Breastfeeding 187

Breastfeeding

As a mother, one of the best things that only you can do for 

your baby is to breastfeed. Breastfeeding is more than a lifestyle 

choice—it is an important health choice, and any amount of 

time that you can do it will help both you and your baby. Enjoy 

the special bond with your baby as he or she stares into your eyes 

and warmly nuzzles against your skin while breastfeeding—it’s 

an amazing feeling!

Breastfeeding is best 

It is best to give your baby only breast 

milk for the first 6 months of life. This 

means not giving your baby any other 

food or drink—not even water—during 

this time. Drops of liquid vitamins, minerals, and medicines are, of course, fine, 

as advised by your baby’s doctor. It is 

even better if you can breastfeed for your 

baby’s first year or longer, for as long as 

you both wish. Solid iron-rich foods, 

such as iron-fortified cereals and pureed 

vegetables and meats, can be started 

when your baby is around 6 months old. 

Before that time, a baby’s stomach cannot digest them properly. Solids do not 

replace breastfeeding. Breast milk stays 

the baby’s main source of nutrients during the first year. Beyond one year, breast 

milk can still be an important part of 

your child’s diet.

Breastfeeding is normal and healthy for 

infants and moms. Breast milk has disease-fighting cells called antibodies that 

help protect infants from germs, illness, 

and even sudden infant death syndrome 

(SIDS).

Breast milk is different from infant 

formula 

l	 Colostrum (koh-LOSS-truhm), the 

thick, yellow first breast milk that you 

make during pregnancy and just after 

birth, will give your baby the best start 

at life. It is known as “liquid gold.” 

It is rich in nutrients and antibodies 

to protect your baby as he or she first 

enters the world. Although your baby 

gets only a small amount of colostrum 

at each feeding, it matches the amount 

his or her tiny stomach can hold. A 
188 The Healthy Woman: A Complete Guide for All Ages

Breastfeeding Is Linked to a Lower Risk of These Health Problems

In infants: In mothers:

•	 Ear	infections •	 Type	2	diabetes

•	 Stomach	viruses •	 Breast	cancer

•	 Respiratory	infections •	 Ovarian	cancer

•	 Atopic	dermatitis	(ay-TOP-ihk	DUR-muh-TEYE-tuhss) •	 Postpartum	depression

•	 Asthma	(in	young	children)

•	 Obesity

•	 Type	1	and	type	2	diabetes

•	 Childhood	leukemia	(loo-KEE-mee-uh)

•	 Sudden	infant	death	syndrome	(SIDS)

•	 Necrotizing	enterocolitis	(NE-kroh-teye-zeeng	entur-oh-koh-LEYE-tuhss),	a	disease	that	affects	the	

gastrointestinal	tract	in	preterm	infants	

Studies	are	still	looking	at	the	effects	of	breastfeeding	on	osteoporosis	(OSS-tee-oh-puh-ROH-suhss)	and	

weight	loss	after	birth.

newborn stomach is only the size of a 

large marble at first! Colostrum is exactly what a new baby needs at first.

l	 Your milk changes over time to meet 

your baby’s needs. Your breast milk 

that begins to be made by the third to 

fifth day after birth has just the right 

amount of fat, sugar, water, and protein 

that is needed for your baby’s growth. 

It will be a thinner type of milk, but 

just as full of all of the nutrients and 

antibodies for your baby.

l	 Infant formula cannot match the exact 

chemical makeup of human milk, especially the cells, hormones, and antibodies that fight disease.

l	 For most babies, breast milk is easier 

to digest than formula. It takes time 

for their stomachs to adjust to digesting proteins in formula because they 

are made from cow’s milk.

How the breast makes milk

There are special cells inside your breasts 

that make milk. These cells are called 

alveoli (al-VEE-uh-leye). When your 

breasts become fuller and more 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 and some women experience 

breast changes after their baby is born. 

If you have a question about your breast 

changes, you can ask your health care 

provider or a lactation consultant.

