Announcement!

I am extremely excited to announce the release of my breastfeeding book, The "Yes, It's Normal!" Guide To Breastfeeding, available NOW in the Amazon Kindle store and in print at Lulu.com. It's a short, encouraging book in question-and-answer form, along with appendices that offer additional useful information. If you or someone you know is pregnant or has a new baby, you really should check this book out. At just $1.50 for Kindle, what do you have to lose? And, if you want to make it a nice shower gift or new-mom present, it's available for $9.99 in print with a full-color cover and spiral-bound for convenience. I am also working on creating an ePub version so that it will be available for other e-book readers and in other e-book stores.

Click here for the Kindle version.
Click here for the print version.

I've posted some excerpts here, so you can get a sense of what the book is like. Please pass this link along to anyone you think might be interested!

Excerpts from The "Yes, It's Normal!" Guide To Breastfeeding
by Jessica Shaham
Copyright (c) 2011 Jessica Shaham. All rights reserved.

From the introduction:

What’s in this guide?

It’s 3:00 in the morning. You’re up with your four-day-old baby, nursing for the sixteenth time today. You’re tired, your nipples are sore, and you’re not sure if the baby is actually getting anything to eat. You’re seized with the sudden fear that you’re doing something wrong, but who can you call at three in the morning for help? You pull out your iPhone and Google “Is my baby getting enough milk?” You’re bombarded by links to websites full of what looks like good information, but some of them are contradictory, and there’s just so much out there. How do you know which sites to trust? You glance over at your pile of “mommy” books, consider grabbing one of the breastfeeding books you registered for. But there are 21 different pages to look at all related to milk supply!

What now?

Now you open up this book on your Kindle app. You see in the table of contents, “How do I know if baby is getting enough to eat/drink?” You scroll to the page. And there, right in front of you, is a clear, half-page answer. You read it quickly and put the Kindle down. That’s all you needed to know. Your baby has fallen asleep, and you’re ready to join him.

That’s what this guide is for. Many new mothers share similar concerns, and I’ve tried to compile the most common questions that come up in the first few weeks of your baby’s life and give you short, reassuring answers to those questions. If and when you need more information on a particular topic, I’ve also provided the direct address of a recommended webpage that will have more answers and detailed information for you. There’s a lot of misinformation out there. It’s important to know which websites to trust and who to go to for advice. I’ve pointed you toward reliable, up-to-date sources that I use regularly, so that when you do have a chance to do more reading, you’ll know where to go.

After the question-and-answer part of the guide is a glossary that will define many of the common words and phrases associated with breastfeeding. You will also find a few appendices with additional information you might find interesting or useful as your nursing relationship begins and continues.

When in doubt, though, contact a local International Board Certified Lactation Consultant (IBCLC), a local La Leche League leader, or an experienced breastfeeding mother you trust for personalized help on a particular question. If you have any concerns about your baby’s health, contact your pediatrician immediately.
Though I have done plenty of reading and have experience nursing a baby, I am not a medical professional, and my advice is not a substitute for consultation with a qualified expert. The advice provided in this text is for your information only, and you should use your best judgment when deciding what’s best for your health and the health of your child(ren). Sometimes I reference studies that I found in my own personal research, but I have not verified the results of the studies or their methodologies. My goal is to provide a helpful and reassuring introduction to breastfeeding.

To find a La Leche League meeting near you, visit the La Leche League International website at www.llli.org and use their “Find local support” feature to locate a group in your area.

To find a list of IBCLC’s near you, visit the International Lactation Consultant Association website at www.ilca.org, go to the Directories tab and select “Find a Lactation Consultant” (http://www.ilca.org/i4a/pages/index.cfm?pageid=3337).

Sample Questions:

What is the number one piece of advice you would give a new mother about breastfeeding?
 

The first thing I would say to any new mother is, “Keep nursing!” The more you nurse, the easier it gets, and the more you nurse, the more milk you make. You’ll often hear “breastfeeding is normal” or “breastfeeding is natural,” which is true, but it’s important to remember that breastfeeding is a skill that must be learned and practiced, by both mother and baby. Just like with any skill, the more you do it, the better at it you get. When my first son was born, I was so convinced that breastfeeding was natural and instinctive that I was very discouraged by how complicated it all seemed. I felt like I needed three or four hands. When my second son was born, despite all the reading I had done, it still took several weeks for me to find comfortable positions and the easiest way to get him latched on and sucking as quickly as possible. As awkward as you may feel in the first few weeks, you’ll find it getting easier by the day if you just keep at it.

