Breast Feeding

• Breastfeeding should be started as soon as possible after birth, usually in the first hour.
• Full milk letdown doesn't usually occur until 2-3 days after delivery
• offer both breasts, alternating which one you offer first (10 min 1st breast, as long as wanted on 2nd)
• full letdown will occur in 5-20 minutes
• feed q2-3 hours or at least 8-12 x per day (wake up baby if haven't fed in 3 hours during 1st month)
• Newborns should be nursed whenever they show signs of hunger (increased alertness or activity, mouthing, rooting) crying is a late indicator of hunger
• newborns may not demand feeding during 1st few days/weeks , so wake baby and offer milk after 4 hours of sleeping
• baby will fall asleep or stop when sated; signs of adequate milk supply 1-3 bm/day, 6-8 wet diapers/day, long drawing sucks, satisfied p feeds, br's full before & soft after feeds
• NO need to supplement with other foods/liquids: sterile water, glucose water may exacerbate hyperbili due to prevention of adequate milk (calorie) intake. Extra water is NEVER required, even if it is hot outside.
• avoid nipples/pacifiers
• When discharged 48 hrs after delivery, all breastfeeding mothers and their infants should be seen by their pediatrician or other knowledgeable health care provider when the newborn is 2-4 days of age.
• Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months of age.  Infants weaned before 12 months of age should not receive cow's milk but should receive iron-fortified infant formula.
• It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually possible (exclusive breastfeeding during the first 6 months of life and continuation for the second 6 months if possible)

Contraindications to breast feeding:

• Can't Give Him/Her Milk/Tit
• Chemo/antimetabolites, Illicit Drug Use
• Galactosemia
• HIV, HTLV, HSV lesions on breasts
• Miliary Tb/Active Tb (until 2 weeks post start of abx)

Mom's diet: nutrient content of milk remains very constant, regardless of maternal intake, unless her own body stores become severely depleted. Drinking more fluid will not increase milk volume. If vegan and no vit b12, infant is at risk for b12 deficiency.

To increase milk supply: adeq sleep, decr stress, adeq fluids, (1 qt milk + 1 qt H2O/d), nurse @least q3 h during 1st few wks,pump for 10 min p ea feed

Positioning:
• cross cradle - better positional control
• football - csect,twins,large br,premature baby,better visualiz
• side lying - csect,sleepy baby, NOC feeding,uncomfortable sitting
• cradle - good p 1mo (better head control by infant)

Breast Milk, pros and cons
Feeding spurts