The alveoli make milk in response to the 

hormone prolactin, which rises when the 

baby suckles. Another hormone, oxytocin 

(oks-ee-TOH-suhn), causes these small 

muscles around the cells to contract and 

move the milk through a series of small 

tubes called milk ducts. The milk ducts 

are located underneath the nipple and 

areola (air-ee-OH-luh), which is the 

darker skin that circles your nipple.
Breastfeeding 189

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)

Babies knows how to latch and 

feed

Did you know that an alert, healthy newborn infant can latch on to the mother’s 

breast with little or no help? Babies are 

born knowing how to find the breast and 

suckle all by themselves. All they need is 

a chance to practice. The more milk your 

baby removes from the breasts, the more 

milk you will make. Immediately after 

birth, ask the hospital to delay unnecessary procedures, if possible, and to allow 

you and your partner some quiet time to 

snuggle with your baby during the first 

hour or two.

Learning to “dance” 

Learning to breastfeed is like learning 

to dance. It is best to wait until you and 

your baby are calm. 

l	 Hold your baby, wearing only a diaper, 

skin-to-your-skin up against your bare 

chest and 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.

l	 Softly talk to your baby and massage 

him or her with gentle strokes.

l	 When awake, your baby will move his 

or her head back and forth, looking 

USED	wITH	PERmISSION	BY	SONjA,	jANNA	AND	THE	

INTERNATIONAL	LACTATION	CONSULTANT	ASSOCIATION.
190 The Healthy Woman: A Complete Guide for All Ages

and feeling for the breast with his 

or her mouth and lips. Your baby 

might even look up at you and make 

eye contact. This is an important time 

for your baby to learn that you are his 

or her mother, so enjoy this special 

time by talking or singing softly to 

your baby.

l	 Support his or her neck and shoulders 

with one hand and hips with the other 

as he or she twists and turns in an effort to find your breast.

As your baby looks for your breast

l	 Support your baby with your arms so 

that you both are comfortable.

l	 Allow your breast to hang naturally 

and, when your baby feels it with his 

or her cheek, he or she will open his 

or her mouth wide and reach it up and 

over the nipple.

l	 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.

l	 You will see that, at first, your baby’s 

nose is 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.

l	 Allow your baby’s arms to hug your 

breast.

l	 Do not put your hands on your baby’s 

head. As it tilts back, you can support 

your baby’s upper back and shoulders 

with the palm of your hand and pull 

your baby in close.

ExAmPLE	Of	A	gOOD	LATCH

Signs of a good latch

l	 How it feels is more important than 

how it looks. The latch feels comfortable 

to you, without hurting or pinching.

l	 Your baby’s chest is against your body 

and he or she does not have to turn his 

or her head while drinking.

l	 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.

l	 When your baby is positioned well, his 

or her mouth will be filled with breast.

l	 The tongue is cupped under the breast, 

although you might not see it.

l	 You hear or see your baby swallow. 

Some babies swallow so quietly, a 

pause in their breathing may be the 

only sign of swallowing.

l	 You see the baby’s ears “wiggle” 

slightly.

l	 Your baby’s lips turn out like fish lips, 

not in. You may not even be able to see 

the bottom lip.

l	 Your baby’s chin touches your breast.
Breastfeeding 191

Ask for help if you need it!

Once you have started to breastfeed, keep trying! There are many people who can

support you in your effort to give your baby the best start. Some may already have

been helping you during your pregnancy and birth.

International Board Certified Lactation Consultant (IBCLC) – also called a “lactation consultant,” this person is a credentialed health care professional with the highest level of knowledge and skill in breastfeeding support. IBCLCs help mothers to

breastfeed comfortably by helping with positioning, latch, and a wide range of breastfeeding concerns. Ask your hospital or birthing center for the name of a lactation consultant who can help you. You also can contact the International Lactation Consultant

Association, which has a lactation consultant directory. (See page 205 for contact

information).