The second basic piece of advice I always offer is, “Give it six weeks.” The first few days and weeks can be challenging, and even painful, as you adjust to having a new baby and all the new demands placed on you by this change in your life. If you persevere through the first six weeks, nursing on demand, getting used to the baby’s cues and needs, it only gets easier. I’ve seen new mothers go from “Why is this so hard? I don’t want to do this anymore!” to “Oh yeah, I think I’ll nurse for at least a year,” in the space of just a few weeks. There’s something about that six-week point after which everything starts to seem easier. Also, as the baby grows, breastfeeding gets easier just because the baby is stronger and more able to support himself. If you stick it out for those first six weeks and put in the work at the beginning, you’ll be able to continue your breastfeeding relationship for as long as you and your child desire.

What do I do if baby needs to eat while we’re out and about?

The idea of nursing outside the house can be intimidating. Most of us are not interested in flashing our breasts to the general public. Before my son was born, nursing in public was one of my great fears. I couldn’t see myself lifting up my shirt in public like that. Also, if you’re used to nursing in a particular chair at home, or using a support pillow such as a Boppy or My Brest Friend, it can be hard to get comfortable when you don’t have one available. I do recommend that you practice nursing in other positions or places in your own home so that you can find ways that work for you. If you’re worried about what people might see, try nursing in front of a mirror a few times. You’ll see that from the front, the baby hides almost everything.

 
You should know that nursing in public is absolutely legal, and the majority of U.S. states and the Federal government have laws protecting the right of mothers to breastfeed in public, and that public breastfeeding is generally not considered “indecent exposure.” It’s also nice to know that many malls offer a “family care” area or something similar that is equipped with private nursing booths and comfortable chairs as well as diaper-changing facilities. I was pleasantly surprised to find such a place in my local mall when my son was a baby. Baby-oriented stores also often have “mother rooms” for the same purpose. You can ask a staff member if you’re not sure where to find it. Supermarkets and other stores will often try to accommodate your request for a private place to nurse, either by informing you about a lounge area in the restroom or allowing you to use the employee lounge. This will vary from store to store. I, frankly, would rather nurse just about anywhere but a public restroom, but if you’re in need of privacy, that may be an option for you. I also found that most department stores were happy to allow me to nurse in an empty fitting room. I also liked nursing in my car when that was an option.

If a private area is not available, or you’re not in a position to seek one out but you are uncomfortable with the idea of possibly exposing a breast, there are options for cover-ups, as well. You can purchase nursing covers or shawls in many fun patterns and colors. There are also specially designed nursing shirts. I purchased a nursing shirt from Motherhood Maternity* that looks like a nice v-neck+camisole unit. The v-neck can be moved aside, where a cutout in the lining allows access to the breast without exposing anything else. Old Navy also sells similar types of shirts. Nursing, like pregnancy, is becoming fashionable and mainstream, and it is easier and easier to find solutions like this. 

Another option I used often is to wear two layers, a camisole or tank top under a loose t-shirt or blouse. Lift up the top shirt, pull down or open the camisole/tank top, open your bra, and nurse. Your stomach, sides, and back are covered by the camisole, and everything else is covered by the loose top shirt.

 
Despite my qualms in the beginning, I quickly became used to the idea of nursing in public. I felt like I was in my own little “nursing bubble,” and even though there were people around me, I didn’t particularly care what they saw or what they thought. The only thing that mattered was feeding my son. Some women even become comfortable enough with nursing in public to continue walking around while nursing the baby, although I never quite made it to this point. You can also “wear” the baby in a front carrier, sling, or wrap and learn to nurse while wearing the baby. This is usually the most discreet and efficient way to nurse in public, if you can manage it, and you get the bonus of having your hands free. I eventually did figure out how to nurse in my Asian-style front carrier (called a mei tai), and I found this to be incredibly convenient when I had to nurse the baby and keep track of my toddler at the same time, especially in a crowded place like the zoo! 

Rest assured, there are options, and it can be done. And I like to think that the more women we see nursing in public, the more normal nursing in public becomes, and the less embarrassed anyone will need to be.

*I am not endorsing any specific brand, nor am I being compensated for naming any particular store or manufacturer.


Other Questions Include:

• How often should my baby be eating?
• Do I have to switch sides during a feeding? How long should the baby stay on each breast?
• My baby is suddenly eating nonstop. What’s going on? Do I have enough milk for him?
• Does what I eat get into the breastmilk? How do I know if something I’m eating is bothering the baby? 

