Appendix

Suggested Uses for PureLan

PureLan^TM100 is an all-natural hypoallergenic lanolin that creates a moisture barrier, allowing skin to rehydrate from within. An added benefit is that PureLan does not need to be removed before breastfeedings.

Using Cabbage Compresses for Engorgement

• Obtain fresh, green cabbage or use chilled cabbage. Green cabbage is less expensive. Warm cabbage is ineffective.
• Break off individual leaves and rinse with cold water. Pat dry with clean cloth or paper towel. (May have been sprayed with insecticide.)
• Pack clean, dry, rinsed leaves around both breasts, covering the breasts completely with a single layer of leaves. A bra will hold leaves against the breasts. f
• Replace leaves as they wilt. Warm, wilted leaves are ineffective.
• Continue procedure until breasts flow with milk, usually from 30 minutes to one hour. Continued use will cause lactation suppression. In extreme cases of engorgement, compresses may be used no longer than two hours at a time with the supervision of a lactation consultant.

Using Cabbage Compresses to Suppress Lactation

• For ultimate suppression and comfort, application of chilled cabbage compresses should be as soon as possible in the postpartum period.
• Application may begin in postpartum period whenever the patient desires, preferably before signs of lactation. For ultimate suppression and comfort.
• Break off individual leaves and rinse with cold water. Pat dry with clean cloth or paper towel. (May have been sprayed with insecticide.)
• Pack clean, dry, rinsed leaves around both breasts, covering the breasts completely with a single layer of leaves. A bra will hold leaves against the breasts.
• Replace leaves as they wilt. Warm, wilted leaves are ineffective.
• Continue procedure until breasts are soft and comfortable and tissues have returned to the consistency of nonlactating breasts, which may be at least 18 hours.

Increasing Milk Supply
Note: Thyroid deficient mothers may not produce enough milk. Mothers with a history of thyroid deficiency or those who are not producing adequate milk should have their thyroid level tested.

Drugs: Antihistamines, sedatives and some birth control pills may decrease milk supply. Smoking may also decrease milk supply. Insufficient glandular breast tissue is rare. Breast reduction may reduce milk supply.

Before Feedings or when Pumping:

• Milk production is suppressed if milk is not secreted. Successful breastfeeding requires adequate milk ejection reflex (MER) also know as "let down." Cold, pain, stress, fatigue and mental anguish interfere with MER. Caffeine and smoking may also interfere.
• Use relaxation techniques such as soft music, visual imagery and a relaxing environment.
• Employ gentle stroking of the breast (even by the baby).
• Add warmth to breasts (opposed to cold) for 5 minutes before pumping or breastfeeding.
• When possible, pump after you have been with your baby to take advantage of hormonal stimulation.
• Use double electric breast pump.
• Use pump breast shield inserts for a closer fit and increased stimulation.
• Try a different pump. (i.e. Medela Classic rather than a Medela Lactina or Pump In Style.)
• Massage breasts while pumping.

During Feedings:

• Nurse baby frequently, every 2 to 2 1/2 hours or more often as infant desires. Feed a minimum of eight times in 24 hours. Allow your baby to nurse as long as he wants, but do not restrict feedings.
• Take baby to bed with you and nurse. There is evidence that allowing lots of skin contact for 24 to 48 hours increases the milk-making hormone in your system.
• Keep baby stimulated to complete an entire feeding.
• Unwrap or undress down to diaper. Sometimes babies will respond better with family members other than mom. You can then feed "skin to skin."
• Try gentle baby "sit ups" or walk your fingers up the baby's spine.
• Use the "burp and switch" technique. Nurse baby on the first side until sucking slows down or stops. At this point stimulate baby again and then nurse on the other side. Keep repeating this until the baby completes the feeding, using each breast several times.
• Stroke baby's skin or gently lift baby's upper arm during feedings and/or gently massage the baby's temple area.
• Massage breasts towards the nipple during feedings to increase milk flow, being careful not to disturb baby's latch.
• Feeding tube devices such as SNS or Hazelbaker Feeder may be needed. Talk with the Lactation Consultants at 817-250-BABY (817-250-2229) for more information.