Breastfeeding Peer Counselor or Educator – a breastfeeding counselor who 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. You can find a peer counselor with the 

Women, Infants and Children (WIC) Program or mother-to-mother support group

meetings from the La Leche League resources at the end of this chapter, or call the

National Breastfeeding Helpline. Some breastfeeding educators have letters after

their names like CLC (Certified Lactation Counselor) or CBE (Certified Breastfeeding 

Educator). These are not the same as IBCLCs but still can be quite helpful.

Doula (DOO-la) – a woman who 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 help women physically and emotionally, and those who are trained in breastfeeding can help you be more successful with

breastfeeding after birth.

Pediatrician – a medical doctor who focuses on treating babies, children, and teens.

OB/GYN or obstetrician/gynecologist – a medical doctor who focuses on treating

women’s reproductive health issues before, during, and after pregnancy.

Certified Nurse-Midwife – a health professional who provides care to women during

pregnancy, labor, and birth. Midwives can also provide breastfeeding advice.

Practice makes perfect

l	 During the early days and weeks during breastfeeding, you and your baby 

are both learning how to breastfeed. 

Take your time and be patient. Breastfeed as often and as long as your baby 

wants. Soon you will both be experts!

l	 As your baby gets older, you will be 

able to hold your baby close to you at 

Call the National Breastfeeding 

Helpline at (800) 994-9662 to talk to 

a trained peer counselor for answers 

to common questions and problems.

your breast with his or her mouth at 

your nipple and your baby will latch 

on easily.
192 The Healthy Woman: A Complete Guide for All Ages

l	 What works well for one feeding 

might not work well at the next. Try 

different positions until you find one 

that works for both of you.

Problems latching

If your baby is having trouble latching, 

you can gently stroke your baby’s lips 

with your nipple until he or she opens 

his or her mouth really wide and keeps it 

open. Then you can pull your baby close 

so that the chin and lower jaw moves 

into your breast first to take a large 

mouthful of breast. 

Get help if you are having trouble. (See 

page 191 for a list of people who can 

help you.)

Tips for Making Breastfeeding Work

1.	Breastfeed early and often. Breastfeed

as soon as possible after birth, within the

first hour of life. If you had a vaginal birth 

you can hold your baby and breastfeed

right away. If you had a c-section or general anesthesia after the birth for a surgery,

tell your doctor and nurse that you want

to breastfeed as soon as you are both in

the recovery room.

2.	Breastfeed at least 8 to 12 times every

24 hours to make plenty of milk for your baby.

3.	Keep your baby in your hospital room with you (also called “rooming in”) so you can

see your baby’s first signs of being hungry. When babies are hungry they become 

more alert and active, may put their hands or fists to their mouths, make sucking 

motions with their mouth, or turn their heads looking for the breast. Crying is a late

sign of hunger.

4.	Make sure you are both comfortable and follow your baby’s lead after he or she is

latched well onto the underside of the breast, not just the nipple. Some babies take

both breasts at each feeding, while others 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. 

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. Let your baby decide when

to stop nursing.

5.	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 with

you helps babies cry less, and stabilizes the baby’s heart and breathing rates.

6. Avoid using pacifiers, bottles, and supplements of infant formula in the first few 

weeks unless there is a medical reason to. It’s best just to breastfeed to get the

milk process running smoothly and to keep your baby from getting confused while

he or she is learning to breastfeed.
Breastfeeding 193

Breastfeeding holds

Some moms find that the following 

positions are also 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.

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 with 

large breasts, flat or inverted nipples, overactive let-down, 

or who had a c-section. 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 keeps 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.

4.	Side-Lying	Position – useful for mothers who had a 

c-section or to help any mother get some extra rest or 

sleep while the baby breastfeeds. This hold allows you 

to rest or sleep while your baby nurses. Lie on your side 

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

baby faces your body.
194 The Healthy Woman: A Complete Guide for All Ages

What if...

You have pain? Many moms report that 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. Your nipple also 

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.