Appendices:
Appendix A: Introducing Solid Foods
Appendix B: Weaning Your Baby from the Breast
Appendix C: “Off-Label” Uses for Breastmilk
Appendix D: Pumping and Storing Breastmilk
Appendix E: Bad Advice and Hospital Practices that Interfere with Breastfeeding Success

-----

There's a lot more in the book - 28 questions, plus a glossary and the five appendices. The print version is 73 pages, so it's shorter than your average breastfeeding book while still containing tons of useful information.

Oh, and the Kindle app is available for Android, iPhone/iPad/iPod, Blackberry, and PC for free, so even if you don't have a physical Kindle, you can still download and read my book on any of those devices, as well!

If you have any questions about the book, please feel free to ask me in the comments. I'll respond promptly.

Breastfeeding Basics - Part V: Six Months to One Year

Thanks for sticking with me so far. I recommend you read the previous posts in this series before jumping in here, unless you have a baby in this age range and you just can't wait to find out what wisdom I have to impart.

Introduction, Parts I, II, III, IV

By now, you should be quite comfortable with nursing. You've gotten this far, which means you've met the first part of the recommendations from the AAP, the WHO, and many other health agencies in exclusively breastfeeding for the first six months. Breastfeeding should be feeling quite routine by now. You know your baby's cues. You've gotten through growth spurts. Your baby may even have a tooth or two, or will very soon. Your baby is growing and healthy and doing all kinds of "tricks," like rolling over, and probably sitting without support. Some babies even begin crawling around six or seven months of age. Your baby is interactive, loves to play, grabs and holds objects of interest and brings them to her mouth.

Introducing Solid Foods


So what's next? Well, at six months of age, if you feel you and your baby are ready, you can begin to introduce solid foods! "Solid" foods means any food that is not breastmilk.

A few things you should know before I start:
First of all, you don't have to give solids if you don't want to or if you feel like your baby isn't ready. Some babies of this age still don't quite know what to do with food when offered, while others have been trying to grab and eat your PB&J for a month already. Breastmilk still provides all of the nutrients, fats, and sugars your baby needs. Before the age of one or so, any solid foods are just for practice, for baby to get used to new textures and flavors and to learn to bring food to the mouth, "chew" it, and swallow it. You don't have to worry if it seems like your baby isn't getting a "full meal" of solids at first. Getting a hunk of banana from the plate to his mouth is an accomplishment all by itself, and getting that banana into his mouth and swallowing it is another. That's why he needs to practice!

Do not give whole (cow's) milk until your baby is over 12 months old.


There are two ways to introduce solid foods. One is to begin with baby cereals and/or vegetable and fruit purees and feed your baby with a spoon. The other is to give your baby safe finger foods and let him learn to pick them up and eat them at his own pace. My first son insisted on being fed purees for a long time before he started understanding how to feed himself, while my second son wanted nothing to do with spoons and purees and wanted finger foods almost from the start. That's not to say he ate much at first, but he learned. Like I said, it takes practice!

So where and how to start? Well, you want to start with a simple food. Rice cereal (found in the baby food aisle - we're not talking about Rice Chex, here!) is a popular first food, for two reasons: 1) It is vitamin-fortified, so your baby is getting necessary nutrients (especially iron); and 2) Rice is basically a hypoallergenic food, meaning your baby is very unlikely to have any kind of adverse reaction to it.

The best way to prepare rice cereal is to put a small amount in a bowl and add some expressed breast milk until it reaches the texture you want. Then you feed it to your baby using a small spoon. He may not quite get the idea at first, or he may just not like the taste. Offer a small amount and see how he does. Give him a few tries before you give up. Try it in the middle of the day, when he is alert and happy, and offer the food after breastfeeding, or in between usual feeding times. You don't want solids to replace breast milk meals just yet!

You can also start with pureed vegetables or fruits. Bananas, avocados, squash, peas, sweet potatoes/yams, and pears are all great first foods. Most breastfed babies will prefer sweeter foods first, as breast milk is very sweet. You can peruse the baby food aisle at your local supermarket for ideas on first foods - the jars labeled "Stage 1" are generally bananas, pears, squash, sweet potatoes, or applesauce, all of which are good to start with. I don't have anything against jarred baby foods, but if you prefer to prepare your own baby food, simply steam your fruits or veggies until they are very soft, then put them in the blender until you achieve the desired texture. You can freeze the purees in ice cube trays and thaw one per meal (each cube is one ounce of food), or keep them in empty baby food jars in the fridge, or whatever other solution you like. There are lots of ideas out there on the web! Bananas and avocados don't need to be cooked. You can just mash them with a fork!

