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Breastfeeding Handbook

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					Breastfeeding
Handbook
                                                                                           Table of contents

   Breastfeeding, the natural choice ......................................................................................4

   Milk, from breast to baby ...................................................................................................5

   Beginning breastfeeding .....................................................................................................6

   Frequency and duration of breastfeeding ..........................................................................7

   Take advantage of baby’s instincts ....................................................................................8

   The latch ...............................................................................................................................9

   Checking the latch ............................................................................................................10

   Your baby’s tummy size .....................................................................................................11

   Positioning .................................................................................................................... 12,13

   Breastfeeding tips ..............................................................................................................14

   Sleepy and fretful babies ..................................................................................................15

   Burping your baby ..............................................................................................................16

   Nutrition and breastfeeding ..............................................................................................17

   Is there anything I should avoid while breastfeeding? ....................................................18

   Caring for your breasts ......................................................................................................19

   Storing, freezing, and using breastmilk............................................................................20

   Relationship changes ........................................................................................................21

   Common concerns .......................................................................................................22,23

   Frequently asked questions ..............................................................................................24

   Breastfeeding help.............................................................................................................25


KFL&A Public Health | Breastfeeding Handbook                                                                                                    3
    Breastfeeding, the natural choice

    Best for babies                              •	 helps	to	protect	against	cancer	of	the	
                                                    breast and ovary,
    Breastfeeding:
    •	 provides	the	best	food	that	is	always	    •	 helps	to	keep	bones	strong,
       fresh and ready,                          •	 promotes	closeness	and	touching	
    •	 increases	protection	against	ear,	           with baby,
       chest, and stomach infections,            •	 saves	money	and	time	with	no	
    •	 promotes	better	brain	development,           formula to buy or prepare, and
    •	 protects	against	meningitis,              •	 reduces	garbage	in	our	world.
    •	 increases	protection	against	allergies,
    •	 increases	protection	against	illnesses	
       such as childhood diabetes, Crohn’s
       disease, and Celiac disease,
    •	 may	increase	protection	against	
       Sudden Infant Death Syndrome
       (SIDS), and
    •	 helps	to	promote	proper	jaw	and	
       teeth development.


    Best for mothers
    Breastfeeding:
    •	 helps	the	uterus	to	return	to	its	
       normal size and controls bleeding
       after birth,
    •	 helps	to	use	up	the	extra	fat	gained	
       during pregnancy,




4                                                  KFL&A Public Health | Breastfeeding Handbook
                                               Milk, from breast to baby

   When the placenta is delivered, the
   breast is triggered to make milk. What
   keeps it going is the baby sucking and
   stimulating the breast.

   Breastmilk is made in the alveoli
   throughout	the	breast.	The	milk	flows	
   along ducts to the nipple and areola.
   Each breast has 4 to 17 nipple openings.

   The	milk	flows	through	the	ducts	by	
   means	of	a	let-down	reflex.	At	each	
   feeding	this	let-down	may	take	just	
   seconds or up to a few minutes to start.
   Most women have at least two let downs
   each feeding.

   Some mothers feel this as a tingling
   around the nipples. Being comfortable
   and	relaxed	helps	the	milk	flow.

                                 baby nurses




                                                              breasts make
                                                                  milk
               breasts make
                 more milk



                                                baby nurses
                                                   more

KFL&A Public Health | Breastfeeding Handbook                                 5
    Beginning breastfeeding

    Breastfeeding soon, after birth, within the     The	first	hour	or	two	after	baby	is	born	is	
    first	hour	provides	many	benefits	for	both	     a special time for both you and baby. Your
    mother	and	baby.	Baby’s	sucking	reflexes	       baby	uses	all	five	senses	to	connect	with	
    are strongest during this period, and the       you and to learn about the world. Hold,
    quiet, alert state allows infants to learn to   touch, and breastfeed your baby during
    breastfeed effectively.                         this important time.

    At	first	your	breasts	produce	small	            Breastfeed your baby as soon as you can
    amounts of milk called “colostrum”. It is       after birth. Newborns are often alert and
    an	easily	digested	yellowish	fluid	which	       ready to nurse right away. Breastfeeding
    is rich in nutrients and helps to protect       early will help your milk to come in
    your baby from infections. Between the          sooner.	Think	of	this	first	breastfeeding	
    second and the fourth day, the colostrum        as	a	learning	experience	for	you	and	your	
    begins to change into mature breastmilk.        baby. Breastfeeding is a skill and may
    This milk may look thin and bluish, but is      take time to learn.
    full of nutrients and is the perfect food for
    your baby.

