Many women choose to breast-feed their babies for at least the first few months. They are aware that breast-feeding is the best way to build up a newborns immunity system and prevent allergies. In addition, nursing a child is an excellent way for mother and baby to bond while not having to fuss with the expense and time of preparing bottles and formula. Many new moms find that nursing causes contractions which help shrink the uterus back to normal size relatively quickly.

Initial milk

The first milk coming from the breasts after giving birth is a thin, yellowish liquid called colostrum. It contains more protein, salt, and antibodies than regular breast milk. It is extremely easy to digest and is therefore the perfect first food for your baby. It is low in volume, but high in concentrated nutrition, for the newborn. Colostrum has a laxative effect on the baby, helping him pass his early stools and thus aiding in the excretion of excess bilirubin and helping prevent jaundice. Within a few days your milk will come in and you will often feel a heaviness in your breasts as they fill with milk. This is sometimes called the let-down reflex which is frequently stimulated by the cry of your hungry child. To establish an adequate milk supply it is important that your baby nurse frequently. If she’s not hungry enough to nurse for long or has difficulty getting started, it may help to express some of your breast milk. To do this place your thumb at the top of the areola, with your fingers underneath. Squeeze the edges of the areola as you press back toward your chest wall, almost as if you are milking your breast. Often this will help your baby get the milk more easily, encouraging her to suck more productively.

Helpful tips for breast-feeding

You will want to sit in a comfortable chair which supports your back and arms. Position your infant so her mouth can easily get to your breast. A quiet spot away from the turmoil of the household is ideal, but not always possible. Soothing music may help relax both of you. Alternate the breasts each time you begin feedings, since the first breast gets sucked more vigorously. If your infant has problems latching on to the breast, consult your pediatrician or local breast-feeding support group for help. La Leche is a nationwide group which continually offers support by phone for new mothers. Avoid smoking, drinking alcohol, and using illegal drugs, all of which can pass through the milk to your baby. Even prescription drugs should be taken with care; be certain to make your doctor aware that you are breast-feeding when you receive a prescription.

Is my baby getting enough milk?

Typically, during the first few days while the baby is receiving mothers immunity-boosting colostrum, he will wet only one or two diapers per day. Once the mother’s milk comes in, usually on the third or fourth day following birth, the baby should begin to have 6-8 wet cloth diapers or 5-6 wet disposable diapers per day. (An easy way to feel the weight of a wet disposable diaper is to pour 2-4 tablespoons of water in a dry diaper.) In addition, most young babies will have at least two to five bowel movements every 24 hours for the first several months, although some babies will switch to less frequent but larger bowel movements at about 6 weeks. You will know your baby is getting enough milk if:

• The baby nurses frequently, averaging at least 8-12 feedings per 24-hour period.
• The baby is allowed to determine the length of the feeding, which may be 10 to 20 minutes per breast or longer.
• Baby’s swallowing sounds are audible as he is breastfeeding.
• The baby gains at least 4-7 ounces per week after the fourth day of life. Periodic well baby check-ups are important for this reason.
• The baby is alert and active, appears healthy, has good color, firm skin, and is growing in length and head circumference.
• If you have any concerns regarding your baby, they should be addressed with your health care provider.

Breast Care

One hazard of breast-feeding is cracked nipples, which can become a problem if your baby is not latching on to the breast properly. The main cause is improper positioning. The baby should be face to nipple, and tummy to tummy with you. The baby’s chin should be just below the nipple, and the baby needs to open her mouth wide to take in a good mouthful. Some mothers find that rinsing their nipples after nursing and drying them with a hair dryer can be beneficial. It may also help to express a small amount of milk and let it dry on the nipple, forming a protective coating. Never use soap on your breasts; even creams and lotions can aggravate cracked nipples. Plastic lined nursing pads or plastic bra shields may exacerbate the problem; if discomfort persists, consult your doctor. A more serious problem is mastitis, an infection of the breast caused by bacteria within the duct system. Symptoms include swelling, pain, heat, and perhaps a fever. Apply hot compresses and massage your breasts before nursing. If a fever or discomfort persists, consult your healthcare provider.

Healthy diet

It is of extreme importance to drink extra water and nonfat milk while nursing. A good rule of thumb is to drink at least 8 oz. of liquid each time you nurse the baby.T rial and error will show which foods you consume pass through your breast milk to your baby andcause gassy discomfort. Common culprits include cabbage, garlic, onions, broccoli, and turnips. In addition, some mothers find that consuming caffeine can lead to an alert, fussy, sleepless baby, so be careful to limit your caffeine consumption.