You or your baby are frustrated? Take a short break and hold your baby in an upright

position. Consider holding him or her skin-to-your-skin. Talk, sing, or provide your finger for sucking for comfort. Try to breastfeed again in a little while.

Your baby has a weak suck, or makes 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 if your baby’s suck feels

weak or if you are not sure he or she is getting a good feeding of milk. Your baby

might have a health problem that is causing the weak suck.

You have other concerns? Contact a lactation consultant or your doctor for help.

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.

l	 You can expect at least 8 to 12 feedings in a 24-hour day

l	 In the first few days after birth, your 

baby will likely want to breastfeed 

about every hour or two in the daytime, and a couple of times at night 

during which your baby can have one 

longer sleep stretch. 

l	 Babies develop their own feeding 

schedules. Some babies feed every 

hour for 2-6 hours and then sleep for 

a longer period, and others will breastfeed every 2-3 hours day and night. 

Follow your baby’s cues for when he or 

she is ready to eat.

How to know baby gets enough milk

Many babies, but not all, lose a small 

amount of weight in the first days after 

birth. Your baby’s health care provider 

will check his or her weight at your first 

visit after you leave the hospital. Make 

sure to visit your baby’s health care provider within 3 to 5 days after birth and 

then again at 2 to 3 weeks of age for 

checkups. You also can tell if your baby is 

getting plenty of milk by keeping track 

of the number of wet diapers and diapers 

with bowel movements.

Most mothers can make plenty of 

milk for their baby. If you think you 

are having a milk supply problem, 

talk to a lactation conultant.
Breastfeeding 195

Minimum Number of Wet Diapers and Bowel Movements in a 

Baby’s First Week (It Is Fine if Your Baby Has More)

Baby’s age 

(1 day = 24 hours)

# of wet diapers # of bowel movements Color & texture of 

bowel movements

Day 1 (first 24 hours 

after birth)

1 The first one usually occurs 

within 8 hours after birth

Thick, tarry, and black

Day 2 2 3 Thick, tarry, and black

Day 3 5–6 3 Looser, greenish to yellow

Day 4 6 or more 3 Yellow, soft and watery

Day 5 6 or more 3 Loose, seedy yellow color

Day 6 6 or more 3 Loose, seedy yellow color

Day 7 6 or more 3 Larger amounts of loose,

seedy yellow color

Some babies will switch to less frequent but large bowel movements at about 6 weeks of age.

Other signs that your baby is getting plenty 

of milk are:

l	 Baby is mostly content and gaining 

weight steadily after the first week of 

age. From birth to 3 months, typical 

weight gain is 2/3 to 1 ounce each day.

l	 Baby is passing clear or pale yellow 

urine, not deep yellow or orange. Baby 

has at least three stools every 24 hours 

after day 1.

l	 Baby alternates short sleeping periods 

with wakeful, alert periods. Baby is 

satisfied and content after feedings. 

l	 Your breasts feel softer after you feed 

your baby.

Consult your baby’s health care provider 

if you are concerned about your baby’s 

weight gain.

Ways to Wake Your Baby to 

Breastfeed

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. You can:

•	Remove any blankets.

•	Change your baby’s diaper.

•	Place your baby skin-to-skin.

•	Massage your baby’s back, abdomen, arms, and legs.

Common Concerns and 

Solutions

Most breastfeeding concerns can be

prevented, and, if an issue arises,

there are many ways to treat it right

away by calling on a lactation consultant or other health care provider. Getting plenty of rest and fluids, reducing 

stress, and eating a healthy diet will

also help you feel better and be able

to cope with any early challenges you

might face after your baby is born.
196 The Healthy Woman: A Complete Guide for All Ages

Babies With Special Needs

Some babies have health problems

that make it more challenging to

breastfeed. You can stay firm with your 

choice to breastfeed and get help from

a lactation consultant. Breast milk and

early breastfeeding are still best for

both the health of you and your baby,

especially if your baby is premature

or sick. Even if your baby can’t breastfeed directly from you, it’s best to express or pump your milk and give it to

your baby with a cup or bottle. Be sure

to continue lots of skin-to-skin contact

with your baby.