    Ask for help in getting your baby latched
    and positioned on your breast.
    A good latch and position every time she
    nurses will help prevent nipple soreness
    and keep a good milk supply.
    Babies were born to breastfeed, but
    some moms may feel a little less ready.
    Ask for help (see page 26.)




6                                                     KFL&A Public Health | Breastfeeding Handbook
                                           Frequency and duration of
                                                      breastfeeding
   Breastfeed your baby often—8 to 12           At the start of the feed, your baby will
   times in 24 hours. Watch for your baby’s     have shallow and quick sucks. When
   cues that he is ready to feed. As your       your	milk	starts	to	flow	the	sucks	should	
   baby grows the number of feedings per        become deep and slow. There should
   day will decrease.                           also be a pause during the suck when
                                                your baby’s mouth opens the widest.
   Hunger cues                                  Your baby is drinking milk during this
   •		 Hand	to	mouth	movements,	rooting         pause. A baby should be allowed to
   •		 Wiggling,	moving	arms	and	legs           breastfeed	until	satisfied	and	your	
                                                breast should feel softer. When your
   •		 Sucking	sounds	and	movements             baby no longer has strong “deep and
   •	 Soft	cooing	or	sighing	sounds             slow” sucks, offer the second breast. It
   •	 Rapid	eye	movements	during	her	light	 is important to offer your second breast
         sleep                                  even though your baby may be full after
                                                the	first	breast.	He	may	nurse	for	20-40	
                                                minutes (total for one or both breasts)
   It is best to feed your baby before he is    at	a	feeding.	At	the	next	feeding,	offer	
   too upset. Crying is a late feeding cue.     the breast that the baby may not have
   It is better to try to comfort a crying baby emptied, or the opposite breast from the
   before putting him to the breast. Undress one	he	started	on	at	the	first	feeding.	This	
   the baby to the diaper and hold the baby     is often the breast that feels the fullest.
   between mom’s breasts. Most babies will
   calm down, then try again.                   Ideally,	in	the	first	four	to	six	weeks	you	
                                                should breastfeed only, so your baby
                                                will learn to breastfeed well. Do not give
                                                your	baby	artificial	nipples,	(i.e.	pacifiers	
                                                or bottles) unless medically indicated.
                                                This will also help to establish your milk
                                                production.




KFL&A Public Health | Breastfeeding Handbook                                                     7
    Take advantage of baby’s instincts

    Babies are born with instincts which help     To help your baby open wide, use a
    them	figure	out	how	to	breastfeed.		The	      repeated light touch of your breast
    following images are a good way to use        against her chin and lips. By moving your
    the baby’s natural ability to latch on. The   baby toward and away from the breast,
    following principles will help to get the     touching it lightly, she will feel the cue
    baby to latch properly:                       she is waiting for and will open really
    •	 Support	the	baby	by	putting	your	          wide, with the tongue down over the
         hand at the back of the baby’s neck      lower lip. Waiting until the baby opens her
         and upper shoulder. The baby’s head      mouth as big as a yawn is very important
         will be tilted back slightly.            to get a comfortable latch. Once the baby
    •	 The	baby’s	ear,	shoulder	and	hip	          opens wide, quickly bring the baby on,
       should be in a straight line.              aiming your nipple for the roof of your
                                                  baby’s mouth. The nipple should fall
    •	 Snuggle	the	baby’s	neck	and	               well back in the baby’s mouth, making it
       shoulders in tight.                        comfortable and effective for feeding.




8                                                   KFL&A Public Health | Breastfeeding Handbook
                                                                             The latch

   The arrow indicates the “comfort zone”,
   which is where your nipple should fall.
   Figure 1
   Pull the baby in so his chin touches
   the breast and the nipple is pointing to
   baby’s nose.
   Figure 2
   Using	your	finger	to	tip	the	nipple	up,	                       Figure 1
   touch the baby’s top lip with your nipple.
   Repeat this chin into the breast, your
   nipple on the top lip, until the baby opens
   his mouth as big as a yawn. The baby’s
   tongue should be down and over his
   lower gum.
   Figure 3                                                                  Figure 2
   When the mouth is open wide, and the
   breast is resting on the baby’s chin, let
   the nipple fall into the wide open mouth,
   moving	your	finger	away	from	the	breast.
   Figure 4
   Taking a good amount of breast helps the
   nipple reach the comfort zone, avoiding
   friction and promoting a comfortable,                          Figure 3
   effective breastfeeding.
   Text and drawings related to latch reprinted with permission
   by New Harbinger Publication, Inc. from Breastfeeding Made
   Simple, N. Mohrbacher and K. Kendall-Tackett.
   www.newharbinger.com




