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What to Expect When Breastfeeding
The Amazing Female Breast
The female breast has the ability to deliver exactly what your baby needs - the right type and amount of milk to meet your baby's health and developmental needs.
How? The type of milk your breast produces changes as your baby grows. That is why experts recommend that babies be fed only breast milk for the first six months and that breastfeeding continue once solids are introduced.
The breast also responds to cues from your baby. Suckling tells your body to make milk. More suckling tells your body to release the milk for your baby to drink.
Changes in Your Breasts
You probably noticed changes to your breasts throughout your pregnancy as your breasts started getting ready to feed your baby. Most mothers will notice some breast growth, change in colour of the areola, tenderness and the appearance of noticeable veins in the breast during pregnancy. Once your baby is born, you may notice more changes to your breasts, including:
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Increased fullness - once your baby drinks the first milk from your breast, the colostrum, the breast starts trying to figure out exactly how much milk your baby needs. At around 2-4 days after giving birth, you may notice that your breasts are fuller and heavier. This will subside if your baby is feeding often and removing enough milk. If the feeling of fullness becomes painful, your breasts may be engorged. Click HERE for suggestions on how to deal with engorgement.
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Nipple tenderness - your nipples may feel tender at the start of a feed. This tenderness should go away as your baby sucks and starts to drink. If the tenderness does not go away, try a different breastfeeding position and try to re-latch your baby. Do your best to help guide your nipple to the back of baby's mouth. If baby's mouth covers a good amount of areola and breast tissue, not just the nipple, it is less likely to lead to nipple tenderness. Click HERE for suggestions on how to deal with sore nipples.
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New sensations - some mothers may feel a new sensation when the milk ejection reflex releases, or delivers, the milk from the breast, also known as "let down". For most mothers, this improves or becomes more familiar with each breastfeed.
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Leaking - it is common for breasts to leak milk in the early days, as the breast is trying to determine how much milk the baby needs. Some women may notice leaking before a feed or from the breast not being suckled during a feed. As well, just hearing a baby cry may trigger the Milk Ejection Reflex and lead to leaking. As the lactation system matures, the breast learns how much milk to make for your baby and the leaking stops. Breast pads may help keep you comfortable if you are experiencing leaking.
To wake or not to wake?
When to wake your newborn baby to breastfeed.
Wake your baby to feed if:
In the first few days of life, wake your baby to feed if your baby does not wake on their own within 2-3 hours of breastfeeding.
Parents may also have to work to keep their newborn baby awake during feeds. Breast compressions during feeds can help keep your baby actively feeding at the breast.
Let baby sleep if:
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Baby is waking at least 8 times in 24 hours to feed.
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Baby stays awake at the breast.
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Baby shows signs of satisfaction after feeds.
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Baby is having the appropriate number of wet and dirty diapers for their age.
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Baby is gaining weight.
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Baby has a wet, pink mouth and bright eyes.
In these situations, follow baby's cues for feeding - called responsive cue-based feeding.
Click HERE to download or read the Sleep Well, Sleep Safe booklet provided by Best Start for tips and answers to frequently asked questions about sleep.
Breastfeeding a New Baby
Frequent Feedings
During the first few days, it might seem like your baby is feeding very frequently. That is natural. When the baby is first born, the breast is full of colostrum. Colostrum is very nutritious, it comes in smaller quantities and it takes longer to remove from the breast compared to more mature milk. Let your newborn baby feed as long as they want - colostrum will help with nutrition, immunity and stimulating bowel movements so it is important the baby gets as much as possible.
Frequent feeding, which can also occur when the baby gets older, may be referred to as cluster feeding. With cluster feeding, the frequent breast stimulation helps increase a mother's milk supply to meet the needs of your growing baby.
Early Arrivals
When your baby is premature
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Breast milk is very important for premature babies.
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The breast milk of a mother who has delivered early is different and specially designed to meet the needs of preterm babies. This breast milk is higher in proteins, fats, sodium, iron, chloride and other nutrients.
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Holding your premature baby skin-to-skin is very good for both you and your baby and it will help your body produce the hormones that impact your milk supply. This is sometimes called Kangaroo Mother Care.
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Preterm babies often have a weak suck, which will get stronger with age. For this reason, mothers of preterm babies may want to continue to use alternate methods of milk removal such as hand expression and pumping breast milk to build your milk supply and provide it to your growing baby. Work with your lactation professional to create a plan that works best for you.
