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Breastfeeding Questions and Concerns Every New Mom Should Know
Before your baby is born, check your breasts for flat or inverted nipples. Place your thumb and index finger around the areola in a “C” shape, about an inch from the base of the nipple, and gently press your thumb and index finger together. The nipple should project outwards. If the nipple pulls back on the breast or stays flat, ask your doctor, certified lactation consultant or La Leche League leader for advice.
Wearing plastic shells during the last few months of pregnancy can help the nipples to protrude outwards. However, some authorities suggest that a baby who is properly latched to the breast will breastfeed effectively, regardless of the size or shape of the mother’s nipples. Either way, it’s helpful to understand proper positioning and talk to a lactation consultant or health care provider about this issue before your baby is born.
Uncomfortable breast fullness can occur which can make your breasts feel hard, hot and painful because the baby is not getting enough milk. To relieve this engorgement, relieve your baby more often or use a breast pump. Pumping to comfort or just a few minutes, long enough for your breasts to be comfortable, will not overproduce milk. It can also be useful to apply cold compresses between meals and/or warm compresses and a circular massage just before and during feeding.
Sore nipples are a common complaint at first. This may be a new experience for you and may indicate that your baby is not well positioned at the breast. If the pain goes away within a minute and you are comfortable for the rest of the breastfeeding session, there is nothing to worry about. If not, call a lactation consultant or La Leche League leader for suggestions.
Causes of sore nipples include:
- The baby latches too close to the nipple, not taking enough areolar tissue.
- The baby’s lower lip is stuck instead of protruding.
- The baby stuffs the nipple into the mouth instead of opening to accept the breast.
- The baby’s gums rub against the nipple as they come off the breast.
- The baby stresses the tissues and causes pain trying to extract the inverted or flat nipples during the first days/weeks of breastfeeding.
- Moisture remains in an inverted nipple for an extended period.
Too much milk left in the breast can cause a blocked duct. This can happen for a number of reasons and can lead to chest pain that is red and slightly warm to the touch.
Treatment measures for a blocked duct include:
- Wear loose clothing and a non-clinging bra.
- Rest a lot.
- Nursing as often as the baby will cooperate and/or pump between feedings.
- Breastfeeding the baby 8 to 12 times every 24 hours.
- Apply moist or dry heat to the sore area before killing.
- Begin each nursing session on the chest with the painful point.
- Position the baby so that his chin lines up with the sore spot.
- Massage of the painful area during breastfeeding.
If you develop other symptoms, such as fever, chills, pain, or breast pain that is widespread instead of just one spot, you may have a breast infection, also known as mastitis. Contact a certified lactation consultant, La Leche League leader, or health care provider for advice. Some breast infections will go away with the same treatment you would use for a blocked duct.
If your symptoms persist or if you have a high fever, you may need an antibiotic prescribed by your doctor. Most antibiotics are safe to take while breastfeeding, but discuss this issue with your healthcare provider to be sure.
Is the baby getting enough milk?
Weight gain is the most accurate way to tell if your baby is getting enough milk, so weigh your baby. A normal weight gain is about four to eight ounces per week. As your baby gets a little older, weight gain will become more apparent. If you are concerned about your baby, talk to your health care provider or a lactation consultant.
Also, keep track of your baby’s diaper changes, as what goes in must come out. At first, your baby will only have one or two wet diapers a day. Once the milk supply increases, the baby should have five to seven wet diapers (six to eight if using cloth diapers) and three to five bowel movements each day. Some babies may have a small bowel movement with each diaper change.
The first bowel movements will be dark black, with a tarry consistency. Both the color and consistency will change within a day or two of the increased milk supply. The color of a breast milk stool is most often a mustard yellow, but it can vary from brown to yellow to yellow-green. The consistency is runny and runny and will stay that way as long as your baby is fed only human milk. Also, while nursing, your baby should be swallowing after every couple of sucks, so listen for swallowing. Other indicators include that your breasts become softer after a feed, that your baby’s skin feels smooth and firm, and that the baby seems satisfied after a feed.
