Introduce a pacifier only after breastfeeding is well established (different for every mom and baby, but usually at least 3-4 weeks).
Offer the pacifier only after first offering the breast and allowing your baby to nurse until satisfied.
Don’t use the pacifier to “put off” a feeding – this is a recipe for diminished milk supply and slow weight gain. Instead offer it only to satisfy a need for “comfort” sucking if you are unable or unwilling to let your baby meet that need at the breast.
Don’t assume that if your baby takes the pacifier and goes to sleep, he wasn’t hungry – the act of sucking, even if he gets no food, produces a hormone that causes sleepiness. Sucking on the pacifier may simply cause him to sleep through his hunger.
If you use the pacifier to calm your baby at a time when you can’t nurse (in the car, for example), be sure to offer the breast as soon as it is possible, even if you must wake the baby to do so.

In the mother, possible symptoms of thrush include:

intense nipple or breast pain that occurs from birth, lasts throughout the nursing, and is not improved with better latch-on and positioning
sudden onset of nipple and/or breast pain after the newborn period
nipples that are itchy or burning and appear pink or red, shiny, flaky, and/or have a rash with tiny blisters
cracked nipples
shooting pains in the breast during or after feedings
vaginal yeast infections
In the baby, possible symptoms of thrush include:

diaper rash
creamy white patches inside baby’s mouth, cheeks or on the tongue
a whitish sheen to the saliva or inside of the lips
baby repeatedly pulling off the breast or refusing to nurse (because his mouth is sore)
The baby may also be without visible symptoms.

If you suspect that you have thrush, contact your health care provider and your counselor.  You need to contact your doctor to get a proper diagnosis, and treatment if you do have thrush.  Both mother and baby need to be treated for the infection to go away.  Your counselor can give you support while you continue breastfeeding during treatment.

HOME REMEDY FOR THRUSH

Mix 1 cup of warm water and 1 tablespoon of vinegar

Use this solution to rinse both breasts after every feeding.   Also, swab baby’s mouth with this solution after every feeding.  You can wrap your finger in a washcloth then dip it into the water/vinegar solution and swab baby’s mouth.

You must do this after every single feeding.  You should start to see relief within 24-48 hours.  Continue the treatment for 10 days.

The baby’s teeth begin to erupt**
The mother develops mastitis
The mother is planning on returning to work
The mother is prescribed a drug or needs to undergo some medical tests
Mother or baby is ill or hospitalized
The mother is pregnant

If you want to wean your baby because of any of the above reasons, please consult your counselor, a lactation consultant or your doctor.  They will be able to help you continue to nurse under these circumstances.

If you want to or need to wean for other reasons, please see the guidelines below to help you.

 GRADUAL WEANING – This  is easiest for both mother and baby.   Eliminate one feeding per day* no more often than every two or three days.  This will allow the mother’s milk supply to decrease slowly, without fullness and discomfort.

PARTIAL WEANING – This allows the mother to eliminate one or more feedings a day*,  yet still continue to breastfeed for the other feedings.

ABRUPT WEANING – Breastfeeding is stopped completely in one day.   This is most difficult for mother and baby.  This should be done with the help of your counselor, lactation consultant or doctor.

PLANNED WEANING – This is when the mother decides to stop breastfeeding before receiving cues from her baby that he is ready to stop.  Follow the steps for a gradual weaning to make this transition better for mom and baby.

NATURAL WEANING – This is when the baby decides he no longer wants to breastfeed.  This very rarely happens before the age of 1.  Follow you baby’s cues and breastfeed as often or as little as he wants.

IMPORTANT! If the baby is younger than 1 year, you need to consult with the baby’s doctor about what to substitute for the breastmilk.   If the baby is exclusively breastfeeding you will need to substitute formula-feeding(s) for the eliminated breastfeeding(s).  If the baby drinks well from a cup and is eating other foods, you may be able to substitute other drinks and foods for the eliminated breastfeeding(s).

