Alaska

e Families

epartment of Health and Human Services

on Women’s Health
for American Indian and Alaska Native Families 3

tfeeding for

ican Indian

d Alaska

e Families

y Guide to

erican Indian and Alaska Native 

 families who embrace life.

all women who choose to breastfeed.

This Booklet, along with the 1-800-994-9662 andwww.womenshealth.gov website, are designed to help you feelconfident in your decision to breastfeed. Breastfeeding will helpyour baby avoid many health problems.Breastfed babies are less likely to have:

• Ear infections• Diarrhea• Colds• Flu 

Breastfed babies may be less likely to become obese.Research shows that obesity is part of the reason that many of our people suffer from type 2 diabetes.Babies were born to be breastfed.
for American Indian and Alaska Native Families 3

5

Human Services encourages all women to

ths before introducing solid foods and

onths and thereafter for as long as desired.

he traditions of American Indian and

tice of breastfeeding respects our heritage

children, our

eeding

estions

g for American

es is part of a series of Guides by the

man Services’ Office on Women’s Health to

Office on Women’s Health encourages all

6 months. 

tant for American Indian and Alaska

milies and communities struggle with

obesity and diabetes. The people of Gila

zona, working together with the scientists

Health (NIH) found that breastfeeding

ming overweight and possibly developing

feeding Promotion Group of Arizona came

message of hope with our communities.

g for American Indians and Alaska Native

of these partnerships and the generous

ealth and Human Services’ Office on

tutes of Health/National Institute of

ney Diseases, and the Diabetes Center of

edical Center.

 Breastfeeding... 

Breastfeeding Promotion Group of ArizonaMelinda Aguirre, CLE, Diabetes Center of Excellence, Phoenix IndianMedical CenterBernadette Anderson, Diabetes Program, San Carlos Apache IndianCommunitySara Defelice, BS, RD, CLE, Inter-Tribal Council of ArizonaGailyn Lewis, Genesis Program, Gila River Pima Indian Community Priscilla Lopez, MCH Coordinator, Tohono O'odham NationDeborah Morago, WIC Program, Gila River Pima Indian CommunitySue Murphy, RD, MPH, CDE, IBCLC, Diabetes Center of Excellence,Phoenix Indian Medical CenterJanine Roumain, MD, MPH, NIH Research SpecialistSandra Sangster, BS, CLE, NIH Program SpecialistRoberta Seepie, CLE, Breastfeeding Program Coordinator, Salt RiverPima Maricopa Indian CommunityShona Stack, RD, CLC, Inter-Tribal Council of ArizonaA special thank you to the following for their tireless,collaborative efforts, traditional wisdom, and talent:John Molina, MD, Las Fuentes Clinic, Guadalupe, ArizonaGila River Indian CommunitySalt River Pima-Maricopa Indian CommunitySan Lucy VillageTohono O’odham NationAk-Chin Indian Community San Carlos Apache Indian CommunityInter-Tribal Council of Arizona, WICNative American Community Health Center, Phoenix, ArizonaWilliam Daychild, the American Indian artist who created thePIMC Breastfeeding LogoNational Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases
 Breastfeeding... for American Indian and Alaska Native Families 7

astfed

 people and traditions strong

. 

re all one child

hrough Mother Sky.”

hawnee proverb

Is breastfeeding easy?• Once breastfeeding is established, it is easy.

Breastfeeding is natural, but you, your body,and the baby may need time to get adjusted. 

• Breastfeeding makes you part of a miracle

that you can share with your baby.Breastfeeding is not painful, although yournipples may be sensitive at first. 

• Since before anyone can remember,

American Native and Alaska Native women have made enough breastmilk for their children, often more than one child at a time. Villages,communities, and entire nations have thrived and grown strong frommother’s milk. Trust your body, you will have enough.

• You are giving your baby a gift that only you can give. We are here today

because our ancestors breastfed. All of our great leaders were breastfed.Our ability to breastfeed has not changed. You can do this.

• Being a mother is a new journey with each baby. It is normal to worry a

little and wonder. Talking to an Elder, friend, mother, or aunt can helpyou begin this most sacred passage into motherhood. 

• Nurture yourself as you would nurture your baby. Be patient with

yourself as you and your baby learn together. 

