Self Care

Establishing Breastfeeding

• It is wise to discourage visitors for the first week so you can rest and the baby won't be overstimulated.
• Plan for night feedings. Keep your baby close and convenient for feedings. Many mothers choose to sleep with their baby.
• It may take six weeks for your milk supply to adjust to baby's need, but if you think your baby is not getting enough to eat call your Lactation Consultant at 817-250-BABY (817-250-2229).

Taking Care of Your Breasts

• Good handwashing before feeding your baby can help decrease sore nipples and/or breast infections.
• You may want to wear a comfortable, supporting bra. Bras that close in the front open easily to expose the entire breast. Sleep bras are also available for nighttime.
• The fullness in your breast will diminish after approximately 10 days to two weeks; this is not a sign of low milk supply. This may occur about the time of the first growth spurt. Moms sometimes are tempted to give the baby a bottle at this time, but the baby needs to feed more at the breast so the mother will be able to make more milk for the growing baby.
• Cleanse breasts with clear water only. Babies learn where milk comes from by smell, and soap may leave a different smell. They need to learn the smell of your skin and of your milk. Strong fragrances such as hairspray, perfume, powder, lotions and deodorants can confuse the baby in the first few days.
• Air-dry your nipples after every feeding to help prevent skin breakdown and possible infection. If your breasts are leaking between feedings, your may want to use bra pads. Changing pads often is very important because wet pads can cause sore nipples and infection.
• You may use lubricants such as Purelan or Lansinoh ointment on your nipples if your skin is dry, damaged or tender. Make sure your nipples are dry before applying these lubricants. See also: Appendix: Suggested Indications and Uses for Purelan.
• Some moms may have yeast infections in their nipples, which usually causes pain. Tell your midwife, doctor, nurse or lactation consultant if you suspect yeast or if you had a yeast infection in pregnancy and you have painful or cracked nipples. Also see Appendix, The Link Between Infant's Oral Thrush and Nipple/Breast Pain in Lactating Women.
• Avoid plastic liners in bras or pads because moisture and heat is held in. Breasts need to have air circulation.
• If a feeding is missed, you will need to release milk in your breasts by hand expression or pumping for comfort and to help establish your milk supply.
• Changing nursing positions with every feeding may help to prevent and/or decrease sore nipples.
  See Appendix: Mastitis (Breast Infection) Prevention and Treatment. 

Breastfeeding should not be painful. If you dread breastfeeding your baby, please ask for help.

Nutrition

• Eat all foods in moderation. If you or the father of the baby have problems with any particular food, you may want to eliminate or decrease amounts of that food.
• Eat three nutritious meals and two snacks daily.
• Unless you are allergic to any of these foods, a peanut butter and jelly sandwich on whole-wheat bread with an 8-ounce glass of whole milk makes a good 500-calorie snack.
• Consult the hospital staff or the hospital dietitian about menu selections if advice is needed.
• Breakfast is important to keep up stamina, and a midafternoon snack will also help.
• Cut down on sugar, salt and refined foods.
• You can usually return to pre-pregnant weight faster if breastfeeding.
• Trying to lose weight quickly (dieting) is usually not a good idea when you are breastfeeding. Your fat stores help give you energy to produce breastmilk. If you lose weight too quickly you may also diminish your milk supply.
• If you normally drink caffeinated beverages, you may need to watch for signs of increased fussiness or wakefulness in your baby. No more than two caffeine drinks in 24 hours is recommended.
• Alcoholic beverages are not recommended.
• There are no specific foods needed to make breast milk. There are no specific foods to avoid unless your baby reacts with rash, gas or fussiness or if father, mother or other family members have certain food allergies or sensitivities.

Rest and Relaxation

• Rest is necessary for a good milk supply, staying healthy, (body and mind) and energy.
• Taking a nap or getting 10 to 15 minutes of rest one to two times each day is important.
• Lie down to breastfeed. It conserves energy.
• Get help with housework or do only a bare minimum.
• Take on former chores and activities gradually.
• Take baby along for outings. Mothers can breastfeed discreetly by wearing a two-piece outfit with a front button blouse, open from the bottom or some of the new fashions made especially for breastfeeding mothers.
• It is OK to go out (for a break) between feedings without your baby.
• Bottles of expressed milk or formula (if expressed milk is unavailable) may be used after establishing your milk supply at about four to five weeks. This is the ideal time to introduce a bottle. Sometimes it is difficult to get the baby to take a bottle if it is introduced later than four to five weeks. Avent Bottle systems are recommended to help with proper jaw development.

