Many women choose to breastfeed their babies for an extended period of time.  Chances are, if you do, you’ll find yourself pumping breast milk at some point.  It’s funny, but I always had a hard time pouring breast milk down the sink drain… it wasn’t just a waste, it was personal.  So what do you do with breast milk when you pump and don’t use it right away?  If you are planning to use the milk within 4-24 hours you can store it in a bottle (see guidelines below).  If you plan to freeze it, just about every bottle manufacturer sells breast milk storage bags that are made expressly (pun intended) for this purpose.  Make sure that you seal the bag well before putting it in the refrigerator or freezer.

Here are some simple breast milk storage guidelines to follow for storing your freshly expressed breast milk:

At Room Temperature: Up to 6 hours at 66-72 degrees F

In an insulated pack with ice packs: Up to 24 hours

In the refrigerator: 5-8 days at 32-39 degrees F

In the freezer compartment of your refrigerator: 3-6 months

In a deep freezer: 6-12 months 

To thaw frozen breastmilk, run warm (not hot) water over the bag until the milk has thawed.  Once breast milk is thawed it must be used immediately or it can be stored in the refrigerator for up to 24 hours.  It cannot be stored in the refrigerator or the freezer again. 

Throughout the Breastfeeding 101 series we have been touching on a variety of topics.  One topic that I have to include is Mastitis.  Having had Mastitis with all three of my children, I know how terrible it can feel.

Mastitis: An infection of the breast, usually only occurring in women who are breastfeeding their babies.

The most common bacteria causing mastitis is called Staphylococcus aureus. In 25-30% of people, this bacteria is present on the skin lining normal, uninfected nostrils. It is probably this bacteria, clinging to the baby’s nostrils, that is available to create infection when an opportunity (crack in the nipple) presents itself.

Symptoms of mastitis include:

• pain
• redness
• warmth in the breast
• swelling and/or tenderness
• fever and flu like symptoms (chills, trembling)
• engorgement

In some cases there will be red streaking on the breast, originating at the source of the infection.  Mastitis often will occur within the first few weeks of breastfeeding, but it can occur at any time during breastfeeding.  It usually only affects one breast, although I have had the luck of having double mastitis with my first baby.  Double whammy!

Here are some helpful suggestions that you can use if you think you might have mastitis:

• Apply a warm compress to the affected part of the breast, especially before nursing.
• Apply gentle massage to the affected area, while using a warm compress or while in the shower (with warm water on the breast) or in a warm bath.
• Use cold cabbage leaves to reduce the swelling and provide a bit of relief.  This may sound like an old wive’s tale, but it really works.  While breastfeeding I always have a head of green cabbage in the fridge for this purpose.  Crunch a nice cool cabbage leaf in your hands to crackle it, then lay it on the affected area and keep it there until it is not cool anymore.  Do not leave cabbage leaves on the breast for more than a couple of hours at a time and be sure not to cover the nipple.  The cabbage leaves draw milk from the ducts to help reduce the swelling, so if you notice any reduction in milk supply discontinue use immediately.
• Breastfeed first from the breast with the infection and let the breast drain completely.  This will help reduce the pain.
• If symptoms do not go away after trying these suggestions, call your doctor, you may need antibiotics to treat the infection.

Do not stop breastfeeding!  It is very important to continue breastfeeding while you have the infection.  Discontinuing could worsen the problem.  Also be sure to stay hydrated.  Drink plenty of water.

Also important to note is that your baby will not catch this infection.  This is an infection of the breast tissue and cannot be passed to your child.

As I’ve said in previous Breastfeeding 101 posts, I cannot emphasise enough the importance of having a good support system.  Familiarize yourself with your local La Leche League chapter, a midwife, or a good lactation consultant.  You will be glad that you did. 

Our last Breasfeeding 101 post was mainly about demand feeding, which is a very important subject indeed, but one of the first things that must be done when breastfeeding is finding a comfortable position to nurse your baby in.  There are four main positions to consider.  You may favor one of them over another, or you may choose to use all four, depending on the time of day, or your circumstances.  Here are the four main breastfeeding positions:

The Cradle Hold

The cradle hold is one of the most commonly known breastfeeding positions.  While using this position you are cradling your baby’s head in the crook of your arm, while holding the baby’s body snugly against yours with that same arm.  If you are feeding from the right breast you will cradle your baby’s head in the right arm.    The baby’s body is facing you with her chest, stomach and legs resting across or below your opposite breast, either horizontally or at a slight angle.  Your forearm and hand are supporting the baby’s spine and bottom.

