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Getting Ready to Breastfeed

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Breastfeeding works on a supply and demand basis: the more your baby nurses, the more milk you will produce. It may take some time for your body to get into a rhythm, so be patient and keep trying.

Your body knows exactly what to do to prepare you to breastfeed your baby. Your breasts have been changing during your pregnancy just for this reason.

During pregnancy:

• Your breasts may get bigger and feel tender when touched. This tenderness should go away after the third or fourth month of pregnancy.
• Your hormones start to prepare your breasts for breastfeeding (lactation).
• The milk ducts in your breasts start collecting "colostrum," the milk that appears the first few days after birth.  Colostrum is the perfect first food for your infant. It has lots of antibodies to keep your baby from getting sick. Sometimes a little colostrum may leak out during pregnancy. If this happens, use disposable or cotton breast pads (without plastic liners) to absorb it. Do not express or pump out the colostrum.
• The area around the nipples (the areola) will get darker during pregnancy and the surrounding glands get bigger. These glands decrease bacteria, and they naturally moisturize and protect the areola and the nipple. While you are pregnant, don't wash with soaps or put oil or lotion on your nipples. You don't want to work against your body's natural way of getting ready to breastfeed.

Our breastfeeding basics class provides an introduction or refresher to breastfeeding, including valuable tips.

Preparing your Breast

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How to support your growing breasts

You can wear your regular bra while you are pregnant. However, if your breasts get bigger, a supportive cotton bra in a larger size may be more comfortable during pregnancy and while you are breastfeeding. This may also protect your breast tissue from stretching too much.

Nursing bra

You can wait until the last few months of pregnancy to buy a nursing bra, when your breasts are at their largest. And you may still need a larger bra once your baby is born.

Flat or inverted nipples

Some nipples look flat or actually pull back into the breast and look sunken or inverted after they're pinched. If your nipples are flat or inverted, talk to us about how you can breastfeed successfully. Many mothers are able to breastfeed successfully with flat or inverted nipples. Breastfeeding education and support are available.

How to prevent sore nipples

To prevent sore nipples during your pregnancy, don't wash your breasts with a rough washcloth or pull on them. Rubbing the nipples too hard can make them sore even before you start breastfeeding. In rare cases, strong nipple stimulation causes some women to go into labor before the baby is ready to be born.

How and When Your Body Makes Milk

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Even before your baby is born, the milk ducts in your breasts start collecting colostrum, which is a type of breast milk that appears late in pregnancy and during the first few days after birth.

Facts about colostrum:

• Colostrum contains antibodies (cells that destroy bacteria and viruses) that help your baby fight off infection. Formula doesn't contain antibodies.
• One teaspoon of colostrum equals the nutritional content of one ounce of formula.
• A one-day-old baby only needs ½ teaspoon of colostrum for every feeding. This volume increases to 1 teaspoon of colostrum on the second day.
• The thick colostrum makes your baby suck more strongly, which gives your body a strong signal to begin producing milk.
• Colostrum also helps your baby coordinate sucking, swallowing, and breathing in the first three days of life. Since it is thicker than formula, it does not come gushing out like formula from a bottle. Even if your baby does get colostrum into his or her lungs, it won't harm the baby the way formula would. This is because human colostrum is not a foreign substance for a baby.

From colostrum to mature milk

Your breasts begin to produce milk about 12 to 48 hours after the birth of your baby. The new milk mixes with colostrum for a week to 10 days so that this transitional milk looks yellowish and watery. Mature milk is usually bluish white and looks somewhat like skim milk. Even though human milk looks watery, about half of the calories in breast milk come from fat.

As you begin to produce milk, your breasts will feel firm and full. Milk may start to leak from one side while the baby is nursing the other side. This mild engorgement is commonly referred to as "the milk coming in."

Starting to Breastfeed

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Milk production starts about 12 to 48 hours after your baby is born. Even before your milk production is fully ready, your newborn will begin to seek many hours of skin-to-skin contact, so your early attempts to breastfeed are beneficial.

You and your baby, right after delivery:

• Babies have a special energy reserve for their first 2 to 3 days of life. They have extra fat surrounding their neck, shoulders, kidneys, and liver. This energy store is slowly used for baby's heat and energy needs.
• Your baby's stomach still has some high-protein amniotic fluid for his or her first day of life.
• Infants pass only a small amount of urine since their kidneys do not yet excrete water.
• Your colostrum is salty, which stops a baby from sweating too much. It passes on immunities and makes the baby sleepy and relaxed, which helps your infant conserve energy.
• Small amounts of colostrum help newborns learn how to suck, swallow, and breathe so that they will be ready for larger amounts of breast milk at a faster flow.

