Your Guide to Breastfeeding

Common 

Questions

Tear-out

Feeding

Chart!

Why Breastfeeding

is important

Why Breastfeeding

is important

Learn about the health benefits for 

both mom and baby! Pages 4-5

Learning to 

Breastfeed

What you can do even before 

your baby is born. Page 11

Common 

Questions

Can I breastfeed even 

if I am sick? Find out the 

answer to this question 

and others. Page 26

Tear-out

Feeding

Chart! Page 45

Breastfeeding 

in Public

Tips for making 

it work. Page 33

Common

Challenges

Learn tips for saying 

farewell to sore 

nipples! Page 18

U.S. Department of Health and Human Services, 

Office on Women’s Health
2

Your Guide to Breastfeeding

January 2011

Introduction

The experience of breastfeeding is special for so many reasons, including:

•	The joyful bonding with your baby

•	The perfect nutrition only you can provide

•	The cost savings

•	The health benefits for both mother and baby

In fact, breast milk has disease-fighting antibodies that can 

help protect infants from several types of illnesses. And mothers who breastfeed have a lower risk of some health problems,

including breast cancer and type 2 diabetes.

Keep in mind that breastfeeding is a learned skill. It requires 

patience and practice. For some women, the learning stages can be

frustrating and uncomfortable. And some situations make breastfeeding even harder, such as babies born early or health problems in

the mother. The good news is that it will get easier, and support for

breastfeeding mothers is growing.

You are special because you can make the food that is uniquely perfect for your baby. Invest the time in yourself and your baby

– for your health and for the bond that will last a lifetime.

The U.S. Department of Health and Human Services’ Office on Women’s 

Health (OWH) is raising awareness of the importance of breastfeeding to 

help mothers give their babies the best start possible in life. In addition to 

this guide, OWH offers online content at http://www.womenshealth.gov/

breastfeeding and provides the National Breastfeeding Helpline at 800-994-

9662. The Surgeon General’s Call to Action to Support Breastfeeding puts 

forth steps that family members, communities, clinicians, health care systems, 

and employers can take to make breastfeeding an easy choice for mothers. 

Learn more at http://www.surgeongeneral.gov. OWH also partners with 

the Health Resources and Services Administration’s Maternal and Child 

Health Bureau to educate employers about the needs of breastfeeding 

mothers via The Business Case for Breastfeeding. 

The Affordable Care Act (health care reform) helps pregnant women and 

breastfeeding mothers get the medical care and support they and their 

children need. Learn more at http://www.healthcare.gov.

U.S. Department of Health and Human Services,

Office on Women’s Health
Contents

4 Why Breastfeeding is important

Health benefits for babies and mothers

6 finding support and information

Types of health professionals who can help with breastfeeding, and how to find support by phone 

8 how Breast milk is made

How your body meets your baby’s nutrition needs

10 Before you give Birth

Steps you can take before the baby arrives, and what 

your family members can do

11 Learning to Breastfeed

How to hold your baby and know if your baby is getting 

enough breast milk

18 Common Challenges

Tips for troubleshooting common problems

25 Common Questions

Find out if your baby needs cereal, if you can take 

medicine, and more

28 Breastfeeding a Baby with Health 

Problems

Dealing with jaundice, reflux, and cleft palate and lip

30 Breastfeeding and Special Situations

Information for mothers of multiples, mothers who are 

adopting, and more

33 Breastfeeding in Public

Ways to feel comfortable feeding your baby while out 

and about

34 Pumping and Milk Storage Different ways to express breast milk and how to store it

37 Going Back to Work

Your rights and how to talk to your employer about your 

breastfeeding needs

39 Nutrition and Fitness

How to take care of yourself while breastfeeding

42 Handling Stress

Coping tips to keep stress at bay

43 Tear-out tools 

Write down questions to ask your doctor and your 

baby’s doctor, and keep track of diapers and feedings 

 3

Tools you can use

Breast milk storage guide, page 36

Jot it down: questions to ask your 

baby’s doctor (page 43) and 

questions to ask your health care 

provider (page 44)

Tear-out feeding chart, page 45
4

Why Breastfeeding is important

Breastfeeding Protects Babies

1. Early breast milk is liquid gold.

Known as liquid gold, colostrum (coh-LOSStrum) is the thick yellow first breast milk that

you make during pregnancy and just after birth.

This milk is very rich in nutrients and antibodies to protect your baby. Although your

baby only gets a small amount of colostrum at

each feeding, it matches the amount his or her

tiny stomach can hold. (See page 17 to see just 

how small your newborn’s tummy is!)

2. Your breast milk changes as your baby grows.

Colostrum changes into what is called

mature milk. By the third to fifth day after

birth, this mature breast milk has just the

right amount of fat, sugar, water, and protein to help your baby continue to grow. It is

a thinner type of milk than colostrum, but it

provides all of the nutrients and antibodies 

your baby needs.

3. Breast milk is easier to digest.

For most babies – especially premature babies

– breast milk is easier to digest than formula.

The proteins in formula are made from cow’s

milk, and it takes time for babies’ stomachs to

adjust to digesting them.

4. Breast milk fights disease.

The cells, hormones, and antibodies in breast

milk protect babies from illness. This protection is unique; formula cannot match the

chemical makeup of human breast milk. In

fact, among formula-fed babies, ear infections

and diarrhea are more common. Formula-fed

babies also have higher risks of:

•	 Necrotizing (nek-roh-TEYE-zing) enterocolitis (en-TUR-oh-coh-lyt-iss), a disease

that affects the gastrointestinal tract in preterm infants.

•	 Lower respiratory infections

•	 Atopic dermatitis, a type of skin rash

•	 Asthma

•	 Obesity

•	 Type 1 and type 2 diabetes

•	 Childhood leukemia

Breastfeeding has also been shown to lower the

risk of SIDS (sudden infant death syndrome).

Formula-feeding can raise health risks in babies, 

but there are rare cases in which formula may be a 

necessary alternative. Very rarely, babies are born 

unable to tolerate milk of any kind. These babies 

must have soy formula. Formula may also be needed 

if the mother has certain health conditions and she 

does not have access to donor breast milk. To learn 

more about rare breastfeeding restrictions in the 

mother, see page 26. To learn more about donor 

milk banks, see page 32.

Breastfeeding Glossary

Nutrients are any food substance that provides energy or helps build tissue.

Antibodies (AN-teye-bah-deez) are blood proteins made in response to germs or other foreign substances that enter 

the body. Antibodies help the body fight illness and disease by attaching to germs and marking them for destruction.

The gastrointestinal system is made up of the stomach, and the small and large intestines. It breaks down and 

absorbs food.

The respiratory system includes the nose, throat, voice box, windpipe, and lungs. Air is breathed in, delivering oxygen. Waste gas is removed from the lungs when you breathe out.
 5

Mothers Benefit from Breastfeeding

1. Ways that breastfeeding can make your 

life easier. 

Breastfeeding may take a little more effort

than formula feeding at first. But it can make

life easier once you and your baby settle into a 

good routine. When you breastfeed, there are

no bottles and nipples to sterilize. You do not

have to buy, measure, and mix formula. And

there are no bottles to warm in the middle of

the night.

2. Breastfeeding can save money.

Formula and feeding supplies can cost well

over $1,500 each year, depending on how much

your baby eats. Breastfed babies are also sick

less often, which can lower health care costs.

3. Breastfeeding can feel great. 

Physical contact is important to newborns. It

can help them feel more secure, warm, and

comforted. Mothers can benefit from this

closeness, as well. Breastfeeding requires a

mother to take some quiet relaxed time to

bond. The skin-to-skin contact can boost the

mother’s oxytocin (OKS-ee-TOH-suhn) levels.

Oxytocin is a hormone that helps milk flow

and can calm the mother.

4. Breastfeeding can be good for the mother’s 

health, too. 

Breastfeeding is linked to a lower risk of these

health problems in women:

•	 Type 2 diabetes

•	 Breast cancer

•	 Ovarian cancer

•	 Postpartum depression

Experts are still looking at the effects of

breastfeeding on osteoporosis and weight loss 

after birth. Many studies have reported greater

weight loss for breastfeeding mothers than for

those who don’t. But more research is needed

to understand if a strong link exists.

Breastfeeding During an 

Emergency

When an emergency occurs, breastfeeding can 

save lives:

•	 Breastfeeding protects babies from the risks 

of a contaminated water supply.

•	 Breastfeeding can help protect against respiratory illnesses and diarrhea. These diseases 

can be fatal in populations displaced by 

disaster.

•	 Breast milk is the right temperature for babies 

and helps to prevent hypothermia when the 

body temperature drops too low.

•	 Breast milk is readily available without needing other supplies.

5. Nursing mothers miss less work.

Breastfeeding mothers miss fewer days from

work because their infants are sick less often.

Breastfeeding Benefits Society

The nation benefits overall when mothers breastfeed. Recent research shows that if 90 percent of

families breastfed exclusively for 6 months, nearly

1,000 deaths among infants could be prevented.

The United States would also save $13 billion per

year – medical care costs are lower for fully breastfed infants than for never-breastfed infants. Breastfed infants typically need fewer sick care visits,

prescriptions, and hospitalizations.

Breastfeeding also contributes to a more productive workforce because mothers miss less work to

care for sick infants. Employer medical costs are

also lower.

Breastfeeding is also better for the environment.

There is less trash and plastic waste compared to

that produced by formula cans and bottle supplies.
6

Finding Support and Information

While breastfeeding is natural, you still may need

some advice. There are many sources of support

available for breastfeeding mothers. You can seek

help from different types of health professionals,

organizations, and members of your own family.

Under the Affordable Care Act (health care reform), more and more women will have access to

breastfeeding support without any out-of-pocket 

costs. And don’t forget, friends who have successfully breastfed can be a great source of information and encouragement!

Health Professionals Who Help with 

Breastfeeding

Pediatricians, obstetricians, and certified nursemidwives can help you with breastfeeding. Other

special breastfeeding professionals include:

• International Board Certified Lactation 

Consultant (IBCLC). Lactation consultants

are credentialed breastfeeding professionals 

with the highest level of knowledge and skill in 

breastfeeding support. IBCLCs are experienced

in helping mothers to breastfeed comfortably by

helping with positioning, latch, and a wide range

of breastfeeding concerns. Many IBCLCs are

also nurses, doctors, speech therapists, dietitians,

or other kinds of health professionals. Ask your

hospital or birthing center for the name of a

lactation consultant who can help you. Or, you

can go to http://www.ilca.org to find an IBCLC

in your area.

• Breastfeeding Peer Counselor or Educator. A

breastfeeding counselor can teach others about 

the benefits of breastfeeding and help women

with basic breastfeeding challenges and questions.

A “peer” means a person has breastfed her own

baby and is available to help other mothers. Some

breastfeeding educators have letters after their 

names like CLC (Certified Lactation Counselor)

or CBE (Certified Breastfeeding Educator).

Educators have special breastfeeding training but

not as much as IBCLCs. These professionals still

can be quite helpful.

• Doula (DOO-la). A doula is professionally

trained and experienced in giving social support

to birthing families during pregnancy, labor,

and birth and at home during the first few days

or weeks after birth. Doulas who are trained in

breastfeeding can help you be more successful

with breastfeeding after birth.

Mother-to-Mother Support

Other breastfeeding mothers can be a great source

of support. Mothers can share tips and offer one

another encouragement. There are many ways you

can connect with other breastfeeding mothers:

•	 Ask your health care provider or hospital staff

to recommend a support group.
 7

•	 Search your phone book or the Internet for a

breastfeeding center near you. These centers

may offer support groups.

•	 Find a local La Leche League support group

by visiting the organization’s website at http://

www.llli.org/.

•	 Search the Internet for breastfeeding message

boards and chats. (These resources can be great

for sharing tips, but do not rely on websites for

medical advice – talk to your health care provider.)