In breastfeeding all three of my children, I have found this position best used when they are a bit older and have adequate neck and head control.  Although the baby’s head is well supported in the crook of the arm, this position does not allow for the mother to have much control of the baby’s head position, which is very important in those first days and weeks of the breastfeeding relationship.  Also, if you have had a c-section you may find that this position puts too much strain on your healing abdomen.

When using this position, as with all of the positions, make sure that you are using pillows to prop your arms up if needed.  Holding a baby while breastfeeding can cause great strain on the shoulder and neck muscles and pillows will help alleviate some of this strain.  If you can, have a stool to rest your feet on as well.

The Crossover Hold

The crossover hold is also called the cross-cradle hold.  The crossover hold is a wonderful hold for your first days breastfeeding your newborn, especially if you have a preemie.  In this hold, you are cradling your baby to you, but instead of using the crook of your arm to support the baby’s head you are using the opposite hand and arm.  The baby is in the same position against your body as it is when using the cradle hold, but if you are feeding from the right side, then the left arm and hand are supporting the baby’s spine, neck, and head.  This position is great for newborns and smaller babies because you are able to easily guide the baby’s mouth to the breast (chin first… we’ll discuss this in a future post regarding latching on) and hold it there, as your baby will not have the strength to hold it in position itself.

This is the position that I have always used most frequently with my newborns.  It gives me the most control and keeps the baby right where it needs to be to keep a good latch.

The Football Hold

The football hold is also sometimes called the clutch position.  In this position you will hold the baby under your arm and to your side, like a football player carries the ball.  The baby’s body is held snugly against whichever side you are feeding from, with it’s tummy against your side and its feet behind you, pointing toward your back.  Her face will be towards you with her nose lined up with your nipple.  It is very helpful to have pillows supporting the baby’s body.  A Boppy pillow works great!  Just position it around your side instead of your stomach.  Support the baby’s neck, shoulders and head with your hand and guide the baby’s mouth to the nipple with your hand, chin first.  You may find it helpful to support the breast with your opposite hand.

This position is great for mothers who have had a c-section because there is no pressure on the incision.  It’s also a wonderful position for mothers who are tandem nursing twins!  If your baby is having trouble latching on this position is very helpful as well.

Reclining Position

The reclining position is a wonderful position for mothers who are recovering from a c-section or for night time feedings.  In this position you can cradle the baby’s head with either the top or bottom arm, with his body close and facing you.  This position requires pillows to support the mother’s body.  Have your partner prop pillows behind you for support, and even place one in between your knees to keep your hips and back in proper alignment.  Use a pillow or folded blanket to elevate baby’s head if necessary.  You should avoid bending down towards the baby or causing the baby to reach for the nipple.

I found that I used this position more when my baby’s were a bit older, mostly because I am fairly small breasted and so it always seemed difficult for my babies to reach me to nurse when they were very small.  However, when they were older this was a great position, especially at night.

I would encourage you to try out all of these positions at some point so that you can decide which works best for you and your baby.  Here are some general tips for breastfeeding:

• Alternating breasts that you nurse from first at each feeding helps increase milk production
• It’s a good idea to alternate positions, as each position favors different milk ducts, and using a variety of holds will help reduce the chances of clogged milk ducts
• Create a comfortable space for nursing times.  A comfy chair with plenty of pillows at hand, and a distraction-free environment will help you and your baby be able to relax.
• Keep a record of the times that you breastfeed and which side you start on.  There are plenty of fun bracelets and even iPhone apps that will help you with this.

One of the most important things that we can discuss in the Breastfeeding 101 series is proper latch.  Your baby latching on properly is the key to the start of a successful nursing relationship.  As we have discussed in previous posts, breastfeeding is a learning experience for both mother and child.  In this post we’ll talk about what the proper latch looks like and how to help your baby achieve it.

