Ten Steps to Successful Breastfeeding
Have a written breastfeeding policy that is routinely communicated to all health care staff.
Train all health care staff in the skills necessary to implement this policy.
Inform all pregnant women about the benefits and management of breastfeeding.
Help mothers initiate breastfeeding within one hour of birth.
Show mothers how to breastfeed and how to maintain lactation even if they are separated from their infants.
Give infants no food or drink other than breastmilk unless medically indicated.
Practice rooming-in—allow mothers and infants to remain together twenty-four hours a day.
Encourage breastfeeding on demand.
Give no pacifiers or artificial nipples to breastfeeding infants.
Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.
The Ten Steps to Successful Breastfeeding form the basis of the Baby-Friendly Hospital Initiative, a worldwide breastfeeding quality improvement project created by the World Health Organization and the United Nations Childrens’ Emergency Fund.
Baby-Friendly hospitals and birth centers also uphold the WHO International Code of Marketing of Breastmilk Substitutes by offering education and educational materials that promote human milk rather than other infant food or drinks, and by refusing to accept or distribute free or subsidized supplies of breastmilk substitutes, nipples, and other feeding devices.
Frequently Asked Questions (FAQ)
Why should I consider breastfeeding over bottle-feeding?
Choosing breastfeeding over bottle-feeding is a personal decision. The American Academy of Pediatrics (AAP), American Medical Association (AMA) and The Academy of Nutrition and Dietetics believe that breast milk is uniquely superior for infant feeding. It is the best source of nutrition, with the ideal combination of nutrients for your baby’s immune system.
What are the advantages of breastfeeding for my baby?
- Easier digestion
- Provides infection-fighting antibodies that can lower incidence of diarrhea, respiratory infections, ear infections, gastrointestinal infections and disease
- Protection against developing allergies
- Protection against developing diabetes
- Improves cognitive development
- Lowers risk of childhood and adolescent obesity
- Lowers risk of Sudden Infant Death Syndrome (SIDS)
What are the advantages of breastfeeding for me?
- Reduced risk of breast, uterine and ovarian cancer
- Increased emotional contact and bonding with your infant
- Reduced stress levels and risk of postpartum depression
- Faster return to prepartum weight
- Reduced costs compared to formula-fed babies
- Breastfeeding is convenient: it is always ready to feed
- Breast milk is species-specific: human milk for your human baby
What's in breast milk?
Breast milk contains the right proportions of proteins, fats, vitamins and carbohydrates to meet your baby’s needs. It also has numerous components of antibodies that protect your baby from viral and bacterial illnesses.
Colostrum is the first milk your body produces after delivery. This amazing substance is easily digested and is full of concentrated nutritional and protective ingredients such as protein, Vitamin A and numerous antibodies. Colostrum also acts as a kind of mild laxative to help clear meconium from your baby’s intestinal tract, which can help protect your baby from jaundice.
The birth of your baby and placenta causes a drop in the hormone progesterone, which triggers the production of copious amounts of milk 2-8 days after birth. Most women will have a full supply of mature milk by day 10. This mature milk is perfectly made to meet your baby’s needs, as it contains:
- Make digestion easier
- Protect against bacterial and viral infections
- Provide protection against E. coli and salmonella
- Provide a source for calories
- Assist in brain development
- Vitamins A, D, E and K
- Carbohydrates (including lactose)
- Decrease unhealthly bacteria in the stomach
- Improve absorption of phosphorus, magnesium and calcium
- Immunological Protection
When should I begin breastfeeding my baby?
Begin breastfeeding your baby as soon as it is born. In the first hour or so after birth, newborns are often alert and interested in breastfeeding. Keeping your infant in close body contact with you in those early hours and days is very beneficial in getting breastfeeding off to a great start. Your nurses or lactation consultants can assist you with placing your infant skin-to-skin, which has many benefits, such as:
- Stabilizing baby’s temperature better than the warmer
- Baby is less likely to have low blood sugar
- Baby may self-latch to the breast (watch for head-bobbing and follow baby’s lead)
- Quickest way to calm a fussy baby
- Baby will be more alert, will breastfeed better and more frequently
If your infant does not nurse in that first hour or so, keeping your infant skin-to-skin will meet all your infant’s needs at that time.
How do I know when my baby wants to be fed?