After and Between Feedings:

• Use an electric breast pump with double pumping set-up and pump both breasts for 10 minutes after each daytime nursing period to further stimulate your milk supply. Use in a relaxing environment and think positively.
• Keep a record of your baby's feedings as well as wet diapers and bowel movements. A feeding log is provided for this purpose. The Lactation Consultant will want to know whether you notice a decrease in output of urine or stool.
• Do all pacifying at the breast. Avoid pacifiers or bottle nipples as they may interfere with milk production. Supplements, if needed, can be given with a soft eye dropper, medication syringe, feeding tube device such as the Hazelbaker Feeder, SNS or an infant training cup.
• Eat a balanced, nutritious diet and drink fluids to satisfy your thirst. Keep in mind that frequent, unrestricted nursing is the most effective way to maintain and improve milk supply. No food or fluid has been proven to increase milk supply.
• Get plenty of rest. Nap when your baby naps. Minimize other household or other outside responsibilities. Take steps to decrease as much stress as you can by getting help with everything not involved in feeding the baby.
• Accept help offered by friends and family. Be pampered.

Food Supplements:

• Try two capsules of brewer's yeast three times daily with food. (Contains B vitamins and protein.) Caution: Do not use with MAO inhibitors. May cause increased blood pressure.
• Herbs that may help increase the milk supply include:
  • Blessed Thistle, one tablet (200 to 350 mg) three times a day
  • Mother's Milk Tea, three to four cups a day
  • Fennel Tea, 2 teaspoons crushed seed per cup of boiling water, drink up to three cups per day
  • Fenugreek, two to three capsules three times a day or fenugreek seed tea may be used, but is less potent.

Caution: Mothers should be aware of the potential for herbs to cause diarrhea. Mothers with diabetes should use caution because of the herb's tendency to lower blood glucose levels. Women with asthma should be informed of the possibility of increased asthma symptoms.

Prescription Medications:

• Metoclopramide (Reglan) 21 day treatment may help increase milk supply: 10 mg three times daily for seven days, then 10 mg two times daily for seven days, then 10 mg once per day for seven days. Possible side effect includes depression in mother.
• Syntocinon (synthetic oxytocin) may improve milk ejection reflex (MER). Packaged in 2ml and 5 ml spray bottles. One spray into one or both nostrils two to three minutes before pumping or breastfeeding is adequate. When spray container is empty do not discard because often the sight of the container will elicit the MER.

The above medications should be used as a last resort. Lifestyle changes will often correct problems with decreased milk supply. Call the Harris Methodist Fort Worth Hospital Breastfeeding Resource Center at 817-250-BABY (817-250-2229) for more information.

Clogged Milk Ducts

Before Feedings:

• Use warm, moist compresses to affected area. "Breast Baths" work well. Hang breasts in pots of warm water, massage and express milk. Cabbage leaf compress may also be helpful.
• Massage the "lumpy" area towards the nipple.

During Feedings:

• Nurse frequently beginning with the sore breast.
• Massage the breast during the feeding, but be careful not to disrupt the baby's latch-on.
• You may want to try altering nursing positions. It may help to position the baby's chin toward the sore spot. Try leaning over the baby while nursing if you can to avoid straining your back. Probably the most important thing is to make sure the baby is latched on correctly.

After and Between Feedings:

• Remove your bra at night or all day, especially during feedings. Avoid ill-fitting bras and do not bunch your clothing under your arm while feeding.
• Avoid purse or diaper bag straps pressing against your breast. Avoid sleeping on one side or on your stomach.
• Pump or hand-express affected breast after nursing or for missed feeding. Do not allow your breasts to become overly full.
• Do slow, gently wide arm circles with bra off several times per day.
• Avoid long intervals between feeding. Do not substitute bottles for feedings until tenderness or lump has resolved.
• The lump should resolve in one week or less.
• Continue with above treatment for one to two weeks even after symptoms have resolved.
• Call your caregiver immediately if you develop additional symptoms, such as: fever greater than 101 degrees, chills, fatigue, nausea, headache or other flu-like symptoms.

For Recurrent Clogged Milk Ducts:

• A major cause may be fatigue and/or exhaustion. Limit the nursing mother to polyunsaturated fats such as olive, corn and canola oils rather than lard, butter and Crisco.
• Use one tablespoon per day of lecithin on salads or take by spoon.