Some of the most common health

problems at birth are:

•	being born early, or being premature

•	Down syndrome

•	heart defect

•	jaundice

•	cleft lip or palate

•	tongue-tied

•	needing to be in the intensive care

unit

Pumping and hand expression

If you must be away from your baby, it 

will be important to remove milk during the times your baby normally would 

feed to make sure you will continue to 

make enough milk for him or her. Milk 

can be removed through a breast pump 

or by hand. When pumping or hand expressing milk, you can help your milk to 

start flowing by having a picture of your 

baby, a baby blanket, or other piece of 

your baby’s clothing that has your baby’s 

scent on it close by. You also can apply 

a warm, but not hot, moist compress to 

the breast, gently massage the breasts, 

or sit quietly and think of a relaxing setting. It is best to wash your hands before 

pumping your breast milk and to make 

sure the area where you are pumping is 

also clean. After each pumping, you can 

refrigerate your milk, place it in a cooler 

or insulated cooler pack, or freeze it in 

small (2 to 3 ounce) batches for the baby 

to be fed later. You can keep germs from 

getting into the milk by washing your 

pumping equipment with soap and water 

and letting it air dry.

Human Milk Banks

If you can’t breastfeed and still want

to give your baby human milk, the best

place to go is to a milk bank that 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. Go to the Human Milk 

Banking Association of North America (HMBANA) resource listed in the

resource section on page 205.
Breastfeeding 197

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.

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,	hospitalgrade	pumpRuns	on	battery	or	

plugs	into	an	electrical	

outlet.

Easy	to	use.	

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	$250	or	

more

Going back to work

Breastfeeding keeps you connected to 

your baby, even when you are away at 

work, and your baby will continue to receive the best nutrition possible.

l	 After you have your baby, arrange with 

your employer to take as much time 

off as you can, because it will help you 

and your baby get into a good breastfeeding routine and help you make 

plenty of milk.

l	 If you can’t breastfeed your baby directly during your work breaks, plan 

to leave your expressed or pumped 

milk for your baby. The milk can 

be given to your baby by the caregiver with a bottle or cup. 

Some babies don’t like 

bottles; they prefer to 

breastfeed. So be patient 

and give your baby time 

to learn this new way of 

feeding. Babies may better learn other ways of 

feeding from their dad or 

another family member.

l	 You can help your baby 

practice bottle-feeding by 

giving him or her a bottle 

occasionally after he or she is 

around 4 weeks old and well 

used to breastfeeding. During 
198 The Healthy Woman: A Complete Guide for All Ages

these practice times, offer just a small 

amount (an ounce or two) of milk 

once a day.

l	 Talk with your employer about breastfeeding, such as why breastfeeding is 

important, why pumping is necessary, 

and how you plan to fit pumping into 

your workday, such as during lunch 

or other breaks. You could suggest 

making up work time for time spent 

pumping milk. If your day care is close 

to your job, try to arrange to go there 

to breastfeed your baby during work 

time.

l	 Request a clean and private area where 

you can pump your milk, preferably 

some place other than the bathroom. 

You also need a place to wash your 

hands and your pump parts.

l	 You can start pumping and storing 

your milk before you go back to work 

so that you have lots of milk stored 

and ready for the first week when you 

are away from your baby. It is helpful 

to copy your baby’s feeding schedule 

when coming up with your pumping 

schedule. Pumping patterns are affected by your breast size and milk storage capacity, so pay attention to your 

breasts. When they start to feel full, 

pump until your milk stops spraying 

and then for a few more minutes each 

time. Don’t wait until they are very 

full and swollen. Expect each breast 

to make about 1 ounce of milk every 

hour.

l	 Some states have laws that say employers have to allow you to breastfeed 

at your job, set up a space for you to 

breastfeed, and/or allow paid or unpaid 

time for breastfeeding or pumping. 

