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Breastfeeding Links & Tips
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Medela
Medela is the manufacturer of the breastpumps and most of the other breastfeeding accessories sold on this site.

Ask Medela's Lactation consultant
Submit a question to Medela's board-certified lactation consultant. Visit this link and then click on the lactation consultant's name underneath her photo to submit your question by e-mail.

Medela's breastfeeding FAQs (Frequently Asked Questions)
Click on this link to view answers to frequently asked questions, such as: "When will my milk come in?", "How can I tell if my baby is getting enough milk?", "What if I don't have enough milk or my baby is gaining weight poorly?" and many more.

Breastfeeding.com
The #1 site for breastfeeding information, support, and attitude. This site has one of the most extensive list of breastfeeding links I have seen on the web. It also offers a very active breastfeeding message board.

Dr. Jack Newman's breastfeeding handouts - provided by First Feast, Breastfeeding and Maternity Center
Dr. Jack Newman is a pediatrician who operates four breastfeeding clinics in Toronto, Ontario and speaks worldwide on breastfeeding issues. This website offers information on all common breastfeeding questions, and offers a wealth of information. Most common questions are covered, including: sore, flat or inverted nipples; how to tell if your baby is getting enough breast milk; colic; when to introduce solids; breastfeeding while working outside the home; common breastfeeding myths; thrush; plugged ducts/mastitis; and many more topics.

American Academy of Pediatrics revised statement on Breastfeeding
(issued December, 1997) The revised statement on breastfeeding recommends that breastfeeding be continued for at least 12 months, and thereafter for as long as mutually desired.

Cost of Formula Feeding
Visit this website to calculate the cost of formula feeding your infant for the first 12 months of life. You will quickly see that the cost of artificial baby milk far outweighs the cost of renting a Medela Lactina breastpump for a year or purchasing a Medela Pump In Style.

La Leche League International
A nonprofit organization supporting breastfeeding mothers.

101 Reasons to Breastfeed Your Child
Sponsored By ProMom, Inc. Offers breastfeeding advocay information and a number of breastfeeding links.

Dr. Hale's Breastfeeding Pharmacology Page
Dr. Hale is the author of the book "Medications and Mother's Milk", and his site offers a great deal of information on transmission of medications into breastmilk. This site has recently added a new feature - "ask the lactation consultant", which provides answers to almost every breastfeeding question you could imagine. If the answer to your question is not already available, you can submit your question via e-mail!

Pumping List Website
The pumping list is a support group for women who use a breastpump to supply breastmilk for their infants. Pump usage varies from full time to part time. Discussion topics center around lactation and pump use as well as supply problems, etc.

Supply Boosters
Useful tips on how to boost your milk supply compiled by the moms at the pumping list website. Includes recommended dosages for natural supplements such as Brewer's Yeast and Fenugreek, plus the recipe for "Tiger's Milk", a natural supply booster.

American Academy of Pediatrics Home Page.
From this site, you can conduct an online search for specific children's health related topics.

How to choose a correctly fitted breastshield.
A link to Medela's site which explains how to tell if you need to order Large or Extra Large PersonalFit breastshields. Includes a video that shows proper fit of the breastshield during pumping.

Sore Nipples - Prevention and Treatment
This is the full text of the Medela handout on Prevention and Treatment of Sore Nipples.

When One Child is Breastfed....
An essay on all of the health, social, economical, community, and family benefits attained when one child is breastfed.

Nutritional Information for the Breastfeeding Mom
For breastfeeding mothers who want to know how to care for themselves nutritionally while insuring the highest quality breastmilk for their babies.

Medications in the Breastfeeding Mother
Published by the American Academy of Family Physicians. Physicians receive little education about breast-feeding and even less training on the effects of maternal medications on the nursing infant. Yet, concern about potential harm to the nursing infant from maternal medications is often cited as a reason to advise discontinuation of breast-feeding. Overwhelming evidence demonstrates the benefits of breast-feeding and the deleterious effects that can result from premature weaning. This article provides information to facilitate medication use in breast-feeding mothers. This article lists medications which are considered safe in treatment of a variety of conditions in breastfeeding mothers, as well as a list of medications which are not recommended during breastfeeding.

