Medical director of well newborn care answers questions for nursing moms
In honor of World Breastfeeding Week, we asked Laura Kair, pediatric hospitalist and medical director of well newborn care at UC Davis Children’s Hospital, to answer some frequently asked questions about breastfeeding.
Q: What are the benefits of breastfeeding? For mom and for baby?
A: Breastfeeding is great for both infant and maternal health. Breast milk is alive and carries immune information from mom to baby and helps prevent babies from catching infections, including pneumonias, ear infections, vomiting and diarrhea. Breastfeeding helps prevent chronic diseases like allergies, diabetes and certain leukemias in infants. For mothers, it decreases their risks of cardiovascular disease, diabetes, breast and ovarian cancers.
Q: How soon should moms breastfeed after delivery?
A: The sooner the better! If mom and baby are both healthy and able, then breastfeeding in that first hour can be very helpful to establish the milk supply. Infants are often alert during this time and can have a great feed before falling asleep for several hours. It is great to catch them while they are alert!
Q: How can I tell if my baby is getting enough breast milk?
A: In the first day, babies only need a teaspoon at a time of colostrum, which is the first form of breastmilk. In our hospital, nurses, lactation consultants or doctors will watch the baby feed and assess the latch, as well as ensure that the infant appears to be swallowing. We follow how often the baby pees and poops, and check their weight and behavior to ensure they are getting enough.
Q: How often should you breastfeed per day? How long per session?
A: In the first few weeks, babies should breastfeed a minimum of eight to 12 times per day. At first, sessions might take up to 45 minutes, but as the baby gets more efficient, feedings can last somewhere closer to 10 to 20 minutes.
Q: My baby is having trouble latching. What should I do?
A: There are many ways to hold the baby, and there are strategies that can help, depending what the underlying issues are with the latch. If your baby is struggling to latch or went home from the hospital not feeding at the breast and you are working to establish a latch, I’d recommend working with a lactation consultant to help identify both the reasons and next steps. If you do not have direct access to a lactation consultant, you can talk with your baby’s doctor or your doctor, as well.
Q: Is pain normal during breastfeeding?
A: During the first few days postpartum when a new mother is struggling to achieve a good latch, there can be some pain from damage to the nipples. This should heal and resolve. Ongoing breastfeeding is not generally painful. If the woman is experiencing pain, one of many things could be going on.
When the breasts are overfull (engorged), that fullness can be uncomfortable. Plugged ducts can lead to swelling and pain in the breasts, as well. Gently massaging the swollen area can sometimes help alleviate this. If the breasts are red, that could be an infection (mastitis). If the baby is having too shallow a latch due to positioning, a tongue tie or other factors, this can lead to pain during a feeding. Underlying breast disease in the mother can also lead to pain. I recommend seeing your doctor and/or a lactation consultant to assess the latch and for a breast exam, if you are having pain during breastfeeding.
Q: What are some aids that can help breastfeeding moms?
A: Nothing beats good positioning! Get yourself a good couch, chair or bedroom spot to breastfeed where you can position yourself with pillows to support the baby and your arms so you are not hunched over. This can go a long way!
Q: How do you know when to switch breasts when feeding?
A: When the infant’s suckling has slowed down, the infant appears calm and relaxed and the breast feels emptied.
Q: How do you keep your baby awake during feeding?
A: Using your hand to gently compress the breast tissue can stimulate faster flow of milk from that area of the breast, which can often stimulate the baby to begin sucking again. Also gently touching the baby’s back or feet can help. Keeping baby unbundled and skin-to-skin can help keep them a bit more alert.
Q: What are some tips that you would recommend to moms who would like to breastfeed successfully?
A: Talking with family members, colleagues, or friends who have breastfed for several months or longer can be helpful. It can be helpful to talk through the logistics of feeding, returning to work and pumping if that is part of your plan, navigating travel, etc. with someone who has done this successfully.
Q: How much water should you drink? Does beer help?
A: Women without medical problems that affect their thirst can drink water during breastfeeding. It is important not to get dehydrated. Other than that, adding additional fluids won’t increase the milk supply. While a beer every now and then is not harmful for a breastfeeding mother, it doesn’t improve milk supply like people once thought. And alcohol can be dehydrating, so it certainly shouldn’t be used with increasing the milk supply as the goal!
Q: Can you take over-the-counter medications while breastfeeding? How about vitamins?
A: Most medications and prenatal vitamins are safe during breastfeeding. When in doubt, ask your doctor. Lactmed is a free database kept by the US National Library of Medicine. You can search any medication or herbal remedy and see what is known about its effects during lactation. The results are written for a medical audience, though, and can be a bit dense to read. It is a good website to look at with your health care provider if you have questions about the safety of a certain medicine during breastfeeding.
Q: Are there foods I should avoid? How about alcohol?
A: Food safety is a bit more relaxed during lactation, when compared with pregnancy. The milk will take on some of the smells and flavors from what you eat, which is good for exposing baby to new things.
Alcohol should be used sparingly, if used during lactation. There is no need to “pump and dump” unless it is for comfort, as the alcohol in the milk will leave through the bloodstream as it clears the mother’s system. Alcohol levels peak about 30 to 60 minutes after a drink and clear in about three hours. If the mother drinks more than one standard drink, then this would take longer. If the mother is under the influence of alcohol, a designated parent or caregiver should provide care for the infant.
Q: Do pacifiers hinder breastfeeding efforts?
A: Ah, pacifiers. We love them, we hate them! There is some evidence that for some babies, early pacifier use may lead to breastfeeding difficulties. The medical evidence is not very strong to support this. The most important things to consider are that babies show us feeding cues, they root, smack their lips, vocalize, and these are the way they say they want to eat. If we give them a pacifier, then we can block these cues, and then the baby must escalate to crying before getting fed, which can then sometimes make it more challenging to get them to latch. The American Academy of Pediatrics recommends not introducing pacifiers until breastfeeding is fully established, around three to four weeks. After this point, pacifiers are recommended during sleep, as they are associated with a decreased risk of sudden infant death syndrome.
Q: How long should moms breastfeed their babies?
A: The World Health Organization (WHO) recommends exclusive breastfeeding for 6 months and ongoing breastfeeding for at least two years. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding (no food or drink other than breast milk) for six months followed by continued breastfeeding plus complementary foods for at least one year or longer, as mutually desired by mother and infant.
Q: Tell me about the lactation support available at UC Davis Health.
A: For mothers who deliver at UC Davis Medical Center, the labor and delivery and postpartum nurses are all trained in supporting breastfeeding. There are lactation consultants in labor and delivery and postpartum available every day of the week.
On Thursday mornings, Debbie Albert, an international board-certified lactation consultant, leads a lactation support group from 9:30 to 11:30 a.m. on a walk-in basis at the Glassrock Building at 2521 Stockton Blvd, Room 7106, in Sacramento. Shirley German, an international board-certified lactation consultant, schedules visits in Davis. Additional information, including prenatal breastfeeding classes is available at: https://health.ucdavis.edu/wellness/classes/breastfeeding_babybasics.html.
For women who are eligible for WIC, they can also seek additional lactation support through WIC. Our lactation consultants can also refer mothers to several community support groups in the Sacramento region if patients reach out to them with questions.