If you want to try the finger-food method, you want chunks of food that are big enough for the baby to grasp in a fist or between thumb and forefinger. Banana is fantastic for this, or steamed baby carrots. As your baby gets better at grasping and mouthing the food, you can offer other simple, soft foods, including well cooked pasta, peas, potatoes, etc. Always supervise your baby's eating!

When you introduce new foods, start with simple, one-ingredient foods at first so you can observe for any kind of allergic reaction or intolerance. Introduce one new food at a time and wait a few days before introducing another new food, so that if the baby does have a reaction, you'll know what he reacted to. For example, if you give banana on Monday as his very first solid food, give only banana for a few days. Maybe Thursday you'll introduce pears. For the next few days, only give either bananas or pears. Then on Sunday, you could add carrots. Then you can give bananas, pears, or carrots at any given meal, until you introduce a fourth food a few days later. And so on. Once you've accumulated a "menu" of options, you can offer mixtures, like a banana-pear puree, since you know he can tolerate both bananas and pears. As the baby gets older, you'll introduce more interesting and complex foods, but it's good to start simple and small.

There are lots of good websites out there with ideas on what kinds of foods to offer at what ages. Yogurt is an excellent food to offer around nine months of age. Hold off on allergenic foods like peanuts until after a year. There are also other baby cereals, such as oatmeal and wheat, that are good to add to your baby's diet, if you're going the puree route. Oatmeal has a much higher nutritional value than rice and has a more interesting flavor, as well. You can also just give your baby real oatmeal!

Also, don't give a baby younger than one year honey. Honey can cause botulism, a potentially fatal form of food poisoning, in babies under a year old. Cooking the honey does not kill the spores that contain the toxin. After a year of age, the baby's immune system is mature enough to handle the spores.

Other Developments


During the second six months of life, your baby is learning all sorts of things. His brain is developing incredibly fast. He'll start to recognize his name and other important words. He'll start crawling and maybe walking. Along with mobility and increased understanding comes distractibility! Your busy baby may not want to stay at the breast for a long time anymore, which may be good news for you. He'll eat fast and then hop off to go explore again. Most babies nurse faster and less often after six months, which means you're no longer "tied" to your baby. Plus, once you've successfully introduced solid foods, you can get away for a couple of hours without having to worry about leaving a bottle. Whoever is caring for your baby can give him solid foods to keep him busy until you get back to nurse him! Remember that babies under a year old should still be getting the vast majority of their calories from breast milk, so don't let solids totally replace breastfeeding yet.

By the time your baby is approaching 12 months of age, if he is eating solids well, you may be able to start cutting back on nursing if you want. There is no need to cut back or stop if you don't want to! "Extended" breastfeeding past 12 months is still very beneficial for both you and your baby. In fact, the WHO recommends continuing to breastfeed until at least two years of age! We'll talk more about "extended" breastfeeding in the next section on toddler nursing.

But, if you're ready to stop at a year, I'll still say congratulations! You nursed your baby for a year! You made it! If you want to wean, you can start replacing breastfeedings with whole milk (at 12 months) in a cup or bottle and/or with meals of solid foods. Your baby needs the fats from some kind of milk (breast milk, cow's milk, goat's milk, soy milk, almond milk... something like that) for his brain development, so you'll want to make sure he's getting some kind of milk to drink. Weaning from the breast should be a slow process, for yours and baby's sake. If you wean abruptly, your baby will be very unhappy, and you may have to contend with engorgement and other discomfort. Instead, try cutting back by one feeding every few days, to give your breasts time to adjust milk production to the new, lower demand. If you want, you can continue to nurse once or twice a day, e.g. before bed and first thing in the morning. If you want to stop completely, those two are probably the last ones you'll be able to eliminate. Mid-day feedings are the easiest to replace with other foods.

The next and last post in this series will be about toddler nursing, which is a whole new source of enjoyment and frustration. You may have a taste of toddler nursing already, with nursing gymnastics, distractibility, and new habits that may not be totally desirable. But hopefully you're also finding new reasons to enjoy nursing.

Breastfeeding Basics - Part IV: Six Weeks to Six Months

By now, you've read the Introduction and Parts I, II, and III of this series. I hope that you're finding breastfeeding and mothering in general to be getting easier.

