Your breasts hurt and you have already heard of abscesses? So you fear the worst? Don’t panic! There are a number of alarm signals to consider first.

• The first signs of a breast engorgement: in the breasts there is too much milk because the baby drinks less, or has been weaned too quickly.  Express some milk from the breast under a warm shower and you should feel better.
• Further signs are inflammation of the lymphatic nodes (red lines on the breasts) or mastitis (inflammation of the breast glands, a reddening and swelling on one side of the breast). Both can be treated through rest and with warm compresses (small towel soaked in warm water).
• And if it’s the scary abscess? Abscesses do not appear without warning: you will have a fever, swelling in the armpits and pus in the milk. Whatever it is, there is no cause for alarm: if you don’t breastfeed for a few days, your milk production should not be affected. Seek your doctor’s advice.

• If your nipples are cracked, leave few drops of milk to dry on the nipples after the feed.
• Make sure that your baby is lying in a proper position. Maybe the pain was caused by a wrong position of the child.
• If you don’t see any injury on your nipples, but they still hurt, check your baby’s oral cavity. If there are white spots that don’t go away, it’s a fungus. In this case, you both have the “Candida Abicans” fungus, more known as Candida. Nothing dramatic about this since it’s a fungus that can be cured easily. Talk to your pediatrician and use the medicine prescribed by him after you breastfeed. It should heal very fast.

You will have to produce a lot of liters of milk, so make sure you take enough “raw material”. This period is therefore not the time to diet. Breastfeeding alone will help you to lose weight. The rule for this period is: eat well and drink a lot.

Compared to your regular diet, you must take about an additional 500 calories a day.

What should you eat? Eat what you like to eat. Your baby will discover the same tastes because your food intake has an influence on the breast milk.

So, do not immediately cut out certain foods. However, if your baby makes a face every time you eat for example garlic or asparagus, take this food out from your diet. The baby also has a right to his own preferences. And since the baby draws out your bodily fluids, remember to also drink sufficiently after breastfeeding to restore balance in your body.

Your doctor will most likely prescribe you additional vitamins and iron supplements.

Breastfeeding should be a joy for you, and not only feel as an obligation. And you can maintain this joy as long as is good for your everyday life and body.

Some babies stop the habit of breastfeeding by themselves.  Even if you are an absolute champion in breastfeeding, know that breast milk only provides sufficient nutrition in the first 6 months. After this, you can still breastfeed, but your baby will need solid foods to supplement his diet. 

It is thought that breastfeeding is the most natural thing in the world, but sometimes it is not that easy.

There is a rule of hygiene: before each breastfeeding you must wash your hands. Hold your baby in a position that won’t leave your arms and back sore. Add support around you with plenty of cushions and pillows. Many women find the cradle position works well, although it really depends on what is most comfortable for you. Get yourself and your baby in a relaxed position before you start feeding. Pay attention to how your breasts feel when your baby latches on. He should take in a big mouthful of breast, the areola. If latching on hurts, break the suction – by inserting your little finger between your baby’s gums and your nipple – and try again. Once your baby latches on properly, he will be able to do the rest.

Remember to change the breasts, to achieve balance. With each breastfeeding, the milk quantity that you have is being determined, and it should be equal for both breasts. If you do not remember and have to crack your head trying to figure it out, use a trick to remember with which breast you should start the feeding (put a safety pin on the strap of your bra on the breast with which you should start).

Some women adjust to breastfeeding easily, encountering no major hurdles. But many new mothers find it hard to learn – so if you’re feeling discouraged, remember that you’re not the only one. If you feel like giving up (or just want professional advice), contact a breastfeeding counsellor (most hospitals have them).

Breastfeeding takes practice. Give yourself as much time as you need to get it down to a fine art. If you’re having a bad feeding day, tell yourself that tomorrow will be better. And keep in mind that any problems you are having are likely to be temporary. By the time of your six-week check, you’ll probably be breastfeeding without giving it a second thought. If not, don’t hesitate to ask for support.

Did you know?

• Make sure your baby is latching on to the full areola and not just the nipple, because if he just sucks on the nipple it will get sore and hurt very fast.
• Apply wet and warm compresses 3-5 minutes before breastfeeding to help the milk to flow.
• Make sure the baby can breathe properly while breastfeeding.
• Ideally you should alternate the breast each time you breastfeed; at the beginning of a feed your baby sucks stronger and your breast adapts the production of milk to the sucking of your baby.
• Most common reason for sore nipples is wrong latching.
• Always wash your hands before you start to breastfeed your child.
• Don’t use alcohol or other products on your breast because they could lead to irritation.
• To avoid infection and sore nipples, rub some drops of your own milk around the nipple area after you breastfeed and let them dry.
• Don’t bottle-feed your baby additionally because this would lead him to drink less breast milk and thus less milk will be produced.