                                                                             Figure 4


KFL&A Public Health | Breastfeeding Handbook                                             9
     Checking the latch

     A good latch looks right:                    If the latch isn’t right:
     •	 Baby’s	mouth	is	wide	open	with	top	        •	 Try	pulling	the	baby’s	bottom	in	
        and bottom lips turned out (think             close to your side. This should pull
        breastfeeding, not nipple feeding).           the chin into the breast. If it’s still
     •	 Baby’s	head	is	slightly	tilted	so	chin	is	    uncomfortable take her off the breast
        pressed into breast. The baby’s nose          and try again.
        will not be touching your breast.          •	 To	break	the	latch,	put	your	finger	
     •	 More	of	your	areola	(brown	area	              in the corner of her mouth between
        around your nipple) is visible above          her gums and when the suction is
        the baby’s mouth than is visible              broken, move her away from your
        below (asymmetrical latch).                   breast.


     A good latch feels right:
     •	 Breastfeeding	should	not	hurt.	
     •	 In	the	early	days,	you	may	feel	the	
        first	few	sucks	as	the	baby	stretches	
        the breast far into her mouth.
     •	 This	feeling	will	not	continue	through	
        the whole feeding and disappears
        after	the	first	week.




10                                                  KFL&A Public Health | Breastfeeding Handbook
                                                            Your baby’s tummy size




                                                        week 1                                        week 2    week
                     day 1      day 2     day 3         day 4         day 5         day 6     day 7




                        size of a
                        hazelnut                                 size of a cherry




                               week 2     week 3        week 4       week 5         week 6
                                                                                      to
day 5        day 6   day 7                                                          month 6




f a cherry                                         size of a walnut




         KFL&A Public Health | Breastfeeding Handbook                                                          11
     Positioning

     Breastfeeding should not be painful. Here are several positions to help your baby get
     a proper latch onto the breast.

                                                 Cross cradle hold
                                                 •		 Baby	should	be	tummy	to	tummy	with	
                                                     you.
                                                 •		 Your	hand	should	be	at	the	nape	of	
                                                     baby’s neck.
                                                     •		Baby’s	ears,	shoulder	and	hip	
                                                        should be in a straight line.
                                                         •		Baby’s	head	should	be	tilted	
                                                         back slightly so his chin will be
                                                         tucked well into the breast.




                                                 Football hold
                                                 •		 Useful	after	c-section	and	for	
                                                     premature babies.
                                                 •			 You	may	want	to	sit	in	a	large	
                                                      armchair or sofa to give you enough
                                                      elbow room for this position.
                                                        •		You	may	find	this	position	more	
                                                           comfortable if baby’s head
                                                          and body are well supported
                                                          with pillows at the level of your
                                                          breast.




12                                                 KFL&A Public Health | Breastfeeding Handbook
                                                                                          Positioning

                                                                     Cradle hold
                                                                     •	 Baby	should	be	tummy	to	tummy	with	
                                                                        you.
                                                                     •	 Your	baby’s	ears,	shoulder	and	hip	
                                                                        should be in a straight line.
                                                                          •	 Tuck	the	baby’s	hands	between	
                                                                             your breasts, or tuck the lower
                                                                               arm around your side to get
                                                                                baby in close to you.
                                                                                •	Support	your	baby’s	head	
                                                                                and body with your elbow, arm
                                                                               and hand.
                                                                            •	Bring	your	baby	to	your	breast.	


                                                                     Lying down position
                                                                     (Try after c-section, you may need to prop
                                                                          your back with pillows)
                                                                     •	 Baby	should	be	tummy	to	tummy	with	
                                                                        you.
                                                                             •	You	will	probably	want	a	pillow	
                                                                               for your head and behind your
                                                                                 back.
                                                                                 •	With	your	free	hand	
                                                                                 supporting the baby’s
                                                                                 shoulders, pull baby in
    Graphics and text are adapted from Breastfeeding
                                                                               towards you.
    Basics, Nova Scotia Department of Health Promotion
    and Protection, 2007. Reprinted with written permission                 •	Baby’s	chin	should	be	tilted	
    from Nova Scotia Department of Health Promotion and Protection
    Illustrations: Bonnie Ross
                                                                         into the breast, and the nose will be
                                                                         tipped away from the breast.