I debated how to divide up the next few sections. I considered doing a post just on the next six weeks, up through three months, and then do a three to six month post. But, I chose to combine these because most of the issues I want to cover could come up really at any time, from birth to six months, and not that much changes from here on out until you start offering solid foods (to be covered in the next part). What I'll do, then, is divide Part IV into two subsections, up through three months and then up through six months, and then cover the more universal issues that may arise.

Six Weeks to Three Months


By now, you've weathered at least two growth spurts. When you come out of the six-week growth spurt and into "after the first six weeks" territory, you'll realize how much your baby has grown. You'll notice that he nurses more effectively, probably for a shorter amount of time, and, if you're lucky, maybe less often as well. In the next six to eight weeks, your baby will start smiling (if he hasn't already), laughing, showing better and better head control, showing interest in grabbing items, and recognizing and showing delight in human faces, especially those of his close family. His hunger signals should become more obvious and readable to you, and you're probably starting to see some real personality emerge. Your baby isn't just a needy lump anymore (no offense, but, really, in those first few weeks, they don't do much but eat, sleep, cry, and poop, right?). He's an enjoyable human being in his own right, and you can actually start to play with him and interact with him.

In addition, you are starting to feel more like yourself again. Sure, you're probably feeling sleep-deprived, but the major aches and pains and soreness and general not-yourself-ness you felt after the birth should be greatly improved. Your postpartum bleeding should be done with or mostly done, you've been back for your postpartum visit with your OB or midwife, and you're much more up-and-at-'em than you have been since the baby was born.

This is a good time to point out the symptoms of postpartum depression. This is only tangentially relevant to this blog post, so I'm pointing you elsewhere for detail. Basically, if you're feeling melancholy, depressed, overly anxious, having disturbing thoughts or desires about harming yourself or your baby, strong feelings of guilt or failure, etc., please seek help. These feelings are not normal and you don't have to live with them or expect to "snap out of it" on your own. There are plenty of resources out there to help identify, diagnose, and treat postpartum depression (PPD), and many of the medications used for the treatment of PPD, if needed, are safe for breastfeeding.

By the time you reach about three to four months postpartum, your milk production should have largely adjusted to the needs of your baby. You'll find you're feeling engorged less often, if at all, and hopefully leaking less (if this was a problem for you to begin with). You may also find, if you're pumping, that it's harder to produce as much for the pump. This is all due to the switch-over from hormonally driven production to demand-based production. In the first phase of breastfeeding, milk production is stimulated and controlled by hormones. As time goes on, the automatically-produced hormones cease, and your baby's demand - the amount of milk she takes in and the frequency of her feedings - instead stimulates the breasts and brain to produce milk in line with what your baby needs.

Be forewarned that there is another growth spurt around three to four months of age.

Three to Six Months


Now is the time to sit back and enjoy the progress you've made. Making it to six months exclusively breastfeeding is a great accomplishment! In these three months, just keep nursing on demand. Don't worry about giving water or other foods. Just nurse your baby when he's hungry!

During this time, you may find your baby is developing some annoying habits. Some babies will suddenly decide they only like to nurse in certain positions or places. Many babies become very distractible around four months of age because they've suddenly become aware of the world around them and want to participate. It can definitely be frustrating to have the baby pop on and off the breast constantly while nursing. Whenever practical, you can nurse in a darkened, quiet room to minimize distractions. At least this way, he'll get a good meal in a few times a day, even if the rest of the day is more erratic. As he gets more used to the world "happening" around him, and he starts to make the connection between popping off the breast and being hungry, he should become more reliable again.

Also during this time, your baby will probably start teething. Symptoms of teething may include excessive drooling, difficulty finding a comfortable position lying down, suddenly refusing to nurse, wanting to nurse more, chewing on hands (or your nipples), chin or cheek rash (due to the drool), diaper rash and mucousy poop (due to swallowing excess saliva), stuffy nose, mild fever (not higher than about 99 degrees Fahrenheit), red, inflamed gums, ear infection or ear ache, difficulty sleeping, and general fussiness. Some babies show almost none of these symptoms, while others may have all of them. Teething can make nursing difficult for both of you, as it may hurt him to suck, and his latch may suffer as he tries to adjust his latch to the changes in his mouth. Also, these symptoms may go on for weeks before a tooth actually comes through. It's usually not quite as hellish as I'm making it sound here, and you'll find effective ways to help soothe and calm your baby. It may be as simple as allowing him to chew on a cool washcloth, or you may want to give him Infant Tylenol (as directed!!) to help dull some of the pain of teething. Once the tooth comes through, you may have to help him readjust his latch once more so that it's comfortable for you.

