The Normal Course of Breastfeeding from Kellymom.com
Nursing your newborn--what to expect during the early weeks
The First Week
How often should baby be nursing?
Frequent nursing encourages good milk supply and reduces engorgement. Aim for nursing at least 10 - 12 times per day (24 hours).
You CAN'T nurse too often--you CAN nurse too little.
Nurse at the first signs of hunger (stirring, rooting, hands in mouth)--don't wait until baby is crying. Allow baby unlimited
time at the breast when sucking actively, then offer the second breast. Some newborns are excessively sleepy at first--wake
baby to nurse if 2 hours (during the day) or 4 hours (at night) have passed without nursing.
Is baby getting enough milk?
Weight gain: Normal newborns may lose up to 7% of birth weight in the first few days. After mom's milk comes in, the average
breastfed baby gains 6 oz/week (170 g/week). Take baby for a weight check at the end of the first week or beginning of the
second week. Consult with baby's doctor and your lactation consultant if baby is not gaining as expected.
Dirty diapers: In the early days, baby typically has one dirty diaper for each day of life (1 on day one, 2
on day two...). After day 4, stools should be yellow and baby should have at least 3-4 stools
daily that are the size of a US quarter (2.5 cm) or larger. Some babies stool every time they nurse, or even
more often--this is normal, too. The normal stool of a breastfed baby is loose (soft to runny)
and may be seedy or curdy.
Wet diapers: In the early days, baby typically has one wet diaper for each day of life (1 on day one, 2 on day two...). Once
mom's milk comes in, expect 5-6+ wet diapers every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons
(45 mL) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet.
Read more about breast changes, weeks 2-6 of breastfeeding,
Choices that can affect breastfeedingby Andrea Eastman, MA, CCE
As I was preparing for a meeting last month, I decided that I wanted to focus on childbirth and breastfeeding.
My goal was to list as many obstetric interventions as possible and then discuss how each and every one could directly or
indirectly influence the initiation and duration of breastfeeding.
At the top of the list was MIDWIFE or DOCTOR. We discussed how important it is for the caregiver's
philosophy of birth to match our own. We also talked about the difference between seeing birth and breastfeeding as normal
life events, and seeing birth as an illness, and breastfeeding as fraught with complications.
PREP, SHAVE, and ENEMA were next on my list. The important one here is the enema. An enema taken during
labor stimulates the bowels. In addition, it may also make the contractions during labor stronger. Stronger contractions may
make a mother choose medication to deal with the pain, and every type of maternal medication gets to the baby, and can affect
the baby's ability to stay awake and suck properly.
Next on my list was LABORING IN BED. Women who labor in bed often experience more pain and a slower
labor. More pain means that she may ask for drugs. A slower labor means that she is at risk for "failure to progress", which
may mean pitocin augmentation, the accompanying IV drip, etc. Pitocin will mean stronger, more painful contractions. Laboring
in bed, possibly flat on her back, the woman's uterus is compressing the blood vessels that supply the placenta and the baby
with oxygen. Too little oxygen and stronger contractions may mean that the electronic monitor could show fetal distress. Failure
to progress, incoordinate uterine contractions, and fetal distress are all reasons to have the doctors do cesarean surgery.
Cesareans and the accompanying medications can affect breastfeeding.
Next was FASTING (NO FOOD OR DRINK) except for the occasional ice chips. Studies have shown that allowing
women to eat and drink during labor can reduce the length of the labor by as much as 90 minutes. Labor is hard work, and the
body needs the energy to work effectively. Dehydration means more painful contractions and slower labor. Fatigue combined
with a slower labor may make a woman feel that she needs medications. And we all know that medications get to the baby and
can affect breastfeeding.
INTRAVENOUS FLUIDS (IV) given to women in labor (such as glucose) can keep the glucose levels in mom's
and baby's blood abnormally high. The body compensates by making extra insulin. Suddenly the baby is born, it's glucose supply
is cut off, and it has all that extra insulin. This could lead to neonatal hypoglycemia, which may mean a trip to the Neonatal
Intensive Care Unit (NICU), which means separation from mom. Dr. Righard's studies have shown that separation from mother
after the birth can have almost as dramatic effect on the baby's ability to latch on as maternal medications. Some women on
IVs experience fluid overload. Extra fluids in the woman's body means perhaps worse engorgement, which can affect a baby's
ability to latch on properly. Engorgement can lead to the death of the cells responsible for secreting milk, thus having an
impact upon the mother's milk supply.