KFL&A Public Health | Breastfeeding Handbook                                                                      13
     Breastfeeding tips

     Signs that your baby is                      •	 Make	sure	your	baby	is	latching	on	
                                                     properly. Have the latch checked by
     breastfeeding well
                                                     an	expert	if	her	weight	gain	is	low,	if	
     Your baby is breastfeeding well if she:         she seems hungry too often, or if you
     •	 makes	good	swallowing	sounds	once	           have sore nipples.
        your milk is in.                          •	 Apply	moist	heat	to	breasts	a	few	
     •	 is	done	feeding	and	your	nipple	is	          minutes before feeding or pumping.
        comfortable, wet, and intact.             •	 Massage	your	breasts	before	and	
     •	 and	you	are	satisfied	after	the	             during feeding or pumping.
        feeding.                                  •	 Nurse	her	a	second	time	on	each	
     •	 wets	at	least	6	diapers	every	24	            breast. Use breast compressions
        hours by 4 days old (less before your        to keep your baby swallowing. The
        mature	milk	is	in,	for	example,	3	on	        more milk that is removed from your
        day 3).                                      breast, the more milk your breast will
                                                     produce.
     •	 passes	at	least	3	stools	in	24	hours	
        by day 3.                                 •	 Nurse	your	baby	more	often	(i.e.,	if	
                                                     feeding 8 times in 24 hours increase
     •	 is	active	and	alert	with	good	skin	
                                                     to 10 to 12 times).
        colour.
                                                  •	 Express	your	breastmilk	frequently	if	
     •	 regains	birth	weight	by	10	days	of	
                                                     your baby does not feed, or does not
        age.
                                                     feed well on one or both breasts even
     •	 gains	from	140	to	245	grams	per	             if small amounts are obtained (see
        week (4.5 to 7 ounces).                      page 19).
                                                  •	 Use	relaxation	and	rest	frequently	to	
     Making more milk                                reduce your stress and to encourage
     If you are concerned that your baby is not      your letdown.
     breastfeeding well, these are ways you       Giving formula at these times will result
     can increase your breastmilk supply:         in you producing less milk. The more
                                                  often your baby breastfeeds, the more
                                                  milk you will make.


14                                                  KFL&A Public Health | Breastfeeding Handbook
                                               Sleepy and fretful babies

   If your baby is sleepy:                      If your baby is fretful or frantic at
   •	 he	needs	to	be	awakened	for	              feeding time your baby needs to learn
        feedings until an appropriate weight    how to breastfeed. If he gets upset
        gain pattern is seen.                   or	excited,	he	may	“forget”	how	to	
   •	 keep	him	close	so	he	can	feed	            breastfeed, even though he did it well
      frequently.                               another time.
   •	 he	will	breastfeed	more	often	if	kept	
      skin-to-skin on your chest while you      Try these suggestions:
      are awake.                                •	 Stay	as	relaxed	and	patient	as	
                                                    possible to soothe your baby.
   •	 it	will	be	easier	to	feed	him	when	he	
      shows signs of lighter sleep.             •	 Watch	for	hunger	cues	and	do	not	
                                                   wait for crying before feeding.
   Some other suggestions:
   •	 Unwrap	and	undress	him.	Change	the	 •	 Calm	your	baby	by	letting	him	suck	
      diaper if wet.                              on	your	finger	for	a	minute.	Offer	
   •	 Lift	him	to	your	shoulder	and	rub	his	      your	middle	finger	with	the	pad	side	
      back. Massage his body.                     up and follow along the roof of his
                                                  mouth. This should stimulate sucking
   •	 Roll	him	gently	from	side	to	side.	Talk	
                                                  and “remind” him how to suck and to
      to him.
                                                  latch on.
   •	 Express	a	little	milk	from	your	nipple	
      so when you bring him to the breast      •	 Express	a	drop	of	milk	onto	the	nipple	
      there is something to tempt him.            to entice your baby.
   •	 To	increase	the	amount	of	milk	
      that your baby receives, you can
      use breast compressions. To do
      breast compressions, use a c-hold.
      With a good amount of breast in
      your hand, bring your thumb and
      fingers	together		(gently,	but	firmly)	
      compressing your breast. Continue to
      hold the compression while your baby
      is drinking. When your baby stops
                                                                  compression
      drinking, restart the compression.