Bottom teeth should never come in direct contact with your breast, as a baby with a proper latch should put his tongue over his bottom teeth. The top teeth should rest only lightly on the breast and not dig in. If you have tooth marks on your breast, you may need to help him readjust his latch. Often, he will adjust it on his own in a day or so as he figures out what to do with this new thing in his mouth.

If your baby bites you during this time, it is typically not meant aggressively. He may just be seeking relief from the teething symptoms. The best way to deal with biting while nursing is to immediately put the baby down, make an exaggerated sad face, and say "No bite! That hurts Mommy!" Then allow him to nurse more. If he associates biting with not nursing, he should stop biting. If you yelp or make a funny noise but don't withdraw the breast, he may think it's funny and start biting more often just to see your reaction. It's difficult, and it hurts, but you definitely want to stop this behavior quickly if it happens.

Common Issues


Thrush
Thrush is an infection caused by yeast. Thrush can be present on your nipples or in the baby's mouth or both. It is passed back and forth by nursing. Symptoms of thrush in the mother may include suddenly very sore nipples, especially at latch-on, pink or red or scaly nipples, cracking or bleeding nipples despite no change in baby's latch, a burning sensation within the breast during nursing or let-down, concurrent vaginal yeast infection. Symptoms of thrush in the baby include whitish patches in the mouth that do not wash away, pain in the mouth, excessive gassiness if the yeast invade the digestive tract, yeasty diaper rash. Mother and baby may show some or all of these symptoms, possibly not simultaneously. It can be very difficult to positively diagnose thrush.

There are many treatments for thrush. Some work better for some people. You may need to work at it for a few weeks to find the best treatment for you and your baby. Options range from prescription Nystatin (either cream for you or an oral suspension for baby's mouth and for your nipples), over-the-counter Monistat or Lotrimin (cream to apply to your nipples), gentian violet, grapefruitseed oil, or a combination of the above. A good place to get ideas for how to identify and treat thrush can be found here.

Plugged Ducts and Mastitis
A plugged duct is exactly what it sounds like - when a milk duct become clogged with solidifying milk. This usually occurs due to unresolved engorgement but can happen any time, especially if your baby has gone longer than usual without nursing. It can also occur if you are wearing restrictive clothing such as a bra with an underwire that is not properly positioned.

A plugged duct must be treated, as it can lead to mastitis, which is an infection of the milk duct. Untreated mastitis can lead to abscess or even loss of milk. It is important to identify and treat plugged ducts and mastitis promptly.

A plugged duct feels like a sore spot on the breast. I associate the feeling of a plugged duct with the way a bruise feels or a tender muscle after a cramp or strain. It will be a single spot on your breast, and you can usually feel a lump at that spot if you prod with your fingers.

To treat a plugged duct, nurse on the affected breast as often as possible (but don't let the other side become too engorged!). You can also pump or hand-express in between feedings. Keep the breast as empty as possible. Massage the affected area as you nurse and pump to encourage the plug to break free. Apply moist heat to the site of the plug to encourage milk flow. Direct the hot water from the shower to the breast as well, and massage while applying heat or in the shower. Get plenty of rest and drink lots of fluids to keep your immune system as strong as possible to fight off infection. After about 24 hours, you should find yourself feeling better. Sometimes the site of the plug may feel tender for a day or two after the plug is released.

Symptoms of mastitis include general fatigue, possible fever, increased pain in the affected breast, redness on the outside of the breast that corresponds to the site of the plugged duct, and flu-like symptoms. These symptoms usually come on quite suddenly and in conjunction with a plugged duct. Begin treating the plugged duct and rest and drink plenty of fluids. If your home treatment is effective, you should feel better within 12 to 24 hours. If your symptoms get worse, or you do not feel better within 24 hours, call your doctor, as you may need antibiotics to help clear the infection.

Pumping and Storing Milk
You may need to return to work after six weeks, or you may decide that you'd like to be able to be away from your baby during the day for other reasons. If you plan to continue exclusively breastfeeding, you'll need to pump and store breastmilk for the baby to eat while you're away. It is best to start pumping a few weeks before returning to work. I'm not going to get into a lot of detail here, as this is meant to be short. I'll just give you a few highlights.