How long each breastfeed should take?

Breastfeeding differs from child to child. Some children drink slowly, some faster. Some babies gulp; others enjoy drinking in stages. There are babies who are happy with one breast, and others who drink from both breasts. There is also no “norm” for the babies. On the other hand, you must not prolong the breastfeeding time indefinitely; this makes little sense. Feeds can take as little as 5 or as many as 40 minutes.

What to eat during breastfeeding

Common problems in breastfeeding

Painful nipples

Painful breasts

Breast Engorgement

After the euphoria of the birth and discharge from the clinic, coming home is not always easy. You feel overloaded and you find breastfeeding complicated and tiring. You have the impression of not being able to go out and being “locked” at home. Or maybe you also think you have too little milk and are uncertain if the baby is drinking the right amount of milk. But let’s take a calm look at things.  Relax during breastfeeding. Remain calm. Imagine how lucky you are to be able to breastfeed – even if it scares you a bit and you wonder how you will manage everything!

If your baby is crying, it’s probably hungry. Therefore, you only have a choice: breastfeed it. But you will also have to learn to tell the difference: after several weeks, the baby crying doesn’t mean exclusively that he is hungry. It can also be that his diapers are wet, he is tired, or simply that he wants to be cuddled. You will learn when to do what by paying good attention.

Generally, a newborn needs to be breastfed every 3-4 hours. As time goes by the time between feeds will increase (since the milk the baby drinks changes and the baby also drinks more at each feed).

Most babies develop an individual regular drinking pattern. In the next few pages you will find a table which shows the theoretical number of meals per day according to the baby’s age. You can check there, but remember that these are average figures. Maybe your baby drinks more often or less often, or maybe more in the mornings and less in the evenings. It will – like all people – have its own rhythm.

Also your body will adapt to the rhythm of your baby. Maybe you will experience how your breasts swell and the milk is coming, when your baby is crying (and even a few minutes before the baby gets hungry). Sometimes you will be waiting impatiently for it to wake up, after its feeding time has passed for a bit, as your breasts are already ready for feedingThe most important thing if you are breastfeeding is that you are relaxed.

Breastfeeding is a magical experience, but it takes a bit of getting used to. You are a bit afraid and wondering how it works? Don’t worry breastfeeding is something that can be learned.

Breastfeeding offers a lot of benefits:

• Human breast milk is the healthiest form of milk for human babies and has all everything that is important for the development of the body and the brain of the baby.
• At any stage, even if your baby is premature, the nutrients in your breast milk re adapted to the need of the baby.
• Your milk contains antibodies that support the health of your baby and help to prevent diseases and allergies.
• The colostrum (the milk that is produced in the first days after the baby is born) helps the baby to eject the meconium.
• Breast milk is sterile, has always the right temperature, is always available and doesn’t cost anything.
• Through breastfeeding the mother and baby experience deep bonding.
• In the first weeks after the delivery, breastfeeding helps the uterus to get back to its usual size. It can be accompanied by contractions and pain, but it helps the mother to recover faster from the delivery.

Be aware that it is very important that the mother follows a balanced and healthy diet while she breastfeeds.  Nicotine, caffeine and alcohol are absorbed by the body and go directly to the milk so you shouldn’t smoke, drink coffee or alcohol while you are breastfeeding.

Also inform you doctor that you are breastfeeding. Any medication, that may be prescribed for you, can be transmitted into your milk this may harm the baby.

How to breastfeed?

How to choose a breast pump?

How to overcome breastfeeding problems?

Benefits of breastfeeding for child and mom.

Storage recommendations for breast milk are based upon a small number of studies that have examined the safety and nutritional value of breast milk that is stored under a variety of conditions. These recommendations apply to breast milk intended for full term healthy infants. Women with premature infants should discuss breast milk storage recommendations with their doctor.

Breast milk that is pumped may be safely stored in the refrigerator or freezer. It can even be left at room temperature (approximately 77 to 79º F or 25 to 27º C) for up to four hours. This is in contrast to infant formula prepared from powder, which should not be left at room temperature after it is prepared.

Refrigerator storage — freshly pumped breast milk can be safely stored in a standard refrigerator that maintains the temperature at 35 to 40º F (1 to 4º C) for up to eight days. The coldest part of the refrigerator or freezer is best, generally towards the back and away from the door. Milk can be stored in an insulated cooler with freezer packs, not ice.