When I was preparing for the birth of our first child I took at breastfeeding class, which was one of the best decisions I made.  Before going into the class, I just assumed that the proper latch involved the entire nipple and areola being taken into the baby’s mouth.  I soon learned that this was not necessarily so.

The proper latch will have the baby’s lower gum well below the nipple, on the areola (the dark area around the nipple).  You will be able to see the areola above the baby’s upper lip.  It looks a little bit like a crescent moon shape.  The baby’s lips will be flared out on both top and bottom.  They should not be tucked into the mouth.  The photo above demonstrates this beautifully.  To facilitate this:

• Get into a comfortable and supported position for breastfeeding.
• Start by lining the baby’s nose up with your nipple.
• You may need to encourage your baby to open her mouth wide by brushing her upper lip with your nipple.  You want to see the baby’s mouth wide open (as if she was yawning) and the tongue covering the bottom gums (see image below).  This might take a few times of encouraging the baby to open her mouth.  If the tongue is not covering the bottom gums and the mouth is not wide open, it can result in the baby chomping down on your nipple.  A newborn can chomp down pretty hard!  Also, the baby will not be able to take the nipple in at the correct angle, which prevents let down and results in a very unhappy baby.
• Bring the baby to the breast, chin first, then nose.

Below is an excellent rendering of what the proper latch looks like from an internal view.

You’ll notice that the nipple is angled upwards and goes far back into the throat.  Did you know your breast could do that???  Don’t worry, the baby will not choke.  The baby nurses from the areola and the nipple.  The nipple should reach all the way to the baby’s soft palette.

Touch your tongue to the roof of your mouth and you will feel the hard palette of your mouth.  If you bring your baby to your breast and your nipple stops at the hard palette of baby’s mouth, when she starts to nurse it will hurt like heck!  The baby will effectively be clamping the nipple between their tongue and their hard palette, which really hurts.

Now touch your tongue farther back against the roof of your mouth until you feel the soft area in the back.  This is the soft palette and this is where your nipple needs to be for the baby to nurse efficiently.  When baby starts to nurse, they encourage the milk ducts to let down (release the milk) by massaging the areola and stimulating the release of the milk.  This cannot happen if the areola and nipple are not far enough back in the baby’s throat.

How can you tell if you have achieved proper latch?

The first 10-30 seconds of a breastfeeding session can be a little bit painful as the baby starts to massage and the milk lets down.  If you feel pain beyond that first 10-30 seconds then chances are the baby is not latched on properly.  Gently insert your pinky into the corner of the baby’s mouth to release the suction and remove the baby from the breast.  Take a look at your nipple.  You may find that it looks pinched, indicating that the nipple was being clamped between the tongue and the hard palette.  Try latching again, and keep trying until baby gets a good latch.  Many breastfeeding problems can be solved with paying careful attention to the latch.  If you are having trouble achieving the proper latch, if breastfeeding continues to be painful for you or the baby seems frustrated and hungry all of the time, seek the help of a lactation consultant.  

Tips for achieving the proper latch:

• Make sure you are in a comfortable position.  Use pillow to support you.
• Wait for it.  If the baby’s mouth is not wide open, with the tongue covering the bottom gums, just try again.
• Avoid using scented body lotions.  They can be too much for the baby and cause the baby to refuse the breast.
• If you have large breasts, support the breast with your hand, if possible.
• Take a moment to burp the baby before nursing on each side.  If the baby has any trapped gas, they will likely refuse the breast or fuss at the breast, even though they are acting as though they are hungry.
• Do not wait for the baby to cry to be fed before you feed him.  A frustrated baby will have a harder time latching on correctly.

What questions do you have about proper latch?

Feeding your baby can be one of the most rewarding things that you do.  We have covered a lot so far in the Breastfeeding 101 series, including the mother’s needs, the value of breast milk, how the baby benefits , and benefits to the mother.  Today we start to get into the nuts and bolts of feeding your baby, starting with demand feeding, and how often your baby should nurse.