How do I get started? While you are pregnant, tell your health care provider that you want tobreastfeed. Ask women in your community who breastfed to share theirstories. They will tell you how breastfeeding is a special gift that only amother can give to their child.
 Breastfeeding... for American Indian and Alaska Native Families 9

Milk The baby

For the first several days after birth, your bodymakes colostrum. Colostrum is rich, yellowish,thick, and in small amounts. It gives your baby ahealthy dose of early protection against diseases.

Your baby will probably be awake the first hour after being born, then go to sleep. Thisis a good time to feed your baby.

.

Your baby will drink about 1 teaspoon ofcolostrum at each feeding. You may not see thecolostrum, but it has what the baby needs andin the right amount.

It is normal for the baby to sleep heavily. Labor and delivery is hard work for the baby.Some babies like to nuzzle and may be too sleepy to latch well at first. Feedings may beshort and irregular. As your baby wakes up, take advantage of your baby’s strong instinct to suck and feedevery 1-2 hours. Your baby will love the flavor of your breast milk. Many babies like toeat or lick, pause, savor, doze and then eat again.Ask the nurse not to give your baby any formula or water unless medically indicated.

Your white milk comes in. It is normal for it to beyellow or golden at first. It may look thin in thebeginning and then becomes thick & creamy atthe end. It’s natural that your baby will like it.

Your baby will feed a lot, 8-12 times or more in 24 hours. Your baby’s stomach is littleand your milk is easy to digest, so it is normal for your baby to eat often. Expect yourbaby to take at least 15-20 minutes on each side. Breastfed babies don’t eat on schedule.It is okay if your baby eats every 1-2 hours and then sometimes sleeps 2-3 hours beforeeating again. As your baby grows, the feedings will be shorter and less often.The baby might take only one side at a time or seem to like one side better. Don’t worry,the baby will get enough from one side and will learn to eat on both sides soon. After delivery, it is normal for a baby to lose a little weight. Your baby will regain his orher birth weight by two weeks.

White breast milk, lots of it.

Your baby will be better at breastfeeding and have a larger stomach to hold more.Feedings will take less time and will be farther apart.

ew weeks keep you from sharing the gift of

 beating of your heart, the rhythm of your

ur special milk teaches your baby to love the

How do I hold the baby when I breastfeed? There are 3 common ways to hold your baby. Use the positions that arecomfortable for you and your baby. Keep your baby's face, belly button,and knees close, next to your body. Tummy to tummy. Use pillows,rolled up towels, or blankets to keep your back, arms, and shoulderscomfortable.
 Breastfeeding... for American Indian and Alaska Native Families 11

mb

s

he

ll

e

.

Football HoldRecliningSitting

nal Pictures courtesy of the Tohono O'odham

Department of Human Services, CommunityHealth Services Branch

How do I know that my baby is getting enough milk? Trust yourself to do what our women have always done. In the first fewdays, expect the baby to eat every 1-2 hours and have several diaperchanges. As your white milk comes in, there will be more and morediaper changes. The baby’s stools will become runny, yellowish, and mayhave little white “seeds.” By the end of the first week, 5-6 or more diaperchanges and 8 to 12 feedings every 24 hours will tell you that the baby isgetting enough.Why does my baby want to eat so often?• It is normal and important for new babies to breastfeed often. Your milk

is the perfect match for what your baby needs. It is easily digested andyour baby’s stomach is small, so your baby needs to “refill” often.

• After the first few weeks, your baby will be an expert breastfeeder and

have a larger stomach to hold more. Feedings will spread out and beginto take less time.

Baby’s Age Wet Diapers Dirty Diapers Color and Texture

Day 1 (birth)Day 2Day 3Day 4 (or whenmilk increases)Day 5Day 6Day 7

Thick, tarry and blackThick, tarry and blackGreenish yellowGreenish yellowSeedy, watery mustard colorSeedy, watery mustard colorSeedy, watery mustard color

123

5-65-65-65-6

This chart shows the minimum number of diapers for healthy, fullterm babies. It is fine if your baby has more.
What do I do if I have sore nipples?

Sore nipples go away quickly. Once you aresure the latch and position are okay, try thesetips:• Start feeding on the least sore side first and

try a different position with each feeding. 

• Try a putting little breast milk or lanolin on

the nipple and let it air-dry.

• Don’t tug if clothing or pads stick to your

nipples. Wet the clothing or pads before gently peeling them off. 