WIC Program

Food, nutrition counseling, and access to health

services are provided to low-income women, infants, and children under the Special Supplemental

Nutrition Program for Women, Infants, and Children. This program is popularly known as WIC

(Women, Infants, and Children). Breastfeeding

mothers supported by WIC may receive educational materials, peer counselor support, an enhanced

food package, breast pumps, and other supplies.

Breastfeeding mothers are also eligible to participate in WIC longer than non-breastfeeding mothers. To find contact information for your local

WIC program, visit http://www.fns.usda.gov/wic/

Breastfeeding/breastfeedingmainpage.htm or call

the national office at 703-305-2746.

Learn more about breastfeeding basics 

and find other online resources at 

http://www.womenshealth.gov/

breastfeeding.

The National Breastfeeding Helpline

The National Breastfeeding Helpline from the Office on Women’s Health has trained breastfeeding peer counselors 

to provide support by phone. The counselors can help answer common breastfeeding questions. They can also 

help you decide if you need to see a doctor or lactation consultant. The Helpline is available for all breastfeeding 

mothers, partners, prospective parents, family members, and health professionals seeking to learn more about 

breastfeeding. The Helpline is open from Monday through Friday, from 9 a.m. to 6 p.m., EST. If you call after 

hours, you will be able to leave a message, and a breastfeeding peer counselor will return your call on the next 

business day. Help is available in English or Spanish. 

Call 800-994-9662 for Support!
8

H

Knowing how the breast works to produce milk

can help you understand the breastfeeding process.

The breast itself is a gland that is made up of several parts, including:

• Glandular tissue – body tissue that makes and

releases one or more substances for use in the

body. Some glands make fluids that affect tissues or organs. Others make hormones or assist

with blood production. In the breast, this tissue

is involved in milk production.

• Connective tissue – a type of body tissue that 

supports other tissues and binds them together.

This tissue provides support in the breast.

• Blood – fluid in the body made up of plasma,

red and white blood cells, and platelets. Blood

carries oxygen and nutrients to and waste materials away from all body tissues. In the breast,

blood nourishes the breast tissue and provides 

nutrients needed for milk production.

• Lymph – the almost colorless fluid that travels

through the lymphatic system and carries cells

that help fight infection and disease. Lymph tissue in the breast helps remove waste.

• Nerves – cells that are the building blocks of 

the nervous system (the system that records and

transmits information chemically and electrically within a person). Nerve tissue in the breast

makes breasts sensitive to touch, allowing the

baby’s sucking to stimulate the let-down or

milk-ejection reflex and milk production. (See

page 9 to learn how let-down works!)

• Fatty tissue – connective tissue that contains 

stored fat. It is also known as adipose tissue.

Fatty tissue in the breast protects the breast

from injury. Fatty tissue is what mostly affects

the size of a woman’s breast. Breast size does

not have an effect on the amount of milk or

the quality of milk a woman makes.

Lobe

(Each mammary gland forms a lobe of the breast, 

which consists of a single major branch of alveoli 

and milk ducts that end at the nipple pore)

Areola

(The dark area around the nipple)

Nipple

Milk duct

(Tube through which milk travels)

Alveoli cells

(Grape-like clusters of tissue that secrete milk)
 9

What is a let-down reflex?

A let-down reflex or milk ejection reflex is 

a conditioned reflex ejecting milk from the 

alveoli through the ducts to the sinuses of the 

breast and the nipple. (See the anatomy of the 

breast on page 8.) This reflex makes it easier 

to breastfeed your baby. Let-down happens a 

few seconds to several minutes after you start 

breastfeeding your baby. It can happen a few 

times during a feeding, too. You may feel a 

tingle in your breast or you may feel a little 

uncomfortable. Keep in mind that some women 

don’t feel anything. 

Let-down can happen at other times, too, such 

as when you hear your baby cry or when you 

may just be thinking about your baby. If your 

milk lets down as more of a gush and it bothers 

your baby, try expressing some milk by hand 

before you start breastfeeding.

Special cells inside your breasts make milk. These

cells are called alveoli (al-VEE-uh-leye). When your

breasts become fuller and tender during pregnancy,

this is a sign that the alveoli are getting ready to 

work. Some women do not feel these changes in

their breasts. Others may sense these changes after

their baby is born.

The alveoli make milk in response to the hormone

prolactin (proh-LAK-tin). Prolactin rises when the

baby suckles. Another hormone, oxytocin (oks-eeTOH-suhn), causes small muscles around the cells

to contract and move the milk through a series of

small tubes called milk ducts. This moving of the

milk is called let-down reflex.

Oxytocin also causes the muscles of the uterus

to contract during and after birth. This helps the

uterus to get back to its original size. It also lessens

any bleeding a woman may have after giving birth.

The release of both prolactin and oxytocin may be

responsible in part for a mother’s intense feeling of

needing to be with her baby.
10

Before You give Birth

To prepare for breastfeeding, the most important

thing you can do is have confidence in yourself.

Committing to breastfeeding starts with the belief

that you can do it!

Other steps you can take to prepare for breastfeeding:

1.	 Get good prenatal care, which can help you

avoid early delivery. Babies born too early often need special care, which can make breastfeeding harder.

2.	 Take a breastfeeding class.

3.	 Ask your health care provider to recommend

a lactation consultant. You can establish a relationship before the baby comes, or be ready

if you need help after the baby is born.

4.	 Talk to your health care provider about your 

health. Discuss any breast surgery or injury you

may have had. If you have depression or are

taking medications, discuss treatment options

that can work with breastfeeding.

5.	 Tell your health care provider that you would 

like to breastfeed your newborn baby as soon 

as possible after delivery. The sucking instinct

is very strong within the first hour of life.

6.	 Talk to friends who have breastfed or consider 

joining a breastfeeding support group.

Talk to Fathers, Partners, and Other 

Family Members About How They 

Can Help

Breastfeeding is more than a way to feed a baby – it 

becomes a lifestyle. And fathers, partners, and other special support persons can be involved in the breastfeeding 

experience, too. Partners and family members can:

•	 Support the breastfeeding relationship by being 

kind and encouraging. 

•	 Show their love and appreciation for all of the 

work that is put into breastfeeding.

•	 Be good listeners when a mother needs to talk 

through breastfeeding concerns.

•	 Make sure the mother has enough to drink and gets 

enough rest, help around the house, and take care 

of other children at home.

•	 Give emotional nourishment to the child through 

playing and cuddling. 

Fathers, partners, and other people in the mother’s support system can benefit from breastfeeding, too. Not only 

are there no bottles to prepare, but many people feel 

warmth, love, and relaxation just from sitting next to a 

mother and baby during breastfeeding.

What Dad Can Do

The bond between mother and baby is 

important, but so is the bond between 

father and baby. Babies need cuddles 

and hugs from their dads, too! In fact, 

skin-to-skin contact helps baby and 

father bond much like it does for mother 

and baby.
 11

Learning to Breastfeed

Breastfeeding is a process that takes time to master.

Babies and mothers need to practice. Keep in mind

that you make milk in response to your baby sucking at the breast. The more milk your baby removes

from the breasts, the more milk you will make. 

After you have the baby, these steps can help you

get off to a great start:

•	 Breastfeed as soon as possible after birth.

•	 Ask for an on-site lactation consultant to come

help you.

•	 Ask the staff not to give your baby other food

or formula, unless it is medically necessary.

•	 Allow your baby to stay in your hospital room all day

and night so that you can breastfeed often. Or, ask

the nurses to bring your baby to you for feedings.

•	 Try to avoid giving your baby any pacifiers or

artificial nipples so that he or she gets used to

latching onto just your breast. (See page 12 to 

learn about latching.)

How often should I breastfeed?

Early and often! Breastfeed as soon as possible after 

birth, then breastfeed at least 8 to 12 times every 24 

hours to make plenty of milk for your baby. This means 

that in the first few days after birth, your baby will 

likely need to breastfeed about every hour or two in 

the daytime and a couple of times at night. Healthy 

babies develop their own feeding schedules. Follow 

your baby’s cues for when he or she is ready to eat.

How long should feedings be?

Feedings may be 15 to 20 minutes or longer per breast. 

But there is no set time. Your baby will let you know 

when he or she is finished. If you are worried that your 

baby is not eating enough, talk to your baby’s doctor. 

See page 45 for a feeding tracker if you would like to 

write down when your baby wants to eat.
12

Bringing Your Baby to the Breast

When awake, your baby will move his or her head

back and forth, looking and feeling for the breast

with his or her mouth and lips. The steps below

can help you get your baby to “latch” on to the

breast to start eating. Keep in mind that there is no

one way to start breastfeeding. As long as the baby

is latched on well, how you get there is up to you.

•	 Hold your baby, wearing only a diaper, against

your bare chest. Hold the baby upright with his

or her head under your chin. Your baby will be

comfortable in that cozy valley between your

breasts. You can ask your partner or a nurse

to place a blanket across your baby’s back and

bring your bedcovers over you both. Your skin

temperature will rise to warm your baby. 

•	 Support his or her neck and shoulders with one

hand and hips with the other. He or she may

move in an effort to find your breast.

•	 Your baby’s head should be tilted back slightly

to make it easy to suck and swallow. With his or

her head back and mouth open, the tongue is

naturally down and ready for the breast to go on 

top of it.

•	 Allow your breast to hang naturally. When your

baby feels it with his or her cheek, he or she

may open his or her mouth wide and reach it up

and over the nipple. You can also guide the baby

to latch on as you see in these illustrations.

•	 At first, your baby’s nose will be lined up opposite your nipple. As his or her chin presses into

your breast, his or her wide open mouth will

get a large mouthful of breast for a deep latch.

Keep in mind that your baby can breathe at the

breast. The nostrils flare to allow air in.

•	 Tilt your baby back, supporting your baby’s

head, upper back, and shoulders with the palm

of your hand and pull your baby in close.

Getting your baby to latch:

Tickle the baby’s lips to

encourage him or her

to open wide.

Pull your baby close so 

that the chin and lower 

jaw moves into your

breast first.

Watch the lower lip and

aim it as far from the

base of the nipple as 

possible, so the baby

takes a large mouthful

of breast.

When my son was born 4 years ago, we had a very 

difficult time breastfeeding because he wasn’t latching correctly. He seemed almost lazy and disinterested in eating. In the first 2 weeks, he lost quite a bit 

of weight and appeared gaunt and fussy. Naturally, 

I was nearly frantic with worry. Luckily, I connected 

with an amazing lactation consultant. She put me on 

a rigorous, week-long regimen which consisted of 

nursing, then bottle feeding breast milk, then pumping every 3 hours. I was completely dedicated to the 

regimen, and when I met with her a week later, she 

was stunned by the results. My son had gained an 

entire pound, and she said he had developed a perfect latch. She called us the miracle mom and miracle 

baby! I was so proud of us. My determination paid 

off and I enjoyed breastfeeding for 7 months. 

– Jill

Bridgewater, MA

Some babies latch on right away, and for some it 

takes more time.
 13

Signs of a good latch

•	 The latch feels comfortable to you, without

hurting or pinching. How it feels is more important than how it looks. 

•	 Your baby’s chest is against your body and he or

she does not have to turn his or her head while 

drinking.

•	 You see little or no areola, depending on the

size of your areola and the size of your baby’s

mouth. If areola is showing, you will see more

above your baby’s lip and less below.

•	 When your baby is positioned well, his or her

mouth will be filled with breast.

•	 The tongue is cupped under the breast, although you might not see it.

•	 You hear or see your baby swallow. Some babies

swallow so quietly, a pause in their breathing

may be the only sign of swallowing.

•	 You see the baby’s ears “wiggle” slightly.

•	 Your baby’s lips turn out like fish lips, not in.

You may not even be able to see the bottom lip.

•	 Your baby’s chin touches your breast.

Help with latch problems

Are you in pain? Many moms report that their

breasts can be tender at first until both they and

their baby find comfortable breastfeeding positions and a good latch. Once you have done this,

breastfeeding should be comfortable. If it hurts,

your baby may be sucking on only the nipple.