To see if your state has a breastfeeding law for employers check on the La 

Leche League International Web site 

listed in the resource section on page 

205. Even if your state does not have 

breastfeeding laws, most employers 

support breastfeeding employees when 

they explain their needs.

Breastfeeding in Public

The	federal	government	and	many	

states	have	laws	that	allow	women	to	

breastfeed	anyplace	they	are	usually	

allowed	to	be.	If	you	still	feel	uncomfortable	breastfeeding	in	public	you	

can:

•	wear	clothes	that	allow	easy	access	

to	your	breasts,	such	as	tops	that	

pull	up	from	the	waist.	

•	Breastfeed	your	baby	in	a	sling.	

Slings	or	other	soft	infant	carriers	

are	especially	helpful	for	traveling—

making	it	easier	and	in	keeping	your	

baby	comforted	and	close	to	you.

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

It’s	usually	helpful	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.
Breastfeeding 199

Common Q&As

If I have small breasts or very large

breasts, can I still breastfeed? Of 

course! Breast size is not related to the 

ability to produce milk for a baby. Breast 

size is due to the amount of fatty tissue 

in the breast and the milk storage capacity of your breast. Small breasts make 

plenty of milk; they just do not store a 

lot of milk. Therefore, babies will breastfeed often from a mother with smaller 

breasts. Large breasts make plenty of 

milk too.

Can I still breastfeed if I had 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.

Can I breastfeed if I become ill? Yes! 

Most common illnesses, such as colds, 

flu, or diarrhea, can’t be passed through 

breast milk, and your milk will have antibodies in it to help protect your baby 

from getting the same sickness.

Can I take medicines while breastfeeding? Although almost all medicines pass 

into your milk in small amounts, most 

medicines have no effect on the baby 

and are compatible with continuing to 

breastfeed. The list of medicines that you 

should not take while breastfeeding is 

very short. Discuss any medicines you 

are taking with your doctor and also ask 

before you start taking new medicines, 

including prescription and over-thecounter 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. The American Academy of Pediatrics has more detailed information 

on this topic. See page 430 for contact 

information.

Do I need a special diet while breastfeeding? Women often try to improve 

their diets while they are pregnant. Staying with this improved diet after your 

baby is born will help you stay healthy, 

which will help your mood and energy 

level. You can eat the same number of 

calories that you ate before becoming 

pregnant, which helps weight loss after birth. But every mother’s needs are 

unique. There are no special foods you 

should avoid and no special foods that 

will help you make more milk.
200 The Healthy Woman: A Complete Guide for All Ages

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. In a 

baby, this can cause symptoms such as 

loss of appetite, slow motor development, 

being very tired, weak muscles, vomiting, and problems with the blood. You 

can protect your and your baby’s health 

by taking vitamin B12 supplements while 

breastfeeding.

All mothers should drink enough fluids 

to stay well hydrated for their own health. 

But fluid intake does not affect the 

amount of milk you are making. Always 

drink when you are thirsty. If your urine 

is dark yellow you should drink more fluids. Excessive caffeine intake (more than 

five 5-ounce cups of coffee or caffeinated 

soft drinks per day) can cause the baby 

to be fussy and not able to sleep well, 

but moderate caffeine intake (fewer than 

five 5-ounce cups) usually doesn’t cause a 

problem for most breastfeeding babies.

You also should avoid drinking large 

quantities of alcohol. If you have an occasional drink of alcohol, you should 

wait for about 2 hours to pass before 

breastfeeding. Also, many babies don’t 

like the taste of your milk after you have 

had an occasional drink and will breastfeed more when the alcohol is out of 

your system.

For more information on healthy eating, see the Nutrition chapter on page 

317 and the MyPyramid Web site listed in the resource section on page 205.

Can	my	baby	be	allergic	to	my	milk?