However, if your baby shows any of the following signs, contact your doctor immediately:
- weak cry
- Skin without resilience (when pinched, stays pinched)
- Dry mouth and dry eyes
- Less than the usual amount of tears
- Minimal urine production (less than two wet diapers in 24 hours)
- Fontanel (soft spot) on baby’s head is sunken or depressed
If you’ve had breast surgery before, be sure to tell your healthcare provider. Many mothers have been able to fully breastfeed their babies after breast surgery. However, it is important that your health care provider knows your history and previous breast surgeries so that you and your baby can be closely monitored to make sure that your milk production is good and that the baby is gaining weight.
Increasing your milk supply
How much milk you make depends on how much and how often milk is removed from your breasts. As baby’s demand increases, your body will increase its supply, but you may find the following suggestions helpful if you’re worried about your milk supply:
- Feed the baby on both breasts at each nursing session.
- Feed the baby twice on each breast at each nursing session.
- Use the lying position from time to time so that you rest while the baby nurses.
- Nurse at the first indications of the baby.
- Drink plenty of fluids (depending on your individual needs).
- Use a breast pump between feedings.
- See a certified lactation consultant for a complete breastfeeding evaluation.
The baby constantly wakes up at night
There are many reasons why a baby wakes up at night. You may have a newborn who is a light sleeper and wakes easily. Also, human milk digests twice as fast as formula, so breastfed babies get hungry more often than bottle-fed babies.
The baby is always sleepy
Certain medications used during labor and delivery can make the baby extremely sleepy. If the baby sleeps constantly in the first week, it is important to wake him up to nurse so that your milk supply will be established and the baby will grow and gain weight normally. Try to breastfeed frequently at night when it’s quieter. Reach out to another mom or a breastfeeding counselor for tips on how to wake a sleeping baby.
Breastfeeding and the mother’s medications
Most antibiotics and pain relievers are compatible with breastfeeding. However, you should always discuss any medication with your healthcare provider or pharmacist.
The potential risks of a drug, whether by prescription or over-the-counter, must be weighed against the risks of weaning and obtaining artificial milk.
When to ask for help with breastfeeding
Seek help when:
- Your newborn has fewer than five to seven very wet diapers, or three to five bowel movements each day, even after your milk supply increases in the first week.
- The baby’s urine is dark in color or has a strong smell.
- Pain in the nipple or chest gets worse and persists between feedings.
- Breastfeeding becomes painful. (A little soreness at first is normal, but should fade as your baby learns to nurse.)
The baby looks full of gas You may have heard that babies react to foods in their mothers’ diets, but this is quite rare. Infant formula is much more likely to cause some kind of problem than a reaction to the mother’s diet.
Infant massage often helps calm a baby who seems gassy, so you can read books on infant massage to find a technique that your baby likes. You can also try colic retention to see if it helps the baby to be more comfortable. Place your baby face down over your forearm with his head in the crook of your elbow, your hand supporting his midsection and his legs hanging down.
Supplements and artificial nipples
Supplements of water or artificial milk (formula) in the first weeks of breastfeeding can contribute to poor milk supply, prolonged engorgement, jaundice, or problems with cow’s milk allergy or intolerance for both you as for your baby.
Avoid artificial nipples and pacifiers because they can confuse your baby when he is learning to breastfeed. A baby uses their mouth and tongue differently when taking a bottle or pacifier compared to a human breast. Among other things, artificial nipples are firmer than your breast, and a baby holds them in the front of the mouth. If the baby does the same while breastfeeding, he may not suckle enough and not get as much milk.
The nipples may become sore during the process. Some very sensitive babies even refuse to nurse after using artificial nipples.
Because there’s no way to know in advance whether your baby will be able to switch easily, it’s best to avoid artificial nipples until your baby has been nursing well for at least three to four weeks and the likelihood of confusion is reduced. . If you need to feed your baby differently from the breast, use an alternative to bottles, such as a spoon, dropper, or small feeding cup. Consult an expert breastfeeding counselor about these options.
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