Should I buy or borrow a pre-owned breastpump?
A link to Medela's site which explains that personal use breastpumps such as the Pump in Style, and all others besides the Lactina, should not be shared between mothers due to potential health risks.

Engorgement - Prevention and Treatment
This is the full text of the Medela handout on Prevention and Treatment of Engorgement.

Breastmilk collection and storage guidelines
This is the full text of the Medela handout on breastmilk collection and storage, which includes guidelines for length of time breastmilk is useable after refrigerator or freezer storage, and after thawing.

Adoptive Breastfeeding Resource on the Web
Offers support and information on breastfeeding an adoptive infant. Also has a very active message/support board.

Breastfeeding Multiples
An excellent resource for moms who are breastfeeding twins or triplets. Also has a vast array of breastfeeding links which would be of interest to all breastfeeding moms!

Pumping for Premature Infants
Advice for mothers who are providing breastmilk for preemies.

General Instructions for the Pump In Style
If you have lost your Pump In Style instruction booklet, click here to visit the link on Medela's website which contains general instructions for the Pump In Style.

PostPartum International (Postpartum Depression Resource)
Visit this link for information and assistance with PostPartum Depression.

Lactina Vs Pump In Style?
This is a link to the "iVillage.com" Parent's Place message board, for one parent who had mistakenly bought a Gerber breastpump which led to early weaning of her first child (similar to my own experience with the Evenflo breast pump). She posted a message asking whether she should buy a Pump In Style or Rent a Lactina. The overwhelming response was that she should purchase a Pump In Style.

Congresswoman Maloney Supports a Woman's Decision to Breastfeed
Visit this link to view the recent bills introduced to Congress by Representative Maloney, including H.R. 285, the Breastfeeding Promotion Act.

Breastfeeding and Returning to Work
Sponsored by ProMom.org, this page offers advice to moms who must return to part or full time employment outside the home while continuing to breastfeed their infants. The site includes a sample letter, written to the human resources manager at a large work site, which worked: the employee's need for a private and clean place to pump was accommodated.

CONTACT US
Contact us to give us feedback on this site, or to suggest additional links.

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SORE NIPPLE MANAGEMENT - PREVENTION AND TREATMENT

Breastfeeding is meant to be a comfortable, pleasant experience. Most of us have heard stories of sore nipples. You can avoid this problem most of the time. However, many new mothers still find their nipples are tender for the first few days when the baby starts nursing. This usually disappears by 1-2 weeks.

CAUTION: blisters, cracking, bleeding, and/or pain that continues during or between feedings is not normal. Check with a lactation consultant, La Leche Leage, or Nursing Mother's Council if you have any of these problems.

PREVENTION: To prevent nipple tenderness, start with correct positioning and latch on:
Cradle position:

  • Place a pillow or two in your lap to support your baby.
  • Place your baby's head on the crook of your arm.
  • Make sure your baby is turned towards you - chest to chest - at breast level.
  • Support your breast with your hand in an "L" or "C" position, thumb on top of breast, fingers below, away from the areola.
  • Tickle your baby's lower lip until he opens WIDE, then quickly pull him onto your breast. Be patient. This may take a minute.
  • Make sure your baby's lips are behind the nipple, encircling the areola.
  • The tip of the baby's nose should be touching the breast.<
    FOOTBALL/CLUTCH Position:
  • Put a pillow or two at your side to help support your arm and your baby.
  • Support your baby's neck and the lower back of his head in your hand, with your forearm supporting his upper body against your side.
  • Follow the final four steps listed for the Cradle position above.
    LYING DOWN Position:
  • Lie on your side with pillows supporting your back and your top leg, which is bent forward.
  • Place your baby on his side facing you.
  • Follow the final four steps listed for the Cradle position above.

Vary nursing positions for the first week.