PITOCIN, in addition to causing stronger, more painful contractions, is also an anti-diuretic, which
means that it makes the body retain more fluids which means more engorgement, which can have a negative effect on breastfeeding.
Pitocin use also increased the likelihood of jaundice in the baby.
ANAGLESIA - demerol, stadol, nisentil, nubain - affects the perception of pain. Some women experience
relief, some women hallucinate. All of these drugs cross the placenta and can affect the baby. Narcotics such as these can
lead to what nurses call "blue baby syndrome". Lower APGAR scores can affect the care required by the baby, and thus may mean
separation from mother to monitor its breathing, etc. These drugs can also affect the baby's desire and ability to breastfeed.
A sleepy baby combined with fluid-overload engorgement is a serious threat to breastfeeding. If the sleepy baby gets jaundiced,
then the pediatrician may order supplements, etc. And we all know what supplementation can do to the mother's confidence and
her milk supply.
ANESTHESIA - epidural, spinal, intrathecal - removes the sensation of pain, as well as stop the production
of endorphins in the mother's body (the natural painkillers). Yes, epidurals can affect the baby. The degree to which the
baby is affected depends upon the particular "cocktail" used by the anesthesiologist. There are many studies that show the
effects of this type of medication can be longer lasting. Epidurals mean that the mother will have to have the whole host
of accompanying interventions: IV; internal electronic fetal monitor; urinary catheter; automatic blood pressure cuff; possibly
pitocin augmentation, etc. Her labor may slow down, her uterus may contract ineffectively. She won't be able to feel the contractions
to push her baby out, which may mean forceps or vacuum extraction, and an episiotomy. It may affect her labor so dramatically
that the doctor orders a cesarean. If they let the medication wear off so she can push, she will be deprived of the endorphins
that would have helped her deal with the intense sensations, and will be left to deal with the fresh, new pain of transition
on her own. This may make her request a "top-off", which can mean a prolonged second stage. Doctors rarely let a woman push
for more than two hours, which may mean a cesarean, even if she has dilated to 10 cms. And cesareans can affect breastfeeding.
Epidural use, whether for vaginal birth or cesarean birth, can increase the likelihood of jaundice in the baby. All drugs
must be broken down by the infant's immature liver. The liver is also responsible for processing the bilirubin (making it
water soluble) so that it can be excreted by the baby.
ARTIFICIAL RUPTURE OF MEMBRANES (AROM) means that the cushioning forewaters are gone. This can dramatically
increase the pain felt with each contraction. The baby's head is suddenly compressed more with each contraction, which may
cause the normal dip in the fetal heart tones to dip a little farther. The doctor may interpret this as fetal distress and
order a cesarean.
EXTERNAL AND INTERNAL ELECTRONIC FETAL MONITORING (EFM) was developed by physicians determined to detect
fetal distress early and therefore lower the incidence of cerebral palsy. However, a study published in the New England Journal
of Medicine last year showed that routine EFM has not lowered the incidence of cerebral palsy, and questioned its value in
predicting cerebral palsy. In fact, some doctors have argued that routine EFM has increased the cesarean rate. Thus, EFM can
indirectly have a negative effect on breastfeeding because of the medications used for the cesarean surgery, separation from
VAGINAL EXAMS are painful, require a woman to be flat on her back, can lead to premature rupture of
membranes, increased risk of infection, and can be misleading if they are overdone, and if they are done by different people.
Imagine laboring for hours, and you hit a plateau. You have continued hard labor, but the vaginal exam done to check your
dilation every 30 minutes shows no progress. You will probably feel very discouraged. They may put you on pitocin, if you
aren't already on it. You may run out of time, according to the doctor. He will come in, check you, declare that there is
no way THIS baby is coming through THIS pelvis, and order a cesarean for failure to progress, or cephalopelvic disproportion,
or incoordinate uterine function. We have already discussed the negative effects that pitocin and cesareans can have on breastfeeding.