KFL&A Public Health | Breastfeeding Handbook                                                15
     Burping your baby

     A breastfed baby does not swallow as         Why do babies cry?
     much air as a bottlefed baby, but he still
                                                  Babies cry for many reasons–discomfort,
     needs to be burped. Air in his stomach
                                                  loneliness, hunger, fear, tension, or
     can cause pain. Try to burp your baby
                                                  tiredness. Some babies cry more than
     once during a feeding (when changing
                                                  others even when they are healthy and
     breasts, if he seems uncomfortable or if
                                                  well fed.
     he falls asleep too soon) and at the end
     of the feeding.
                                                  You can try these suggestions:
                                                  •	 If	you	know	she	has	been	well	fed	
     To burp your baby, either on your shoulder
                                                     and burped, try walking, rocking
     or sitting on your lap, support his head
                                                     or standing and swaying. She has
     and pat or rub his back. A bubble can
                                                     become familiar with your heartbeat,
     come up easier if the back is straight.
                                                     your voice, and your movements for
     Some babies spit up after feedings. As
                                                     many months. You cannot spoil your
     long as your baby appears content and
                                                     baby by responding to her needs.
     gains weight as the weeks go on, don’t
     worry about spitting up mouthfuls of milk    •	 Adjust	coverings	if	she	seems	too	
     now and then.                                   warm or too cool.
                                                  •	 Offer	your	breast	again	if	she	seems	
                                                     hungry. Use breast compressions
                                                     and	reoffer	the	first	and	second	
                                                     breast to ensure your baby has
                                                     received enough higher fat milk that
                                                     comes at the end of feedings.




16                                                 KFL&A Public Health | Breastfeeding Handbook
                                        Nutrition and breastfeeding

   Food                                        Fluids
   You	may	find	you	are	hungrier	when	         It is important that you stay hydrated. It
   you	are	breastfeeding.	The	extra	           was once thought you needed a lot of
   nutrients you eat and fat stored in your    extra	fluid	to	produce	enough	breastmilk.	
   body during pregnancy, will be used to      The nutrients in your milk come from
   produce breastmilk. Eating well while       the food you eat and stores found in
   you are breastfeeding is very important     your body. In fact, the most important
   to ensure the quality of your breastmilk    factors in determining how much milk
   is consistent and perfect for your baby.    you produce are how often you nurse
   However, if you have a poor diet the        and how well milk is removed from your
   nutrients needed to make the milk will be   breast.
   taken from your body. Choose a variety
   of foods from “Canada’s Food Guide to       You do need to drink to meet your normal
   Healthy Eating”. To receive a copy or for   fluid	requirements	and	to	satisfy	your	
   other information on healthy eating, call   thirst. It is recommended that women
   KFL&A Public Health at 613-549-1232,        take	in	2.2	L	(9	cups)	of	fluid	each	day.	
   ext.	224.                                   This	includes	fluid	from	milk,	juice,	tea,	
                                               and coffee. To quench your thirst choose
                                               water	most	often.	Limit	juices	and	other	
                                               sweet drinks. They can contain a lot of
                                               calories and offer little nutrition. The best
                                               way to tell if you are getting enough to
                                               drink is that your urine should be pale
                                               yellow.




KFL&A Public Health | Breastfeeding Handbook                                                   17
     Is there anything I should avoid while breast-
     feeding?

     Food                                         Smoking
     Many	women	find	they	can	eat	any	food	       If you smoke, breastfeeding is still best
     without problems. There is no research to    for your baby. Remember, tobacco smoke
     suggest any one food should be avoided       is very harmful to babies as well as older
     while breastfeeding. The variety of foods    children. Quitting smoking, or smoking
     you	eat	will	help	to	expose	your	baby	to	    well away from your child is the best
     different	flavours.	Research	suggests	       thing you can do for you and your child.
     that	this	exposure	may	help	your	baby	to	    For additional information or resources
     accept	new	foods	and	flavours	as	they	get	   on quitting smoking, call the Tobacco
     older.                                       Information	line	at	613-549-1232,	ext.	
                                                  333.
     Alcohol
     It is best to avoid alcohol while
     breastfeeding. If you do choose to
     have one occasional drink, have it with
     a meal and wait two to three hours
     before breastfeeding your baby. For
     more information about alcohol and
     breastfeeding, call Child & BabyTalk
     613-549-1154 or 1-800-267-7875,
     ext.	555.	TTY	613-549-7692	or	
     1-800-299-1136.




