Breastfeeding rates in the United States are trending upward, with 79 percent of newborns in 2011 starting off their lives at their mother's breast, compared with 75 percent of newborns in 2007, according to the Centers for Disease Control and Prevention.
However, some mothers may not have the support they need when they begin to breastfeed and when challenges arise, said Dr. Ruth Lawrence, a professor of pediatrics and obstetrics and gynecology at the University of Rochester School of Medicine in Rochester, New York. "That's why having a peer-support group who can help a nursing mother is very important."
Classes are available to help teach mothers-to-be before she gives birth, as well as peer-support groups, lactation consultants and organizations, such as La Leche League, to offer guidance and answer questions after she delivers, Lawrence told Live Science.
Here is a primer to help with breastfeeding-related questions.
Nutrition
Breastfeeding not only nourishes babies, studies have shown that it can also provide them with a strong immune system and lowers the risk of sudden infant death syndrome (SIDS). Also, mother's milk is easier to digest than formula. A report published in the medical journal The Lancet in January 2016 found that if all children and infants were breastfed, the deaths of 820,000 children per year might be prevented, equaling to 13 percent of all deaths of children under 5.
Staying hydrated, eating healthy foods, and voiding alcohol and smoking can help with the production of nutritious milk for the infant. It is a myth that a mother needs to drink milk to make milk, according to the Los Angeles Children’s Hospital. Mothers should drink 6 to 8 glasses of fluids (water, juice, milk) a day to produce enough milk and to stay hydrated.
Eating a balanced diet and continuing to take prenatal vitamins will keep both mother and child healthy during the breastfeeding process. Also, a mother only needs to eat an additional 400 to 500 calories to retain her energy levels, according to the Mayo Clinic.
Mothers should wash fruits and vegetables to remove possible pesticides. Before taking any medications a mother should consult her medical professional. Moderate levels of caffeine — 2 to 3 cups (16 to 24 ounces) — are safe for both mother and baby, but too much can lead to fussiness and sleeping problems in infants.
Mothers should avoid fish that may be high in mercury, such as swordfish, king mackerel and tilefish. Smoking should always be avoided while breastfeeding. The baby is exposed to nicotine through the breast milk when the mother smokes. Secondhand smoke also increases the risk of SIDS and respiratory illnesses.
Alcohol is fine in moderation, but mothers should time their drinks so that they can avoid breastfeeding for two to three hours after the drink. According to the Mayo Clinic, alcohol takes two to three hours for 12 ounces (355 milliliters) of 5 percent beer, 5 ounces (148 ml) of 11 percent wine or 1.5 ounces (44 ml) of 40 percent liquor to leave the body, depending on body weight. It is a myth that pumping and dumping speeds the elimination of alcohol from the body. Mothers should never breastfeed while alcohol is still in their system because it can harm the baby.
Many mothers worry if they’re babies are getting enough to eat. A child is getting plenty of breast milk if it is steadily gaining weight, producing at least six wet diapers a day and is content between feedings, according to the Mayo Clinic. Yellow, seedy and loose stools are also signs of a healthy breastfed baby. How often a child needs fed depends on age and individual needs. The American Academy of Pediatrics (AAP) states newborns need to be fed every 1.5 hours to 3 hours, which equals out to 8 to 12 or more times per 24 hours once the mother’s milk has come in. The mother should wake the baby to eat if 3 to 4 hours have passed since the last feeding. If the baby doesn’t wake up to eat on a regular basis, the mother should consult with her pediatrician.
Weaning
How long a baby breastfeeds varies, but for the greatest benefits AAP recommends breastfeeding exclusively for at least 6 months. It also recommends the continuation of breastfeeding for at least 1 year while new foods are introduced into the child’s diet. Mothers can continue to breastfed after one year as long as it is comfortable for the mother and child. “Weaning is an individual process and a decision between mother and baby,” said Sharon McDuffie, a lactation specialist at MedStar Washington Hospital Center, in Washington, D.C. "Mothers please don’t take it personal if your baby makes the decision before you do."
Mothers stop breastfeeding for several reasons. "Some moms stop after the baby gets settled into eating solid foods, usually around six to nine months,” said Dr. Iffath Hoskins, a clinical associate professor in the department of obstetrics and gynecology at the NYU Langone Medical Center. "Some stop because of a decreased amount of breast milk, and some stop when the baby is becoming more active, around 1 year old or so."
Positioning
Positioning the baby is key to breastfeeding success. The basic breastfeeding positions include the cradle hold, cross-cradle hold, football hold, side-lying hold, laid-back or baby-led. Debbie Pierce, a registered nurse and board-certified lactation consultant at Kaiser Permanente in Colorado, recommends varying breastfeeding positions to prevent plugged milk ducts.
Once the baby is held in a position that is comfortable, presenting the nipple can help with latching on. The mother should hold the baby so that the head is level with the breast, nose to nipple. Then, the baby should be turned so the mother and baby are tummy-to-tummy. Support the breast with the free hand that isn’t holding the baby with all four fingers underneath it, away from the areola (darkened area around the nipple) to best present the nipple, recommended Terry Bretscher, a nurse and lactation supervisor at Pomona Valley Hospital Medical Center.
Many experts recommend tickling the baby's lower lip with the nipple and waiting for the baby's mouth to open wide before offering the breast. Then, pull the baby in to latch on. The tip of the baby’s nose and chin should be touching the breast during proper positioning. Mothers shouldn’t worry about suffocation. The baby will pull off if unable to breathe.
Pumping
Pumping is a good option for mothers who want to share the feeding experience with other family members. Pumping may also be necessary for medical or special feeding needs.
The question of how often to pump is typically a problem that new mothers face. Nancy Hurst, a registered nurse, a certified lactation consultant and director of women’s support services at Texas Children’s Pavilion for Women, said that the frequency of pumping depends on the reason for the breast stimulation. If the infant is not able to breastfeed directly, the pump acts as mom’s mechanical baby. In this situation, the mother will need to pump at least six times a day; more often (eight times a day, including at night) during the first 10 days post-birth to build her milk production. If an infant is not breastfeeding well, the mother should pump after a few feedings per day, preferably after feedings when the infant didn’t nurse as well.
If a mother is returning to work or away from the baby for an extended period of time the frequency of pumping will depend on the age of the infant at the time the mother returns to work and what the baby’s feeding schedule is. “For instance, if the baby is 6 weeks old the mom will need to pump more often when away from her infant, versus if the baby is 3 months or older,” said Hurst.
Pumping at work can create some challenges, but mothers should know their legal rights. Section 4207 of the Fair Labor Standards Act requires employers to provide reasonable break time for an employee to pump milk for her nursing child for up to one year after the child's birth. The employer must also provide a place, other than a bathroom, for breast pumping.
Breast milk, like other foods, should be kept at safe temperatures and should be handled properly to avoid contamination. The CDC provides guidelines for the proper handling and storage of human milk.
Privacy considerations
Breastfeeding in public, at work, etc., is a hot topic online and in the media. Some feel that since breastfeeding is natural, covering up or breastfeeding in private isn’t needed; others believe that these practices show modesty. It is not against the law to breastfeed in public. In fact, 49 states in the United States (all except Idaho), the District of Columbia and the U.S. Virgin Islands have laws that protect mothers who choose to breastfeed in public, according to The National Congress of State Legislatures.
A mother should choose the practice that is most comfortable to her and her child. If a covering is required, remember that heavy fabrics can cause babies to overheat in warm weather. Also, avoid feeding in bathrooms to prevent the transfer of bacteria from hands to the breast.
Additional resources