1. Pumping takes practice. Your body is used to responding to your baby's sucking, not to a pump. You'll need to figure out ways to stimulate let-down with the pump. Some helpful hints include keeping a picture of your baby with you when you pump, relaxing as much as possible while pumping, not looking at the pump while using it, having something nearby that you associate with nursing (even a video or audio recording of your baby on your phone can help!). 
2. You want to pump more than you need. You may not want to have too much more than you need, but you may have "off days" where you don't produce as much, or you might spill your milk one day (boo!), or you might have a mommy-brain moment and forget to properly refrigerate your milk, or your baby may suddenly be extra-hungry one day and drink more than usual while you're gone. Having extra milk in the freezer as backup will be helpful!
3. Pump on a schedule. If possible, pumping on a regular schedule will mimic your baby's reasonably regular feeding habits, stimulating your breasts to produce the milk you need when you need it.
4. Storing milk: Breastmilk can be stored at room temperature for four to six hours, in a fridge for up to three days, in a standard freezer for four to six months, and in a deep freezer for six to 12 months. You can store milk in the most convenient way for you, in a bottle, milk storage bag, ice cube tray, or whatever other solution you find. Make sure the receptacle is clean and can be frozen safely (if you're putting it in the freezer).

Keep at it! You've made it through the hardest part. In the next section, we'll talk about introducing solids and what to expect as your baby approaches her first birthday!

Breastfeeding Basics - Part III: The First Six Weeks

I hope that by now you've read the first three installments of this series, the Introduction, Part I, and Part II. This post will address the first six weeks postpartum.

Your milk should have come in full force before the end of the first week of your baby's life. You'll be practicing attaining a good latch, experimenting with the most comfortable and convenient ways to hold your baby, and getting used to responding to your baby's cues and needs. You're starting to recover from the birth but still basking in the glow of having a newborn baby.

You may also be feeling quite overwhelmed. You're having to wake often at night to feed your baby. You feel like you're constantly feeding, changing diapers. You feel like you have no time that is your own. And you're still not quite used to this "parenthood" business.

Hang in there! It does get easier.

There are two bits of advice I would offer all new mothers in regard to breastfeeding.

The first is, "Keep nursing!" You have probably gathered by now that the more you nurse, the more milk you make, and the more practice you and your baby get at breastfeeding. Nursing on demand is the main key to a successful breastfeeding relationship.

The second piece of advice is "Give it six weeks." The first six weeks are hard. I won't sugarcoat it. Your hormones are crazy, you're sleep-deprived, you're still recovering from the strain of the birth (and possibly still healing from tears, episiotomy, or c-section), you're nursing constantly, and you feel like you don't even have a moment to pee or eat without the baby needing you. I know. It's hard. It's okay to admit that it's hard. It's okay to be frustrated if the baby starts fussing just as you sit down to eat your dinner. But, there's something about that six-week mark that makes the future seem brighter. Once you've gotten through six weeks, you're feeling better, you and the baby are better at this breastfeeding thing, you've been through two growth spurts, so the baby may be spreading out his feedings a bit, and you're starting to get into your role as a mommy.

Hang in there.

It does get easier.

A few practical points to help you keep going.

Nursing in Public


By the time your baby is a few weeks old, you've undoubtedly needed to be out and about with him, even if it's just to doctor's appointments or the grocery store. And if you were out for more than an hour or two, you probably needed to nurse him while you were out. Some women don't mind nursing in public, while others hate it. It can be uncomfortable, especially if you're still new to nursing and are not keen on the idea of exposing your breasts for any passer-by to notice. Also, you may have gotten used to nursing at home, in a comfortable chair, using pillows to help support the baby.

Here are a few tips to make nursing in public easier on you.

1. Wear nursing-friendly clothing - The most comfortable ensemble I've found for nursing in public is a standard nursing bra under any tank top or camisole (or a nursing tank!), with a loose-fitting t-shirt or blouse over that.  You unhook the bra, lift the top shirt, and pull down the neckline of the undershirt so that only a few inches of boob are exposed, just long enough for the baby to latch. You can let the top shirt fall over the baby's head or drape over the breast that is in use so that no skin is showing. The undershirt covers your stomach, sides, and back, and the baby's head covers the rest.
2. Purchase or make a nursing cover - There are many brands of nursing cover out there, from a hat for the baby to an apron-like contraption for mom. If the first tip doesn't offer you the coverage you want, or you are not able to wear such an ensemble for some reason, a nursing cover can be helpful. In a pinch, you can also drape a blanket or towel across your shoulder to cover the baby.
3. Practice at home - If you know you're going to be in nursing-in-public situations often, get some practice at home, first. Try nursing cross-legged on the floor, or sitting in a dining-room chair, or even in your car in the driveway or garage. If you get some practice holding the baby without your comfy chair or pillow fort, nursing in public will come more easily as well. Also, practice in front of a mirror so you can see how little skin is actually exposed while you nurse.
4. Find nursing-friendly locations at places you frequent - Many malls now have family-care areas that include comfortable and private nursing stalls. See if yours offers such an amenity, as it can be very helpful. Baby stores such as Babies R Us often have Mother Rooms, with a comfortable chair and a door that closes so you can nurse privately. Most department stores have no problem with your using a fitting room stall to nurse, or they may have a lounge area in or near the restroom that would be more comfortable. You can also ask at many stores if there is a private location you could use, other than a restroom. I have also found it quite comfortable to nurse in my car in a pinch.