18                                                  KFL&A Public Health | Breastfeeding Handbook
                                                 Caring for your breasts

   •	 Make	sure	your	baby	is	positioned	         How to hand express milk
      and latched on properly every time.        Everyone’s breasts are different, so be
      Your breasts should feel comfortable       patient and practice. Soon you’ll get your
      while breastfeeding.                       milk	flowing.	Express	the	breastmilk	into	
   •	 Change	breast	pads	when	wet	and	           a sterilized container.
      avoid plastic liners in the breast pads.   •	 Place	your	thumb	and	two	forefingers	
                                                     a few centimetres (1 to 1.5 inches)
   •	 Wash	your	breasts	with	water	only	             behind the base of the nipple.
      while bathing.
                                                 •	 Press	back	toward	your	ribs.
   •	 Wear	a	supportive	(not	tight)	nursing	
      bra.                                       •	 Gently	compress	the	breast	between	
                                                    the	thumb	and	fingers	and	roll	the	
   •	 Rest	or	sleep	when	your	baby	sleeps	          thumb	and	fingers	toward	the	nipple.	
      for	the	first	few	weeks.                      This	gentle	expression	squeezes	the	
                                                    milk ducts around and behind the
   Expressing	breastmilk	by	hand	                   nipple area.
   You may need to express breastmilk if:        •	 Rotate	the	thumb	and	finger	position	
   •	 your	breasts	are	too	hard	for	your	           to	milk	the	entire	breast	if	expressing	
      baby to latch on.                             to collect milk or to increase your
                                                    breastmilk supply.
   •	 you	want	to	give	your	baby	breastmilk	
      when you are away from your baby.          •	 Repeat	the	above	procedures	in	a	
                                                    rhythmic motion that mimics the
   •	 you	need	to	increase	your	breastmilk	
                                                    rhythm of the baby’s suck (position,
      supply.
                                                    push back, roll forward)


                                Push to
          C-hold               chest wall            Roll               Finish roll




KFL&A Public Health | Breastfeeding Handbook                                                   19
     Storing, freezing, and using
     breastmilk
     Store breastmilk in a sterile plastic or      When using thawed breastmilk, warm
     glass container, or in special breastmilk     milk to room temperature and shake
     freezer bags. Cooled breastmilk may be        gently	to	mix	it.	Thawed	milk	may	taste	
     added to already frozen breastmilk if         or smell different from fresh, but it is still
     there is more frozen milk than fresh milk.    good.
     Date all stored breastmilk so older milk is
     used	first.	                                  For	a	copy	of	“Expressing	and	Storing	
                                                   Breastmilk” call Child & BabyTalk at
     Breastmilk can be thawed in the               613-549-1154 or 1-800-267-7875,
     refrigerator in about 12 hours. To thaw       ext.	555	or	visit	our	website	at	
     breastmilk more quickly place under cool,     www.kflapublichealth.ca
     then gradually warmer running water.
     Do not microwave as this can change
     the quality of the milk. Thawed milk can
     be stored in the refrigerator for up to 24
     hours if not needed right away. Do not
     refreeze.




       Breastmilk can be safely stored:              For a premature or hospitalized baby:
       •	 in	the	refrigerator	for	up	to	eight	       •		 Use	a	fresh	container	that	has	
          days.                                          been boiled for 15-20 minutes.
       •	 in	a	separate	freezer	above	the	           •	 Refrigerate	milk	within	one	hour	
          refrigerator for one month.                   after pumping.
       •	 in	a	deep	freezer	for	six	months.	         •	 Use	or	freeze	the	milk	within	48	
                                                        hours.