Gently break your baby’s suction to your breast by

placing a clean finger in the corner of your baby’s

mouth and try again. Also, your nipple should not

look flat or compressed when it comes out of your

baby’s mouth. It should look round and long, or

the same shape as it was before the feeding.

Are you or your baby frustrated? Take a short 

break and hold your baby in an upright position.

Try holding him or her between your breasts skin

to your skin. Talk, sing, or provide your finger for

sucking for comfort. Try to breastfeed again in a

little while. Or, the baby may start moving to the

breast on his or her own from this position.

Does your baby have a weak suck or make only 

tiny suckling movements? Break your baby’s suction and try again. He or she may not have a deep

enough latch to remove the milk from your breast.

Talk with a lactation consultant or pediatrician if 

your baby’s suck feels weak or if you are not sure

he or she is getting enough milk. Rarely, a health

problem causes the weak suck.

A Good Latch

A good latch is important for your baby to breastfeed effectively and for your comfort. During the 

early days of breastfeeding, it can take time and 

patience for your baby to latch on well.
14

Breastfeeding Holds

Some moms find that the following positions are helpful ways to get comfortable and support their babies

in finding a good latch. You also can use pillows under your arms, elbows, neck, or back to give you added

comfort and support. Keep in mind that what works well for one feeding may not work well for the next.

Keep trying different positions until you are comfortable.

1. Cradle hold – an easy, common hold that is comfortable for most

mothers and babies. Hold your baby with his or her head on your forearm and his or her whole body facing yours.

2. Cross cradle or transitional hold – useful for premature babies or

babies with a weak suck because it gives extra head support and may

help babies stay latched. Hold your baby along the opposite arm from

the breast you are using. Support your baby’s head with the palm of

your hand at the base of his or her neck.

3. Clutch or “football” hold – useful for mothers who had a c-section

and mothers with large breasts, flat or inverted nipples, or a strong

let-down reflex (see page 9). It is also helpful for babies who prefer to

be more upright. This hold allows you to better see and control your

baby’s head and to keep the baby away from a c-section incision. Hold

your baby at your side, lying on his or her back, with his or her head

at the level of your nipple. Support baby’s head with the palm of your

hand at the base of the head. (The baby is placed almost under the

arm.)

4. Side-lying position – useful for mothers who had a c-section or to

help any mother get extra rest while the baby breastfeeds. Lie on your

side with your baby facing you. Pull your baby close so your baby faces

your body.
 15

Tips for Making It Work

1. Learn your baby’s hunger signs. When

babies are hungry, they become more alert

and active. They may put their hands or fists

to their mouths, make sucking motions with

their mouth, or turn their heads looking for the

breast. If anything touches the baby’s cheek –

such as a hand – the baby may turn toward the

hand, ready to eat. This sign of hunger is called

rooting. Offer your breast when your baby

shows rooting signs. Crying can be a late sign

of hunger, and it may be harder to latch once

the baby is upset. Over time, you will be able to

learn your baby’s cues for when to start feeding.

2. Follow your baby’s lead. Make sure you are

both comfortable and follow your baby’s lead

after he or she is latched on well. Some babies

take both breasts at each feeding. Other babies

only take one breast at a feeding. Help your

baby finish the first breast, as long as he or she

is still sucking and swallowing. This will ensure

the baby gets the “hind” milk – the fattier milk

at the end of a feeding. Your baby will let go of

the breast when he or she is finished and often

falls asleep. Offer the other breast if he or she

seems to want more. 

3. Keep your baby close to you. Remember that

your baby is not used to this new world and 

needs to be held very close to his or her mother.

Being skin to skin helps babies cry less and stabilizes the baby’s heart and breathing rates.

4. Avoid nipple confusion. Avoid using pacifiers, bottles, and supplements of infant formula

in the first few weeks unless there is a medical

reason to do so. If supplementation is needed,

try to give expressed breast milk first. But it’s

best just to feed at the breast. This will help

you make milk and keep your baby from getting confused while learning to breastfeed.

5. Sleep safely and close by. Have your baby

sleep in a crib or bassinet in your room, so that

you can breastfeed more easily at night. Sharing

a room with parents is linked to a lower risk of

SIDS (sudden infant death syndrome).

6. Know when to wake the baby. In the early 

weeks after birth, you should wake your baby

to feed if 4 hours have passed since the beginning of the last feeding. Some tips for waking

the baby include: 

•	 Changing your baby’s diaper

•	 Placing your baby skin to skin

•	 Massaging your baby’s back, abdomen, and legs

If your baby is falling asleep at the breast during 

most feedings, talk to the baby’s doctor about a

weight check. Also, see a lactation consultant to

make sure the baby is latching on well.

Vitamin D

Babies need 400 IU of vitamin D each day. Ask 

your baby’s doctor about supplements in drop form.

How long should I breastfeed?

Many leading health organizations recommend that 

most infants breastfeed for at least 12 months, with 

exclusive breastfeeding for the first 6 months. This 

means that babies are not given any foods or liquids 

other than breast milk for the first 6 months. These 

recommendations are supported by organizations including the American Academy of Pediatrics, American Academy of Family Physicians, American College 

of Obstetricians and Gynecologists, American College 

of Nurse-Midwives, American Dietetic Association, 

and American Public Health Association.
16

Making Plenty of Milk

Your breasts will easily make and supply milk

directly in response to your baby’s needs. The more

often and effectively a baby breastfeeds, the more

milk will be made. Babies are trying to double their

weight in a few short months, and their tummies

are small, so they need many feedings to grow and

to be healthy.

Most mothers can make plenty of milk for their

baby. If you think you have a low milk supply, talk

to a lactation consultant. See page 6 for other 

types of health professionals who can help you.

What will happen with you, your baby, and your milk in the first few weeks 

Time Milk The Baby You (Mom)

Birth Your body makes 

colostrum (a rich, 

thick, yellowish milk) 

in small amounts. It 

gives your baby a 

healthy dose of early 

protection against 

diseases. 

Will probably be awake in the first hour after birth. This is a 

good time to breastfeed your baby. 

You will be tired 

and excited.

First 

12-24 

hours

Your baby will drink 

about 1 teaspoon 

of colostrum at each 

feeding. You may 

or may not see the 

colostrum, but it has 

what the baby needs 

and in the right 

amount. 

It is normal for the baby to sleep heavily. Labor and delivery are hard work! Some babies like to nuzzle and may 

be too sleepy to latch well at first. Feedings may be short 

and disorganized. As your baby wakes up, take advantage 

of your baby’s strong instinct to suck and feed every 1-2 

hours. Many babies like to eat or lick, pause, savor, doze, 

then eat again. 

You will be tired, 

too. Be sure to 

rest. 

Next 

3-5 

days

Your white milk 

comes in. It is normal for it to have a 

yellow or golden tint 

first. Talk to a doctor 

and lactation consultant if your milk is 

not yet in.

Your baby will feed a lot (this helps your breasts make 

plenty of milk), at least 8-12 times or more in 24 hours. 

Very young breastfed babies don’t eat on a schedule. 

Because breast milk is more easily digested than formula, 

breastfed babies eat more often than formula-fed babies. It 

is okay if your baby eats every 2-3 hours for several hours, 

then sleeps for 3-4 hours. Feedings may take about 15-20 

minutes on each side. The baby’s sucking rhythm will be 

slow and long. You might hear gulping. 

Your breasts 

may feel full and 

leak. (You can 

use disposable 

or cloth pads in 

your bra to help 

with leaking.) 

The first 

4-6 

weeks

White breast milk 

continues. 

Your baby will likely be better at breastfeeding and have a 

larger stomach to hold more milk. Feedings may take less 

time and will be farther apart. 

Your body gets 

used to breastfeeding so your 

breasts will be 

softer and the 

leaking may slow 

down. 
 17

How to Know Your Baby Is Getting 

Enough Milk

Many babies, but not all, lose a small amount of

weight in the first days after birth. Your baby’s doctor

will check his or her weight at your first visit after

you leave the hospital. Make sure to visit your baby’s

doctor within three to five days after birth and then

again at two to three weeks of age for checkups.

You can tell if your baby is getting plenty of milk

if he or she is mostly content and gaining weight

steadily after the first week of age. From birth to

three months, typical weight gain is 2/3 to 1 ounce

each day.

Other signs that your baby is getting plenty of 

milk: 

•	 He or she is passing enough clear or pale yellow

urine, and it’s not deep yellow or orange (see the

chart below).

•	 He or she has enough bowel movements (see

the chart below).

•	 He or she switches between short sleeping periods and wakeful, alert periods.

•	 He or she is satisfied and content after feedings.

•	 Your breasts feel softer after you feed your baby.

Talk to your baby’s doctor if you are worried that

your baby is not eating enough.

How much do babies typically eat?

A newborn’s tummy is very small, especially in 

the early days. Once breastfeeding is established, 

exclusively breastfed babies from 1 to 6 months of 

age take in between 19 and 30 ounces per day. If 

you breastfeed 8 times per day, the baby would eat 

around 3 ounces per feeding. Older babies will take 

less breastmilk as other food is introduced. Every 

baby is different, though.

Hazelnut Walnut

The Newborn Tummy

At birth, the baby’s stomach can comfortably digest 

what would fit in a hazelnut (about 1-2 teaspoons). 

In the first week, the baby’s stomach grows to hold 

about 2 ounces or what would fit in a walnut.

See our diaper tracker on page 46!

Minimum number of wet diapers and bowel movements in a baby’s first week

(it is fine if your baby has more) 1 day = 24 hours 

Baby’s gea number of Wet number of Bowel Color and exture of Bowel t

diapers movements movements

Day 1 (first 24 1 The first one usually occurs Thick, tarry, and black 

hours after birth) within 8 hours after birth 

Day 2 2 3 Thick, tarry, and black 

Day 3 5-6 3 Looser greenish to yellow (color may vary)

Day 4 6 3 Yellow, soft, and watery 

Day 5 6 3 Loose and seedy, yellow color 

Day 6 6 3 Loose and seedy, yellow color 

Day 7 6 3 Larger amounts of loose and seedy, yellow color 
18

Common Challenges

Breastfeeding can be challenging at times, especially

in the early days. But it is important to remember

that you are not alone. Lactation consultants are

trained to help you find ways to make breastfeeding work for you. And while many women are faced

with one or more of the challenges listed here, many

women do not struggle at all! Also, many women

may have certain problems with one baby that they

don’t have with their second or third babies. Read

on for ways to troubleshoot problems.

Challenge: Sore Nipples

Many moms report that nipples can be tender at

first. Breastfeeding should be comfortable once

you have found some positions that work and a

good latch is established. Yet it is possible to still

have pain from an abrasion you already have. You

may also have pain if your baby is sucking on

only the nipple.

What you can do

1.	 A good latch is key, so see page 13 for detailed 

instructions. If your baby is sucking only on

the nipple, gently break your baby’s suction to

your breast by placing a clean finger in the corner of your baby’s mouth and try again. (Your

nipple should not look flat or compressed

when it comes out of your baby’s mouth. It

should look round and long, or the same shape

as it was before the feeding.)

2.	 If you find yourself wanting to delay feedings

because of pain, get help from a lactation consultant. Delaying feedings can cause more pain

and harm your supply.

3.	 Try changing positions each time you breastfeed. This puts the pressure on a different part

of the breast.

4.	 After breastfeeding, express a few drops of

milk and gently rub it on your nipples with

clean hands. Human milk has natural healing

properties and emollients that soothe. Also

try letting your nipples air-dry after feeding,

or wear a soft cotton shirt.

5.	 If you are thinking about using creams, hydrogel

pads, or a nipple shield, get help from a health

care provider first.

6.	 Avoid wearing bras or clothes that are too tight

and put pressure on your nipples.

7.	 Change nursing pads often to avoid trapping in 

moisture.

8.	 Avoid using soap or ointments that contain

astringents or other chemicals on your nipples.

Make sure to avoid products that must be

removed before breastfeeding. Washing with

clean water is all that is needed to keep your 

nipples and breasts clean.

9.	 If you have very sore nipples, you can ask your

doctor about using non-aspirin pain relievers.