If Milk Supply Seems Low

• Check with a Lactation Consultant or health-care provider before taking any medications.
• Increase frequency of feedings every two to three hours or more frequently if your baby seems hungry.
• Breastfeed at least 10 to 15 minutes on each breast.
• Use both breasts at every feeding.
• Rest and relax, getting help with housework and other responsibilities.
• Discontinue giving your baby all supplements, water and juice so that baby will feed more at breast.
• Make sure your protein and calorie intake is sufficient.
• Eat 2,000 to 2,500 calories per day of well-balanced foods.
• Drink eight to 10 8-ounce glasses of fluids every 24 hours.
• Avoid medications that interfere with milk production, such as Parlodel, TACE, antihistamines and some birth control pills. Also see Appendix, Increasing Milk Supply.

Engorgement

• Milk engorgement (breasts feel full) is a positive sign showing that your hormones are working to create milk. This can occur when breastfeeding is delayed, interrupted or when "let down" does not occur. Breasts become firm, painful and warm to touch. Skin may appear shiny and transparent.
• To relieve this fullness you may want to breastfeed every 1 1/2 to 2 hours.
• Your nipples may become flattened. Be sure to soften the areola (the darker part of your breast) by expression of milk for a better latch on by the baby. It is important that your baby continue to feed with at least 1/2 inch of the areola in his or her mouth. If the baby sucks only the nipples they may crack and baby will probably not get enough to eat.

Steps for Each Feeding

• Applying warm wet packs for no more than five minutes or taking a warm shower helps milk release and drip out.
• Massaging your breasts before expressing will help your breast milk flow easier.
• When feeding your baby, switch breasts every 10 minutes, if possible.
• After feeding, use a hand pump, electric pump or hand express to further empty the breasts.
• It is helpful to use cold packs or ice packs for about 20 minutes between feedings or if you are unable to express any milk by hand expression or pumping.
• Use green cabbage leaf compresses. See the Appendix for more information.
• Ibuprofen is compatible with breastfeeding. It may relieve inflammation from engorgement. Use as directed on the label or by physician.
• If engorgement continues untreated, permanent damage to the breast tissue may occur and your breast may become infected.

If help is needed, call your Lactation Consultant at 817-250-BABY (817-250-2229).

Sore Nipples

• Shorter, more frequent feedings are best.
• Allow your milk to come out before baby latches on by massaging the breast.
• Reposition baby on your breast, repeat latch on until not painful – the jaws should compress the areola (the darker part of the breast).
• Begin feeding on least sore side. Warm, wet packs after feeding are helpful and feel good.
• Allow your nipples to air dry.
• Apply Purelan or Lansinoh to nipples after air-drying. See Appendix.
• Avoid tight-fitting bras or underwire bras that press into the breast tissue.
• Avoid nursing pads with plastic liners in them and change pads often to decrease growth of germs.
• Use breast shells to keep bra from irritating your nipples further.
• If your nipples are too sore to feed your baby, use an electric breast pump until healing occurs. To avoid nipple confusion you may want to cup feed the expressed breastmilk rather than bottle feeding your baby.
• Always use good handwashing to decrease germs to nipples.
• Yeast infection in nipples can cause soreness or pain.
• Always keep all breastfeeding equipment clean by using hot soapy water and rinsing well.

Call a Lactation Consultant at 817-250-BABY (817-250-2229) if soreness does not improve within one week. Call immediately if breastfeeding is extremely painful. (Also see Appendix, Oral Thrush and Nipple/Breast Pain.)

Medication

• Before taking prescription or over the counter medications, food or diet supplements or herbs please call your health-care provider or a Certified Lactation Consultant.

Fluids

• To determine the correct amount of fluids for you need, listen to your body and drink when you are thirsty.
• To make sure you're drinking enough, check your urine to see that it remains pale yellow.