20                                                   KFL&A Public Health | Breastfeeding Handbook
                                                  Relationship changes

   Fathers                                      Relationships
   Mothers are best at breastfeeding, but       The	two	of	you	will	find	that	your	
   fathers have their special talents too.      relationship is different now that you have
   Changing the baby’s diapers, bathing         become a family. Changes may include
   him, carrying him in your arms or in a       role changes, compromising, planning
   carrier, singing to him, taking him for      ahead or being spontaneous when the
   walks, massaging him, talking to him,        opportunity is there. These changes may
   reading to him, burping him, and many        affect	your	sexual	relationship.		
   more activities are all wonderful ways for
   fathers to create a close and loving         A	mother’s	interest	in	sex	is	often	less	
   relationship with their baby.                after having a baby, but it will gradually
                                                increase as your baby grows. Remember,
   Fathers	are	extremely	important	in	          she has had nine months of hormonal
   supporting and encouraging their             and physical changes to prepare her for
   partners in breastfeeding. Fathers who       this baby. For the father, the baby may
   understand	the	benefits	of	breastfeeding	    not have seemed quite real until she was
   want their babies to have “the best”.        born. His attachment to the baby will
   For a copy of The New Baby Owners            grow	with	time	and	dad	will	enjoy	the	new	
   Manual for Dads, call Child & BabyTalk at    family he has helped to create.
   613-549-1154,	or	1-800-267-7875,	ext.	
   555 or visit our website at
   www.kflapublichealth.ca




KFL&A Public Health | Breastfeeding Handbook                                                  21
     Common concerns

     Engorgement                                  Sore Nipples
     Your milk production increases three         If your nipples become sore, cracked or
     to	five	days	after	the	baby’s	birth.	Your	   blistered or if it hurts the whole time your
     breasts	may	become	full,	firm,	and	          baby is breastfeeding, this may be due to
     uncomfortable if your baby is not feeding    a poor latch or poor positioning.
     regularly or effectively.
                                                  •	 Follow	each	step	in	caring	for	your	
     Suggestions to help soften your breasts:        breasts, page 14.
     •	 Massage	and	express	some	                 •	 Review	pages	5	to	7.	Try	different	
        milk to soften the areola before             feeding positions. One may be more
        breastfeeding. This makes it easier          comfortable than another.
        for your baby to latch on correctly
        (see page 14).                            •	 Start	the	feeding	on	the	side	that	is	
                                                     less sore. If it is still uncomfortable,
     •	 As	long	as	your	breasts	are	leaking,	        take your baby off and try the latch
        you can use warm compresses prior            again.
        to feeding to encourage your milk to
        flow.                                     •	 Express	a	few	drops	of	milk	after	
                                                     each feeding and spread this on the
     •	 Breastfeed	your	baby	every	1.5	to	3	         nipple and areola (dark area) to help
        hours until your breasts are no longer       heal the nipple.
        uncomfortable. Use compressions
        during the feeding.                       •	 You	may	wish	to	use	a	pure	lanolin	
                                                     ointment. Apply a thin coating after
     •	 After	feeding,	place	a	cold	pack	            feedings.
        around your breasts for up to 10
        minutes for comfort and to help           •	 Ask	a	breastfeeding	expert	for	advice	
        decrease swelling, e.g., chilled gel         (see page 26).
        packs, ice chips, or frozen vegetables
        in a plastic bag wrapped in a towel.




22                                                  KFL&A Public Health | Breastfeeding Handbook
                                                        Common concerns

   Plugged Ducts                                Mastitis
   You may have a plugged duct if you notice    Mastitis is a bacterial infection in the
   a reddened, tender, hard or hot area on      breast and does not affect the quality
   your breast.                                 of your breastmilk. If you have a hot,
                                                reddened, and tender area on your
   Suggestions:                                                                             	
                                                breast	and	flu-like	symptoms	(fever,	chills,	
   •	 Continue	to	breastfeed	often	and	use	     aching), call your doctor. You may need
      ibuprofen for pain, if necessary.         medication.
   •	 Apply	a	warm	compress	and	massage	
      the affected area gently toward the    Suggestions:
      nipple before you breastfeed.          •		 Continue	to	breastfeed	often	and	
                                                 follow suggestions for plugged ducts.
   •	 Breastfeed	your	baby	on	the	sore	side	
      first	and	often.                       •		 Drink	plenty	of	fluids.

   •	 Steadily	compress	the	plugged	duct	
      area with as much pressure as you
      can tolerate during the feed.
   •	 Breastfeed	in	different	positions	with	
      the baby’s chin pointing toward the
      site of the plugged duct.
   •	 Express	after	the	feed	if	your	baby	
      has not fed well.
   •	 Make	sure	your	bra	is	not	tight	
      around your breast.
   •	 Get	plenty	of	rest.
   •	 Talk	to	your	healthcare	provider	or	
      phone for advice (see page 25) if
      there is no improvement.