Freezer storage — freshly pumped or refrigerated breast milk can be stored in a freezer that maintains the temperature at 0 to 4º F (-18 to -20º C) for 6 to 12 months. The freezer in a mini-refrigerator does not adequately maintain this temperature range and is not recommended. Pumped milk can be stored in a deep freezer chest (-4º F or -20º C or less) for six to 12 months. The coldest part of the freezer is best, generally towards the back and away from the door.

Thawed breast milk can be safely stored in a standard refrigerator for up to 24 hours. Milk that was frozen and then thawed should not be refrozen.

Breast milk storage containers — Breast milk should be placed in a sealed, clean, glass or rigid plastic bottle designed for storing food products. Although plastic breast milk storage bags are not recommended for hospitalized infants due to the loss of some nutrients, plastic bags can be used to store breast milk for healthy infants.

Milk should be stored in small amounts (one to four ounces) and labelled using permanent ink and a waterproof label. The label should indicate the date the milk was pumped. Milk from different pumping sessions may be combined; the milk should be cooled in the refrigerator before it is combined. Milk that is warm or refrigerated should not be added to frozen milk. The milk should be labelled with the date the milk was pumped. The oldest milk should be used first.

If milk smells or tastes spoiled — some expressed breast milk tastes and smells spoiled (or soapy, in some cases) within hours to days after it is pumped, even if it is stored at an appropriate temperature. A possible cause of this is a higher than normal level of an enzyme, lipase, in the breast milk. Lipase has benefits, although high levels of lipase break down the fat in breast milk, causing it to quickly taste spoiled. It is not known why some women’s milk contains a high level of lipase or if the milk is safe for the baby; however, most babies refuse it.

If you notice after freezing and thawing that your milk smells spoiled or rancid, you can prevent this in the future by scalding the breast milk immediately after it is pumped to inactivate the lipase. Milk should be heated to 180º F (32º C) (when small bubbles form around the edges but the milk is not yet boiling). The milk should then be quickly cooled in a refrigerator or freezer. It is not possible to reverse the enzyme’s activity in breast milk after it has been stored, thus milk that smells or tastes bad should be discarded.

Heating milk destroys some of its beneficial qualities; mothers of sick or premature infants should discuss the best way to store milk with their doctor or lactation consultant.

Preparing pumped breast milk for feeding

The way in which breast milk is handled during storage and prior to feeding can effect the beneficial properties of the milk.

Thawing and warming breast milk — Frozen milk can be safely thawed overnight in the refrigerator or in a warm water bath. To prepare a warm water bath, a sealed container of milk can be placed in a bowl or cup of warm water until it thaws. Thawed milk should be refrigerated until ready to use and can be safely stored for 24 hours.

Thawed or refrigerated milk may be warmed prior to feeding the infant, however some infants accept milk directly from the refrigerator. The warm water bath method can be used to warm refrigerated milk. Bottle-warming devices are also available for purchase; these should be used with care as they can quickly overheat the milk. Do not leave a bottle warmer unattended. Microwaves are not safe to use for warming or defrosting breast milk. They heat milk unevenly, potentially burning an infant’s mouth and destroy some of the beneficial properties of breast milk.

After warming the milk, the temperature should be tested immediately before it is given to an infant; the milk should feel lukewarm or room temperature, but never hot. Milk should be gently swirled to redistribute the cream that often rises to the top during refrigeration.

There are insufficient data to know if it is safe to refrigerate and then rewarm a partially finished bottle of breast milk. Although freshly pumped breast milk has antibacterial properties, milk stored in a refrigerator for more than a day or two begins to lose this property. Milk that smells or tastes bad should not be given to an infant (see ‘If milk smells or tastes spoiled’ above).

How much milk should I offer to my baby?

Many women who exclusively pump or pump while at work wonder how much breast milk their babywill need at each feeding.

The volume of breast milk your baby needs increases with age; infants who are exclusively breastfed require approximately 23 to 24 ounces of breast milk at one month of age and 24 to 30 ounces at six months of age. After six months, most infants begin to consume other foods, and less milk may be needed.

One way to determine how much an infant will need per feeding is to divide the infant’s average intake (eg, 25 ounces) by the number of feedings per day. For example, an infant who nurses eight times per day would need approximately 3 ounces per feeding (25 ounces divided by 8 feedings = 3 ounces). Thus, in this example, it would be reasonable to prepare 3 ounces of milk per feeding, with the understanding that some infants will consume less while others will want more.

Feeding breast milk with a bottle

Babies feed very differently from a bottle compared to the breast. Milk flow from a bottle is fast and the baby usually eats very quickly, sometimes by gulping. Many mothers feel that their infant drinks more milk when he or she is fed with a bottle than when nursed at the breast. It is common to worry that you will not pump enough milk to keep up with this volume.