Breastfeed frequently, every 1-1/2 - 3 hours. (8-12 feedings per 24 hours). Keeping your newborn baby on an artificially longer schedule may make him frantically hungry and increase the liklihood that too vigorous nursing will make your nipples tender.

Release the suction before you remove your baby from the breast. Do this by placing a clean finger in the side of the baby's mouth between his jaws. Don't take him away until you feel the suction break.

After nursing your baby, express a little breastmilk and massage it into your nipples and aereola, then air dry. Leave them exposed to the air as much as possible.

Never use soap, alcohol, or breast creams on your breasts or nipples. Water is all that is needed to clean your breasts when you shower or bathe.

SORE NIPPLE TREATMENT:
If your nipples become sore, try this:

  • Use deep breathing, soft music, or other relaxation techniques before and during breastfeeding.
  • Limit the nursing time on the sore nipple.
  • Nurse on the least sore side first.
  • Express a little milk first to help stimulate let down.
  • Massage your breasts while nursing. This helps to stimulate the milk to flow.
  • Use non-plastic lined bras and/or bra pads. Change the pads frequently to keep the nipple dry.
  • If your nipples become dry or cracked, use a little USP Modified Lanolin on them. This forms a moisture barrier so they stay dry.
  • If your breasts become engorged, try expressing a little milk first. Engorged breasts make it difficult for your baby to latch on. Expressing a little milk by hand or pump helps make the areola softer, the nipple more erect and latch-on easier.
  • Wear multiple holed breast shells for sore nipples between nursings. This allows air to circulate and protects them from further rubbing by your bra.

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BREAST ENGORGEMENT - PREVENTION AND TREATMENT:

During the first week after delivery, as the colostrum is changing to mature milk, your breasts will become full. The normal postpartum fullness usually diminishes within 3-5 days. Engorgement may develop if your baby does not adequately remove the milk from your breasts. During this time, your breasts will feel hard, painful, and hot.

PREVENTION:
You can prevent engorgement by:

  • Breastfeeding your baby frequently, 8-12 times in 24 hours.
  • Avoiding supplements of water or formula for the first 3-4 weeks unless medically indicated.
  • If you miss any feedings, expressing your milk.
  • When weaning your baby, doing it gradually.

TREATMENT:
  • Apply hot, moist towel (or disposable diaper) to your breasts for 2-5 minutes, or take a hot shower before nursing your baby.
  • Hand express some milk to soften the areola after using moist heat. This makes it easier for baby to attach to the breast.
  • Use gentle breast massage before and during breastfeeding.
  • Try applying icy cold compresses to your breast after nursing to relieve the discomfort and decrease swelling.
  • If your baby takes only one breast, use a hospital-type automatic electric breast pump or hand expression to express milk from the other breast during the engorgement period.
  • If your baby can't latch on or your nipples are flattened, use a hospital-type electric breast pump or hand expression to soften the areola. Use moist heat and breast massage before pumping. Continue pumping every 2 hours, 10 minutes per side, until your baby can latch on.
  • If your nipples remain flat, wear multiple holed breast shells (such as the Medela Softshells for inverted/flat nipples) for half an hour before breastfeeding. This will help draw out your nipple, making it easier for the baby to latch on. Discontinue usage if discomfort occurs.
  • Avoid bottles, pacifiers and nipple shields during this engorgement period. These may cause nipple confusion/preference.

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BREASTMILK COLLECTION AND STORAGE:

Guidelines for normal newborns:

COLLECTING BREASTMILK:

  • First, wash hands well.
  • Wash breastpump equipment that contacts 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 doctor or hospital for any other instructions.
  • When to pump depends on you and your baby's schedule. Your milk supply is most plentiful in the morning, so that is a good time. Try to pump midway between feedings. 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. If you are planning to return to work and continue breastfeeding, begin pumping two weeks before you return. Try to simulate what your pumping schedule at work will be at work.
  • Before pumping, get comfortably seated and relaxed. Pump your breasts according to the breastpump manufacturer's instructions.