**Weaning is not necessary just because your baby is ready to get his first tooth. Keep in mind that a baby cannot bite while he is actively sucking. As a baby breastfeeds, the nipple is positioned far back in his mouth and his lips and gums are positioned about an inch behind the nipple on the areola. The baby’s tongue extends beyond the gums, under the breast and covering his lower teeth, making it impossible to bite while sucking. Most babies never even attempt to bite, but if your baby does, learn to anticipate and prevent the biting. Most biting occurs at the end of a feeding when the baby loses interest and is not actively nursing. Watch your baby and break the suction if you notice this loss of interest. Give your baby eye contact, touching and talking to make it less likely that he will bite to get your attention. Don’t force your baby to nurse if he has indicated that he is not really hungry or interested. If your baby bites as he falls asleep at the breast, anticipate this and remove him from the breast. If you notice that the sucking pattern changes from long, even sucks to short, choppy ones, or if you notice a playful look on the baby’s face, end the feeding. Your natural reaction to biting is to startle and take the baby off the breast. For many babies this reaction is enough to discourage them from ever biting again. If your baby is persistent, calmly and firmly say, “No,” end the feeding, and wait for at least a half hour before offering the breast again.Don’t expect your baby to bite, because most babies do not. If you do experience this problem, remember that it usually ends as suddenly as it began.  Biting is a passing phase and not a reason to wean. Your breastmilk continues to be the perfect food for your baby, providing protective antibodies against illness, and all the ingredients necessary for his growth and development.

What is a growth spurt and how do you know that your baby is going through one? When a baby suddenly wants to nurse more often it is called a “growth spurt” or “frequency day.” Some mothers describe it as wanting to nurse “all the time”. If your baby’s increased desire to nurse seems sudden and there are no other reasons for it – baby is not sick or teething, for example, — it is likely to be a growth spurt. Although every baby is different, growth spurts often happen at fairly predictable ages – around two to three weeks, six weeks and three months. Some experts think a growth spurt has two purposes — to provide the baby with additional calories needed to grow and to adjust the mother’s milk supply to meet the increased demands of a larger baby. It is also reasonable to think that babies, like older children and adults, may simply feel a greater need to eat on some days than on others.What to do during a growth spurt? Nurse, nurse and nurse some more! Breastfeeding works on a supply and demand basis. The more frequently a baby nurses, the more milk the mother’s body will make. During growth spurts it is especially important that babies be nursed as often as they want. In fact, more frequent, shorter nursings build a mother’s milk supply more effectively than infrequent, but longer nursings. Younger babies generally nurse more frequently than older babies because their stomachs are smaller. Nursing as often as twelve times a day is quite normal for the first few weeks.

You may have seen an article in a national “parenting” magazine with advice from a medical doctor on identifying and handling growth spurts. Unfortunately, some of the information about growth spurts and about breastfeeding in general was just plain wrong. The article correctly stated that a baby who suddenly wants to nurse more frequently may be going through a growth spurt and should be nursed more often. However, the doctor incorrectly cautioned against nursing more than every hour and a half because nursing more frequently would result in poor nutrition for the baby, and cracked and sore nipples for the mother.

Research has proven that nursing as often as baby wants will not result in poor nutrition for baby or cracked and sore nipples for mother. As long as a baby is allowed to nurse until satisfied on one breast before the other breast is offered, she will get the nourishment she needs. Frequent nursing does not cause sore nipples; poor latch-on and improper positioning do.

The doctor also advised that babies who want to nurse more frequently could be using their mothers as “pacifiers” and should be broken of this “cycle” of nursing for comfort. Babies who nurse frequently may need comfort, and their instinctive way of seeking it is through sucking. However, it has not been proven that this comfort sucking at the breast does not have some physiological purpose as well. Once breastfeeding is well established, how a baby’s need for comfort sucking is met — breast, thumb sucking, pacifier, or any combination thereof — is a decision that belongs solely to the nursing pair. The concept of a baby using mom as a pacifier turns nature on its head — breasts have been around a lot longer than pacifiers. (Why do you think pacifiers are shaped like nipples anyway?) The advice of this doctor that nursing for comfort is a “cycle” that needs to be broken is a value judgment masquerading as medical advice.