A new baby may not be strong enough to take in an adequate amount of food in a single feeding, and as a result he or she will need to nurse more often.  Compared to a formula fed feeding, a breastfed baby will eat at more frequent intervals.  Why, you may ask?  Breast milk is more easily and quickly digested than formula is.  It is, after all, made by the mother specifically for this purpose!  While a formula fed baby may take a bottle every few hours in the first days of life, a breastfed baby may nurse every 1 1/2- 2 1/2 hours, and at least every 3 hours.  Even if a baby does not cry, you should still offer the breast at frequent intervals.

It’s very important not to limit the time that you nurse.  Sometimes women will experience sore nipples, and thinking that the pain is brought on by nursing for too long, they cut short the feedings.  The real reason for sore nipples is actually an improper latch, not the length of time that you nurse.  Proper latch will be explained in detail in a later post.  It is important to drain the breast at each feeding to avoid milk becoming stagnant in the ducts and to allow the baby to get the nutritious hind milk that comes later on during the feeding.  Demand feeding facilitates this.

Allowing your baby to nurse freely may result in:

• A more content baby
• Plentiful milk supply.  The more you nurse, the more milk you will make.
• Increase of blood to the baby’s face and head, which may contribute to proper development of the brain.

Nursing your baby frequently will also reduce the chances of you developing mastitis, an infection of the milk ducts.  Mastitis is something that you want to avoid at all costs.  Symptoms are flu like (achiness and chills), with fever over 100.4 and hot red lumps or sore areas in the breast.  These symptoms will put you in bed and make it extremely painful to nurse.

If you do come down with mastitis you can massage the milk ducts, especially while the baby is at the breast, use warm compresses in between nursing for pain relief, increase your amount of rest as much as possible, take 1000 mg of vitamin C and an oderless garlic supplement daily.  Continue to nurse while you have mastitis.  Your baby cannot get sick from your milk.  If symptoms continue to worsen after 24 hours,even with the natural treatments, call your doctor.  Your doctor will prescribe antibiotics for the infection.  While on antibiotics make sure to take a probiotic as they can cause thrush in the baby’s mouth and on your nipples.  There are also children’s probiotics that you can administer to the newborn.  Make sure you have an infant probiotic though.  Put a little bit on your nipple before putting the baby to the breast and your baby will safely ingest it.

A sufficient milk supply is so important, and demand feeding will help your body produce the amount of milk that your baby needs.

Signs of sufficient milk supply are:

• a happy baby
• 6-8 wet diapers a day
• frequent yellow, soft curd stools
• your milk may leak or drip, especially during the let-down reflex
• baby will swallow frequently while nursing
• sufficient weight gain, with the baby regaining it’s birth weight by 2 weeks, and doubling it’s birth weight by 6 months (generally)

Your baby will experience a growth spurt at about 3 weeks and 6 weeks.  At these times, he or she will want to nurse even more frequently.  Nurse as often as the baby desires and do not supplement with water or formula. Your body will adjust it’s milk production with the increased demands of your baby.  During this time you may feel a bit full or engorged while your milk supply is increasing, but your breasts will adjust in a couple of days! 

We’ve covered a lot of ground so far during our Breastfeeding 101 series.  I think we’ve come to a good point to talk a little bit about the breastfeeding mother’s needs.  When you are lactating you have specific nutritional needs.  Meeting these needs will help your body to produce the milk that your baby needs.  Here are the main things that you need as a breastfeeding mother:

Water

• The nursing mother needs about 64 oz. a day or 8 8 oz. glasses
• Water ensures a good milk supply.
• Staying well-hydrated helps the mother to feel better physically.
• Water is calorie-free.  Fruit juices can cause weight gain and/or prevent desired weight loss due to empty calories.

Vitamins

• The nursing mother should continue to take her prenatal vitamins for 3-6 months post partum.
• At six months post partum she can switch to a basic vitamin-mineral supplement such as Vitamin Code Women to help provide a boost while lactating (the baby might experience an upset stomach when she consumes an iron supplement).
• Taking a basic B complex supplement helps milk production, incourages feelings of well-being, and increases energy levels, but the mother should NOT exceed 50 mg of B-6 per day.