DIRECTED, SUSTAINED PUSHING - you know, the circle of people standing around the woman flat on her
back or propped up so she is sitting on her tailbone, with her elbows in the air, holding her legs apart, everyone shouting
PUSH, PUSH, PUSH, and counting to 10 over and over again! Holding your breath while closing your glottis raises the pressure
in your abdomen, which has a negative effect on the blood going back to your heart and then to the lungs. This means that
the baby is getting no new oxygenated blood as long as you are pushing this way. Granted, the baby is not getting any new
oxygen when the uterus is contracting, but many women push much longer than the actual contraction. This lack of oxygen can
negatively affect the baby. The EFM may show fetal distress, and an emergency cesarean may be preformed. Interestingly, this
type of pushing actually causes the condition - fetal hypoxia - that it was intended to prevent! So you see how this can have
an indirect effect on breastfeeding. In addition, fetal hypoxia is one of three general categories of pathological jaundice.
LITHOTOMY POSITION - flat on your back - in addition to what we discussed above, pushing your baby
uphill, against gravity can lead to a prolonged second stage. This can lead to fatigue, which may mean the woman is unable
to push her baby out. The doctor may diagnose this as shoulder dystocia, remove the baby with forceps after doing a huge episiotomy.
Next time, she may be convinced that she can't push out her babies, that her pelvis is inadequate, and she may be talked into
a scheduled cesarean.
EPISIOTOMY - yes, this can affect breastfeeding! If your bottom is sore, you sit back farther on your
tailbone. This can affect your ability to properly position your baby, which may lead to sore, cracked, bleeding nipples -
as well as a slow growing baby who cries all the time.
WASHING THE BABY, EYE TREATMENT, SEPARATION FOR OBSERVATION, USE OF A WARMER - all of these things
may mean separation from mom, which can dramatically affect the newborn's ability and willingness to latch on and suck effectively.
GLUCOSE WATER AND PACIFIERS - can satiate a baby with empty calories, and cause infrequent stooling
in the newborn, and thus increase the likelihood of jaundice. This can also lead to nipple confusion, which means sore nipples
for mom, a baby that cries alot, and grows slowly. Mom may be convinced she doesn't have enough milk and may decide to supplement
with formula, which can reduce the mother's milk supply and lead to a vicious cycle that ends with the baby refusing the breast
and the end of breastfeeding for this baby.
CIRCUMCISION can affect the baby's ability and desire to breastfeed. Pain disorganizes babies. Newborns
feel pain more exquisitely. For babies who are already having trouble latching on and nursing, it may be wise to postpone
until the baby is nursing better. I do mention that it can have an effect on breastfeeding, since pain disorganizes babies
and their sucking.
As you can guess, this was a highly charged meeting. The mothers seemed to NEED to talk about what
happened to them. We discussed the fact that it is still possible to successfully breastfeed if you have every intervention
on this list (and many of them had). I ended the meeting by telling them that they each need to give birth where they feel
most safe and to choose a birth attendant with a philosophy of birth similar to their own. I also told them that if they listen
to their bodies and trust their intuition, they already KNOW how to birth their babies!
Copyrightę 1997 Andrea Eastman All rights reserved.
Click Here For Full Report
Study Finds Record High Levels of Toxic Fire Retardants in Breast Milk from American Mothers
In the first nationwide tests for chemical fire retardants in the breast milk of American women, the
Environmental Working Group (EWG) found unexpectedly high levels of these little-known neurotoxic chemicals in every participant
The average level of bromine-based fire retardants in the milk of 20 first-time mothers was 75 times
the average found in recent European studies. Milk from two study participants contained the highest levels of fire retardants
ever reported in the United States, and milk from several of the mothers in EWG's study had among the highest levels of these
chemicals yet detected worldwide.
These results confirm recently published findings from University of Texas researchers, as well as
other U.S. studies, that American babies are exposed to far higher amounts of fire retardants than babies in Europe, where
some of these chemicals have already been banned. In the United States, only California and Maine have acted to restrict the
use of these chemicals.
Breast milk is best
Even women with very high levels of fire retardants in their breast milk should continue
to breastfeed their babies. There are two main reasons why. First, adverse effects on learning and behavior are strongly associated
with fetal exposure to persistent pollutants, not with breast milk exposure. And second, breastfeeding appears
to overcome some of the harmful effects of high fetal exposure to persistent chemicals. Breast milk data are very useful,
however, because they are an excellent measure of fetal blood levels, and fetal exposure to fire retardants.