Ask a lactation consultant for help to improve your 

baby’s latch. Talk to your doctor if your pain does 

not go away or if you suddenly get sore nipples 

after several weeks of pain-free breastfeeding. Sore 

nipples may lead to a breast infection, which needs to 

be treated by a doctor.
 19

Challenge: Low Milk Supply

Most mothers can make plenty of milk for their

babies. But many mothers are concerned about

having enough.

Checking your baby’s weight and growth is the best

way to make sure he or she is getting enough milk.

Let the doctor know if you are concerned. For

more ways to tell if your baby is getting enough

milk, see page 17.

There may be times when you think your supply is low, but it is actually just fine:

•	 When your baby is around six weeks to two

months old, your breasts may no longer feel

full. This is normal. At the same time, your

baby may nurse for only five minutes at a

time. This can mean that you and baby are just

adjusting to the breastfeeding process – and 

getting good at it!

•	 Growth spurts can cause your baby to want to 

nurse longer and more often. These growth

spurts can happen around two to three weeks,

six weeks, and three months of age. They can

also happen at any time. Don’t be alarmed that

your supply is too low to satisfy your baby. Follow your baby’s lead – nursing more and more

often will help build up your milk supply. Once

your supply increases, you will likely be back to

your usual routine.

What you can do

1.	 Make sure your baby is latched on and positioned well.

2.	 Breastfeed often and let your baby decide when

to end the feeding.

3.	 Offer both breasts at each feeding. Have your

baby stay at the first breast as long as he or she

is still sucking and swallowing. Offer the second breast when the baby slows down or stops.

4.	 Try to avoid giving your baby formula or cereal

as it may lead to less interest in breast milk.

This will decrease your milk supply. Your baby

doesn’t need solid foods until he or she is at

least six months old. If you need to supplement the baby’s feedings, try using a spoon,

cup, or a dropper.

5.	 Limit or stop pacifier use while trying the

above tips at the same time.

Challenge: Oversupply of Milk

Some mothers are concerned about having an oversupply of milk. Having an overfull breast can make

feedings stressful and uncomfortable for both

mother and baby.

What you can do

1.	 Breastfeed on one side for each feeding.

Continue to offer that same side for at least

two hours until the next full feeding, gradually

increasing the length of time per feeding. 

2.	 If the other breast feels unbearably full before you are ready to breastfeed on it, hand

express for a few moments to relieve some

of the pressure. You can also use a cold

compress or washcloth to reduce discomfort

and swelling.

3.	 Feed your baby before he or she becomes

overly hungry to prevent aggressive sucking.

(Learn about hunger signs on page 15.)

4.	 Try positions that don’t allow the force of

gravity to help as much with milk ejection,

such as the side-lying position or the football 

hold. (see page 14 for illustrations of these 

positions.)

5.	 Burp your baby frequently if he or she is gassy. 

Some women have a strong milk ejection reflex or

let-down (see page 9). This can happen along with

an oversupply of milk. If you have a rush of milk,

try the following:

1.	 Hold your nipple between your forefinger and

middle finger or with the side of your hand to

Let your baby’s doctor know if you think the baby is 

not getting enough milk.
20

lightly compress milk ducts to reduce the force

of the milk ejection.

2.	 If baby chokes or sputters, unlatch him or her

and let the excess milk spray into a towel or

cloth.

3.	 Allow your baby to come on and off the breast

at will.

Challenge: Engorgement

It is normal for your breasts to become larger,

heavier, and a little tender when they begin making

more milk. Sometimes this fullness may turn into

engorgement, when your breasts feel very hard and

painful. You also may have breast swelling, tenderness, warmth, redness, throbbing, and flattening of

the nipple. Engorgement sometimes also causes a

low-grade fever and can be confused with a breast 

infection. Engorgement is the result of the milk

building up. It usually happens during the third to

fifth day after birth, but it can happen at any time.

Engorgement can lead to plugged ducts or a breast

infection (see page 21), so it is important to try to

prevent it before this happens. If treated properly,

engorgement should resolve.

What you can do

1.	 Breastfeed often after birth, allowing the baby

to feed as long as he or she likes, as long as he

or she is latched on well and sucking effectively.

In the early weeks after birth, you should wake

your baby to feed if four hours have passed 

since the beginning of the last feeding.

2.	 Work with a lactation consultant to improve the

baby’s latch.

3.	 Breastfeed often on the affected side to remove the milk, keep it moving freely, and prevent the breast from becoming overly full.

4.	 Avoid overusing pacifiers and using bottles to

supplement feedings.

5.	 Hand express or pump a little milk to first

soften the breast, areola, and nipple before

breastfeeding.

6.	 Massage the breast.

7.	 Use cold compresses in between feedings to

help ease pain. 

8.	 If you are returning to work, try to pump

your milk on the same schedule that the baby

breastfed at home. Or, you can pump at least

every four hours.

9.	 Get enough rest, proper nutrition, and fluids.

10.	Wear a well-fitting, supportive bra that is not

too tight.

Ask your lactation consultant or doctor for help if the 

engorgement lasts for two days or more.

Ask a lactation consultant for help if you are unable 

to manage an oversupply of milk on your own.
 21

Challenge: Plugged Duct

It is common for many women to have a plugged

duct at some point when breastfeeding. A plugged

milk duct feels like a tender and sore lump in the

breast. It is not accompanied by a fever or other

symptoms. It happens when a milk duct does not

properly drain and becomes inflamed. Then, pressure builds up behind the plug, and surrounding

tissue becomes inflamed. A plugged duct usually

only occurs in one breast at a time.

What you can do

1.	 Breastfeed often on the affected side, as often

as every two hours. This helps loosen the plug,

and keeps the milk moving freely.

2.	 Massage the area, starting behind the sore spot.

Use your fingers in a circular motion and massage toward the nipple. 

3.	 Use a warm compress on the sore area.

4.	 Get extra sleep or relax with your feet up to

help speed healing. Often a plugged duct is the

first sign that a mother is doing too much.

5.	 Wear a well-fitting supportive bra that is not

too tight, because this can constrict milk ducts.

Consider trying a bra without underwire.

Challenge: Breast Infection (Mastitis)

Mastitis (mast-EYE-tiss) is soreness or a lump

in the breast that can be accompanied by a fever

and/or flu-like symptoms, such as feeling run

down or very achy. Some women with a breast

infection also have nausea and vomiting. You

also may have yellowish discharge from the

nipple that looks like colostrum. Or, the breasts

may feel warm or hot to the touch and appear

pink or red. A breast infection can occur when

other family members have a cold or the flu. It

usually only occurs in one breast. It is not always easy to tell the difference between a breast 

infection and a plugged duct because both have 

similar symptoms and can improve within 24 to

48 hours. Most breast infections that do not improve on their own within this time period need

to be treated with medicine given by a doctor.

(Learn more about medicines and breastfeeding

on page 26.)

What you can do

1.	 Breastfeed often on the affected side, as often

as every two hours. This keeps the milk moving freely and keeps the breast from becoming

overly full.

2.	 Massage the area, starting behind the sore spot.

Use your fingers in a circular motion and massage toward the nipple.

3.	 Apply heat to the sore area with a warm compress. 

4.	 Get extra sleep or relax with your feet up to

help speed healing. Often a breast infection is

the first sign that a mother is doing too much

and becoming overly tired.

5.	 Wear a well-fitting supportive bra that is not

too tight, because this can constrict milk ducts.

If your plugged duct doesn’t loosen up, ask for help 

from a lactation consultant. Plugged ducts can lead 

to a breast infection. Ask your doctor for help if you do not feel better 

within 24 hours of trying these tips, if you have 

a fever, or if your symptoms worsen. You might 

need medicine. See your doctor right away if:

•	 You have a breast infection in which both 

breasts look affected. 

•	 There is pus or blood in the milk. 

•	 You have red streaks near the area.

•	 Your symptoms came on severely and suddenly.

Even if you are taking medicine, continue to 

breastfeed during treatment. This is best for both 

you and your baby. Ask a lactation consultant 

for help if need be.
22

Challenge: Fungal Infections 

A fungal infection, also called a yeast infection or

thrush, can form on your nipples or in your breast

because it thrives on milk. The infection forms

from an overgrowth of the Candida organism.

Candida exists in our bodies and is kept at healthy

levels by the natural bacteria in our bodies. When

the natural balance of bacteria is upset, Candida can 

overgrow, causing an infection.

A key sign of a fungal infection is if you develop

sore nipples that last more than a few days, even

after you make sure your baby has a good latch.

Or, you may suddenly get sore nipples after several weeks of pain-free breastfeeding. Some other

signs of a fungal infection include pink, flaky,

shiny, itchy, or cracked nipples or deep pink and

blistered nipples. You also could have achy breasts

or shooting pains deep in the breast during or after 

feedings.

Causes of thrush include: 

•	 Thrush in your baby’s mouth, which can pass

to you

•	 An overly moist environment on your skin or

nipples that are sore or cracked

•	 Antibiotics or steroids

•	 A chronic illness like HIV, diabetes, or anemia

Thrush in a baby’s mouth appears as little white

spots on the inside of the cheeks, gums, or tongue.

Many babies with thrush refuse to nurse or are gassy or cranky. A baby’s fungal infection can also appear as a diaper rash that looks like small red dots

around a main rash. This rash will not go away by

using regular diaper rash creams.

What you can do

Fungal infections may take several weeks to cure,

so it is important to follow these tips to avoid

spreading the infection:

1.	 Change disposable nursing pads often.

2.	 Wash any towels or clothing that comes in contact

with the yeast in very hot water (above 122°F).

3.	 Wear a clean bra every day.

4.	 Wash your hands often, and wash your baby’s

hands often – especially if he or she sucks on 

his or her fingers.

5.	 Put pacifiers, bottle nipples, or toys your baby

puts in his or her mouth in a pot of water and

bring it to a roaring boil daily. After one week

of treatment, discard pacifiers and nipples and

buy new ones.

6.	 Boil daily all breast pump parts that touch the

milk.

7.	 Make sure other family members are free of

thrush or other fungal infections. If they have

symptoms, make sure they get treated.

If you or your baby has symptoms of a fungal infection, call both your doctor and your baby’s doctor so you can be correctly diagnosed and treated 

at the same time. This will help prevent passing the 

infection to each other. 

I had a terrible time learning to nurse my son. My 

nipples were terribly sore and it felt like it wasn’t 

getting any better. After visiting my doctor, the 

lactation consultant, and the pediatrician, it became clear that a horrible case of thrush had been 

the source of my pain. I honestly did not think I 

would make it, but I was too stubborn to quit and I 

am grateful I stuck with it. I am proud to say that I 

breastfed my son until he was 16 months old! 

– Jessica

Edmonton, AB, Canada
 23

Challenge: Nursing Strike

A nursing “strike” is when your baby has been

breastfeeding well for months and then suddenly

begins to refuse the breast. A nursing strike can

mean that your baby is trying to let you know that

something is wrong. This does not usually mean

that the baby is ready to wean. Not all babies will

react the same to the different situations that can

cause a nursing strike. Some babies will continue

to breastfeed without a problem. Others may just

become fussy at the breast, and others will refuse

the breast entirely. Some of the major causes of a

nursing strike include:

•	 Mouth pain from teething, a fungal infection

like thrush, or a cold sore

•	 An ear infection, which causes pain while

sucking 

•	 Pain from a certain breastfeeding position,

either from an injury on the baby’s body or

from soreness from an immunization

•	 Being upset about a long separation from the

mother or a major change in routine

•	 Being distracted while breastfeeding – becoming

interested in other things around him or her

•	 A cold or stuffy nose that makes breathing

while breastfeeding difficult

•	 Reduced milk supply from supplementing with

bottles or overuse of a pacifier

•	 Responding to the mother’s strong reaction if

the baby has bitten her 

•	 Being upset after hearing people argue

•	 Reacting to stress, overstimulation, or having

been repeatedly put off when wanting to 

breastfeed 

If your baby is on a nursing strike, it is normal to

feel frustrated and upset, especially if your baby is

unhappy. It is important not to feel guilty or think

that you have done something wrong. Keep in

mind that your breasts may become uncomfortable

as the milk builds up.