Breast pumps

When you return to work or if you need to be away from your baby for another reason, it will be helpful to utilize a breast pump. There are simple manual ones, but the newer electric pumps are gentler on the breasts and far more efficient than pumping by hand. Breast milk must be refrigerated and can be frozen, so that it can be given to the baby by dad or a caregiver. It is important to get your baby used to accepting a bottle and being fed by someone other than mom well before the situation arises.

Many women enjoy the fact that their milk is so healthy for and digestible by their baby. Although not all women can or prefer to nurse, research points to the significant value which breast-feeding has to infants, mothers, and their families.

You may find it very helpful to talk to a lactation consultant to plan for your return to work. A breast pump and a supportive caregiver are essential!

Breast Pumps

Your best choice may be a fully automatic, double-pumping breast pump. Look for a pump which is portable and easily cleaned. Some women find pumps with intermittent pressure are more comfortable to use. Start using your breast pump at least two weeks before returning to work. The milk can be frozen for later use. Label it by date frozen so that you always use the older milk first. Human milk can be stored:

• at room temperature (66-72F, 19-22C) for up to 10 hours
• in a refrigerator (32-39F, 0-4C) for up to 8 days
• in a freezer compartment with a separate door (variable temperature due to the door opening frequently) for up to 3 to 4 months.
• in a separate deep freeze (0F, -19C) for up to 6 months or longer.

If milk has been frozen and thawed, it can be refrigerated for up to 24 hours for later use. It should not be refrozen. It is best to discard any milk that is left in the bottle after a feeding. Expressed milk can be kept in a common refrigerator at your workplace or in a day care center. You can assure co-workers that the U.S. Centers for Disease Control and the U.S. Occupational Safety and Health Administration agree that human milk is not among the body fluids that require special handling or storage in a separate container. If you don’t have access to a refrigerator, plan to bring a small cooler with a refreezable ice pack to chill the expressed milk.

Preparing to Return to Work

In the weeks prior to returning to work it is essential to acclimate your baby to being fed by someone other than mom. If the baby resists the bottle, have mom switch on and off with the breast until he more willingly accepts it; then move on to having the baby fed by dad, a grandparent, or a friend. If resistance is met, it will help to have dad, or whoever is doing the feeding, drape a scarf or blouse (even a burp cloth) which mom has recently worn over his shoulder. The baby will be comforted by finding his mothers scent still nearby. With patience and adequate practice the baby should be willing to accept a bottle from a caregiver when mom returns to work.

Your Wardrobe

Wear skirts or blouses that button in the front or pull up easily. Avoid solid colors which will show breast milk stains; patterned blouses can best hide leaking and the bulge of breast pads. Wear a nursing bra and keep a spare blouse at work as a backup. Carry plenty of nursing pads and breast shields with you. Disposable wipes and paper towels will make for easier cleanup.

Where to Pump

If you are fortunate, your workplace may provide a lactation room. If not, discuss with your supervisor the possibility of setting aside a small conference room or unused office for a half hour or so to allow you to pump in privacy. Your supervisor will most likely be your ally if you can assure her that you will be working even while pumping. Plan your activities so that you can read or do paperwork during that time! Hopefully the ladies room need be used only as a last resort. Letting your employer know of your pumping needs in advance will give you a chance to develop a plan that will work for both of you. Educating your employer about the important health choice you have made and the relatively minor physical accommodations required in the workplace will encourage cooperation. Of course, there are significant employer advantages to continuing breastfeeding once you are back to work. Research shows that breastfed babies are half as likely to get sick in the first year of life as those receiving formula. If your baby doesn’t get sick as often, you will miss less time from work, an obvious advantage.

Schedules

It will be important to breast-feed your baby before you leave home. If at all possible, it will be helpful to go to your baby during your lunch break in order to breast-feed. You will want to nurse your baby as soon as you get home and in the evening. Even if your caregiver needs to bottle feed two or three times while you are at work, pumping should allow you to maintain your supply of breast milk.

Although there will be initial adaptations for everyone, perseverance in adjusting to breast-feeding while back in the workforce will pay rich dividends for mom, baby, and the rest of the family as well as the employer.

Being a new parent is difficult enough, but what do you do when your newborn seems to cry nonstop? Babies with colic will usually bring their legs up, tighten their abdomen, and cry for hours at a time regardless of attempts to soothe them. Many different theories exist on what causes colic. Some professionals feel it is food allergies while others suggest an immature digestive system, but the bottom line is no one really knows for sure. Colic normally begins when a baby is about two weeks old and disappears around four months of age. It does not have any lasting damage. Once you’ve ruled out all medical causes, you can try the following suggestions to help you and your baby get through this rough time.