Like PCBs, their long-banned chemical relatives, brominated fire retardants are persistent in the environment
and bioaccumulative, building up in people’s bodies over a lifetime. Brominated fire retardants impair attention, learning,
memory, and behavior in laboratory animals at surprisingly low levels. The most sensitive time for toxic effects is during
periods of rapid brain development. Fire retardants in breast milk are one measure of the chemicals that a mother passes on
not only to her nursing infant, but more importantly, to the unborn fetus, which is most vulnerable to impacts from neurotoxic
Brominated fire retardants are in hundreds of everyday products, including furniture, computers, TV
sets and automobiles. Studies worldwide have found them to be building up rapidly in people, animals and the environment,
where they persist for decades. Research on animals shows that fetal exposure to minute doses of brominated fire retardants
at critical points in development can cause deficits in sensory and motor skills, learning, memory and hearing. Levels of
particularly toxic and bioaccumulative types of brominated fire retardants, known as polybrominated diphenyl ethers (PBDEs),
are by far highest in the United States and Canada compared to levels in any other country. Together, the US and Canada account
for almost half of global PBDE use.
For Full Article Click Here
Your Walking Medicine Chest
Issue 133, November/December 2005
Mother's milk is the perfect panacea for a whole host of ailments - from pinkeye to acne. Just
a squirt will do the trick!
Most people know about the health benefits of breastfeeding, but few know about breastmilk's medicinal
benefits. Breastmilk is sterile, antibacterial, and has many healing properties. It can be used to treat a variety of ailments
and can be applied topically for eye and ear infections, minor skin injuries, sore or cracked nipples, diaper rash, sore throats,
and stuffy noses. Is breastmilk an everyday cure-all? Read on and judge for yourself.
Click Here For Full Article
"Mommy, I Want Nummies!" The Benefits of Nursing Past Three
By Jennifer Margulis
Issue 115, November/December 2002
Helen Neumann remembers running into her parents' bedroom during a nighttime thunderstorm and climbing
into their bed. Four years old, she opened the snaps of her mother's flowered flannel nightgown and nursed. "I remember it
as warmth," explains Helen, who lives in Iowa City. "The flannel was soft; I felt safe there."
Although her older sister weaned herself at 11 months, Helen continued to nurse at night until she
was about five years old. Now, at age 30, with a baby of her own, Helen is still close to her mother, talking to her on the
phone almost every day and visiting frequently. Helen's daughter, Irene, was born blue and floppy, after more than 40 hours
of labor, and was immediately taken to the Neonatal Unit of Mercy Hospital. Still, Helen had the wherewithal to insist on
nursing: she picked her tiny newborn up out of the incubator, IV and all, and put her on the breast. Some babies, like Helen
Neumann's sister, wean themselves easily and spontaneously. Other children, like Reed Carr, do not voluntarily stop nursing
until they are toddlers. "Reed nursed before he went to sleep and on waking," says his mother, Catherine Carr, a La Leche
League Leader in Hardwick, Massachusetts. "After his last nursing he turned to me, said, 'Thank you, Mom,' and that was it."
Catherine, who had never met anyone who had nursed a baby for longer than a few months, had hoped to
be able to nurse for a year. She quickly realized that weaning at a year did not make sense for her children. "At that point
they are still babies. I couldn't imagine stopping. If it was right for them, it was right for me."
Click Here For Full Article
Not Just for Babies: 10 Good Reasons to Breastfeed Your Toddler
By Elizabeth Bruce
Issue 103, November/December
The average American may not be ready to admit it, but myriad cultures past and present have accepted
the fact that babies past infancy can benefit from nursing. The !Kung of Africa represent the natural state of human feeding.
Mothers of this nomadic tribe breastfeed each child for up to six years. Sherman Silber, MD, points out that "the human species
has spent more than 90 percent of its existence leading this type of nomadic hunter/gatherer life, and 'civilization' with
its pressures is too recent to have had any appreciable impact on their genetic makeup."1 In our culture, many men and women
are uncomfortable with the functional role of breasts, probably because of our national obsession with breasts as sexual objects.
Unfortunately, people's psychological discomfort seems to increase as the nursing baby grows. Most Americans choose to wean
their babies at about six months.
Whatever the psychological complexities may be, we can no longer deny the health and social benefits
of prolonged breastfeeding. Even the conservative American Academy of Pediatrics now officially recommends that breastfeeding
continue for at least 12 months.2 But what about nursing through a baby's second or even third year? Is breast still best
for toddlers? If we can get past our collective ambivalence, I think the answer is a resounding "yes."