KFL&A Public Health | Breastfeeding Handbook                                                    23
     Frequently asked questions

     What should my baby’s stool be like?          Is it safe to breastfeed if I am taking
     Your baby’s stool will have a mild smell      medicine or if I am sick?
     and will usually be watery and seedy.         In almost all cases, it is safe to continue
     It may be yellow, tan or occasionally         breastfeeding. Call Child & BabyTalk
     green in colour. In the early weeks, your     at 613-549-1154, visit the link for
     baby should have at least three bowel         Motherisk at our web site
     movements a day or may stool with every       www.kflapublichealth.ca,	or	call	
     feeding.	After	the	first	month	your	baby	     Motherrisk at 416-813-6780 for
     may have fewer bowel movements and            additional information.
     may go as long as 4 to 12 days. This is
     not constipation unless the stools are
                                                   Should I give my baby vitamins?
     hard and dry. Many babies strain, grunt,
                                                   Health Canada and the Canadian
     and get red in the face when they are
     trying to have a bowel movement, even         Pediatric Society recommend giving all
     when it is very soft. This is normal.         breastfed babies Vitamin D drops, 400
                                                   I.U. per day. For additional information,
     Should I give my baby anything other          call Dial-a-Dietitian at 613-549-1232,
     than breastmilk?                              ext.	224.
     Health Canada and the Canadian
     Pediatric Society recommend that              Could I get pregnant while I am
     breastmilk is all your baby needs until       breastfeeding?
     he	is	six	months	old.	Your	baby	does	not	     Breastfeeding can be 98 per cent
     need water, other drinks or solid foods       effective as a method of birth control
     until	this	age.	Until	six	months,	solid	      if	your	baby	is	under	six	months	old,	
     foods are not well digested, may lead to      your monthly periods have not returned,
     allergies, and will cause him to take less    and	your	baby	exclusively	breastfeeds	at	
     breastmilk.                                   least every four hours during the day and
                                                   has	no	more	than	one	six	hour	stretch	
     How long should I breastfeed?                 at	night.	The	use	of	pacifiers	and	infant	
     This is a personal choice. Health Canada      formula may cause earlier return to
     and the Canadian Pediatric Society            menstruation.
     recommend breastfeeding to continue
     with the introduction of other foods for up
     to two years or more.


24                                                   KFL&A Public Health | Breastfeeding Handbook
                                                      Breastfeeding help

   This book covers only the most basic
   information. For answers to other           Web sites
   questions, please use the following
                                               •	 KFL&A	Public	Health	–	
   sources:
                                                  www.kflapublichealth.ca

   People                                      •	 La	Leche	League	–	
                                                  www.lalecheleague.org
   •	 KFL&A	Public	Health	Prenatal	
      Breastfeeding Class: call                •	 Dr.	Jack	Newman’s	articles	–	
      613-549-1232 or 1-800-267-7875,             www.breastfeedingonline.com
      ext.	567	to	register.
   •	 Nurses	in	the	hospital.	                 Books
   •	 Your	doctor	or	midwife.	                 •	 La	Leche	League	International.	The
                                                  Womanly Art of Breastfeeding. 7th
   •	 KFL&A	Public	Health’s	Child	&	
                                                  edition, 2004.
      BabyTalk at 613-549-1154 or
      1-800-267-7875,	ext.	555	(TTY	           •	 Breastfeeding	Made	Simple
      613-549-7692 or 1-866-299-1136)
      and talk to a public health nurse.       Look for other breastfeeding booklets
   •	 BabyTalk	Drop-ins:	call	Child	&	         available on our web site or by calling
      BabyTalk at 613-549-1154 or              Child & BabyTalk 613-549-1154 or
      1-800-267-7875,	ext.	555	for	            1-800-267-7875,	ext.	555.
      locations in your area or look on our
      web site.
   •	 Breastfeeding	Buddies:	call	
      613-549-1154 or 1-800-267-7875,
      ext.	555.
   •	 La	Leche	League	Leaders:	call	
      1-800-665-4324 for one near you.




KFL&A Public Health | Breastfeeding Handbook                                             25
               Breastfeeding Buddies
                613-549-1154




           Child & BabyTalk phoneline
 Free phone information for parents, parents-to-be
and other caregivers of infants and young children.
   Public health nurses answer your parenting
         questions on topics from A to Z!

              613-549-1154
            1-800-267-7875,	ext.	555
     Monday to Friday 8:30 a.m.— 4:30 p.m.
   TTY Line 613-549-7692 or 1-866-299-1136
Revised: March 2008

				
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