Caesarean Birth
Many mothers who breastfeed have given birth by Caesarean Section. Here are some tips to help get breastfeeding off to a good start:
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Take the recommended pain medication in the early days; ask your doctor for a medication that is safe to take while breastfeeding.
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Breastfeed your baby early after the birth, in the recovery room if possible.
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Breastfeed your baby often, at least 8 times in 24 hours.
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Find breastfeeding positions that are comfortable for you.
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Hold your baby skin-to-skin often and between feeds.
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Get plenty of rest and spend time with your baby.
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Get up and walk around periodically, a little movement will help the recovery.
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Ask for help with meal preparation and housework from family and friends.
Siblings
If this is not your first baby, you may wonder about the best way to explain breastfeeding to your older children. You may also wonder how you will occupy them while you are breastfeeding your baby.
Many mothers find explaining what they are doing in plain language and inviting their older child to sit with them during breastfeeds helps their older child understand and be part of the breastfeeding experience. Since mothers are often sitting and relaxing during breastfeeds, older siblings may enjoy the opportunity to read, draw, or just visit with their mother at that time. Because mothers can breastfeed anywhere, anytime, they often find that breastfeeding is easy to do while also caring for their older children.
Tandem Feeding
Tandem feeding refers to breastfeeding two children at the same time. Some mothers may still be breastfeeding a child when they are pregnant and at the time of delivery. Many mothers want to continue to breastfeed their older child once their new baby is born. Here are three things to consider if you are tandem feeding:
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Prioritize your newborn.
If you decide to tandem feed, it is important to remember to feed your newborn first and prioritize the newborn’s feeds.
Even if you have been nursing through your pregnancy, your breasts will produce colostrum following delivery. It is important the newborn baby receive as much colostrum as possible.
Also, the older sibling will be able to eat and drink additional foods.
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Tell your health care provider.
You will want to let your health care provider know you are tandem feeding. Be sure to monitor your baby’s wet and dirty diapers and growth so you will know if baby is getting enough breast milk.
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Take care of yourself.
Make sure you are getting enough to eat and drink. Drink lots of water and add 2 - 3 servings of food from the Canada Food Guide to help restore your energy. Do your best to rest and sleep when you can.
If you can, ask friends and family to help out by assisting with household tasks so you have more time to breastfeed.
Is Your Baby Getting Enough Milk?
Three reliable ways to determine if your baby is getting enough milk:
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Does your baby have enough energy to actively feed at the breast by sucking, drinking and swallowing?
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Are the number of wet and dirty diapers appropriate for their age?
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After day four, is your baby is gaining weight regularly?
This feeding chart can help you track the appropriate number of feeds and dirty diapers by age in the first few weeks.
What to Watch For
To make sure your baby is getting enough milk, keep track of the wet and dirty diapers in a 24-hr period.
A wet diaper is heavier than a dry diaper. Add 2 tablespoons of water to a dry diaper to see what it feels like. Your baby's urine should be clear or pale yellow and it should not smell.
A breastfed baby should have 3 or more large, soft, usually seedy poops per day after they are 2 days old. By 3 - 4 weeks of age, some babies will have only 1 - 2 poops per day. After the first 4 - 6 weeks, some babies will start to have one large poop. This is normal as long as your baby is feeding well, seems content and their poops are soft.
Get HELP if:
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Your baby reaches 4 days of age and is having fewer than 6 very wet diapers or 3 soiled (poopy) diapers in 24 hours.
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Your baby is having black poops after they are 4 days old.
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Your baby is very sleepy and always has to be woken up to eat.
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Your nipples or breasts hurt.
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You have a fever or feel sick.
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You are thinking about weaning.
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You are exclusively pumping.
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You are supplementing breastfeeding with formula.
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You are worried about yourself or your baby for any reason.
Taking Care of Mom
Diet and Activity for a Breastfeeding Mother
Nutritional Requirements
Breastfeeding mothers often feel hungry and thirsty during the first several months of breastfeeding. Try not to ignore your feelings of hunger and thirst. Having quick and nutritious snacks like pre-cut fruit and vegetables, yogurt, cheese or crackers on hand will help. Drink plenty of liquids such as water, juice, milk and soup to satisfy your thirst. Drink water and eat while breastfeeding or keep snacks and a water bottle near your favourite breastfeeding area.