Your first breastfeeding sessions:

• Breastfeeding should begin within the first hour of your baby's life. Don't forget: your baby will drink your colostrum at first, since you are not yet producing mature breast milk.
• Nurse whenever your baby wants to eat (or at least every 1½ to 3 hours). This is called "feeding on-demand."
• Put your baby to your breast at the first sign of willingness to nurse (i.e., stirring about in the bassinette, rooting, or making sucking motions).
• Allow your baby to nurse for as long as he or she wants. If your baby is still hungry after finishing the first breast, offer the second breast. Some newborn babies may nurse for about 10 to 15 minutes on each breast. Others may nurse for 15 to 20 minutes on only one side per feeding.
• You should wake your baby up to eat if more than 3 hours have passed since the last feeding. Feedings should be timed from the beginning of one to the beginning of the next.
• Don't offer any supplements such as water or formula, unless we give you special instructions.

You can use a breastfeeding log during the first week of feeding. Circle the time you begin each feeding. Check off a box for each wet diaper and a circle for each bowel movement.

Helping your baby latch on:

• First, find a comfortable chair to sit in or raise the head of your hospital bed. Place pillows behind your back and on your sides to support your body and another pillow on your lap to support your baby.
• Cradle your baby with one arm and hold your breast with the hand of the other arm. Support your breast by placing your thumb lightly above the areola (dark area around the nipple) and your fingers under the breast.
• Make sure that your baby's head is at the level of your breast and that his or her lips are lined up with your nipple. Your baby's face, chest, and knees should be turned toward you so that the two of you are belly to belly.
• Tickle the baby's lower lip with your nipple and wait for the baby to make a wide "O" with his or her mouth before putting the baby to your breast.
• Quickly bring your baby toward you, centering your nipple in the baby's mouth. Make sure your baby is taking the nipple and a good portion of the areola in his or her mouth.
• Make sure your baby's lower lip is sticking out and that the chin is touching your breast. Your baby's nose should barely touch your breast.
  

Nursing Positions

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You might feel that breastfeeding is unwieldy at first. There are 4 positions to try. See what works best for you and your baby:

• Cradle hold. Hold your baby with the arm that is on the same side as the breast from which your baby will nurse. For instance, if you're going to nurse your baby with the right breast, hold your baby with your right arm so that the baby's head rests in the crook, or bend, of your arm.
• Cross-cradle hold. This is similar to the cradle hold, except that you hold your baby with the arm on the side opposite from which you are breastfeeding. Support your baby's head at the base of the neck with your hand. Don't nudge the back of your baby's head. This can cause your baby to pull away from your breast.
• Clutch or football hold. This position is often easier for a mother who has had a cesarean birth or who has large breasts. Use pillows to support your arm. Hold your baby close to your side, with your baby's feet toward your back. Support your baby's shoulders and head with your hand. Your baby's face is next to the breast from which he or she will nurse.
• Lying down while feeding. Use one of your arms to bring your baby close to you. With your free hand, hold your breast by putting your thumb above the areola and your fingers under the breast. After your baby latches on, you may no longer need to hold your breast.

As long as your baby is hungry, he or she will suck, pause, and swallow about once every second. When finished, your baby will stop sucking and may fall asleep. At times you may want to stop nursing when your baby is still attached to your breast. To break the suction, put your finger in the corner of your baby's mouth, between the gums.

Common Problems and Solutions

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Engorgement (swollen breasts)

Your breasts may become engorged (swollen) during the first few days of breastfeeding or when you cut back on nursing. Regular, frequent breastfeeding is the best way to prevent and relieve engorgement. What you can do:

• Take a warm shower or apply moist heat to the breast before nursing.
• Express milk before nursing to help your baby latch on.
• Apply a cool compress to the breast after nursing.
• Take a pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Avoid anti-inflammatory medication like aspirin.

Sore or cracked nipples

Proper positioning will help you prevent soreness and cracking in your nipples. What you can do:

• Vary your nursing position from time to time to relieve the pressure on your nipples. Try sitting up, lying down, and switching between different ways of holding your baby while breastfeeding.
• When you are done nursing, break the suction by putting your finger in the corner of the baby's mouth between the gums.
• After nursing and bathing, allow your nipples to air dry.
• Wash your breasts with water only and avoid lotions and creams.
• Apply breast milk to sore areas.

Plugged ducts

Occasionally, a nursing mother develops a blockage inside her breast that stops some of her milk from flowing to her baby. Sometimes this blockage (called a plugged duct) can cause the breast tissue to become infected. Signs and symptoms of plugged ducts include:

• A tender area or painful lump in your breast
• Skin redness
• A full feeling over a large portion of the breast that stays firm even after nursing

A milk duct can become plugged because your baby does not completely empty your breast during each feeding. This can cause milk to build up. This may happen if:

• Your baby is not given enough time to nurse.
• Your baby is not latched on properly.
• You miss a feeding.
• Feedings are too far apart.
• Your clothing puts too much pressure on the breast tissue. A front or backpack style infant carrier can also cause problems if the straps are too tight.
• You have dried milk secretions on the tip of the nipple or a clogged nipple pore that blocks your milk flow.