Mastitis
Mastitis is an infection of the breast. The risk of developing a breast infection (mastitis) in the first few weeks of breastfeeding is about 10 percent to 20 percent. Symptoms generally include chills and a fever greater than 101 degrees, along with breast tenderness and lumpy areas. The breast(s) may appear red and feel hot. Some women experience additional flu-like symptoms such as nausea, diarrhea, headache, body aches and excessive fatigue.

Causes:

• Damaged nipples
• Inadequate emptying of the breasts
• Inadequate care by the mother, such as skipping meals, unhealthy diets and/or not enough rest
• Vigorous upper body motions as in exercises or manual labor
• "Wires" in underwire bras that press into breast tissue
• Unclean breastfeeding equipment such as nipple shields, breast shells or breast pump

Prevention:

• If nipple tenderness is not improving, contact a certified lactation consultant, physician or midwife for professional assistance.
• Continue cleanliness by washing hands often, especially after using the bathroom and diaper changes and before you handle your breasts.
• Change bra pads often.

Emptying the Breast:

• It is important not to offer the second breast until baby's sucking slows down and swallowing occurs only occasionally.
• Always feel for tender spots or lumps after the baby feeds.

Management of Mastitis:

• Bedrest is important. Be pampered! Get help with other responsibilities until you are feeling better.
  Increase fluids. Especially water.
• Healthy eating with lots of protein and vitamin C.

Antibiotics are essential if signs and symptoms as listed above continue for more than 24 hours. Research indicates that a broad spectrum antibiotic such as Dicloxacillin 500 mg every six hours for 10 days is appropriate.

Steps before Feeding:

• Use warm, moist compresses, breast baths, a warm shower for five minutes or cabbage leaf compress prior to each nursing to encourage better flow of milk. For breast baths, hang breasts into a pot of warm water, massage toward nipples and express milk. Continue heat and massage daily for one to two weeks following the completion of the antibiotics.
• Gently massage your breasts toward the nipple before feeding. Lotion or vegetable oil may be used to help prevent friction rubbing.

Steps during Feeding:

• Continue nursing while you have mastitis. This is not harmful to the baby. Babies usually will remove milk better than pumps. Wake baby to feed if necessary. If your baby is in NICU be sure to tell your nurse that you have mastitis and whether you are taking antibiotics. Begin each feeding on the sore breast and position so that baby's chin points toward the affected area if possible.
• Gently massage the breast while feeding, being careful not to disturb baby's latch. Do not limit sucking on the affected breast for at least the next two feeds. Use pump or hand expression for emptying of second breast if necessary.

Steps after Feeding:

• Again, check your breasts for sore spots or lumpy areas. If you see no improvement contact your certified lactation consultant, physician or midwife.
• Ice packs can be used after nursing to reduce inflammation and swelling. This may also provide some pain relief. Bags of frozen peas or corn make easy-to-use ice packs.
• Ibuprofen is compatible with breastfeeding. It may be used to relieve pain, fever and inflammation. Use as directed on label or by physician.
• Consume plenty of fluids. A nutritious diet with an abundance of Vitamin C and protein is recommended.

Do not attempt to wean at this time.

Infant's Oral Thrush and Nipple/Breast Pain in Lactating Women

Kay Hoover, M.Ed, IBCLC, 613 Yale Avenue, Morton, PA 19070-1922, 610-543-5995

Contact your health care provider or Lactation Consultant if you feel you or your baby are experiencing thrush.

Introduction: Yeast infections that affect babies' mouths and mothers' breasts can threaten the continuation of breastfeeding because of the extreme pain that may occur. One problem is that yeast infections of the nipple and breast may be difficult to diagnose. A second problem is that either the mother or the baby may not appear to be infected, but may be colonized with yeast so that re-infection occurs. Third, there is little information in the medical literature about yeast infections causing breast and nipple pain.

Appearance of Yeast: Yeast on the mucous membranes of the mouth and vagina is white. Yeast skin rashes of the diaper area, under arms, under breasts and the groin appear as red patches on light colored skin. On dark skin, the patches are a darker color. Infected nipple skin may not look different from normal healthy skin.

Predisposing Factors: Studies have found nipple damage, postpartum antibiotic therapy, and yeast vaginitis to be predisposing factors.(1,15) As pregnancy progresses the incidence of vaginal yeast infections increases. The infant can acquire a yeast infection from his or her mother at birth, so treatment of vaginitis during pregnancy is important.