Keeping your baby close to you in those early hours and days will help you learn your baby’s cues for feeding, which may include:
- Stirring (eyes flutter in light sleep)
- Lip smacking
- Placing hands in mouth
- “Rooting”, the newborn reflex that causes the baby to turn its head toward a hand stroking his or her cheek
- Moving the head from side to side
- Crying is usually a late sign
How do I position and latch on my baby for breastfeeding?
There are lots of different positions you can place your baby in to breastfeed. Once your baby is born, you can practice these positions and get a feel for what works best for you and your baby. Your nurses and lactation consultants can assist you with positioning and latch while you are in the hospital.
- Make sure baby is in a drowsy or quiet alert state
- Use nipple to tickle baby’s lips
- Baby’s mouth should open wide to cover the nipple and about 1 inch of areola
- When mouth opens wide and the tongue is down, bring baby to breast, supporting baby at shoulders and base of neck
- Don’t push on the back of the baby’s head
What happens during breastfeeding?
Every time your baby breastfeeds, your body secretes two different hormones. The first hormone is called prolactin, which tells your brain how much milk to make for your baby, based on what milk was removed from the breast. In other words, the more milk removed, the more milk your body will make. For most women, nursing 8-12 times every 24 hours creates plenty of milk for their baby.
The second hormone your body secretes is oxytocin, which helps propel the breastmilk through the ducts in your breasts and down to the nipple for the baby. This is often referred to as “let-down.” Some mothers feel a tingling sensation during let-down, while for others, it goes unnoticed. As the breastmilk begins to flow during the feeding, your baby’s suckling will become deeper and slower and you will often hear the milk being swallowed. This transfer of milk from breast to baby will often last from 5-30 minutes. Allowing your infant to nurse on cue every 1-2 hours will enable you to have a full milk supply.
It is better to allow your baby to nurse until he shows you signs that he is done, rather than to watch the clock and take your baby off after a certain amount of time. Babies usually slow down their suckling, are less vigorous on the breast, unclench their hands and bring their arms to their sides as they come to the end of a feeding. Many will stop and unlatch on their own.
You can tell that your baby has gotten enough because your breasts will become softer to the touch and the feeling of fullness lessens. Your baby might fall asleep and let go of your breast. If not, put a clean finger to the side of your baby’s mouth to break the suction and release the nipple.
If your baby is showing hunger cues, you can change over to the other breast and continue to let your baby feed.
How often should I breastfeed my baby?
We recommend feeding your baby on cue. Bring your baby to your breast as often as the baby asks.
- At first this will typically be every one to three hours, or eight to 12 feedings per day (24 hours).
- At about two weeks of age, your infant will be back to their birth weight, and at this time may go longer periods at night without nursing (4-5 hours), while continuing to feed on cue for 8-12 feedings per day or 24 hours.
*A newborn should not go longer than 4 hours without a feeding, including overnight.
How long should each feeding last?
Should I alternate breasts, and if so, how often?
Your baby’s preference will ultimately determine the method for how often you’ll alternate breasts during feedings. Some babies are able to satisfy themselves nursing on just one breast during each feeding, while other babies nurse on both breasts.
Watch your baby for hunger cues after nursing on the first side. If your baby is still hungry, then nurse on the other side. Your baby will show you when a feeding is over. Alternate the sides on which you start your feeding, and do not worry about nursing the same amount of time on each side during a feeding.
Should I burp my baby during breastfeeding?
Is it normal for my baby to spit up during or after breastfeeding?
How can I tell if my baby is getting enough breast milk?
Common signs that your baby is getting enough breast milk include:
- Your baby seems relaxed and content after feeding.
- Your baby is nursing 8-12 times in a 24 hour period.
- Your baby is back to their birth weight by 2 weeks
- After 2 weeks, your infant is gaining ½-1 ounce per day.
- Your baby’s stool changes from black to yellow in color by day 5.
- By day 6 after birth, your baby has six wet diapers per day and two to three bowel movements every 24 hours.
Trust your instincts. If you’re concerned your baby isn’t getting enough milk, see your Wellstar Pediatrician immediately.
Why are there times when my baby eats more/wants more frequent feedings?
Your baby will go through several growth spurts in the first year. During these times, your baby may require more frequent feedings. Signs your baby may be going through a growth spurt:
- Wakes more frequently
- Unlatches, fusses a bit, and re-latches
- Wants to feed more frequently than normal
- Has been sleeping through the night, but now wakes up several times each night
- Wakes early from naps
There is no set schedule for growth spurts, but approximate ages are:
- 2-3 weeks
- 6 weeks
- 3 months
- 6 months
- 9 months
Growth spurts typically last 2-3 days. The best solution for feeding your baby during growth spurts is to follow your baby’s cues for more frequent feedings. Your body will respond by making more milk to meet your baby’s needs. Call your Wellstar Lactation Consultant or Pediatrician if you need further assistance during a growth spurt.
