursing.

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    La Leche League has several books and informational reprints available. Some of their reprints focus on specific facets of breastfeeding such as nursing the premature baby, breastfeeding and jaundice, and breastfeeding after a Cesarean birth. Their books, reprints, and other helpful material are available through La Leche League, International, 9616 Minneapolis Ave., Franklin Park, IL. 60131. (800-LA-LECHE) Specific reprints are no longer listed in this article as their information is continually changed and updated. However, a free catalogue of their material is available upon request. They can refer you to your nearest local La Leche League leader, group, and/or La Leche League supportive physician. They can also provide counseling and advice for unusual situations or questions which your local La Leche League leader may not know. Specific information sheets and books can be obtained by contacting La Leche League’s headquarters directly, or through your local La Leche League leader.

Further information is also available on their website:http://www.llli.org/

Sleeping baby

First printing: 1983
Updated and revised: 1991
(Revised – 2013)


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