Detecting Nipple and Breast Candidiasis: The unbelievable pain that comes with a yeast infection on the nipples or in the breasts can lead to premature weaning, so early detection and treatment are needed. Most women use the word "burning" as they describe their pain. One mother described her pain as follows: "My nipple feels as if it has a piece of broken glass in it." Some mothers with candida infections report shooting, burning pain in the breasts during and/or after feedings. One women described her breast pain in this way: "Fifteen minutes after breastfeeding it felt as if my baby's saliva was acid which was slowly working its way up my breasts and burning me." Some women experience pain that runs down the arm or across the back in addition to breast pain. One woman said the pain felt like "nerve pain." There is no good way to test for yeast on the nipple, because it rarely cultures.(1) There is no test that shows whether the normal skin colonization of yeast has changed to an invasive infection of yeast.(5) Because there is little to see on the nipples and the baby and/or mother may be asymptomatic, it is appropriate to treat the mother and baby based on the woman's description of her pain. The excruciating pain must be resolved quickly, so that breastfeeding will continue.

Treatment for Mother and Baby: Treatment for both mother and baby must occur at the same time, even if only one has symptoms.(12) The baby's health-care practitioner can prescribe medication for the mother's nipples. If the nipple is damaged there can also be a bacterial infection along with a yeast infection.(9) Other women may have an inflammation. Simultaneous treatment of the nipples with a topical antibacterial cream or ointment or a steroid cream along with the antifungal may help.(9) If the baby sucks on his or her fingers or thumbs, they should be treated.(10) Other places any family member has a yeast infection should be treated, such as diaper rash, vaginal yeast infection, finger and toe nail fungus, jock itch and so on. Moisture left behind by some baby wipes and corn starch, an ingredient in some baby powders, promote the growth of yeast.

• Nystatin for Baby's mouth: Yeast cells reproduce in about one hour, so using nystatin oral suspension every three hours may be helpful when the infection is not clearing up as quickly as anticipated.(10) When treating with nystatin oral suspension, it is important to shake the bottle well before using. Put a small amount (one milliliter) into a small cup. Using a cotton swab, apply nystatin well to all surfaces inside the baby's mouth--between the cheeks and the gums, on the tongue, under the tongue, on the roof of the mouth, and between the lips and gums. Unlike other medicines that work when swallowed, nystatin has to come in direct contact with the yeast. Any medicine that is left in the cup can be given to the baby to drink.
• Nystatin for Mother's Nipples: After feedings, a mother's nipples may be rinsed with water or with a solution of one cup of water plus one tablespoon vinegar. Dry and apply an antifungal cream every three hours, or after every feeding. Before breastfeeding, gently rinse off any residue of medicine on the nipples that has not rubbed off on clothing or breast pads. If using breast pads, change them at each feeding. Nystatin cream is commonly prescribed for the mother's nipples. "Other fungicidal creams that may be used if nystatin fails or there is a recurrence are 2% ketoconazole, miconazole nitrate, and clotrimazole.(12)" If the nipples are so painful that it hurts to wear clothing, breast shells may provide comfort.
• Gentian Violet: Nystatin is over 80% effective for infants' oral thrush (4), so there will be times that other antifungals will be needed to eradicate the yeast. Yeast can grow into several layers of the skin. Gentian violet penetrates through several layers of the skin, so it may be very effective if other antifungals are not helping. When using aqueous gentian violet for baby's mouth and mother's nipples"... a 0.5% or 1% solution of gentian violet should be used and limited to three days of one to two swabbings per day". Gentian violet can be used at the same time as other antifungals.
• Clotrimazole: To make a clotrimazole gel, the pharmacist crushes a 10 mg clotrimazole lozenge and mixes it with 5 ml of glycerin. The gel is applied to the baby's mouth and the mother's nipples every three hours for five applications.(8) There is enough medicine in this recipe for five applications. If the infection remains, a second recipe can be used.
• Fluconazole: "In severe cases, use of systemic antifungal medication should be considered after careful review of the diagnosis."(12) For shooting breast pain the mother may take 100 milligrams of fluconazole once a day for 14 days. The amount of fluconazole the baby would get through breastfeeding would not be enough to treat the infant.(7) The baby will need his or her own medicine.(7) Fluconazole is available for infants and "has an FDA safety profile for neonates one day and older."(7)
• Miconazole: In Australia and Europe, Daktarin oral gel is available for use in a baby's mouth and on a mother's nipple.