If you think you may have a plugged milk duct, it's important to take care of it right away so you can stop a breast infection from developing.

What you can do:

• Breastfeed at least every 1½ to 3 hours. Keep to a regular schedule. This will help drain the breast and clear out the plugged duct as well as give you a chance to bond with your baby.
• Begin each feeding on the side with the plugged duct because the baby empties the first side most effectively.
• If possible, increase the length of time you feed your baby, up to 20 minutes per side, and use both breasts at each feeding.
• Apply moist, warm heat to the plugged duct area for 10 to 15 minutes before nursing.
• Massage the breast just above the sore area while nursing.
• Vary your nursing position from time to time to relieve the pressure on your nipples. Try sitting up, lying down, and switching between using the football hold, cradle hold, and cross-cradle hold.
• Make sure your baby is properly positioned.
• Remove tight clothing or baby carriers. Find a well-fitting bra and use a carrier that does not squeeze the breast tissue.
• Be sure to get enough rest. Sleep when the baby sleeps. Get help with household chores or leave them undone until you feel better.
• Increase your fluid intake to about 8 to 10 glasses of water in a 24-hour period and eat a healthy, balanced diet.
• Look for dried milk secretions or a clogged pore on the nipple. Soak the visible plug in warm water. Then gently try to express the plug by hand.
• If needed, take acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) to help relieve the pain.

Breast infection (mastitis)

If left untreated, a plugged duct may become infected. This is known as "mastitis." The signs and symptoms of a breast infection may include:

• An inflamed area of the breast that is red, sore, and hot to the touch.
• Flulike symptoms—including chills, body aches, tiredness, and fever.

If you have any of these symptoms, contact us right away. It's important that you immediately begin treatment with antibiotics. You should feel better within 24 hours with quick and proper treatment. Make sure that you completely finish all of the pills according to the schedule we recommended, even if you feel like you're completely well.

If your baby is healthy, it's not necessary to stop breastfeeding when you have a breast infection. The breast milk is not infected. Generally, breastfeeding helps your breast heal more quickly and continues to provide your baby all the usual benefits. But if your baby is premature or sick, check with your pediatrician to make sure it's safe to breastfeed while you have a breast infection.

What you can do:

• Get plenty of extra rest.
• Continue breastfeeding frequently and regularly (at least every 1½ to 3 hours). Don't skip feedings. Temporary weaning or discontinuing breastfeeding may slow healing and lead to a sore breast.
• Start each feeding on the affected breast.
• Use moist, warm heat for 10 to 15 minutes on the affected breast before nursing.
• Massage the breast while it is warm and continue massaging during feeding.
• Wear loose-fitting clothing and avoid bras that are too tight.
• Drink plenty of fluids and eat well.
• If needed, take acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) to help relieve the pain.

Leaking breasts

Some nursing mothers experience milk leaking from their breasts between feedings. This can happen when your nipples rub against a bed sheet, bath towel, or clothing, or when you hear a baby cry. This is a normal sign of a strong flow of milk. It usually happens during the first few weeks of nursing as your body adjusts to producing just the right amount of milk for your baby. It can also occur when you stop breastfeeding or when you combine breastfeeding with feeding formula from a bottle.

Once you begin to recognize when your baby wants to eat, your breasts shouldn't leak as often. Going too long without nursing or pumping (more than three hours) can also cause leaking. If you are changing your nursing schedule from nursing on demand to nursing less often, you should expect a certain amount of leaking during this period. It will probably continue until your body has adjusted to the new schedule.

What you can do:

• Try to stop the flow of milk by folding your arms across your breasts and pressing gently. It is best to wait and try this after your baby is 3 weeks old.
• Use disposable or cotton breast pads in your bra to absorb leaking milk. Make sure that the pads don't have a plastic liner. Be sure to change the wet pads.
• Avoid pumping your breasts to control leaking. This can encourage your body to make more milk and, in turn, lead to more leaking.

Decreased milk supply

Increase your rest and nurse the baby frequently. Try staying in bed in your nightclothes and keep the baby with you to let him or her nurse on demand. Make sure that you are drinking enough fluids to satisfy your thirst. If this does not help within a few days, consider these options:

• Take an herbal supplement called fenugreek to help stimulate your milk production.
• Contact your lactation consultant for further help.

Your Care with Me

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Please call our Appointment and Advice line right away if:

• Any part of your breast becomes increasingly red, painful, swollen, or hot.
• You have a new or higher fever.
• You have new chills or body aches.

During your pregnancy, we recommend you enroll in one of our breastfeeding classes.

After your delivery, our postpartum nurses can help you with breastfeeding in the hospital. We also have lactation consultants who are specialists in breastfeeding who can answer your questions about breastfeeding and ensure everything is going well.

In addition to taking advantage of my online resources, I recommend you subscribe to our Healthy Babies newsletter. The newsletter is delivered to your e-mail in box each month, and has information and answers to common questions about newborn care and child development.

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Contacting Me

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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