    STORAGE
    There are several containers available for storing breastmilk. These include specially designed plastic bags, 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. When using plastic bags, use those designed for breastmilk collection. (See Self Expressions "Breastfeeding accessories" page to order breastmilk freezer bags.) Before storing, fold the top several times and seal with freezer or masking tape. Place smaller bags in a larger bag to help protect against punctures. Medela's sterile CSFTM (Collection Storage Freezer) bags come with twist ties for easy sealing and don't need to be double bagged.
    3. Mark the date and amount on each container.
    4. Freeze your milk in two ounce to four ounce portions. Smaller amounts thaw quicker, and you will waste less milk if your baby consumes less than you anticipated.
    5. You may continue to add small amounts of cooled breastmilk to the same container throughout the day. Chill in the refrigerator until evening. Then, freeze in appropriate amounts.
    6. You may also add to previously frozen milk. First refrigerate all freshly expressed milk until cold, then add to the frozen milk.1
    7. If you carefully washed your hands before pumping or expressing, your breastmilk will be safe for around 4-10 hours2,3 at room temperature, 66 - 72 degrees F. Immediate refrigeration, however, is recommended.
    8. Fresh milk may be stored in the back of the refrigerator for 5 to 7 days at 39 degrees F.4
    9. Frozen milk may be stored in the back of a refrigerator-freezer for up to six months.5
    10. Frozen milk may be stored in a -20 degree deep freezer for up to 12 months.6
    11. Defrosted milk may be kept for up to 24 hours in the refrigerator.7 If not used in 24 hours, defrosted milk must be discarded. Never refreeze thawed milk.

    DEFROSTING:
    To defrost frozen milk:

    • Place milk in the refrigerator the night before you're going to use it. Refrigerator defrosting takes about 8 to 12 hours.
    • Place the frozen milk under warm running water or in a pan of warm water. Don't use hot water, as this can destroy some of the milk's immunological components.
    • Fat in breastmilk will separate and rise to the top. By gently swirling the container, you can mix any fat that may have separated.
    • Never refreeze thawed breastmilk.
    • Remember, the color, consistency and odor of your breastmilk may vary depending upon your diet, or exposure to other foods in your refrigerator or freezer.
    • Discard any breastmilk you don't use during a feeding.

    CAUTION: Never microwave breastmilk! Microwaving breastmilk can change the milk's composition, and has the potential to harm your baby.8

    INTAKE GUIDELINES:
    How much breastmilk should you anticipate for your baby at each feeding? That depends on the individual infant, but here are some guidelines.9
    Average intake by age:
    0-2 months - 2-5 oz per feeding - 26 oz per day
    2-4 months - 4-6 oz per feeding - 30 oz per day
    4-6 months - 5-7 oz per feeding - 31 oz per day

    Average intake by weight in a 24 hour period:
    8 lbs. - 21.3 oz
    9 lbs. - 24.0 oz
    10 lbs. - 26.7 oz
    11 lbs. - 29.3 oz
    12 lbs. - 32.0 oz
    14 lbs. - 37.3 oz
    16 lbs. - 42.7 oz

    1Lauwers J. and Woesner C: Counseling the Nursing Mother, p. 436.
    2Hamosh M, Ellis L, Pollock D, Henderson T, and Hamosh P: Pediatrics, p. 492, 1996.
    3Barger J and Bull p: A comparison of the Bacterial Composition of breastmilk stored at Room Temperature and Stored in the Refrigerator. Int J Childbirth Educ 2:29-30, 1987
    4Sosa, Roberto; Barness, Lewis: AJDC, Vol 141, Jan. 1987.
    5Instructions from Mother's Milk Bank at Valley Medical Center, San Jose, CA, Maria Teresa Asquith, Ronald Cohen, MD.
    6Ibid
    7Lauwers J. and Woessner C: Counseling the Nursing Mother, second edition, p. 437, 1989.
    8Renfraw M, Fisher C, and Arms S: Bestfeeding: Getting Breastfeeding Right for You, p. 95, 1990
    9Scipien G, Barnard M, Chard M, Howe J, and Phillips P: Comprehensive Pediatric Nursing, p. 218, 1975.

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