Growth spurts generally last no more that a few days, so if you can, sit back, relax and enjoy the nursing time with your little one. It is good for both of you!

You know you will be returning to work after your baby is born. You want to continue breastfeeding, but you know that you will not be able or don’t want to pump at work. Can you still breastfeed? YES!! Mothers who have made this arrangement work suggest the following tips:

> Delay your return to work as long as possible. A long period of exclusive breastfeeding before returning to work ensures that your milk supply is well established and will be more tolerant of the varying demands placed on it. If possible, it works best if you can wait until your baby is at least three months old.

> Bring a manual pump, or a small battery-powered or electric pump with you when you first return to work. Pump only as much and as often as needed to remain comfortable (not too full). It will take a week or two for your body to adjust to not making as much milk during the workweek and picking up production again on the weekends or days off. After a week or two, you will not need to pump at all.

> Keep your work schedule consistent by working close to the same hours each day. This consistency helps maintain a good milk supply for nursing when you are not at work.

> Don’t be afraid to nurse even more frequently on weekends or days off. Your body will adjust.

> Nurse your baby right before you leave for work and first thing upon returning home. Some moms even use a reverse feeding schedule, waking their babies to nurse every two hours at night so that they eat less during the work day and need less formula supplementation.

Click here for more information.

Hand expression is always an option for any mom. It  works best for the mom who only has to express milk very infrequently. The biggest advantage is that there is no expense and nothing to clean up.

Hand operated pumps are inexpensive and will work  well for the mom who only pumps occasionally.

Automatic electric pumps are the best option for a mom who has to pump on a regular basis. They can be purchased or rented at a  daily rate.

NOTE: Some hand and electric pumps work better than  others. Please check with a counselor or lactation consultant before making a  major purchase to make sure the pump suits your needs.

Visit the Medela website for specific information about pumping and storing breastmilk.

DIRECTIONS:

Circle the hour when your baby nurses (Goal: 8-12 times in a 24 hour period)
Circle the W when your baby has a wet diaper
Circle the S when your baby has a soiled diaper
During the first week, you will use more diapers each day.
DAY ONE
Time:      Mid 1  2  3  4  5  6  7  8  9   10  11  Noon  1  2  3  4  5  6  7   8  9  10  11
Wet Diaper                  W
Black tarry soiled diaper   S

DAY TWO
Time:      Mid  1  2  3  4  5  6  7  8  9   10  11  Noon  1  2  3  4  5  6  7   8  9  10  11
Wet Diaper                   W     W
Brown tarry soiled diaper    S     S

DAY THREE
Time:      Mid 1  2  3  4  5  6  7  8  9   10  11  Noon  1  2  3  4  5  6  7   8  9  10  11
Wet Diaper                   W     W    W
Green soiled diaper          S     S

DAY FOUR
Time:      Mid  1  2  3  4  5  6  7  8  9   10  11  Noon  1  2  3  4  5  6  7   8  9  10  11
Wet Diaper                   W     W    W    W
Yellow soiled diaper         S     S    S

DAY FIVE
Time:      Mid 1  2  3  4  5  6  7  8  9   10  11  Noon  1  2  3  4  5  6  7   8  9  10  11
Wet Diaper                   W     W    W    W    W
Yellow soiled diaper         S     S    S

DAY SIX
Time:      Mid  1  2  3  4  5  6  7  8  9   10  11  Noon  1  2  3  4  5  6  7   8  9  10  11
Wet Diaper                   W     W    W    W    W     W
Yellow soiled diaper         S     S    S    S

DAY SEVEN
Time:      Mid   1  2  3  4  5  6  7  8  9   10  11  Noon  1  2  3  4  5  6  7   8  9  10  11
Wet Diaper                   W     W    W    W    W     W
Yellow soiled diaper         S     S    S    S

It is okay for your baby to have more wet diapers or more soiled diapers.  Call your breastfeeding counselor if your baby has less than the number on the log.