Ways to Cut Down on the Spread of Yeast: Because family members are in close contact, it is easy to spread a yeast infection.

• Good hand washing is important. Wash with warm soapy water, and use lots of friction for at least 15 seconds.
• Use paper towels for hand drying then discard, since yeast can live on a moist towel.
• Use a bath towel only once, then wash it.
• Towels and clothing that come in contact with the yeast should be washed in very hot water (above 50 degrees Centigrade or 122 degrees Fahrenheit). Hang wash in the sun to dry, if possible. Ironing will help kill yeast.
• Put on a clean bra every day or more often.
• Boil items used in the baby's mouth (pacifiers, bottle nipples, teething toys) and anything that comes in contact with the breastmilk (pump kit parts, breast shells, cloth breast pads, and maybe even the bra) for 20 minutes once a day.After one week discard all bottle nipples and pacifiers and purchase new ones.
• Freezing does not kill yeast, so feed the baby any milk collected during the yeast infection within 24 hours of pumping. If breast milk has been stored in the freezer during a bout with yeast, it could be brought to a boil to kill the yeast.
• Think of places yeast can hide. Check pets and farm animals for yeast, especially their ears. Get new tooth brushes for the whole family. One woman found her dental retainer to be the source of reinfection.
• A bleach solution of 3/4 cup household bleach to one gallon of water (or 2 tablespoons to 2 2/3 cups of water) can be used to disinfect surfaces such as a diaper changing pad, baby furniture and toys. Wipe with the bleach solution, rinse and air dry.
• If a yeast infection is not clearing, the mother can try reducing sugar and dairy products in her diet. Some women report that it helps to add acidophilus, garlic, zinc, and B vitamins (from a source other than nutritional yeast) to their diet. A healthy body is the best defense against an overgrowth of yeast.

Bibliography:

1. Amir LH, et al: Candida albicans: is it associated with nipple pain in lactating women? Gynecologic and Obstetric Investigation 41: 30-34, 1996
2. Amir L, Hoover K, Mulford C: Candidiasis & Breastfeeding (Unit 18) Lactation consultant Series, New York: Avery Publishing group, 1995
3. Bauslag N, Michels DL: A Woman's Guide to Yeast Infections. New York: Pocket Books, 1992
4. Casto, DT: Many suitable antifungal agents exist for treating thrush in children. Infectious Diseases in Children 8(5):22, 34, May 1995
5. Charnow JA: Doctors face rising number of candida infections. Infectious diseases in Children 7 (10):32, October, 1994
6. Crook W: The Yeast Connection and the Woman. Jackson, Tennessee: Professional Books, 1995
7. Hale TW: Medications and Mothers' Milk, 5th Edition. Amarillo, TX: Pharmasoft Medial Publishing, 1996
8. Horowitz BJ, Edelstein SW, Lippman L: Sugar chromatography studies in recurrent candida vulvovaginitis. J Reprod Med 29:441-43,1984
9. Huggins KE, Billon SF: Twenty cases of persistent sore nipples. Journal of Human Lactation
   (3): 155-160, 1993
10. Hughes WT: Persistent thrush in young infants. The Pediatric Infectious Disease Journal 6(11): 1074-1075, 1987
11. Johnstone HA, Marcinak JF: Candidiasis in the breastfeeding mother and infant. JOGNN 19(2): 171-173, 1990
12. Lawrence, RA: Breastfeeding: A Guide for the Medical Profession, 4th Edition. Philadelphia: CV Mosby Company, 264- 265, 492-494,1994
13. Piatt JP, Bergeson PS: Gentian violet toxicity. Clinical Pediatrics 756-757, December 1992
14. Rosa C, et al: Yeasts from human milk collected in Rio de Janeiro, Brazil. Rev Microbiol 21 (4): 361-63, 1990
15. Tanguay KE, McBean MR, Jain E: Nipple candidiasis among breastfeeding mothers. Canadian Family Physician 40:1407-1413,1994
16. Trowbridge JP, Walker M: The Yeast Syndrome. New York: Bantum, 1986

Infant's Intake Guidelines

How much breast milk does your baby need for each feeding? That depends on the individual infant, but here are some guidelines.