• If sore nipples start after the first three weeks, ask your baby’s health care

provider to check for thrush. Thrush is a fungal infection that growsquickly in warm, damp places. If you or your baby has thrush, both youand your baby need to be treated. Be sure to see your healthcare providerfor treatment.

Is it okay to use formula, bottles, pacifiers, and water?No, it is not recommended in thefirst 6 months. In the early weeks,formula, plastic nipples, pacifiers,and water can easily interruptbreastfeeding. New babies quicklyget used to the simple way ofsucking from plastic nipples andpacifiers and then will refuse tolatch. Exclusive breastfeeding meansfeeding your baby only breastmilk- no formula, water, rice cereal, orbaby food. Exclusively breastfeeding for 6 months is linked with manyimportant health benefits for you and your baby. Your milk has everything

 Breastfeeding... for American Indian and Alaska Native Families 13

Alaska Native communities, it is

luded with their babies for several weeks.

he beginning encourages you and your

urt, your baby will eat more often.

very 2 weeks in the beginning, and less

tra feedings tell your body to make more

painful and my baby can’t latch.

s

p

to

milk. It will soften the nipple area, so the

breastfeeding. The key to relief is

astfeeding your baby. It will get better in

 or if you have a fever, contact your
 Breastfeeding... for American Indian and Alaska Native Families 15

onths. Regular use of formula and

breaking the natural cycle of

od or water. If you are worried that your

ugh to drink, you can drink more water,

r clinic or WIC. Trust all the generations

 because they could breastfeed. You can

r baby, leave bottles of pumped milk. Be

e, your baby still receives your special gift. 

breastfeeding are a learning time for you,

ill get easier, and you will feel more

thier because you mothered with your

all of our people’s yesterdays and will

ws. 

and solids? 

old. By then, the baby’s stomach is more

omplex food. Your baby will breastfeed

o back to work or school?

ed

Consider some of these combinations:• The caretaker brings the baby to you 1 or 2 times each day or you go to

the baby at nearby childcare.

• Check with your work or school. Many schools and worksites have

breastfeeding areas for breastfeeding moms or onsite day care.

• Pump and save your breast milk.

Pumps vary in effectiveness and price.Hand pumps often work for shortterm, occassional separations. If youwill be missing 2 or more feedings ona daily basis, consider a hospital gradeelectric pump. They will keep yourmilk supply going and make pumpingeasy and quick. 

• Hospital grade electic pumps are usually purchased or rented from a

lactation consultation, hospital, or breastfeeding organization. Try theyellow pages under "breastfeeding," to find a pump. Sometimes localhospitals will let moms have access to their pumps. Also, check withWIC. They may have hospital grade pumps to loan.

The following are tips for pumping

and storing.

• After washing your hands, pump into a clean plastic bottle or storage bag.• Store the milk in the refrigerator or freeze. Try 2-3 oz portions to start with.• Label the portion containers with the date, and use the oldest milk first.

You can store your breast milk:

• At room temperature - for up to 6 hours 

• In the refrigerator - for up to 8 days• In the freezer - for 2 weeks or longer

To thaw and warm frozen breast milk, leave it in the refrigerator overnightor put it under warm, running water or in a bowl of warm water. It willthaw quickly. Don’t microwave. Microwaving breast milk will kill the
 Breastfeeding... for American Indian and Alaska Native Families 17

will burn your baby. Do not refreeze your

within 24 hours.

erent each time you pump or after it is

ges in color, consistency and odor

ats. The cream and any colostrum will

stir or shake and it will be fine. Don’t

baby will still drink it. 

er to give your baby the gift of mother’s

t from your decision to continue

at while I am breastfeeding?

 that you

eal to eat

e that your

 foods,

hem again

 foods

 is part of

o. 

ay is

 cans of

ces of

other the

hat your

ssy, try

ages that have caffeine. If you do not eat

 Your body will adjust to make sure your

eed?

astfeeds, the greater the benefits are for

reastfeeding for 6 months before

 and your baby the most benefits. Every

time you breastfeed, you give the gift of life.Traditionally, our babies were kept healthyby breastfeeding over a year. Breastfeedingis such an important part of a healthy startthat the goal of the Department of Healthand Human Services is for all babies toreceive only breast milk for the first 6months. Ideally, babies should receivebreast milk through their first year of life.Although our lives are different from ourgreat-grandparents, our babies can be

breastfed exclusively for the first 6 months. If you need help or ideas, seethe “Where to Get Help” section starting on page 19. 