• Switch from a dairy-based formula to soy or hypoallergenic formula.
• If you’re breast-feeding, eliminate dairy from your diet.
• Bundle your baby tightly.
• Feed your baby in an upright position.
• Make sure you burp your baby often during feedings.
• Take your baby for a ride in the car or stroller.
• Carry your baby around in a sling or pouch.
• Walk around holding your baby using the colic carry. Place your baby on your arm face down, with her face on your open hand and her legs straddling your inner elbow. Then, support her back with your other hand.
• Use a vibrating bouncy seat.
• Play different types of music to see what will soothe your baby.

If you need a break and no one else is around, it’s okay to let your baby cry while safely secured in her crib or bassinet. Make sure you watch out for other signs that may indicate a more serious problem. If your baby has frequent, green, watery stools accompanied by vomiting or signs of dehydration such as a sunken soft spot on the top of her head, call your pediatrician right away.

Newborn babies do spend most of their time eating and sleeping! As a new parent you are likely to be anxious about the feeding of your baby, worrying that she won’t get enough nourishment or will be fussy. Information below is designed to relieve some of that anxiety!

On-Demand Feedings

A parent making this choice has decided to feed his baby whenever he seems hungry. This is frequently seen as the most natural approach, especially in the first few weeks of life. When your baby cries, check for soggy or dirty diapers or whatever else may be making him uncomfortable. If he is still fussy, it is safe to assume he is hungry. Parents need not worry about spoiling an infant. Feeding him when he’s hungry gives him a sense of security and lets him know his needs will be met. All the love and attention you can give him will help him feel content. Newborns have very little capacity in their stomachs and require small, frequent feedings. The intervals can vary from one to three hours during the day and (hopefully!) a bit farther apart during the night. Within six weeks or so, depending upon birth weight, babies will be eating about every four hours during the day and getting up once between 11 pm and 7 am. If you are breast-feeding, on-demand feeding may work best for you, since frequent feedings help establish an adequate milk supply.

Scheduled Feedings

Some parents like a more structured approach! By the time the baby is about two weeks old, the parents gradually space the feedings further apart, increasing the intervals by 15 minutes or so at a time, until the feeding schedule is about every four hours. Some parents feel this makes their babies less fussy and more willing to sleep through the night. Scheduled feedings may work best for you if you plan to have your child in child care within the first few months; many child care providers feed babies on a schedule.

Breast-feeding

Because it provides needed antibodies, human milk is the best possible form of food for an infant. Nursing your baby gives you skin-to-skin contact which is soothing for both of you. Breast-fed babies may nurse as often as once an hour but have fewer health problems. Breast milk is more easily digestible than formula. The major downside is that only the mother can feed the baby unless she pumps and stores her breast milk. Although the breast milk itself comes without cost, nursing bras, breast pump, breast shields and a few bottles can bring the cost to approximately $300 a year.

Formula Feeding

Formula can certainly give your baby the nutrients he needs to grow and thrive. It comes in many different forms, so be sure to read carefully the manufacturers instructions on the formula container. Water needs to be added to concentrated formula, but you certainly don’t want to dilute the ready-to-use type. Formula made in advance needs to be stored in the refrigerator or freezer and used within 48 hours. Bottles should be washed in hot soapy water and rinsed well before adding the formula. When warming the bottle, use your wrist to test the temperature. If you can feel it, the formula is too hot. If you can’t feel the liquid, it is the right temperature for your baby. Be especially careful of warming bottles in the microwave; it is no longer recommended due to the tendency for the heating to be uneven. The size of the hole in the nipple is critical to your baby. If the hole is too small, the baby will get too much air and may get frustrated by not getting the formula she seeks. You can enlarge the hold by poking it with a red-hot needle. If the hole is too large, your baby will get too much formula too quickly and likely spit up or choke. Throw those nipples away! It the nipple becomes too gummy, boil it in a pan of water with a bit of salt.

Which type of formula to use?

Milk-based formula is the most widely used. Although cow’s milk is the foundation, its been changed by adding lactose and nutrients as well as having the butterfat replaced with vegetable oils and animal fats more easily digested by babies. Soy formula is recommended for babies who are unable to digest lactose. This is usually evidenced by bouts of diarrhea. Strict vegetarian families often choose soy formula because no animal products are used.

Burping

No matter how or what your baby is fed, if your baby becomes cranky during feeding, stop and burp him. Many formula-fed babies like to be burped after every two or three ounces because they take in a good amount of air. Breast fed babies may need burping about halfway through the feeding. Try several alternatives to see which method your baby prefers:

• Hold your baby upright over your shoulder; pat or rub her back gently.
• Let him sit on your lap, with your hand across his stomach and chest, rubbing or patting his back gently.
• Place her face down over your lap and pat her back gently.

No matter which method you choose, relax and allow feeding your baby to be an opportunity to bond with your newborn. Be sure to address any questions or concerns you may have with your healthcare provider.