This pamphlet will tell you about:

The benefits of breastfeeding Good positions for breastfeeding Tips on diet, going back to work, and birth control

Breastfeeding is natural, but it takes practice. You and your baby can learn together.

Benefits

Breast milk is nature's perfect baby food. Your milk has just the right nutrients, in just the right amounts, to nourish your baby fully. It also helps your baby's mind and body grow. Breastfeeding (also called nursing) is a good choice for both the baby and the mother.

Baby

There are many reasons why breastfeeding is best for your baby:

• The colostrum—a yellow, watery pre-milk—that your breasts make for the first few days after birth helps your newborn's digestive system grow and function.
• Breast milk has antibodies that help your baby's immune system fight off sickness. Babies who are breastfed also have a lower risk of asthma, allergies, and colic.
• The protein and fat in breast milk are better used by the baby's body than the protein and fat in formula.
• Babies who are breastfed have less gas, fewer feeding problems, and often less constipation than those given formulas.
• Breastfed babies are at lower risk for sudden infant death syndrome (SIDS).

Mothers

Breastfeeding isn't just good for babies. It's good for mothers, too. Breastfeeding:

• Is convenient—it's always available and at the right temperature.
• Releases the hormone oxytocin. This makes the uterus contract and helps it return to its normal size more quickly. This also cuts down on bleeding after delivery.
• May lower your risk of osteoporosis and some forms of cancer.
• Burns calories. It may help you lose pounds gained during pregnancy faster than you would if you were bottle feeding (see "Diet").
• Is cheaper than bottle feeding.
• Creates a special bond between you and your baby.

Facts About Breastfeeding

During pregnancy, your nipples may start to drip a little colostrum. After you give birth, your body sends a signal to your breasts to start making milk. Within a few days, colostrum is replaced by milk.

When your baby suckles at your breasts, the nerves in your nipples send a message to your brain. In response, your brain releases hormones that tell the ducts in your breasts to "let down" their milk so that it flows through your nipples. This is called the let-down reflex. It first occurs when your milk comes in a few days after delivery.

Some women barely notice the let-down reflex. Others have a pins-and-needles feeling in their breasts a few minutes after their baby starts nursing. When your milk lets down, you also may feel engorgement. Engorged breasts feel full and tender.

Once feeding is established, the first milk that flows out of your breasts is watery and sweet. This quenches the baby's thirst and provides sugar, proteins, minerals, and fluid. As the feeding goes on, the milk becomes thick and creamy. This milk will give your baby the nutrients he or she needs to grow.

If the baby is latched on right, he or she will have your entire nipple and much of the areola (the darker skin around the nipple) in his or her mouth. The baby's nose will be touching your breast. The baby's lips also will be curled out around your breast. The baby's sucking should be smooth and even. You should hear him or her swallow. You might feel a slight tugging. You may have discomfort for the first few days. You shouldn't feel any severe pain, though.

Getting Started

Although breastfeeding is a natural process, it may take some practice and patience to master. Mothers and babies have to learn together.

To help give you a good start, during pregnancy tell your doctor that you plan to breastfeed. Your doctor will examine your breasts and answer any questions you may have.

During labor, remind the doctor and nurses that you plan to breastfeed. They can help you get started right after delivery. If possible, nurse in the first hour after your baby is born. At this time, your newborn is most alert and ready to suck. Later, your baby may be too sleepy to nurse well.

How to Breastfeed

Babies are born with the instincts they need to nurse, such as the rooting reflex. When you and your baby are ready to begin nursing, find a good position (see box). This will help you to hold the baby comfortably. Also, the baby will be able to get a good grasp on your breast.

Cup your breast in your hand and stroke your baby's lower lip with your nipple. The baby will open his or her mouth wide (like a yawn). Quickly center your nipple in the baby's mouth, making sure the tongue is down, and pull the baby close to you. Bring your baby to your breast—not your breast to your baby.

Check the baby's technique. If the baby is not latched on well, start over. To break the suction, insert a clean finger between your breast and your baby's gums. When you hear a soft pop, pull your nipple out of the baby's mouth.

Let your baby set his or her own nursing pattern. Many newborns nurse for 10–15 minutes on each breast. (A baby who wants to nurse for a very long time—such as 30 minutes on each side—may be having trouble getting enough milk.)

Nurse on demand. When babies are hungry, they will nuzzle against your breast, make sucking motions, or put their hands to their mouth. Follow these signals rather than the clock. Crying is a late sign of hunger. You may nurse very often (8–12 times in 24 hours) in the baby's first weeks of life.

When your baby empties one breast, offer the other. Don't worry if your baby doesn't continue to nurse, though. You don't have to nurse at both breasts in one feeding. At the next feeding, offer the other breast first. You may want to attach a safety pin to your shirt to remind yourself which breast to start with at the next feeding.