Research shows that a mother’s milk 

is affected only slightly by the food in 

her diet. 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 in your diet include some or 

all of these:

l	 green stools with mucus (MYOOkuhss), diarrhea, vomiting

l	 rash, eczema (EG-zuh-muh), dermatitis, hives, dry skin

l	 fussiness during and/or after feedings

l	 crying for long periods without being 

able to feel consoled

l	 sudden waking with discomfort

l	 wheezing, coughing
Breastfeeding 201

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 his or her 

symptoms. If your baby ever has problems breathing, call 911 or go to your 

nearest emergency room.

Will physical activity affect my breast

milk? Regular physical activity 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 during physical activity. (See page 346 of the Fitness

chapter for more information.)

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? Breastfeeding can delay the return of normal ovulation and 

menstrual cycles. But, like other forms of 

birth control, breastfeeding is not a sure 

way to prevent pregnancy. You should 

talk with your doctor or nurse about 

birth control choices that are compatible 

with breastfeeding, including the lactational amenorrhea (ay-men-uh-REEuh) method (LAM).

Can I breastfeed if I smoke? If you 

smoke tobacco, it is best for you and your 

baby if you try to quit as soon as possible. 

If you can’t quit, though, it is still better 

to breastfeed, since your baby is at higher 

risk of having respiratory problems and 

SIDS. Breastfeeding lowers the risk of 
202 The Healthy Woman: A Complete Guide for All Ages

both of these health problems in your 

baby. Be sure to smoke away from your 

baby and change clothes to keep your 

baby away from the secondhand smoke 

on your clothing.

I heard that breast milk can have toxins

in it from my environment. Is it still

safe for my baby? Breast milk remains 

the best way to feed and nurture young 

infants and children. The advantages of 

breastfeeding far outweigh any possible 

risks from environmental pollutants. 

Infant formula is usually not a better 

choice because the formula itself, 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. 

For more information on your health 

and the environment, see page 400.

Will my baby get enough vitamin D if

I breastfeed? All infants and children, 

including those who are exclusively 

breastfed and those who are fed formula, 

should have at least 200 International 

Units (IU) of vitamin D per day, starting 

during the first 2 months of life, to help 

them build strong bones. New research 

suggests that the mother should be getting 200 to 400 IU of vitamin D per 

day to ensure plenty of vitamin D in her 

milk and for her own health. You can 

buy vitamin D supplements for infants 

at a drug store or grocery store. Sunlight 

can be a major source of vitamin D, but 

it is hard to measure how much sunlight 

your baby gets. Ask your doctor and your 

baby’s doctor about vitamin D.

Does my breastfed baby need vaccines?

Is it safe for me to get a vaccine when

I’m breastfeeding? Yes. Vaccines are still 

important to your baby’s health. Follow 

the schedule your doctor gives you and, 

if you miss any, check with him or her 

about getting back on track. Most nursing mothers may also receive vaccines. 

Breastfeeding does not affect the vaccine 

and vaccines are not harmful to breast 

milk. Breastfeeding during or after the 

vaccines are given can help with pain relief and soothing an upset baby.

What should I do if my baby bites me?

A baby can’t bite and breastfeed at the 

same time, although many older babies 

will try! If your baby starts to clamp 

down, you can put your finger in his or 

her mouth and take him or her off of 

your breast with a firm, “No.” If your 

baby continues to bite you, you can try a 

few things: 

l	 Stop the feeding immediately so the 

baby is not tempted to get another 

reaction from you. Don’t laugh. This is 

part of your baby’s learning limits.

l	 Offer a teething toy, or a snack or 

drink from a cup instead.

l	 Put your baby down for a moment 

to show that biting brings a negative 

consequence. You can then pick him or 

her up again to give comfort.

I just found out that I’m pregnant. Can

I still breastfeed my toddler? 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 
Breastfeeding 203

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 stomachs 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 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 need more fluids, healthy 

foods, and rest because you are taking 

care of yourself and two small children.

Breastfeeding is a unique experience and 

every mother has the potential to succeed and make it a wonderful experience. 