What you can do

1.	 Try to express your milk on the same schedule

as the baby used to breastfeed to avoid engorgement and plugged ducts.

2.	 Try another feeding method temporarily to

give your baby your milk, such as a cup, dropper, or spoon.

3.	 Keep track of your baby’s wet diapers and

dirty diapers to make sure he or she is getting

enough milk.

4.	 Keep offering your breast to the baby. If the baby

is frustrated, stop and try again later. You can also

try when the baby is sleeping or very sleepy.

5.	 Try various breastfeeding positions, with your

bare skin next to your baby’s bare skin.

6.	 Focus on the baby with all of your attention

and comfort him or her with extra touching

and cuddling.

7.	 Try breastfeeding while rocking and in a quiet 

room free of distractions.

Ask for help if your baby is having a nursing strike to 

ensure that your baby gets enough milk. The doctor 

can check your baby’s weight gain.
24

Challenge: Inverted, Flat, or Very 

Large Nipples

Some women have nipples that turn inward

instead of protruding or that are flat and do 

not protrude. Nipples can also sometimes

be flattened temporarily due to engorgement

or swelling while breastfeeding. Inverted or

flat nipples can sometimes make it harder to

breastfeed. But remember that for breastfeeding to work, your baby has to latch on to both

the nipple and the breast, so even inverted

nipples can work just fine. Often, flat and inverted nipples will protrude more over time, as

the baby sucks more.

Very large nipples can make it hard for the

baby to get enough of the areola into his or 

her mouth to compress the milk ducts and get

enough milk.

What you can do

1.	 Talk to your doctor or a lactation consultant if 

you are concerned about your nipples.

2.	 You can use your fingers to try and pull your

nipples out. There are also special devices

designed to pull out inverted or temporarily

flattened nipples. 

3.	 The latch for babies of mothers with very large

nipples will improve with time as the baby

grows. In some cases, it might take several

weeks to get the baby to latch well. But if a

mother has a good milk supply, her baby will

get enough milk even with a poor latch.

Ask for help if you have questions about your nipple 

shape or type, especially if your baby is having 

trouble latching well.
 25

Common Questions

Should I supplement with formula?

Giving your baby formula may cause him or her to

not want as much breast milk. This will decrease

your milk supply. If you are worried that your baby

is not eating enough, talk to your baby’s doctor.

Does my baby need cereal or water?

Your baby only needs breast milk for the first six

months of life. Breast milk alone will provide all

the nutrition your baby needs. Giving the baby

cereal may cause your baby to not want as much

breast milk. This will decrease your milk supply.

Even in hot climates, breastfed infants do not need

water or juice. When your baby is ready for other

foods, the food should be iron rich.

Is it okay for my baby to use a 

pacifier? 

If you want to try it, it is best to wait until the

baby is one month old to introduce a pacifier. This

allows the baby to learn how to latch well on the 

breast and get enough to eat.

Is my baby getting enough vitamin D?

Vitamin D is needed to build strong bones. All

infants and children should get at least 400 International Units (IU) of vitamin D each day. To meet

this need, all breastfed infants (including those supplemented with formula) should be given a vitamin

D supplement of 400 IU each day. This should

start in the first few days of life. You can buy vitamin D supplements for infants at a drug store or

grocery store. Sunlight is a major source of vitamin

D, but it is hard to measure how much sunlight

your baby gets, and too much sun can be harmful.

Once your baby is weaned from breast milk, talk

to your baby’s doctor about whether your baby still

needs vitamin D supplements. Some children do

not get enough vitamin D through diet alone.

When should I wean my baby?

The American Academy of Pediatrics recommends

breastfeeding beyond the baby’s first birthday, and

for as long as both the mother and baby would like.

The easiest and most natural time to wean is when

your child leads the process. But how the mother

feels is very important in deciding when to wean.

Is it safe to smoke, drink, or use 

drugs? 

If you smoke, it is best for you and your baby to quit

as soon as possible. If you can’t quit, it is still better

to breastfeed because it can help protect your baby 

from respiratory problems and sudden infant death

syndrome. Be sure to smoke away from your baby

and change your clothes to keep your baby away 

from the chemicals smoking leaves behind. Ask a

health care provider for help quitting smoking!

You should avoid alcohol, especially in large

amounts. An occasional small drink is okay, but

avoid breastfeeding for two hours after the drink.

It is not safe for you to use or be dependent on an 

illicit drug. Drugs such as cocaine, marijuana, heroine, and PCP harm your baby. Some reported side

effects in babies include seizures, vomiting, poor

feeding, and tremors.
26

Can I take medicines if I am breastfeeding?

Although almost all medicines pass into your milk in

small amounts, most have no effect on the baby and

can be used while breastfeeding. Very few medicines can’t be used while breastfeeding. Discuss any

medicines you are using with your doctor and ask

before you start using new medicines. This includes

prescription and over-the-counter drugs, vitamins,

and dietary or herbal supplements. For some women

with chronic health problems, stopping a medicine

can be more dangerous than the effects it will have

on the breastfed baby.

You can learn more from Medications and Mothers’ 

Milk, a book by Thomas Hale, found in bookstores and libraries. The National Library of Medicine also offers an online tool for learning about 

the effects of medicines on breastfed babies. The

website address is http://toxnet.nlm.nih.gov/cgibin/sis/htmlgen?LACT.

Can I breastfeed if I am sick?

Some women think that when they are sick, they

should not breastfeed. But, most common illnesses, such as colds, flu, or diarrhea, can’t be passed

through breast milk. In fact, if you are sick, your

breast milk will have antibodies in it. These antibodies will help protect your baby from getting the same

sickness. (See page 4 to learn about antibodies.)

Breastfeeding is not advised if the mother:

•	 Has been infected with HIV or has AIDS. If

you have HIV and want to give your baby breast

milk, you can contact a human milk bank (see

page 32 for more information).

•	 Is taking antiretroviral medications.

•	 Has untreated, active tuberculosis.

•	 Is infected with human T-cell lymphotropic

virus type I or type II.

•	 Is taking prescribed cancer chemotherapy

agents, such as antimetabolites, that interfere

with DNA replication and cell division.

•	 Is undergoing radiation therapies, but such

nuclear medicine therapies require only a temporary break from breastfeeding.

What should I do if I have postpartum depression?

First, postpartum depression is different than postpartum “blues.” The blues – which can include lots

of tears, and feeling down and overwhelmed – are

common and go away on their own. Postpartum

depression is less common, more serious, and can

last more than two weeks. Symptoms can include

feeling irritable and sad, having no energy and not

being able to sleep, being overly worried about the

baby or not having interest in the baby, and feeling

worthless and guilty. 

If you have postpartum depression, work with

your doctor to find the right treatment for you.

Treatment may include medication such as antidepressants and talk therapy. Research has shown

that while antidepressants pass into breast milk,

few problems have been reported in infants. Even

so, it is important to let your baby’s doctor know if

you need to take any medications.

Let your doctor know if your blues do not go away

so that you can feel better. If you are having any

thoughts about harming yourself or your baby, call

911 right away.

Will my partner be jealous if I

breastfeed?

If you prepare your partner in advance, there

should be no jealousy. Explain that you need support. Discuss the important and lasting health
 27

benefits of breastfeeding. Explain that not making formula means more rest. Be sure to emphasize that breastfeeding can save you money. Your

partner can help by changing and burping the baby,

sharing chores, and simply sitting with you and the

baby to enjoy the special mood that breastfeeding creates. Your partner can also feed the baby

pumped breast milk.

Do I have to restrict my sex life while 

breastfeeding?

No. But, if you are having vaginal dryness, you can

try more foreplay and water-based lubricants. You

can feed your baby or express some milk before

lovemaking so your breasts will be more comfortable and less likely to leak. During sex, you also can

put pressure on the nipple when it lets down or 

have a towel handy to catch the milk.

Do I still need birth control if I am 

breastfeeding?

Like other forms of birth control, breastfeeding is

not a sure way to prevent pregnancy. Breastfeeding can delay the return of normal ovulation and

menstrual cycles. You should still talk with a health

care provider about birth control choices that are 

okay to use while breastfeeding.

I heard that breast milk can have 

toxins in it from my environment. Is 

it still safe for my baby? 

While certain chemicals have appeared in breast

milk, breastfeeding remains the best way to feed

and nurture young infants and children. The advantages of breastfeeding far outweigh any possible risks from environmental pollutants. To date,

the effects of such chemicals have only been seen

rarely – in babies whose mothers themselves were

ill because of them. Infant formula, the water it is

mixed with, and/or the bottles or nipples used to

give it to the baby can be contaminated with bacteria or chemicals.

Does my breastfed baby need vaccines? Is it safe for me to get a vaccine when I’m breastfeeding? 

Yes. Vaccines are very important to your baby’s

health. Breastfeeding may also enhance your baby’s

response to certain immunizations, providing more

protection. Follow the schedule your doctor gives

you, and, if you miss any, check with him or her

about getting your baby back on track. Breastfeeding while the vaccine is given to your baby – or 

immediately afterward – can help relieve pain and

soothe an upset baby. Most nursing mothers may

also receive vaccines. Breastfeeding does not affect the vaccine. Vaccines are not harmful to your

breast milk.

What should I do if my baby bites 

me?

If your baby starts to clamp down, you can put

your finger in the baby’s mouth and take him or

her off of your breast with a firm, “No.” Try not

to yell because it may scare the baby. If your baby

continues to bite you, you can:

•	 Stop the feeding right away so the baby is not

tempted to get another reaction from you.

Don’t laugh. This is part of your baby learning

limits.

•	 Offer a teething toy, or a snack (if older baby),

or drink from a cup instead.

•	 Put your baby down for a moment to show that

biting brings a negative consequence. You can

then pick your baby up again to give comfort.

What do I do if my baby keeps crying?

If your baby does not seem comforted by breastfeeding or other soothing measures, talk to your

baby’s doctor. Your baby may have colic or may be

uncomfortable or in pain. You can also check to

see if your baby is teething. The doctor and a lactation consultant can help you find ways to help your

baby eat well.
28

Breastfeeding a Baby with health 

Problems

There are some health problems in babies that can

make it harder to breastfeed. Yet breast milk and early

breastfeeding are still best for the health of both you 

and your baby – even more so if your baby is premature or sick. Even if your baby cannot breastfeed

directly from you, it’s best to express or pump your

milk and give it to your baby with a cup or dropper.

Some common health problems in babies are listed

below.

Jaundice

Jaundice (JAWN-diss) is caused by an excess of

bilirubin, a substance that is in the blood usually

in very small amounts. In the newborn period,

bilirubin can build up faster than it can be removed

from the intestinal track. Jaundice can appear as

a yellowing of the skin and eyes. It affects most

newborns to some degree, appearing between the

second and third day of life. The jaundice usually

clears up by two weeks of age and is not harmful.

Two types of jaundice can affect breastfed infants – 

breastfeeding jaundice and breast milk jaundice.

•	 Breastfeeding jaundice can occur when a breastfeeding baby is not getting enough breast milk.

This can happen either because of breastfeeding 

challenges or because the mother’s milk hasn’t

yet come in. This is not caused by a problem

with the breast milk itself.

•	 Breast milk jaundice may be caused by substances in the mother’s milk that prevents bilirubin

from being excreted from the body. Such jaundice appears in some healthy, breastfed babies

after about one week of age. It may last for a

month or more and it is usually not harmful.

Your baby’s doctor may monitor your baby’s bilirubin level with blood tests. Jaundice is best treated

by breastfeeding more frequently or for longer

periods of time. It is crucial to have a health care

provider help you make sure the baby is latching on and removing milk well. This is usually all

that is needed for the infant’s body to rid itself of

excess bilirubin.