Protein

• Nursing mothers need about 50-70 grams each day.
• One peanut butter sandwich on whole grain bread and one 8 oz. glass of lowfat milk provides 20 grams of protein.
• Milk supply seems to be related to the amount of protein in a woman’s daily diet.

Calcium

• Nursing moms need about 2000 mg each day.
• If calcium is not readily available for the production of breastmilk, because a mother’s diet is lacking, then it will be taken from the mother’s bones.
• 8 oz. of yogurt contains about 270 mg of calcium, 1 cup of cottage cheese contains about 230 mg.

Iron

• To make sure that hemoglobin levels are at a healthy level eat meat and dark green vegetables. Hemoglobin carries oxygen from the lungs to the body tissues and takes carbon dioxide from the tissues to the lungs.
• Chlorophyll (a natural iron suuplement) can be very helpful in boosting hemoglobin levels in the blood. (Take as directed)

Fruits and Whole Grains

• The lactating mother needs plenty of fruits and whole grains to keep her body strong while she’s breastfeeding.
• They keep mother and baby regular.
• Keep fruit around the house and easily accessible.  Again, a peanut butter sandwich on whole grain bread is great paired with a crispy apple!

Many foods such as dairy, eggs, soy beans, and meat contain both protein and calcium, so if you choose wisely you can make sure that you absolutely meet your nutritional needs.  Remember to keep sweets and caffeine to a minimum.  Strive to eat a well-balanced diet each day.  A good breakfast is a must!  Small frequent meals or snacks throughout the day keeps blood sugar levels steady and will enhance energy levels.

The most important thing to remember is that you are not only feeding yourself, you are feeding your baby!  I thought I was a pretty healthy eater until I had my first child.  When I had a little one to feed I was much more intentional about what I put into my body, knowing that she was benefiting from what I consumed.  Do your research and come up with an eating plan that will enable you to reach these nutritional goals.  A plan can take the guesswork out and make it easy! 

If you’ve been reading along with the Breastfeeding 101 posts, then you know the benefits of breastfeeding when it comes to your own health and the benefits to your child.  These are obviously important factors in your decision to breastfeed.  They have a significant impact both immediately and in the future.  But have you given any thought to the value of breast milk?

Feeding a child throughout their life… do you have any guess as to how much parents will spend to feed their child while the child is living under their roof?  I cannot even imagine what that total is, I just know that with three children in our family, our largest household expense is food.  That’s a lot of money.  When I think of breast milk, from a practical standpoint, I think of the money that it saves during the first year of a child’s life, and possibly longer than that, depending on how long you plan to breastfeed.

My children have never had formula, so I have never actually spent a dime on it.  I don’t know firsthand how much it costs to formula feed.  I did some research though.  When I looked at brand name formula (not the fancy shmancy kind, just basic formula) and then estimated how far one canister would last I found the cost to be staggering!  You can easily spend $75-$80 each week to formula feed your baby.  Multiply that by 4 and that comes to $300-$320 each month.  Multiply that by 12… that’s $3600 for the first year (give or take).  Then you have to take into account the cost of bottles, and all of the other accessories that you might end up buying.  This adds up.  If you can breastfeed for free why wouldn’t you???  You will spend a little bit of money investing in a two or three good nursing bras, nursing tanks, and nursing pads (you can purchase reusable pads), and perhaps a decent breast pump and a few bottles if you plan to be away from your child for some feedings.  These costs related to breast milk are very small in comparison to the cost of formula for one year.

It has also been well documented that breastfed babies get few ear infections and sicknesses, due to the nutritional make up of the breast milk.  As a result, you pay less in medical costs during that first year.  Not only that, but working parents of breastfed babies will miss fewer days of work when their babies are healthier.  Fewer copays, fewer prescriptions filled, fewer days of lost pay equals more money in your wallet!  If you took the $3600 that you might spend on formula in that first year and invested it in a good growth stock mutual fund, you could double the amount in 12 years to $7,200, or quadruple it in 24 years to $14,400.

The value of breast milk is far reaching and very significant.  When the health benefits and the economic benefits are seen together (and there are more than what I have listed here), it’s easy to see that forgoing formula for breast milk is the logical choice.  Even if a mother can breastfeed for 4-6 months she is helping her baby and her family in so many ways. 