Can I breastfeed if I use street drugs, alcohol or tobacco?It is important not to breastfeed if you will be using street drugs, evenonce while breastfeeding. Street drugs go into the breast milk and can staythere for many days, harming the baby. When you breastfeed and drink alcohol, your baby does too. Alcoholdoes not honor you or your baby’s future. If you choose to drink alcohol while breastfeeding, it is important to limitthe amount of alcohol. If you regularly binge drink and cannot stop,formula feeding the baby will be a better choice. Recreational tobacco, smoked or chewed is harmful to you and your baby.Whether your baby breastfeeds or bottlefeeds, second hand smoke willdamage your baby’s lungs. Do not let your baby be around smoke. If youor others smoke, smoke outside, away from the baby. In their mostrecent statement, the American Academy of Pediatrics announced thatnewer reserach shows that the benefits of breastfeeding outweigh thenegative effects from the mother’s smoking. If you smoke, try cuttingdown. The less that you smoke, the better for you and your baby.
 Breastfeeding... for American Indian and Alaska Native Families 19

 breastfeed?

etes.

ives

. If

n even

es

elp

ng

 too. Your blood sugars will be lower and

will be fine, even if your blood sugars are

your diabetes health care provider know

abies may not get enough

need vitamins? 

ril 2003, the American Academy of

rics (AAP) noted that some babies are at

r vitamin D deficiency and rickets.

ts is a bone softening disease caused by

tle exposure to sunlight, dark skin

ng or inadequate vitamin D intake. The

now recommends that all infants,

ding those who are breastfed, have at least

nternational Units (IU) of vitamin D per

months of life and through childhood

amin D supplements, in drop or tablet

 store.

Can I take medicine if I’mbreastfeeding? There are a few medications that make itnecessary to stop breastfeeding.Medicines that require stoppingbreastfeeding include anti-rejectionmedicines, ergotomine, methotrexate,radioactive isotopes, and chemotherapydrugs. Drugs for anti-anxiety, anti-depressant, and anti-psychoticconcerns can be of special concern for nursing mothers also. Be sure thatyour health care provider or pharmacist knows that you are breastfeeding.It is also important to mention any traditional medicines, herbs, and teasthat you are using.If you get sick, keep breastfeeding. Your baby is exposed to the germsbefore you know that you are ill, whether you are breastfeeding or not. Ifyour baby gets sick, breastfeeding will help your baby get better quicker.What about traditional medicines, like herbs and teas?Ask a person that you trust to provide traditional medicine. Be sure thatthey know you are breastfeeding.If you are taking other medicines, be sure that both your health careprovider and traditional healer know about all medicines, herbs and teasyou are taking. If you have questions, ask your traditional healer, healthcare provider, breastfeeding counselor, pharmacist, or Helpline. What about lumps in my breast?Lumps are common with early breastfeeding. As your body gets used tothe milk being there, the lumps will go away. If the lump stays for morethan a day or is uncomfortable, it might be a plugged duct. Use a heatpack before feeding, massage, and offer the side with the lump first;
 Breastfeeding... for American Indian and Alaska Native Families 21

or two, the lump or plugged duct will

can become a breast infection. A breast

you have the flu and give you a fever.

our provider will prescribe antibiotics and

1-2 days. Be sure to use heat packs and

an one child at one time ? 

ed for centuries in American Indian and

ly okay to breastfeed your older child

then breastfeed both after delivery. Try to

h time you nurse or nurse both at the

l adjust to meet your newborn’s early

enough milk to feed both. Some moms

me time because it saves time and helps

HIV or AIDS? 

The HIV virus that causes AIDS can pass

 can get HIV and then AIDS this way. 

ke more information on breastfeeding,

h Information Center’s (NWHIC)

994-9662; TDD 1-888-220-5446 (9am -

EST). If you call during times that the

essage and you will be called back on the

ding Helpline is a project of the U.S.