POSITIONING THE BABY CORRECTLY FOR NURSING
Breastfeeding is meant to be a pleasant, comfortable experience.  You can avoid the problem of sore nipples most of the time.  Many new mothers find their nipples are tender for the first few days when the baby starts nursing.  This usually disappears by 1-2 weeks.  To prevent nipple tenderness, correct positioning and latch on are important.  There are several different positions you can try.

CRADLE POSITION
Place a pillow or two in your lap to support the baby
Place your baby’s head on the crook of your arm
Support the baby’s back with your forearm
Your hand should cup the baby’s buttocks or thigh
Make sure your baby is turned towards you (chest to chest)
The baby’s ear, shoulder and hip should be in a straight line
The baby’s bottom arm can be either under your breast or around your waist

FOOTBALL OR CLUTCH HOLD
(The football hold is a good choice for the mother who has had a cesarean section because it allows her to breastfeed without putting pressure on the incision)
Place a pillow or two at your side to help support your arm and your baby
Your baby should be facing you while his body is tucked under your arm along your side
The baby’s bottom should rest on the pillow near your elbow with his hips against the back of the chair
The baby’s upper back rests along your forearm while you support his neck with your hand

SIDE-LYING
Lie on your side
You can put pillows under your head, behind your back and under the knee of your upper leg
Your body should be at an angle to the bed as you lean slightly backward into the pillow behind your back
The baby should be on his side facing you
The baby’s back should rest against your forearm
To keep the baby on his side, a folded towel or small pillow may need to be propped behind his back
You can offer both breasts while lying on one side or roll over for the baby to nurse on the other side

SLIDE-OVER
(The slide-over position can be helpful in persuading a baby who is refusing one breast to nurse on the less preferred breast)
The baby will start in the cradle position (see above) and nurse from one breast
When it is time for the baby to take the second breast, slide him over without changing his body position

CROSS-CRADLE
(Also known as the modified clutch or transitional hold.  This is an effective position for babies who are having difficulty latching on.)
Support the baby in your lap on a pillow in a horizontal or semi-upright position
Hold the baby using the arm opposite the breast at which he will feed
Your hand supports the baby’s neck and head, his body extends the length of your forearm
Use your same side hand to support the breast
Position the baby’s mouth at the level of your nipple with the baby on his side facing you

Frequent and unrestricted breastfeeding in the early days offers health benefits for both mother and baby.

-Provides the baby with the colostrum he needs
-Prevents painful engorgement in the mother
-Stimulates uterine contractions in the mother and lessens the chances of hemorrhage
-Prevents newborn jaundice
-Stimulates the mother’s milk to increase more quickly

Babies should nurse 8-12 times in a 24 hour period.  Watch for your baby’s cues that he is hungry and don’t worry about the length of time since the last feeding.   Most babies will fall into their own pattern of nursing.  Some will space them evenly and some will nurse more often at certain times of the day and less at others.   It is the overall amount in a 24 hour period that is important.

One or two wet diapers a day are normal for the exclusively breastfed baby during the first two days after birth.  By day five, there should be 5-6 wet diapers per day.

The baby’s first bowel movement, meconium, is dark and tarry.  After the first few days, bowel movements should be a “golden mustard” color with “seeds” in it.  Their is usually no odor associated with the bowel movements of an exclusively breastfed baby.

When breastfeeding is going well, water or formula  supplements are not needed.  There are several reasons that supplements should be avoided.

-Supplements fill up the baby, making him less interested in breastfeeding
-Artificial nipples can weaken a baby’s suck or cause the baby to refuse the breast
-Supplements decrease the time at the breast which can lead to engorgement
-Supplements interfere with the establishment of the milk supply
Allow the baby to finish the first breast before offering the second.