Babies have little control over milk flow from a bottle while they have full control over milk flow from the breast. To minimize this problem, it may help to pace the baby while bottle feeding by taking frequent breaks. Slow flow bottle nipples are available and may help to minimize the differences in flow between bottle and breast feeding. A feeding should take 10 to 15 minutes or more, just like at the breast.

(Source: Up to date, 2010)

BESIDES having enough information on normal breastfeeding, successful breastfeeding also depends on having support from knowledgeable people (be it the doctor, nurse, or a family member) and having a positive mindset that it can be done.

Yet, mothers today still experience barriers that can discourage them from breastfeeding. Health professionals might not know much about breastfeeding and some of them may not be supportive of breastfeeding, notes paediatrician Dr Koe Swee Lee.

On top of that, many mothers who delivered their babies in the 60s to 80s – when the bottle-feeding culture thrived – may not be supportive of breastfeeding, as they do not have enough information.

“The role of the father is also very important. If he supports the wife in breastfeeding, she would more likely be successful,” says Dr Koe.

To overcome the barriers to breastfeeding, the World Health Organisation (WHO) and United Nations Children’s Fund (UNICEF) launched a worldwide programme called the Baby Friendly Hospital Initiative, an effort to ensure all hospital maternity services support breastfeeding.

Mothers can now visit baby friendly hospitals (almost all Malaysian government hospitals and a few private hospitals) – hospitals that practise the Ten Steps (below) to successful breastfeeding as listed by WHO and UNICEF policymakers in the Innocenti Declaration in 1990 on the Protection, Promotion and Support of Breastfeeding.

The Ten Steps are:

1. Have a written breastfeeding policy that is routinely communicated to all healthcare staff.

2. Train all healthcare staff in skills necessary to implement this policy.

3. Inform all pregnant mothers about the benefits and management of breastfeeding.

4. Help mothers initiate breastfeeding within a half-hour of birth.

5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.

6. Give newborn infants no food or drink other than breast milk unless medically indicated.

7. Practise rooming-in – allow mothers and infants to remain together – 24 hours a day.

8. Encourage breastfeeding on demand.

9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

“It is best for mothers to tell their obstetrician or gynaecologist earlier that they would like to breastfeed their child exclusively,” says Dr Koe.

Today, although an estimated 28% of all maternity facilities in the world have at some point implemented the Ten Steps, it is still far from the original goal of ALL maternity facilities practising the Ten Steps by 1995 as stated in the Innocenti Declaration, says the World Alliance for Breastfeeding Action (WABA) in its press release.

As studies have shown that with more of the Ten Steps in place, the more likely women are to achieve their breastfeeding goals, it is important for every maternity, hospital, clinic and community to strive to increase the number of steps in place, even if they cannot achieve all ten steps immediately.

“Therefore, every step counts!” says WABA.

(Source: The Star online, August 1st, 2010)

Women whose infants are hospitalized due to prematurity or illness following birth must rely on a breast pump to stimulate their milk production. The first few weeks following delivery are critical in establishing a milk supply that meets the needs of their infants. Several important hormonal and structural changes take place within the breast during this time.

The amount of breast stimulation during this time is critical to this process. You should pump frequently (at least eight times per day) for about 15 minutes each time until you are producing about one-half ounce per breast. Thereafter, most women find that pumping six to eight times daily and expressing for about two minutes after milk flow stops is sufficient to maintain an adequate milk supply.

By day 10 after delivery, most women who are pumping eight to 10 times per day should be producing approximately 750 to 800 ml (about 25 ounces or 3 cups) of milk per day. However, milk volume varies and can range from 450 to 1200 ml (about 2 to 5 cups) per day.

If you are pumping less than 500 ml (16 ounces) per day by the 10th day, you should discuss ways to improve your milk supply with your doctor or lactation consultant.

Women who return to work after birth and want to continue breastfeeding will need to express their milk several times during their working hours. Pumping will allow you to maintain your milk production and provide your expressed breast milk to your baby while you are separated. Pumping on a schedule similar to your babys feeding pattern is usually sufficient; for most women, this means pumping two to three times over eight hours. If possible, starting back to work in the middle of the work week will help to ease the transition.

It can be challenging to find the time and space to pump, especially for women who do not have a private office. You should discuss your need for a private space with your employer prior to returning to work. While a bathroom is one option, this is not ideal for pumping. It may be helpful to speak with co-workers who have returned to work and pumped to determine if a private space is available. Some employers offer a “pump room” or other private area.