Eating a nutritious diet as laid out by Canada's Food Guide will help you feel your best and recover from giving birth. Your body uses about 350 - 400 calories to produce milk, so adding 2 to 3 extra servings from Canada's Food Guide ( 2 veg & fruit and 1 grain) can help regain the extra calories and make sure you have energy.
Women following a vegetarian diet need a daily source of vitamin B12 which can be found in vitamin B12 fortified foods or a vitamin B12 supplement. Talk to your health care provider about meeting this requirement.
Click HERE to access Canada's Food Guide languages other than English.
Caffeine & Alcohol
Caffeine
Caffeine is found in a variety of sources including coffee, tea, cola and some medication for headaches. It is important to check the label.
Caffeine does pass into breast milk but mothers can have have small amounts (300 mg or 1-2 cups of coffee) without it being harmful to the baby.
Too much caffeine may cause the baby to be wakeful, unusually fussy and have trouble sleeping.
If a baby becomes jittery, wakeful or irritable, the mother could try reducing or eliminating caffeine from her diet.
Alcohol
Alcohol passes through breast milk to your baby and may affect your milk supply. Babies need more time than adults to remove alcohol from their system. The younger the baby, the more difficulty they have clearing alcohol from their body.
It is safest to avoid alcohol while breastfeeding. However, occasional drinking is not a reason to stop breastfeeding. If you chose to drink alcohol, consider ways to decrease risks to the baby:
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Limit the amount you drink to 1 or 2 standard drinks per occasion.
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Drink alcohol after breastfeeding, not before breastfeeding.
Heavy drinking can put your baby’s growth and development at risk. If you plan to have more than 2 standard drinks on an occasion, plan ahead to have expressed and stored breast milk available and someone you trust to care for your baby
For more information on Breastfeeding and Alcohol, please click HERE.
Smoking & Drugs
Smoking
Tobacco products are transferred to breast milk and may decrease the milk supply. Mothers who smoke are encouraged to quit or use nicotine replacement therapy as a safer option to smoking cigarettes. Please speak with your health care provider about which type of nicotine replacement therapy would work for you.
Second-hand smoke has been shown to be a strong risk factor for Sudden Infant Death Syndrome (SIDS). To reduce the risk to the baby:
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Everyone should smoke outside the home.
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Wear a smoking jacket when smoking and remove the jacket before handling baby.
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Wash your hands thoroughly before picking up or cuddling the baby.
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Delay smoking until after breastfeeding and while baby sleeps for long periods.
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Allow as much time as possible between smoking and breastfeeding.
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Decrease the number of cigarettes smoked or try to quit while you are breastfeeding.
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Keep your home and car smoke-free.
Recreational Drugs
Recreational drugs (including cannabis and cannabis products) can transfer to the baby through breast milk and have serious negative effects ranging from mildly toxic to extremely hazardous. There is no safe level of exposure to these drugs.
If exposed, breastfed babies should be closely watched and a health care provider should be contacted. The following side effects are seen in babies exposed to recreational drugs: irritability, tremors, seizures, vomiting, diarrhea, excessive drowsiness, sedation, poor feeding, respiratory distress, increased heart rate and poor sleeping patterns.
Click HERE for the risks of cannabis on fertility, pregnancy, breastfeeding and parenting.
Taking Time for Yourself
Being a new parent can be very busy. It is a 24 hours-a-day, 7 days-a-week job and there are no scheduled breaks, weekends off or holidays. Although it is a wonderful job, it is hard. It is important to take care of yourself as well as your new baby.
Here are some tips:
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Take a few minutes for yourself every day and do something you enjoy. Take time to relax.
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Find opportunities for company and conversation with adults. Spend time with friends and family. Try not to become isolated.
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Consider joining a new mothers or breastfeeding support group. Get to know other women who are going through similar experiences.
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Be realistic with expectations. You cannot do everything at once.
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Give yourself credit for breastfeeding. It is important work for your baby.
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Accept help from family and friends.
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It is alright to complain and let others know when you are having a hard day. Your feelings matter.
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Enjoy the time you are spending nourishing and getting to know your baby while breastfeeding.
Sleep
All parents of young babies will experience sleep changes at some point. Breastfeeding mothers will notice that their sleep depends on their babies’ sleep-wake and feeding patterns. A lack of sleep can impact parents’ physical and emotional well-being. Many parents address these sleep cycle changes by getting sleep and rest during the times the baby is sleeping.