When should I start weaning my baby?
You can begin weaning your baby at the time that is right for your family. The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommend all babies be exclusively breastfed for the first six months, with introduction of solid foods at that time, while continuing to breastfeed for 1 year or longer. The World Health Organization (WHO) recommends six months exclusive breastfeeding, with introduction of solid foods at that time, and continuing to breastfeed for 2 years or longer.
How do I wean my baby from breastfeeding?
In some cases it is the mother who decides to wean her baby from breastfeeding, and in other cases it is the baby who decides. Whatever the reason, it’s best to proceed slowly with weaning, both for physical and emotional reasons.
Abrupt weaning can be emotionally difficult for your baby as he/she will have become accustomed to physical closeness during feedings. Gradual weaning is also helpful in decreasing the breast fullness that can occur if you wean too fast.
As the demand for milk decreases with less nursing, your body will respond by producing less. When either of you decide to wean from the breast, contact your Wellstar Lactation Consultant or Pediatrician for advice.
Tips to ease the process:
- Give your baby plenty of extra attention and reassurance during the time you are weaning.
- Play with your child or engage in fun activities in the time that would have been spent nursing.
- Take your time and give your baby time to adjust.
- Before you start weaning, get your baby used to drinking expressed milk from a cup or a bottle.
Do I need to supplement breast milk with vitamins or calcium?
Breast milk contains enough calcium and iron to meet a baby’s normal requirements. Breast milk may not contain enough Vitamin D, which helps your baby absorb calcium and phosphorous, both of which are essential for strong bone development. Ask your Wellstar Pediatrician about Vitamin D supplements for your baby’s diet.
What is breast engorement and how can I prevent it?
Breast engorgement can occur after the onset of lactation. Engorgement occurs when the breasts aren’t emptied and can cause discomfort that varies from mild to severe. Swollen, tender, full-feeling breasts are indicators that you may be experiencing engorgement. Often times, your first time experiencing this is when your mature milk is coming in during the first week after birth. You may also experience engorgement when your baby starts sleeping through the night, begins eating solid foods, or you return to work.
Take these steps to help prevent the occurrence of breast engorgement:
- Feed your baby frequently, and if you are separated from your infant, pump for comfort.
- Help generate the flow of milk with warm, wet compresses on the affected areas for a few minutes prior to breastfeeding or pumping.
- Some women find it helpful to use a breast pump for just a few minutes, and then let the baby nurse to relieve the engorgement.
- Some women may find a brief application of ice to the breast and armpit area after feedings helps to relieve the discomfort.
- If engorgement persists, you can call and speak to a lactation consultant at one of the Wellstar Breastfeeding Centers, or call your obstetrician or midwife.
Should I stop breastfeeding my baby if I become sick?
In most cases, you can continue to nurse your baby when you have a variety of illnesses, including colds and the flu. Your body makes antibodies against these germs, which are passed along to your baby through your breast milk. Exceptions to breastfeeding include treatments with radioactive compounds and anti-cancer drugs. Consult with your Wellstar Lactation Consultants or pediatrician when you’re ill to be sure the medications you’re prescribed are safe to use while nursing.
Where can I get breastfeeding supplies and advice?
Your breastfeeding concerns are very important to us. The lactation consultants at the Wellstar Breastfeeding Centers can help with many breastfeeding problems, even after you go home from the hospital. Some examples are:
- Sore nipples/breast pain
- Breastfeeding after surgery
- Low milk supply
- Baby not latching to breast
- Baby not gaining weight well
- Questions about medications while breastfeeding
- Breastfeeding if mom or baby is ill
- Breastfeeding twins or multiples
- Combining work with breastfeeding
- Pumping questions/instructions
Wellstar’s Breastfeeding Centers provide inpatient lactation consultations as well as lactation supplies and products needed for the breastfeeding mother. Items include baby scales and hospital-grade electric breast pump rentals, nursing pillows and stools, breast pads, nipple shields, or special needs feeders. Our certified bra fitters can also fit you for a breastfeeding bra.
The Wellstar Breastfeeding Centers also offer private outpatient consultations, by appointment, for assistance after you go home. As a courtesy, lactation consultation fees will be billed to your insurance company. Please check with your provider for more information regarding this service.