Some babies will also need phototherapy – treatment with a special light. This light helps break down

bilirubin into a form that can be removed from the

body easily. If you are having trouble latching your

baby to the breast, it is important that you pump or

hand express to ensure a good milk supply. The same

is true if the baby needs formula for a short time –

pumping or hand expressing will make sure the baby

has enough milk when you return to breastfeeding.

It is important to keep in mind that breastfeeding

is best for your baby. Even if your baby experiences jaundice, this is not something that you caused.

Your health care providers can help you make sure

that your baby is eating well and that the jaundice 

goes away.

If your baby develops jaundice once at home, let 

your baby’s doctor know. Discuss treatment options 

and let the doctor know that you do not want to interrupt breastfeeding if at all possible.

Reflux Disease

Some babies have a condition called gastroesophageal (GASS-troh-uh-SOF-uh-JEE-uhl) reflux

disease (GERD), which occurs when the muscle

at the opening of the stomach opens at the wrong

times. This allows milk and food to come back up

into the esophagus, the tube in the throat. Some

symptoms of GERD can include:

•	 Severe spitting up, or spitting up after every

feeding or hours after eating 

•	 Projectile vomiting, where the milk shoots out

of the mouth

•	 Inconsolable crying as if in discomfort
 29

•	 Arching of the back as if in severe pain

•	 Refusal to eat or pulling away from the breast

during feeding 

•	 Waking up often at night

•	 Slow weight gain

•	 Gagging or choking, or problems swallowing

Many healthy babies might have some of these symptoms and not have GERD. But there are babies who

might only have a few of these symptoms and have

a severe case of GERD. Not all babies with GERD

spit up or vomit. More severe cases of GERD may

need to be treated with medication if the baby refuses

to nurse, gains weight poorly or is losing weight, or

has periods of gagging or choking.

Cleft Palate and Cleft Lip

Cleft palate and cleft lip are some of the most common birth defects that happen as a baby is developing in the womb. A cleft, or opening, in either the

palate or lip can happen together or separately, and

both can be corrected through surgery. Both conditions can prevent babies from forming a good seal

around the nipple and areola with his or her mouth

or effectively removing milk from the breast. A

mother can try different breastfeeding positions and

use her thumb or breast to help fill in the opening

left by the lip to form a seal around the breast.

Right after birth, a mother whose baby has a cleft palate can try to breastfeed her baby. She can also start

expressing her milk right away to keep up her supply.

Even if her baby can’t latch on well to her breast, the

baby can be fed breast milk by cup. In some hospitals, babies with cleft palate are fitted with a mouthpiece called an obturator that fits into the cleft and

seals it for easier feeding. The baby should be able to

exclusively breastfeed after his or her surgery.

Premature and/or Low Birth Weight

Premature birth is when a baby is born before 37

weeks’ gestation. Prematurity often will mean that

the baby is born at a low birth weight, defined as

less than 51⁄2 pounds. Low birth weight can also be

caused by malnourishment in the mother. Arriving

early or being small can make for a tough adjustment, especially if the baby has to stay in the hospital for extra care. But keep in mind that breast

milk has been shown to help premature babies

grow and ward off illness.

Most babies who are low birth weight but born

after 37 weeks (full term) can begin breastfeeding

right away. They will need more skin-to-skin contact

with mom and dad to help keep them warm. These

smaller babies may also need more frequent feedings,

and they may get sleepier during those feedings.

Many babies born prematurely are often not able

to breastfeed at first, but they do benefit from

expressed milk. You can express colostrum by

hand or pump as soon as you can in the hospital.

You can talk to the hospital staff about renting a

hospital-grade electric pump. Call your insurance

company or local WIC Office to find out if you

can get reimbursed for this type of pump. You will

need to express milk as often as you would have

breastfed, so about 8 times in a 24-hour period.

Once your baby is ready to breastfeed directly,

skin-to-skin contact can be very calming and a

great start to your first feeding. Be sure to work

with a lactation consultant on proper latch and positioning. Many mothers of premature babies find

the cross cradle hold helpful. (See page 14 for an 

illustration.) It may take some time for you and the

baby to get into a good routine.

See your baby’s doctor if he or she spits up after 

every feeding and has any of the other symptoms 

mentioned here. If your baby has GERD, it is important to continue breastfeeding. Breast milk is more 

easily digested than infant formula.

If you leave the hospital before your baby, you can 

express milk for the hospital staff to give the baby by 

feeding tube.

If your baby is born with a cleft palate or cleft lip, 

talk with a lactation consultant in the hospital. Breast 

milk is still best for your baby’s health.
30

Breastfeeding and Special Situations

Twins or Multiples

The benefits of human milk to mothers of multiples and their babies are the same as for all mothers

and babies – possibly greater, because many multiples are born early. But the idea may seem overwhelming! Yet many of these moms find breastfeeding easier than other feeding methods because there

is nothing to prepare. Many mothers have overcome

challenges to successfully breastfeed twins and more

even after going back to work.

Being prepared

It will help to learn as much as you can about

breastfeeding during your pregnancy. You can:

•	 Take a breastfeeding class.

•	 Find Internet and print resource for parents of

multiples.

•	 Join a support group for parents of multiples

Many twin and multiple babies are smaller or born 

premature. Please see the information on page 29

for other tips for caring for these babies. Also, talk 

with a lactation consultant about more ways you can 

successfully breastfeed.

through your health care provider, hospital,

local breastfeeding center, or La Leche League

International.

•	 Let your health care provider and family members know that you plan to breastfeed.

•	 Keep in mind that even if your babies need to

spend time in the NICU (neonatal intensive care

unit), breastfeeding is still possible, with some

adjustments.

•	 Find a lactation consultant with multiples experience before the babies are born so that you know 

where to turn for help. Ask her where you can

rent a breast pump if the babies are born early.

Making enough milk

Most mothers are able to make plenty of milk for

twins. Many mothers fully breastfeed or provide milk

for triplets or quadruplets. Keep these tips in mind:

•	 Breastfeeding soon after birth and often is helpful for multiples the same way it is for one baby.

The more milk that is effectively removed, the

more milk a mother’s body will make.

•	 If the babies are born early, double pumping

often will help the mother make more milk.

•	 The doctor’s weight checks can tell you if your

babies are getting enough breast milk. You can

also track wet diapers and bowel movements to tell

if your babies are getting enough. (See our diaper

tracker on page 46.) For other signs that your

babies are getting enough breast milk, see page 17.

•	 It helps to have each baby feed from both

breasts. You can “assign” a breast to each baby

for a feeding and switch at the next feeding. Or,

you can assign a breast to each baby for a day 

and switch the next day. Switching breasts helps

keep milk production up if one baby isn’t eating

as well for a bit. It also gives babies a different

view to stimulate their eyes.
 31

Breastfeeding positions

Breastfeeding twins and more may take practice,

but you and your babies can find your ideal positions and routine. Keep trying different positions

until you find ones that work for you. For some

mothers and babies, breastfeeding twins at the

same time works well. Others find individual feedings to work better. Still others find that it depends

on the time – you may feed one baby at a time at

night and feed two babies at the same time during

the day. Finally, as your babies grow, you may find

that you need to change your feeding routine.

Below are some positions that may work for you:

• Double clutch (“football”) – Place both babies

in the clutch hold. You will need pillows at your

side (and maybe one on your lap) and you will

place the babies on the pillows with their legs 

going toward the back of the chair or couch. If

you are placing the babies in front of you, try

to keep their whole bodies turned toward you,

their chests against your chest. Their bodies

must not be facing up. This is very important to

help prevent nipple pain and to make sure that

the babies are getting enough milk.

• Cradle-clutch combination – Place one baby 

(usually the easiest to latch or stay latched) in

the cradle position and then position the second 

baby in the clutch position.

• Double cradle – Place the babies in front of 

you with their legs overlapping, making an X

across your lap.

Partial breastfeeding 

Even though full, direct breastfeeding is ideal,

many mothers of multiples feed their babies breast

milk or some formula by bottles at times. It is

important to work with your doctor, your baby’s

doctor, and a lactation consultant to figure out

what works best for your family.

Breastfeeding During Pregnancy

Breastfeeding during your next pregnancy is not

a risk to either the breastfeeding toddler or to 

the new developing baby. If you are having some

problems in your pregnancy such as uterine pain or

bleeding, a history of preterm labor, or problems

gaining weight during pregnancy, your doctor may

advise you to wean. Some women also choose to

wean at this time because they have nipple soreness caused by pregnancy hormones, are nauseous,

or find that their growing bellies make breastfeeding uncomfortable. Your toddler also may decide

to wean on his or her own because of changes in 

the amount and flavor of your milk. He or she will

need additional food and drink because you will 

likely make less milk during pregnancy.

If you keep nursing your toddler after your baby is 

born, you can feed your newborn first to ensure he or

she gets the colostrum. Once your milk production

Many breastfeeding basics are the same for twins or 

multiples as they are for one baby. Learn more about 

these important topics:

•	 How to know your babies are getting enough 

milk (page 17)

•	 How to troubleshoot common challenges (page 18)

•	 Ways to keep milk supply up (page 19)

When they were first born, it was too overwhelming 

for me to care for them at the same time. I fed them 

one at a time, which was nice, because I was able to 

bond with each individually. But then I realized that I 

was pretty much feeding one of them every 1 1⁄2 to 2 

hours and in order to get more sleep, I started feeding 

them at the same time. Once I got the hang of feeding 

both at once, I was able to free up so much more 

time! They started to get on the same eating/sleeping 

schedule and while both were sleeping, I would find 

myself having a solid two to three hours to catch up 

on some sleep, relax, and clean up around the house. 

It was so liberating and much needed! I’m so glad I 

figured out something that worked for all of us.

– Jen 

Charleston, SC
32

increases a few days after birth, you can decide how to

best meet everyone’s needs, especially the new baby’s

needs for you and your milk. You may want to ask

your partner to help you by taking care of one child 

while you are breastfeeding. Also, you will have a need

for more fluids, healthy foods, and rest because you

are taking care of yourself and two small children.

Breastfeeding After Breast Surgery

How much milk you can produce depends on

how your surgery was done and where your incisions are, and the reasons for your surgery. Women who have had incisions in the fold under the 

breasts are less likely to have problems making

milk than women who have had incisions around

or across the areola, which can cut into milk ducts

and nerves. Women who have had breast implants

usually breastfeed successfully. If you ever had

surgery on your breasts for any reason, talk with

a lactation consultant. If you are planning breast

surgery, talk with your surgeon about ways he or

she can preserve as much of the breast tissue and

milk ducts as possible.

Adoption and Inducing Lactation

Many mothers who adopt want to breastfeed their

babies and can do it successfully with some help.

Many will need to supplement their breast milk

with donated breast milk from a milk bank or infant

formula, but some adoptive mothers can breastfeed

exclusively, especially if they have been pregnant before. Lactation is a hormonal response to a physical

action, and so the stimulation of the baby nursing

causes the body to see a need for and produce milk.

The more the baby nurses, the more a woman’s

body will produce milk.

If you are adopting and want to breastfeed, talk with

both your doctor and a lactation consultant. They can

help you decide the best way to try to establish a milk

supply for your new baby. You might be able to prepare by pumping every three hours around the clock

for two to three weeks before your baby arrives, or

you can wait until the baby arrives and start to breastfeed then. Devices such as a supplemental nursing

system (SNS) or a lactation aid can help ensure that

your baby gets enough nutrition and that your breasts 

are stimulated to produce milk at the same time.

Using Milk from Donor Banks

If you can’t breastfeed and still want to give your baby 

human milk, the best and only safe place to go is to a human milk bank. You should never feed your baby breast 

milk that you get directly from another woman or through 

the Internet. A human milk bank can dispense donor 

human milk to you if you have a prescription from your 

doctor. Many steps are taken to ensure the milk is safe. 

Donor human milk provides the same precious nutrition 

and disease-fighting properties as your own breast milk.