Sleep is essential for a baby’s growth and development. Babies tend to sleep more around periods of growth and babies grow rapidly in the first year of life. Babies awaken frequently in the night because their bellies are small and they need to feed often. Feeding during the night will help maintain a mother’s supply of breast milk. Nighttime feeding is easily fulfilled by breastfeeding, as they do not require preparation or warming of bottles.
It is important that parents understand that babies will wake during the night for various reasons. For example, they may be experiencing a growth spurt, they may be ill, or they may need to feed. Understanding a baby’s sleep patterns will help parents feel less frustrated and disappointed when a baby wakes during the night.
Points to Remember:
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It is important for parents to get as much sleep as possible. You may need to ask for assistance with household chores from family, friends, or neighbours.
Sex after Birth
Sex after birth is a very personal decision and will be different for each couple. Effective communication will help couples understand when both partners feel comfortable and ready for sex to begin again.
Most couples wait for 4 to 6 weeks after birth to resume sex or until they speak with their health care provider at the 6 week postpartum check up. Some things to keep in mind:
Birth Control - Speak to your health care provider about birth control options and breastfeeding if you plan on becoming sexually active again. Some hormonal birth control methods can reduce a mother's milk supply. These methods include some types of birth control pills, some intrauterine devices (IUDs), birth control skin patches, vaginal rings, etc.
Tenderness & Discomfort - A woman may experience tenderness following a vaginal delivery for several months after the birth of the baby, especially if she had an episiotomy or any tearing/stitches during the delivery. Postpartum women also produce low levels of estrogen until they start ovulating again. For some mothers this may be for the entire time they are breastfeeding. Low estrogen levels may cause vaginal dryness, tightness and tenderness. Talk to your doctor if this is a concern.
Do your best to stay connected to your partner and maintain good communication. Schedule a time to discuss this openly with your partner. Remember it is normal for a couple to experience decreased sexual desire in the period following birth due to the needs of a new baby.
Exercise
Exercise is an essential part of a healthy lifestyle. Light to moderate physical activity is safe and beneficial for breastfeeding mothers and their babies. Light to moderate exercise should not influence the amount, taste, or composition of breast milk.
The benefits of exercise for breastfeeding mothers include:
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Improves overall health and energy level.
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Stimulates the release of feel-good hormones that can help boost your mood and relieve stress.
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Raises your body’s levels of prolactin, the hormone responsible for milk production.
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Helps with a better night’s sleep.
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Helps you to lose your pregnancy weight.
Points to Remember:
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Check with your health care provider before beginning any postpartum exercise program.
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During the first few weeks after your delivery, rest and building up your milk supply should take priority.
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Start exercising for short periods of time, a few days a week, and gradually increase your activity level, intensity and duration.
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Stop exercising if you become too tired, start to feel overwhelmed, feel pain or experience heart palpitations, dizziness, shortness of breath.
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If you start to have bloody vaginal discharge and/or pain or discharge from your caesarean incision, stop exercising immediately and contact your health care provider.
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Drink water to avoid dehydration before, during, and after your workout.
When you resume exercise will depend on your delivery. If you had a vaginal delivery without any complications, and if you were exercising before, it is probably safe to start exercising again after 6 weeks. If you had an episiotomy or a caesarean section, you will have to wait until you have completely healed. Your health care provider is the best person to guide you on when it is safe to start exercising.
Feeling Down
It is normal for mothers to have emotional ups and downs after having a baby. Coping with the needs of a newborn and healing from the delivery can be overwhelming. Some mothers may experience “postpartum blues” that often begin on the third or fourth day after delivery.
Symptoms may include feelings of:
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Sadness
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Hopelessness
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Exhaustion
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Guilt and anger
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Frustrations
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Worry
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Panic or anxiousness
Some women may also experience difficulty:
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Sleeping
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Relaxing
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Remembering things
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Concentrating
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Eating
For most mothers, these symptoms will typically disappear on their own in about 1 to 2 weeks. However, some women may experience these symptoms for more than 2 weeks and they may not disappear on their own. In these situations mothers may be experiencing “postpartum mood disorder.”
It is important to know that you cannot control or stop a postpartum mood disorder from occurring. It is not a weakness and there is help available. Treatment options include:
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Medication
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Counselling
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Support from other mothers with similar experiences.