Milk volumes by Day 10, post delivery:

Average intake by age:

Breast Milk Collection and Storage for Healthy Newborns

Contributions made by Pat Bull, R.N., IBCLC

Introducing the Bottle:

• Four to five weeks of age is an ideal time to introduce a bottle of expressed milk or formula (if expressed milk is unavailable). Introduction may be difficult if later than four to five weeks.

Collecting Breast Milk:

• First, wash hands well.
• Wash breast pump equipment that contacts the breast, milk, or collection containers in a dishwasher or by hand in hot, soapy water. Rinse with cold water, and air dry on a clean towel. Check with your hospital or doctor for any other instructions.
• When to pump depends on you and your baby's schedule. Try to pump when the baby would normally breastfeed. Your milk supply usually is most plentiful in the morning, so that is a good time. Be flexible. If your baby skips a feeding, nurses a shorter time than usual, or only nurses on one side, pump out the rest of the milk and save it.
• Before pumping, get comfortably seated and relaxed. Pump your breasts according to the breast pump manufacturer's instructions.

Storage: There are several containers available for storing breast milk. These include plastic bottles or glass containers. There are advantages to each.

1. If you are going to freeze your breast milk, leave some space at the top of the container. Breast milk, like most liquids, expands as it freezes.
2. Mark the date and amount on each container.
3. Freeze your milk in 2 to 4 ounce portions. Smaller amounts thaw quicker, and you will waste less milk if your baby consumes less than you anticipated.
4. You may continue to add small amounts of breast milk to the same container throughout the day. Chill in the refrigerator until evening. Then, freeze in appropriate amounts.
5. You may also add to already frozen milk. First, refrigerate all freshly expressed milk until cold, and then add to the frozen milk. The newly added milk must be of a lesser amount than the already frozen milk.
6. Carefully washing your hands before pumping or expressing will keep your breast milk will be safe for a few hours at room temperature, 68 degrees F. Immediate refrigeration, is recommended. (1)
7. Fresh milk may be stored in the refrigerator for up to 72 hours at 39 degrees F.
8. Frozen milk may be stored in the back of the freezer portion of a refrigerator-freezer for up to six months (3), or in a -20 degree F deep freeze for up to 12 months.
9. Defrosted milk may be kept for up to 24 hours in the refrigerator.

(1) Brager J. and Bull P: A Comparison of the Bacterial Composition of Breast Milk Stored at Room Temperature and Stored in the Refrigerator. Int J Childbirth education 2:29-30, 1987 (2) Instructions from Mothers' Milk Bank at Valley Medical Center, San Jose, CA, Maria Teresa Asquith, Ronald Cohen, MD. (3) Ibid (4)Ibid (5f) Lauwers J and Woessner C: Counseling the Nursing Mother, 2nd edition, p 437, 1989 (6) Renfrew M, Fisher C, and Arms S: Bestfeeding: Getting Breastfeeding Right for You, p 95, 1990 (7) Scipien G, Barnard M, Chard M, Howe J, and Phillips P: Comprehensive Pediatric Nursing, p 218, 1975

Breast Pumping Guidelines for Babies in NICU

Wash: Wash your hands and underneath nails well before pumping. Daily bathing or shower is adequate cleansing for breasts. Do not wash nipples with soap. After pumping and air drying, Purelan applied to nipples may be useful if you experience discomfort. If you experience pain, contact your lactation consultant or your doctor.

Assemble: Assemble your breast pump pieces. Remember to always pump milk directly into sterile containers. Use hard plastic bottles provided by NICU to pump into. Plastic bags are not recommended. You may pour milk from one bottle into the second bottle, handling lids and sterile collection bottles with care to avoid contamination

Massage: Massage both breasts to help stimulate the milk ejection reflex, (let down) and to increase the fat content of your milk. (See pages 60 & 61 of Breastfeeding Information Guide by Medela, which is included in your pumping kit.)

Double Pump: Double pump 10 to 15 minutes. Begin with suction on minimum. Suction may be increased to your comfort. Breast pumping should never hurt. Pump at least eight times in 24 hours (an average of every two to three hours). It is important to pump day and night. Label your bottles with:

1. First and last name
2. Date and time of pumping (a.m / p.m.)
3. MEDS: list any medications mom has taken during the past 24 hours.
4. ILL: List any family illness, including yourself on the label.