Diet

When you are pregnant, your body stores extra nutrients and fat to prepare you for breastfeeding. Once your baby is born, you need more food and nutrients than normal to provide fuel for milk production. When you are nursing:

Eat a well-balanced diet. During breastfeeding you need about 500 calories a day more than you did before you became pregnant. That's about 2,500 calories a day for most women. Make sure you get 1,000 mg of calcium a day. Your doctor may suggest that you keep taking a daily vitamin. Avoid foods that bother the baby. If your baby acts fussy or gets a rash, diarrhea, or congestion after nursing, let your baby's doctor know. This can signal a food allergy. Drink at least eight glasses of liquid a day.

Is My Baby Getting Enough Milk? For the first few weeks, check for these signals to tell if your baby is well-nourished: My baby nurses often. A newborn should nurse at least 8–12 times in 24 hours (every 2 hours or so). Your baby may spend about 10–15 minutes on each breast. My baby is drowsy and content after nursing. My breasts feel full and firm before feedings. After, they are less full and feel softer. My baby wets at least 6 diapers a day. His or her urine should be nearly clear. During the first month, your baby should have at least 3 bowel movements a day. The stool should be soft and yellow. My newborn baby is gaining weight. Most newborns lose a little weight at first. After 2 weeks, most babies are back up to their birth weight. Newborns should gain weight after the first week. If you are worried that your baby isn't getting enough milk, tell the doctor right away and have the baby's weight checked.

Sex and Birth Control

When you are ready to resume having sex, think about birth control. Women who are breastfeeding are less likely to get pregnant. Even though you may not have menstrual periods while you are breastfeeding, you can still get pregnant. If you don't want to become pregnant during this time, you should use birth control. Talk with your doctor about what form of birth control is right for you. What you were using before pregnancy might not be a good choice now.

Barrier methods such as latex condoms or a copper intrauterine device (IUD) are good options because they do not affect your milk supply. Good choices for hormonal birth control are the mini-pill, implants, or injections. They rely on the hormone progestin and do not contain estrogen.

Combination birth control pills contain estrogen and progestin. Estrogen can decrease your milk supply when you begin breastfeeding. Therefore, this type of birth control pill should not be used until milk flow is steady.

Work

Many mothers keep nursing their babies after they return to work. If you want to breastfeed when you go back to work, you may want to look into buying or renting a breast pump. You also can express breast milk by hand.

Talk to your employer about pumping at work. You'll want to find out if there is a clean, private place you can go to pump and a place for storage.

Practice with the pump a few weeks before your first day back at work. Be sure the pumped milk is stored properly (see box). Give some of the pumped milk to your baby in a bottle or cup. This will help your baby get used to drinking your milk from a cup or a bottle. Talk to your doctor or your baby's doctor about when to start trying the bottle.

Storing Breast Milk
Storage Method	Use Breast Milk Within
In refrigerator (40°F or below)	2 days
Frozen in a deep freeze (0°F or below)	3 months
Thawed and refrigerated (40°F or below)	24 hours
Note: To thaw frozen milk, put the bottle in a bowl of warm water. You also can let milk slowly thaw in the fridge. Do not use a microwave to thaw or warm milk. This destroys the milk's disease-fighting qualities. Also, it can make the milk hot enough to scald your baby.

Any breast milk is better than no breast milk. Try to breastfeed without supplementation for at least the first 6 months of your baby's life if you can. This will help you make enough milk and helps your baby breastfeed easily.

Breast Health

As they start to breastfeed, some women may have a few minor problems. Problems that may occur include:

• Engorgement
• Sore nipples
• Blocked ducts
• Mastitis (an infection of the breast caused by bacteria in the milk ducts)

Most often problems are easy to treat. If you have any of these signs of a problem, contact your doctor:

• Fever
• Pain
• Bleeding
• Rash
• Lumps
• Redness

Breasts are glands. Inside them are tiny sacs. These sacs contain cells that, given the right cues from your hormones, will start to make milk. The sacs are clustered into lobes. Each lobe has one milk duct that carries milk to the nipple. There are about 14–16 of these ducts.

To keep your breasts healthy and to increase the chances of breastfeeding success, try these tips:

• Learn proper nursing technique. (See box "Good Breastfeeding Positions")
• Use your finger to break the suction before you remove your breast from your baby's mouth.
• Gently pat your nipples dry with a clean cloth after feedings. You also might want to expose them to air and dry heat (such as a hairdryer on low).
• Use only cotton bra pads. Change them as soon as they get wet.
• Apply 100% pure lanolin to your nipples after feeding.
• Don't wash your nipples with harsh soaps or use perfumed creams.
• If one nipple is tender, offer the other breast first.

Finally...

Breastfeeding is a special gift of love and health only you can give your baby. Breastfeeding is natural, but it takes practice. You and your baby can learn together.

Glossary

Antibodies: Proteins in the blood produced in reaction to foreign substances, an antigen.

Estrogen: A female hormone produced in the ovaries that stimulates the growth of the lining of the uterus.

Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Osteoporosis: A condition in which the bones become so fragile that they break more easily.

Progestin: A manmade form of the hormone progesterone produced naturally in the body that causes the shedding of the lining of the uterus during menstruation.