Whether you are a new or expecting 

mom, or a partner or family member of 

one, the information and resources here 

can help you. n
204 The Healthy Woman: A Complete Guide for All Ages

One Woman’s Story

When Julian was born, I knew I wanted to breastfeed. And like many other newmoms, I assumed it would go smoothly and that I would have fountains of milk for

my sweet boy. But we didn’t have the blissful start I had imagined.

He latched for the first time, and after a few 

breastfeeding sessions, I was the proud

owner of bruised, sore nipples and was terrified the pain would just continue. While in 

the hospital, I saw two lactation consultants

to help me with Julian’s positioning, but

he continued to have an “inefficient latch,” 

which kept him from getting enough milk,

slowed down my milk production, and left

me with sore nipples. Another challenge I

faced was having Julian away from me to

be under “bili lights” to be treated for jaundice, so he received formula as a supplement. This undermined my confidence and 

hampered my milk production even more.

So it was not surprising when we brought

our bundle of joy home that, despite what

seemed to be nearly endless nursing sessions, Julian still wasn’t getting enough milk and

wouldn’t stop crying. I was crushed when we had to give him the bottle of formula sent

home from the hospital. I felt betrayed by my body and like a total failure as a mother.

The good news is that we got effective help. Our pediatrician referred us to a great lactation consultant whose “hands-on” approach helped to improve Julian’s latch and rebuild

my milk supply. Before I returned to work, we were able to phase out the formula supplementation. It took long, hard work, but we got there. Then, while working full time, I was

able to pump enough milk to give Julian breast milk nearly all the time, using only one

bottle of formula each day.

I proudly breastfed my son for 32 months and strongly feel that a child can benefit from 

breast milk no matter how much you can give him or her. I learned that what makes you a

successful mom doesn’t have anything to do with your breast milk supply and everything

to do with always trying your best.

Ann

Washington, D.C.

Before I returned 

to work, we were 

able to phase 

out the formula 

supplementation.
Breastfeeding 205

For More Information...

Office on Women’s Health, HHS

200 Independence Ave SW, Room 712E

Washington, DC 20201

Web site: www.womenshealth.gov/

breastfeeding

National Breastfeeding Helpline:

(800) 994-9662, (888) 220-5446 TDD

U.S. Department of Agriculture

3101 Park Center Dr

Alexandria, VA 22302-1594

Center for Nutrition Policy and Promotion

Web site: www.mypyramid.gov/

mypyramidmoms

Phone number: (888) 779-7264

The Special Supplemental Nutrition

Program for Women, Infants, and Children

Web site: www.fns.usda.gov/wic

Phone number: (703) 305-2746

Division of Nutrition, Physical Activity, 

and Obesity, CDC

4770 Buford Highway NE, MS K-24

Atlanta, GA 30341-3717

Web site: www.cdc.gov/breastfeeding

Phone number: (800) 232-4636,

(888) 232-6348 TTY

Food and Drug Administration

5600 Fishers Ln

Rockville, MD 20857

Breast Pump Information: www.fda.gov/

cdrh/breastpumps

Infant Formula Information:

www.cfsan.fda.gov/~dms/inf-toc.html

Phone number: (888) 463-6332

American College of Nurse-Midwives

8403 Colesville Rd, Suite 1550

Silver Spring, MD 20910

Breastfeeding Information:

www.gotmom.org

Web site: www.mymidwife.org

American College of Obstetricians and 

Gynecologists

409 12th St SW, PO Box 96920

Washington, DC 20090-6920

Web site: www.acog.org

Phone number: (202) 863-2518 Resource

Center

Human Milk Banking Association of 

North America

1500 Sunday Dr, Suite 102

Raleigh, NC 27607

Web site: www.hmbana.org

International Lactation Consultant 

Association

1500 Sunday Dr, Suite 102

Raleigh, NC 27607

Web site: www.ilca.org

Phone number: (919) 861-5577

La Leche League International

PO Box 4079

Schaumburg, IL 60168-4079

Web site: www.llli.org

Breastfeeding and the Law: www.llli.org/

Law/LawUS.html

Phone number: (800) 525-3243,

(847) 592-7570 TTY