Store: Store your breast milk in the freezer or refrigerator within one hour. Fill bottles no more than three-fourths of the way full to allow for expansion with freezing. (When baby is home form the hospital, you may store for longer periods of time. (See pages XV, XVI.) Use the following storage guidelines while your baby is in NICU:

• In the refrigerator for up to 48 hours after expressing
• In an "inside refrigerator" freezer for up to three weeks
• In a separate-door freezer or a deep freezer for up to three months

Fresh Milk Is Best: It is more beneficial for your baby if you bring milk that has been chilled in the refrigerator for no longer than 48 hours. If chilled milk is more than 48 hours old it needs to be frozen immediately. When you bring your milk from home, let your baby's nurse know whether your milk is frozen or fresh.

Cleaning: Clean your equipment by first washing with cold water, followed with hot soapy water using only packaged liquid soap in the hospital or liquid dishwashing soap at home. Let equipment air dry in a clean, dry spot with a clean towel over them. Sterilize once a day by either boiling for 20 minutes or putting the parts through the dishwasher using the sterilizing and drying option.

Transport: Transport your breast milk to the hospital in an insulated beverage cooler, packing the empty space around the bottles with a towel and then covering it with ice to keep it chilled or to prevent thawing. If milk has been frozen, it must be frozen upon arrival to NICU.

Extra Bottles: Bring your pump to the hospital when visiting your baby so that you can pump while you are there. Extra bottles and labels may be picked up from NICU when you visit your baby. Extra breast pump parts are available for purchase from the Breastfeeding Resource Center and Boutique. After regular store hours, call the charge nurse at 817-250-2030 or 817-250-3120.

References and Cross-References

• Debi Bocar, Certified Breastfeeding Education Course, Oklahoma City, Okla., 1999
• Riordan, Jan and Kathleen G. Auerback: Breastfeeding and Human Lactation, 2nd ed. Boston: Jones and Bartlett Publishers, 1999
• Breastfeeding Answer Book, La Leche League International, 1993
• Journal of Human Lactation: An Imprint Publication – Chicago, Published Quarterly

Breastfeeding Books for Parents:

• Behan, E. Eat Well, Lose Weight While Breastfeeding, New York: Vilard Books, 1992
• Huggins, K. The Nursing Mother's Companion (Rev ed). Boston: Harvard Common Press, 1994
• The Womanly Art of Breastfeeding (6th Rev. Ed.), Franklin Park, Ill.: La Leche League International
• Sears, W. Becoming a Father, Franklin Park, Ill.: La Leche League International, 1986
• Sears, W. The High-Need Baby & Nighttime Parenting, Franklin Park, Ill.: La Leche League International, 1985
• Thevenin, Tine. The Family Bed, Wayne, N.J.: Avery Publishing Group Inc., 1987
• Tellalian, Louise. Breastfeeding and Returning to the Workplace, Waco, Texas: Childbirth Graphics, 1989
• Ludington-Hoe, Susan. Kangaroo Care, New York: Bantam Books, 1993
• Harrison, Helen, The Premature Baby Book, New York: St. Martin's Press, 1983
• Bumgarner, Norma J. Mothering Your Nursing Toddler, Schaumburg, Ill.: La Leche League International, 1997
• Neifert, Marianne. Dr. Mom, New York: Penquin Group, 1987
• Pryor, Gale. Nursing Mother, Working Mother, Boston: Harvard Common Press, 1997
• Satter, Ellyn. Child of Mine: Feeding with Love and Good Sense, Emeryville, Calif.: Bull Publishers, 1991
• Peterson, Debra S. Breastfeeding the Adopted Baby, San Antonio, Texas: Corona Publishing, 1994
• Pearse, P. and Riddell, Edwina. See How You Grow, Hauppauge, N.Y.: Barrons, 1998

All of these publications may be obtained from the Breastfeeding Resource Center and Boutique at Harris Methodist Fort Worth Hospital.

Community Resources:

• Breastfeeding Resource Center, Texas Health Harris Methodist Hospital Fort Worth, 817-250-BABY (817-250-2229)
• La Leche League, 817-588-1006
• Women's Resource Center, Texas Health Fort Worth, 817-346-5506
• Women, Infants and Children (WIC), 817-871-7571
• Breastfeeding Support Center, Texas Health Harris Methodist Hospital Hurst-Euless-Bedford, 817-848-4773