Breastfeeding is one of the best things that you can do for your baby.  The other week we looked at a few ways that the nursing mother benefits from breastfeeding and today we’re going to see the benefits of breastfeeding for the baby.

There really is no substitute for breastmilk.  No matter how hard formula manufacturers try to sell it as such, there is nothing that compares to mother’s milk when it comes to nourishing the baby.  The lactating mother’s body takes it’s cues from the baby and adjusts itself accordingly, and that is something that canned formula cannot do.

Colostrum is the baby’s first food and is produced prior to the baby’s birth as well as during the baby’s first few days of life.  The mother does not produce much of it, which sometimes leads women to think that they are not producing enough for their babies, but rest assured, it is enough.  My husband jokingly referred to it as Momma Yarbrough’s Liquid Gold while I was nursing our newborns (maybe that was too much information, LOL!).  Although colostrum is produced in small amounts, it is concentrated and contains exactly what the baby needs.

• It is packed with antibodies that the mother passes from her own body.  These antibodies retard bacterial growth.  Breastfed babies have seven times fewer the number of infections than formula fed babies.
• It is high in protein and vitamins and low in carbohydrates and lipids.
• It acts as a natural laxative, facilitating the elimination of meconium (the baby’s first bowel movement) and excess bilirubin, which in high amounts causes jaundice).
• Colostrum provides the baby with significant protection against allergies.

After the first few days of the baby’s life, the colostrum transitions to what we think of as traditional breastmilk. At this point the mother’s milk “comes in”.  The mother produces much more of this milk, it is thinner and changes a bit in it’s makeup, providing what the baby needs for continued growth.  There are many benefits from continuing breastfeeding.

• The act of breastfeeding naturally satisfies the baby’s need to suck (some of you who have nursed know this all too well, perhaps).
• Neurological stimulation starts earliest in breastfed babies.  The New York Times cited research showing that prolonged breastfeeding resulted in improved scores on childhood intelligence tests, though it was difficult to conclude whether that was due to the breastmilk itself or the interaction, both physically and socially, that is part of the breastfeeding experience.  Either way it is a good thing!
• Breastmilk helps prevent tooth decay.
• Breastmilk is easier for your baby to digest than formula.  This results in more efficient use of the milk and also accounts for the fact that breastfed babies eat more frequently than formula fed babies.
• It provides every nutrient your baby needs for brain growth and good overall physical development.
• The bonding that comes from the nursing relationship is second to none.

I breastfed each of my three children exclusively for 12-14 months.  They have never ingested one ounce of formula.  My first and third would drink my breastmilk from a bottle if I needed to be somewhere when it was time to eat, but my second child would not have  bottle under any circumstance.  This meant that I did not get out much on my own for the first 12-14 months, but I worked around it and it didn’t affect my life in a negative way.  I have always been thankful to be able to feed my children in this way, and let me tell you, it wasn’t always easy, but the benefits of breastfeeding  outweighed the cons at every turn.

I think it’s important for women to know the facts about breastfeeding, and how the baby benefits from nursing, so that they can make an informed decision about how their baby will be fed.  I will never judge a woman for the decision that she makes, but I do think it is very unfortunate when women make decisions based on formula commercials and what their doctors tell them exclusively.  Please take the time to think about the options and educate yourself about breastfeeding and formula feeding… it will be time well spent, I promise you that! 

Pregnancy and birth are life-changing events to be sure, but there is more than just the birth of the baby to prepare for.  If you are planning to breastfeed your baby, then it is necessary to prepare for that as well.  Unfortunately many women are ill-informed about what to expect during their breastfeeding experience.  Although breastfeeding is the most natural way to feed your baby, it does not always come naturally and there is much to learn before you begin.

There is so much to tell you about this subject.  I think it would be best to break it up into several posts and give you everything you need to know to get a great start to your journey as a breastfeeding mother.  I’ll be covering all of these subjects over the next several posts:

• Benefits to the mother
• Benefits to the baby
• The value of breastmilk
• The breastfeeding mother’s needs
• Breastfeeding techniques
• Demand Feeding
• Breastfeeding “trouble shooting” and natural remedies