If your baby was born premature or has other health 

problems, he or she may need donated milk not only for 

health but also for survival. Your baby may also need 

donated milk if she or he:

•	 Can’t tolerate formula 

•	 Has severe allergies 

•	 Isn’t thriving on formula

You can find a human milk bank through the Human 

Milk Banking Association of North America (HMBANA). HMBANA is a multidisciplinary group of health 

care providers that promotes, protects, and supports 

donor milk banking. HMBANA is the only professional 

membership association for milk banks in Canada, 

Mexico, and the United States and as such sets the standards and guidelines for donor milk banking for those 

areas. You can also contact HMBANA if you would like 

to donate breast milk.

To find out if your insurance will cover the cost of the 

milk, call your insurance company or ask your doctor. 

If your insurance company does not cover the cost of 

the milk, talk with the milk bank to find out how payment can be made later on, or how to get help with the 

payments. A milk bank will never deny donor milk to a 

baby in need if it has the supply.
 33

Breastfeeding in Public

Many women have reported feeling uncomfortable breastfeeding in public, even doing so discreetly. But it is important to remember that you

are feeding your baby. You are not doing anything

inappropriate. And even though it may seem taboo

in some places, awareness of the need to support

new breastfeeding mothers is building.

The federal government and many states have laws

that protect nursing women. These laws are based

on the recognition of organizations such as the 

American Academy of Pediatrics, the American

College of Obstetricians and Gynecologists, American Public Health Association, United Nations

International Children’s Emergency Fund (UNICEF), and the World Health Organization (WHO)

that breastfeeding is the best choice for the health 

of a mother and her baby.

Even with the growing awareness of the benefits

of breastfeeding, you may find it difficult to do so

in public. Yet it is important to believe in yourself

and your choice. Remind yourself that you can

succeed and wear your confidence! Some tips for

breastfeeding in public include:

•	 Wear clothes that allow easy access to your

breasts, such as tops that pull up from the waist

or button down.

•	 Use a special breastfeeding blanket around your 

shoulders. Some babies do not like this, though,

so you’ll have to see what works for your baby.

•	 Breastfeed your baby in a sling. Slings or other

soft infant carriers are especially helpful for 

traveling – it makes it easier to keep your baby

comforted and close to you.

•	 Slip into a women’s lounge or dressing room to

breastfeed.

•	 If you are worried about being too revealing in public, practice at home until you are comfortable.

It helps to breastfeed your baby before he or she becomes fussy so that you have time to get into a comfortable place or position to feed. (Over time, you will

learn your baby’s early hunger cues.) When you get to

your destination, scout out a place you can breastfeed,

if that makes you feel more comfortable.

If someone criticizes you for breastfeeding in

public, check out the La Leche League’s website at 

http://www.llli.org for possible ways to respond.

Most of all, it is important to remember that you

are meeting your baby’s needs. It isn’t possible to

stay home all the time, and you can feel free to

feed your baby while out and about. You should be

proud of your commitment! Plus, no bottles and

formula means fewer supplies to pack!

Follow the instructions for infant slings very carefully. 

Check in with the Consumer Product Safety Commission for warnings before buying a sling.
34

Pumping and milk storage

If you are unable to breastfeed your baby directly,

it is important to remove milk during the times

your baby normally would feed. This will help you

continue to make milk. Before you express breast

milk, be sure to wash your hands. Also, make sure

the area where you are expressing is clean.

If you need help to get your milk to start flowing, have one of the following items nearby – a

picture of your baby, a baby blanket, or an item of

your baby’s clothing that has his or her scent on it.

You can also apply a warm moist compress to the

breast, gently massage the breasts, or sit quietly and

think of a relaxing setting.

Ways to Express Your Milk 

Type How It Works What’s Involved Average Cost

Hand 

Expression

You use your hand to 

massage and compress your breast to 

remove milk.

•	Requires practice, skill, and coordination. 

•	Gets easier with practice; can be as fast as 

pumping. 

•	Good if you are seldom away from baby or 

need an option that is always with you. But all 

moms should learn how to hand express.

Free, unless you need 

help from a breastfeeding 

professional who charges 

for her services. 

Manual Pump You use your hand 

and wrist to operate 

a hand-held device to 

pump the milk. 

•	Requires practice, skill, and coordination. 

•	Useful for occasional pumping if you are 

away from baby once in a while. 

$30 to $50 

Automatic, 

Electric Breast 

Pump

Runs on battery or 

plugs into an electrical 

outlet. 

•	Can be easier for some moms. 

•	Can pump one breast at a time or both 

breasts at the same time. 

•	Double pumping may collect more milk in less 

time, so it is helpful if you are going back to 

work or school full time. 

•	Need places to clean and store the equipment 

between uses.

$150 to over $250 

Hospital-grade electric pumps can be rented from a lactation consultant at a local hospital or from a breastfeeding 

organization. These pumps work well for establishing milk supply when new babies can’t feed at the breast. Mothers who have struggled with other expression methods may find that these pumps work well for them.
 35

Electric Pumps

Milk Storage Bags and Bottles Manual Pump

You can keep germs from getting into the milk by 

washing your pumping equipment with soap and 

water and letting it air dry. 

Storage of Breast Milk 

Breast milk can be stored in clean glass or hard

BPA-free plastic bottles with tight-fitting lids. You

can also use milk storage bags, which are made for

freezing human milk. Do not use disposable bottle

liners or other plastic bags to store breast milk.

After each pumping

•	 Label the date on the storage container. Include

your child’s name if you are giving the milk to a

childcare provider.

•	 Gently swirl the container to mix the cream part

of the breast milk that may rise to the top back

into the rest of the milk. Shaking the milk is not

recommended – this can cause a breakdown of

some of the milk’s valuable components.

•	 Refrigerate or chill milk right after it is

expressed. You can put it in the refrigerator,

place it in a cooler or insulated cooler pack, or

freeze it in small (2 to 4 ounce) batches for later

feedings.

Tips for freezing milk

•	 Wait to tighten bottle caps or lids until the milk

is completely frozen.

•	 Try to leave an inch or so from the milk to the

top of the container because it will expand

when freezing.

•	 Store milk in the back of the freezer – not in

the freezer door.

Tips for thawing and warming up 

milk

•	 Clearly label milk containers with the date it was

expressed. Use the oldest stored milk first.

•	 Breast milk does not necessarily need to be

warmed. Some moms prefer to take the chill off

and serve at room temperature. Some moms

serve it cold.

•	 Thaw frozen milk in the refrigerator overnight,

by holding the bottle or frozen bag of milk

under warm running water, or setting it in a

container of warm water.

•	 Never put a bottle or bag of breast milk in

the microwave. Microwaving creates hot spots

that could burn your baby and damage the

components of the milk.

•	 Swirl the milk and test the temperature by

dropping some on your wrist. It should be

comfortably warm.

•	 Use thawed breast milk within 24 hours. Do not

re-freeze thawed breast milk.
36

Guide to Storing Fresh Breast Milk for Use with Healthy Full-Term Infants

Place Temperature How Long Things to Know

Countertop, 

table

Room temp (60°F85°F)Up to 3-4 hours is 

best.

Up to 6-8 hours is 

okay for very clean 

expressed milk.

Containers should be covered and kept as cool as 

possible; covering the container with a clean cool 

towel may keep milk cooler. Throw out any leftover 

milk within 1 to 2 hours after the baby is finished 

feeding. 

Small cooler 

with a blueice pack. 

59°F 24 hours. Keep ice packs in contact with milk containers at all 

times; limit opening cooler bag. 

Refrigerator 39°F or colder Up to 72 hours is best.

Up to 5-8 days is 

okay for very clean 

expressed milk.

Store milk in the back of the main body of the refrigerator. 

Freezer 24°F or colder Up to 6 months is best.

Up to 12 months is 

okay if milk is stored 

at 0°F or colder.

Store milk toward the back of the freezer where temperature is most constant. Milk stored at 0°F or colder 

is safe for longer durations, but the quality of the milk 

might not be as high. 

Guide to Storing Thawed Breast Milk

Room Temperature

(60°F to 85°F)

Refrigerator

(39°F or colder) Any Freezers 

Thawed Breast Milk Up to 1-2 hours is best.

Up to 3-4 hours is okay.

24 hours Do not re-freeze.

I was committed to breastfeeding, but learning to nurse while learning to take care of a newborn was tough. My 

baby hated taking the entire nipple, and slipping off as she nursed was painful. And when it’s 3 a.m. and your 

baby is fussing and you are sore, those bottles are incredibly tempting. 

At the same time, most of the health professionals I came in contact with – as well as many of my family members 

and friends – seemed to be undermining my breastfeeding relationship. My daycare providers seemed afraid of 

my breast milk, my workplace didn’t offer me a place to pump, and other mothers would act as though my breastfeeding was condemning their choice not to. 

But I remembered that my nurse, Charlene, asked me to give it at least 8 weeks. I remembered that advice and 

decided to wait a little longer. I went back to Charlene for help and she showed me how to combat my daughter’s 

slipping latch. She also put me in touch with a local support group and helped me find professionals who really 

knew how to help. They got me through the most critical period, but it was only my willingness to seek out their 

guidance that allowed me to keep nursing. Don’t be afraid to ask for help whenever you need it!

– Lin

Lock Haven, PA
 37

Going Back to Work

Planning ahead for your return to work can help ease 

the transition. Learn as much as you can ahead of

time and talk with your employer about your options.

This can help you continue to enjoy breastfeeding 

your baby long after your maternity leave is over.

During Pregnancy

•	 Join a breastfeeding support group to talk with 

other mothers about breastfeeding while working.

•	 Talk with your supervisor about your plans to 

breastfeed. Discuss different types of schedules,

such as starting back part time at first or taking

split shifts.

•	 Find out if your company provides a lactation

support program for employees. If not, ask

about private areas where you can comfortably

and safely express milk. The Affordable Care

Act (health care reform) supports work-based

efforts to assist nursing mothers.

•	 Ask the lactation program director, your supervisor, wellness program director, employee human resources office, or other coworkers if they

know of other women at your company who

have breastfed after returning to work.

After the Baby Is Born

•	 Follow the steps on page 15 to set up a breastfeeding routine that works for you and your baby.

•	 Ask for help from a lactation consultant or your

doctor, if you need it.

During Your Maternity Leave

•	 Take as many weeks off as you can. At least

six weeks of leave can help you recover from

childbirth and settle into a good breastfeeding 

routine. Twelve weeks is even better.

•	 Practice expressing your milk by hand or with

a quality breast pump. Freeze 2 to 4 ounces at

a time to save for your baby after you return to

work. See pages 34-36 for more information

about pumping and storage.

•	 Help your baby adjust to taking breast milk

from a bottle (or cup for infants 3 to 4 months

old) shortly before you return to work. Babies

are used to nursing with mom, so they usually

drink from a bottle or cup when it’s given by

somebody else.

•	 See if there is a childcare option close to work,

so that you can visit and breastfeed your baby,

if possible. Ask if the facility will use your

pumped breast milk.

•	 Talk with your family and your childcare provider about your desire to breastfeed. Let them

know that you will need their support.

Back at Work

•	 Keep talking with your supervisor about your 

schedule and what is or isn’t working for you.

Keep in mind that returning to work gradually

gives you more time to adjust.

•	 If your childcare is close by, find out if you can

visit to breastfeed over lunch.

•	 When you arrive to pick up your baby from childcare, take time to breastfeed first. This will give

you both time to reconnect before traveling home

and returning to other family responsibilities.

•	 If you are having a hard time getting support,

talk to your human resources department. You

can also ask a lactation consultant for tips.

Get a Quality Breast Pump

A good-quality electric breast pump may be your

best strategy for efficiently removing milk during the workday. Contact a lactation consultant or

your local hospital, WIC program, or public health

department to learn where to buy or rent a good

pump. Electric pumps that allow you to express

milk from both breasts at the same time reduce

pumping time.
38

Find a Private Place to 

Express Milk 

Work with your supervisor to find a private place

to express your milk. The Affordable Care Act

(health care reform) supports work-based efforts

to assist nursing mothers. The Department of

Labor is proposing a new regulation to allow nursing women reasonable break time in a private place

(other than a bathroom) to express milk while at

work. (Employers with fewer than 50 employees

are not required to comply if it would cause the

company financial strain.)