Points to Remember:
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Some of these symptoms are normal after the birth of a baby, however, if you are concerned or they continue for more than 2 weeks talk to your health care provider.
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Contact your local public health unit to find out about support groups available in your community.
Illness & Medication
Many women who have long term medical conditions are able to meet their breastfeeding goals by working closely with a health care provider and lactation professional.
If you have an infection, your body makes antibodies to help fight the illness. Your baby will receive the antibodies through your breast milk. The antibodies you pass to your baby in your breast milk will give your baby some protection against the illness. Very few illnesses will require you to stop breastfeeding so even when you are sick you can usually continue to breastfeed your baby.
Points to Remember:
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Encourage friends and family to not visit the baby if they are sick.
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Wash your hands with soap and water before you breastfeed your baby and after you change your baby’s diaper.
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If you become ill, speak with your health care provider and ask about any precautions you should take or if breastfeeding is not recommended during the illness.
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If you are unable to breastfeed during your illness, hand expression or pumping can help maintain your milk supply. By maintaining your milk supply you may be able to resume breastfeeding once you recover. A lactation professional in your area can help you with your specific situation.
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It is important to check with your health care provider or pharmacist before taking any prescription medications, over the counter medications, herbs and/or traditional medicines.
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If a medication is not compatible with breastfeeding you should ask your primary health care provider or pharmacist if another medication that is compatible with breastfeeding can be used.
What to watch for:
If you are taking medication or herbal remedies, watch for any changes in your baby's feeding or sleep patterns, fussiness, rash, constipation or diarrhea. These changes should be discussed with a health care provider.
Returning to Work or School
Many new mothers face situations where they find themselves away from their breastfed baby for extended periods of time due to a return to work or school. In each case, it is important for mothers to know:
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A mother's right to breastfeed in public is protected by legislation. Mothers, whether staying at home or returning to work, are welcome to breastfeed in public places, restaurants, schools and workplaces.
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When separated from their babies for longer periods of time due to work, school, or additional commitments, mothers are able to express and store their breast milk. This enables mothers and their babies to continue their breastfeeding experience and ensures the baby is able to receive breast milk.
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Continuing to breastfeed after returning to work or school has many benefits:
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Many mothers who return to school or work while breastfeeding find they are able to maintain their breastfeeding relationship with their baby.
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Baby will continue to receive the immune protection from breast milk and as a result be less likely to get sick. This also means less sick days for mom from work or school.
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Breast milk has all the nutrients baby requires for growth and development.
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Breast milk is easy to prepare and feed to the baby in your absence.
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Points to Remember:
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You may need to pump or hand express and store milk while away from your child.
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Hand expressing/pumping can be done to provide breast milk for feedings, increase your comfort, and maintain your milk supply. The frequency of hand expressing/pumping will depend on your feeding goals.
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Meet with your employer/teacher before returning to work or school to develop a plan to support your breastfeeding goals. The plan should include appropriate space and time to feed your child or express breast milk.
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Know your breastfeeding rights in relation to work as outlined by the Ontario Human Rights Commission.
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Choose a childcare provider close to your work or school. This may increase the likelihood of visiting your child during the day and to breastfeed if you choose to.
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Ask your co-parent or childcare provider to feed your expressed breast milk while you are away. Expressed breast milk can be given from a bottle, cup, or spoon.
Breastfeeding in Public
Women have a legal right to breastfeed in public including malls, restaurants, stores, schools and parks – anytime, anywhere.
Points to Remember:
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Find a relaxing place to breastfeed and begin breastfeeding when the baby shows early signs of hunger. Breastfeeding in public when the baby is relaxed is easier than waiting until baby is extremely hungry and crying.
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If you feel anxious about breastfeeding in public, practice in front of your partner or a close friend. Some mothers also practice in front of a mirror to gain confidence.
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Wear clothing that is suitable for breastfeeding – shirts that lift up, a loose cardigan or jacket, an easy access bra etc.
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If you don’t want to breastfeed in public, many public places have a private room for breastfeeding. Ask about this at the front desk or administration office.
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Consider in advance how you might respond if someone asks you to stop breastfeeding in public. For example, "My baby is hungry, so I am breastfeeding, as is my right by law. If you have an issue with this, perhaps you could find another place to sit".
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Talk with staff or management if someone is making it difficult for you to breastfeed in public.