Department of Health and Human Services and is staffed with trainedpeer counselors. For serious problems, they will refer you to a lactationconsultant organization or association or will advise that you follow upwith your healthcare provider. They do not give medical advice. The Helpline also offers a breastfeeding packet with pamphlets on basicbreastfeeding issues as well as special breastfeeding situations. You also canfind more information on the NWIC web site: www.womenshealth.gov. NWHIC can also provide you with a copy of the HHS Blueprint forAction on Breastfeeding by the Department of Health and Human Services’Office on Women’s Health. This concise, current, scientifically basedpublication was compiled by the Office on Women’s Health with thesupport of many other governmental agencies including the Office of theSurgeon General, Food and Drug Administration (FDA), EnvironmentalProtection Agency (EPA), Centers for Disease Control (CDC), and theUS Department of Agriculture (USDA). Use this publication forinformation about the benefits of breastfeeding, managing breastfeedingin the health care system, supporting breastfeeding at work or school, andhow increased breastfeeding will help our communities’ futures.

WICThe Supplemental Nutrition Program for Women, Infants and Children(WIC) provides nutrition education, breastfeeding promotion andsupport, and supplemental foods to pregnant, breastfeeding andpostpartum women, and to infants and children up to age 5. Some WICoffices have special breastfeeding peer counselors and professionalbreastfeeding counselors to help you. You can usually find WIC by askingthe staff at your local clinic, health department, or social services. You canalso check the national WIC web site at www.fns.usda.gov/wic/ for localand state WIC programs.
 Breastfeeding... for American Indian and Alaska Native Families 23

pital /Clinic, Local

h Department, or Tribal

partments have breastfeeding support

an Medical Center, Diabetes Center

tfeeding support hotline

9473). 

y many as a leading authority on

gue helps new mothers with monthly

oups have large lending libraries. La

ne counseling. Like the Helpline, they

ous problems and they do not give

mation call 1-800-La-Leche

ebsite at www.lalecheleague.org.

 or Lactation Consultants

ation consultant is a professional health

ants are trained to help families succeed

nt has “IBCLC” written after her name,

ational Board of Lactation Consultant

earby, check the IBCLC organization

st of all the currently certified IBCLCs

States. You can also look in your local

g”.

In summary, for breastfeeding success from the beginningBefore birth – Let your family and provider know that you willbe breastfeeding. Consider these questions:1. What will help me to be successful with breastfeeding? 2. If I need help, where can I go for breastfeeding support?3. How do I want the family, health care providers, and hospital tohelp me with breastfeeding?4. If I will be going back to work or school, what are my options? 
 Breastfeeding... for American Indian and Alaska Native Families 25

 that you want to breastfeed. 

f know that you are exclusively

or also let them know.

 hour after birth. 

as much as possible, instead of the in

 suck is usually strong in the first hour

ital 

t

4

ve

hout consulting with you first. Let the

he baby when the baby is hungry.

When you go home • Breastfeed every 2 hours, around the clock. Feedings

usually take at least 20 minutes. 

• Your baby becomes a better eater by practicing and gets just

what is needed from the colostrum that your body makes. 

• Soon your white milk will come in. Breastfeed every 2-3

hours or at least 8-12 times in 24 hours. The more youbreastfeed, the more milk you will have. As you and your baby learn theart of breastfeeding, it will become easier.

• Safe bedding practices and back to sleep:

- Place your baby on his/her back on a firm tight-fitting mattress in

a crib that meets current safety standards.

- If you are using a blanket, put your baby with feet at the foot of the 

crib. Tuck a thin blanket around the crib mattress, reaching only as far as your baby’s chest.

- Try dressing your baby in sleeper instead of using a blanket.- Do not place your baby on a water bed, sofa, soft mattress, pillow, 

or other soft surface. 

After the first few weeks• The feedings will likely begin to spread out and may not take as long. • Congratulate yourself; You are doing what no one else can do for all

your child’s tomorrows.

Notes 
 Breastfeeding... 

“All things are connected,

whatever befalls

the earth, befalls the children

of the earth.” 

~ Chief Seattle

for American Indian and Alaska Native Families 27

eless thread in our cloth of life. 

Alaska Native children are precious.

their tomorrows with mother’s milk.

 to choose breastfeeding by sharing

benefits of mother’s milk and by

 as they learn about breastfeeding. 

astfeeding is part of our tomorrows.

 be ready for challenges in their lives

d. As our families pass the gift and

to their children and families; our

utures will be stronger and healthier. 

d it begins with mother’s milk.
 Health and Human Services

n Women’s Health

e Avenue, SW, Room 712E

gton, D.C., 20201

omenshealth.gov

00-994-9662

1-888-220-5446

August, 2006