If your company does not provide a private

lactation room, find another private area you can

use. You may be able to use:

•	 An office with a door

•	 A conference room

•	 A little-used closet or storage area

The room should be private and secure from

intruders when in use. The room should also

have an electrical outlet if you are using an 

electric breast pump. Explain to your supervisor

that it is best not to express milk in a restroom.

Restrooms are unsanitary, and there are usually

no electrical outlets. It can also be difficult to

manage a pump in a toilet stall.

Pumping Tips 

It may take time to adjust to pumping breast

milk in a work environment. For easier pumping,

try these tips for getting your milk to let-down

from the milk ducts:

•	 Relax as much as you can

•	 Massage your breasts

•	 Gently rub your nipples

•	 Visualize the milk flowing down

•	 Think about your baby – bring a photo of 

your baby, or a blanket or item of clothing

that smells like your baby

When to Express Milk

At work, you will need to express and store milk

during the times you would normally feed your

baby. (In the first few months of life, babies need

to breastfeed 8 to 12 times in 24 hours.) This turns

out to be about 2 to 3 times during a typical 8-hour

work period. Expressing milk can take about 10 to

15 minutes. Sometimes it may take longer. This will

help you make enough milk for your childcare provider to feed your baby while you are at work. The

number of times you need to express milk at work

should be equal to the number of feedings your baby

will need while you are away. As the baby gets older,

the number of feeding times may go down. Many

women take their regular breaks and lunch breaks to

pump. Some women come to work early or stay late

to make up the time needed to express milk.

Storing Your Milk

Breast milk is food, so it is safe to keep it in an employee refrigerator or a cooler with ice packs. Talk

to your supervisor about the best place to store 

your milk. If you work in a medical department,

do not store milk in the same refrigerators where

medical specimens are kept. Be sure to label the

milk container with your name and the date you

expressed the milk.

Call to Action to Support 

Breastfeeding 

The Surgeon General’s Call to Action to Support 

Breastfeeding explains why breastfeeding is a national 

public health priority and sets forth actionable steps 

that businesses, communities, health systems, and 

others can take to support nursing mothers. Learn 

more at http://www.surgeongeneral.gov.

The Business Case for Breastfeeding is a resource 

kit that can help your company support you and 

other breastfeeding mothers in the workplace. 

Share this website with your supervisor: http://www.

womenshealth.gov/breastfeeding/governmentprograms/business-case-for-breastfeeding.
 39

N

Healthy Eating

Many new mothers wonder if they should be on a

special diet while breastfeeding, but the answer is

no. You can take in the same number of calories

that you did before becoming pregnant, which

helps with weight loss after birth. There are no

foods you have to avoid. In fact, you can continue

to enjoy the foods that are important to your family – the special meals you know and love.

As for how your diet affects your baby, there are

no special foods that will help you make more

milk. You may find that some foods cause stomach upset in your baby. You can try avoiding those

foods to see if your baby feels better and ask your 

baby’s doctor for help.

Keep these important nutrition tips in mind:

•	 Drink plenty of fluids to stay hydrated (but fluid

intake does not affect the amount of breast

milk you make). Drink when you are thirsty, and

drink more fluids if your urine is dark yellow. A

common suggestion is to drink a glass of water

or other beverage every time you breastfeed.

Limit beverages that contain added sugars, such

as soft drinks and fruit drinks.

•	 Drinking a moderate amount (up to 2 to 3 cups

a day) of coffee or other caffeinated beverages

does not cause a problem for most breastfeeding babies. Too much caffeine can cause the

baby to be fussy or not sleep well.

•	 Vitamin and mineral supplements cannot replace

a healthy diet. In addition to healthy food choices, some breastfeeding women may need a multivitamin and mineral supplement. Talk with your

doctor to find out if you need a supplement.

•	 See page 25 for information on drinking alcohol and breastfeeding.
40

Can a baby be allergic to breast milk?

Research shows that a mother’s milk is affected

only slightly by the foods she eats. Breastfeeding

mothers can eat whatever they have eaten during

their lifetimes and do not need to avoid certain

foods. Babies love the flavors of foods that come

through in your milk. Sometimes a baby may be

sensitive to something you eat, such as dairy products like milk and cheese. Symptoms in your baby

of an allergy or sensitivity to something you eat

include some or all of these:

•	 Green stools with mucus and/or blood, diarrhea, vomiting

•	 Rash, eczema (EG-zuh-muh), dermatitis, hives,

dry skin 

•	 Fussiness during and/or after feedings

•	 Crying for long periods without being able to 

feel consoled 

•	 Sudden waking with discomfort

•	 Wheezing or coughing

Babies who are highly sensitive usually react to the

food the mother eats within minutes or within 4 to

24 hours afterward. These signs do not mean the

baby is allergic to your milk itself, only to something you are eating. If you stop eating whatever is

bothering your baby or eat less of it, the problem

usually goes away on its own. You also can talk

with your baby’s doctor about any symptoms. If

your baby ever has problems breathing, call 911 or

go to your nearest emergency room.

Fitness

An active lifestyle helps you stay healthy, feel better,

and have more energy. It does not affect the quality or quantity of your breast milk or your baby’s

growth. If your breasts are large or heavy, it may

help to wear a comfortable support bra or sports

bra and pads in case you leak during exercise. It is

also important to drink plenty of fluids. Be sure to

talk to your doctor about how and when to slowly 

begin exercising after your baby’s birth.

MyPyramid Plans for Moms

The USDA’s online, interactive tool can help you 

choose foods based on your baby’s nursing habits and 

your energy needs. Visit http://www.mypyramid.gov/

mypyramidmoms/pyramidmoms_plan.aspx to:

•	 Figure out how much you need to eat

•	 Choose healthy foods

•	 Get the vitamins and minerals you need

For a sample of nutrition needs for breastfeeding 

mothers, see page 41.

Vegan diets

If you follow a vegan diet or one that does not 

include any forms of animal protein, you or your 

baby might not get enough vitamin B12 in your 

bodies. This can also happen if you eat meat, but not 

enough. In a baby, this can cause symptoms such as 

loss of appetite, slow motor development, being very 

tired, weak muscles, vomiting, and blood problems. 

You can protect your and your baby’s health by taking vitamin B12 supplements while breastfeeding. 

Talk to your doctor about your vitamin B12 needs.
41
Handling Stress

Both short- and long-term stress can affect your

body. In fact, stress can make you more likely to

get sick. It can also make problems you already

have worse. It can play a part in a range of issues,

including trouble sleeping, stomach problems,

headaches, and mental health conditions.

Having a new baby and learning how to breastfeed

can be very stressful events. But it is important for

mothers to take care of themselves. Try to listen to

your body so that you can tell when stress is affecting your health, and take these steps to feel better!

• Get help from a professional if you need it.

A therapist can help you work through stress and

find better ways to deal with problems. For more

serious stress-related disorders, like post-traumatic

stress disorder, therapy can be helpful. There also

are medications that can help ease symptoms of

depression and anxiety and help promote sleep.

• Relax. It’s important to unwind in a way that

works for you. Try a bubble bath, deep breathing, yoga, meditation, and massage therapy. If

you can’t do these things, take a few minutes to

sit, listen to soothing music, or read a book.

• Sleep. Your stress could get worse if you don’t get

enough sleep. It is hard to fight off illness when

you sleep poorly. With enough sleep, it is easier to

cope with challenges and stay healthy. Try to get

seven to nine hours of sleep every night. If you

can’t, try to sleep when the baby sleeps.

• Eat right. Try to fuel up with fruits, vegetables,

proteins, and whole grains. See pages 39-41 for 

more nutrition information.

• Get moving. Physical activity not only helps 

relieve your tense muscles but helps your mood

too! Your body makes certain chemicals, called

endorphins, before and after you exercise. These

relieve stress and improve your mood. If you

are a new mother, ask your doctor when it is

okay to start exercising.

• Talk to friends. Friends can be good listeners.

Finding someone who will let you talk freely

about your problems and feelings without

judging you does a world of good. It also helps

to hear a different point of view. Friends will

remind you that you’re not alone.

• Compromise. Sometimes, it’s not always worth

the stress to argue. Give in once in awhile.

• Keep a journal. Write down your thoughts.

Have you ever typed an e-mail to a friend about

your lousy day and felt better afterward? Why

not grab a pen and paper and write down what’s

going on in your life! Keeping a journal can be a

great way to get things off your chest and work 

through issues.

• Help others. Helping someone else can help

you. Help your neighbor, or volunteer in your

community.

• Get a hobby. Find something you enjoy. Make

sure to give yourself time to explore your interests.

• Set limits. Figure out what you can really do.

There are only so many hours in the day. Set

limits with yourself and others. Don’t be afraid

to say no to requests for your time and energy.

• Plan your time. Think ahead about how you’re

going to spend your time. Write a to-do list. Figure out which tasks are the most important to do.

• Don’t deal with stress in unhealthy ways.

This includes drinking too much alcohol, using

drugs, or smoking, all of which can harm the

baby. It is also unhealthy to over-eat in response

to stress.

42

Did You Know?

Breastfeeding can help mothers relax and handle 

stress better. Skin-to-skin contact with your baby has 

a soothing effect.
 43

Questions to Ask Your Baby’s Doctor

Use this tear-out form to write down questions you have for your baby’s doctor and bring it to your

next visit.

If your baby is not eating well or if you are concerned about your baby’s health, call the pediatrician

right away.

1.

2.

3.

4.

5.

6.

7.
44

Questions to Ask Your Health Care Provider

Use this tear-out form to write down questions you have for your health care provider and bring it to

your next visit.

If you have symptoms of an infection (see page 21) or urgent health concerns, call your health

care provider right away.

1.

2.

3.

4.

5.

6.

7.
 45

Mon Tue Wed Thurs Fri Sat Sun

6 a.m.

7 a.m.

8 a.m.

9 a.m.

10 a.m.

11 a.m.

12 p.m.

1 p.m.

2 p.m.

3 p.m.

4 p.m.

5 p.m.

6 p.m.

7 p.m.

8 p.m.

9 p.m.

10 p.m.

11 p.m.

12 a.m.

1 a.m.

2 a.m.

3 a.m.

4 a.m.

5 a.m.

Feeding Chart

Mark your baby’s feedings in the chart below. The times should be when the feeding begins. 

You can note how long the baby fed at each breast. But keep in mind that feeding times 

will vary. Your baby will let you know when he or she is finished eating. If you are feeding 

pumped breast milk, include the amount your baby eats.
46

Baby’s Age Number of 

Wet Diapers

Number of Bowel 

Movements

Color and Texture of 

Bowel Movements

Day 1 (first 24 

hours after birth)

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Day 11

Day 12

Day 13

Day 14

Day 15

Day 16

Day 17

Day 18

Day 19

Day 20

Day 21

Day 22

Day 23

Day 24

Day 25

Day 26

Day 27

Day 28

Day 29

Day 30

Diaper Tracker

You do not have to track diapers for a month to know your baby is eating well, but some 

women find it helpful to write it down. Weight gain is the best way to know if your baby is 

eating well. Talk to your baby’s doctor if you are concerned.
 47

Health Information from the Office on 

Women’s Health

The Office on Women’s Health (OWH) offers free women’s health information on more than 800 topics through

our toll-free call center and website, http://www.womenshealth.gov. Other information resources include:

Could I have Lupus?

http://www.girlshealth.gov

Helping girls learn about health and growing up 

http://www.bestbonesforever.gov

Helping girls build strong bones 

http://www.couldihavelupus.gov

Providing an online community for women with lupus 

http://www.womenshealth.gov

Empowering women to live healthier lives
U.S. Department of Health and Human Services

Office on Women’s Health

200 Independence Ave, S.W. Room 712 E

Washington, DC 20201

www.womenshealth.gov

800-994-9662 • TDD 888-220-5446

Scan this code using your smartphone to

go directly to womenshealth.gov.

January 2011