"Colic"

Many, many babies, regardless of how they are fed, go through a fussy period in the evening from about two weeks of age until about three months of age. This fussy period can last anywhere from an hour to three or four hours, and usually consists of the baby crying or fussing for no apparent reason, nursing often, and being very difficult to soothe. This is usually called "colic," although most medical professionals don't actually know what causes it. This time every day or evening can be very stressful, as hearing your baby cry and not being able to comfort him is upsetting. There are plenty of books and websites out there offering miracle cures for "colic," but, as with hiccups, some techniques work better for some people than others. In the end, you just have to find the best way to get through it. If there are other caregivers around, don't be afraid to take turns holding the baby, rocking him, dancing around, singing to him, etc. Sometimes white noise such as static from the radio or running the vacuum cleaner can be soothing. If he wants to nurse, nurse him. This frequent nursing is called "cluster feeding," and nursing is often the best comfort you can offer. Many babies also calm down during a ride in the car, if you can manage it. The good news is that for most babies, this fussy period peaks at around six weeks of age and gradually gets better and better (lasting for less time or not happening every day) over the next six weeks after that.

Food Sensitivities

Very few babies actually react to something their mother is eating. Yes, proteins and some other substances from what you ingest do get into the breastmilk in small quantities, and some babies may be sensitive to these substances. If your baby shows increased fussiness, gassiness, spitting up, or a rash after you eat a specific type of food, try eliminating that food from your diet for a few days or weeks and see if the symptoms improve. If the symptoms are more constant, it may be something you eat all the time. The most common culprits are dairy products and eggs. Some babies are also sensitive to nuts, soy, and caffeine. If you believe your baby is reacting to something in your diet, you'll need to completely eliminate that food from your diet for at least two weeks to really get a sense of whether it's making a difference. Keep in mind that common foods like dairy products and eggs make their way into many foods you eat, even if they aren't specifically milk or egg products, so check package labels carefully.

Remember, though, that unless you have a reason to think your baby is reacting to something you're eating, you should feel free to eat whatever you want (within reason!). You don't have to restrict your diet unless your baby is sensitive to something you're eating.

Growth Spurts

One last topic to cover. After the first week of rapid growth, your baby will probably fall into a fairly predictable pattern of nursing. And then, suddenly, you'll find that he won't stop nursing, possibly for hours at a time. After two to three days of this strange and frustrating nursing behavior, he will suddenly spend a day sleeping almost the entire day, waking less often than usual to eat and possibly making you fear something is terribly wrong. If your baby follows this pattern at around three weeks of age and again around six weeks of age, he probably just experienced a growth spurt. The best possible thing you can do during a growth spurt is nurse on demand. As annoying or frustrating as it can be to have the baby attached to you for what may actually be hours at a time, it's important to remember that this is very short-term, and that it means your baby is headed for a period of rapid growth. Providing him with the milk he needs is vital. Plus, the frequent nursing will help increase your milk supply to meet the demands of your bigger baby! 

If this increased, frequent nursing lasts for more than three days, you should see a lactation consultant to make sure you're producing enough milk or that your baby is getting enough. If the excessive sleep lasts for more than a day or so, you should see your pediatrician to make sure nothing else is going on. Also, watch your baby for signs of lethargy (acting tired, not wanting to nurse, seeming sleepy or "limp") and dehydration (dry mouth and skin, sunken fontanel, dry eyes, dark urine). If you see anything unusual or concerning, absolutely call your pediatrician immediately!

I think that's all you need for now. Remember, give it six weeks! Keep at it! It does get easier. The next post will cover six weeks to three months, the second half of the "newborn" or "fourth trimester" period.