Breastfeeding: A Complete Guide

Breast milk is the best food you can offer your new baby. At about 6 months, your baby will be ready for other foods, but you can continue breastfeeding until your child is 2 years of age and beyond.

Why breast milk

Breast milk is naturally and uniquely produced by each mother for her own baby, so your baby is less likely to be exposed to foreign allergenic material. It contains antibodies and other immune factors that help prevent illness, has the right amount and quality of nutrients for your baby's first food needs, and is easy on the digestive system, meaning less chance of constipation or diarrhoea. Breastfeeding offers your baby the best start, but it's not always easy — problems are common, so don't be afraid to ask for help and support.

What should breastfeeding mothers eat?

Breastfeeding burns a lot of calories, so eat a variety of nutritious foods and drink plenty of fluids. You don't need to avoid milk, egg, peanut or other foods while breastfeeding — there's no evidence that avoiding certain foods prevents allergy in your child. Avoid dieting while breastfeeding.

Colostrum, foremilk and hindmilk

Colostrum is the first milk produced in the early days after birth — thick and yellowish for some women, thin and watery for others, and very rich in proteins, vitamins, minerals and infection-fighting antibodies found only in breast milk. You'll know colostrum is changing into breast milk when it turns milky white and your breasts feel full — your milk "coming in." How long this takes varies from mother to mother; if it hasn't come in within 72 hours of birth, talk to your doctor.

The milk at the start of each feed, foremilk, is watery and satisfies your baby's fluid needs; as the feed continues, it's gradually replaced by rich, fatty hindmilk, which satisfies hunger and provides needed calories.

How do I know when it's time to feed?

At first you'll feed on demand — whenever your baby is hungry, which could be as often as every 2 to 3 hours, typically 8 to 12 times over 24 hours. Let your baby set the pace — sometimes babies feed more frequently for short periods, called "cluster feeding," often in the evening, which is normal and might mean a growth spurt.

Expressing breast milk

If your breasts are engorged (large, sore, feeling extremely full), your newborn may have difficulty latching — expressing some milk by gently massaging or pumping can help him latch. If you'll be away from your baby at feeding time, expressed milk lets your baby drink from a cup or bottle, and is also a way to keep breastfeeding while your baby is in child care — make sure the centre or home has a refrigerator, since breast milk must stay chilled until feeding time.

Are there ever reasons not to breastfeed?

Rarely. If you're receiving chemotherapy (especially cyclosporine, methotrexate, bromocriptine, cyclophosphamide, doxorubicin), have HIV, or take street drugs (especially PCP), talk to your doctor — you may be advised not to breastfeed. If you have a medical condition or take prescription medications, always talk to your doctor before nursing, though with most prescription medications you can continue, since only small amounts pass through breast milk.

How will I know if my baby is feeding well?

Feed from each breast for as long as she wants, alternating which breast you start with each feeding. Signs of good feeding: short swallowing sounds (a "K" sound) that gradually become longer and deeper as milk is released, your baby is content afterward, nursing isn't painful, and your breasts feel full before and empty after. Signs of poor feeding: a lot of lip-smacking, your baby isn't content afterward, and nursing is painful.

How will I know if my baby is getting enough?

Six or more wet nappies in 24 hours; stools that are yellow, soft and seedy (often after every feeding early on, less frequent after the first month but still soft and yellow); and steady weight gain, checked by your baby's doctor at each visit.

Practical tips

• Wash your hands before breastfeeding.
• For cracked or sore nipples, let them air-dry naturally after each feed, and consider a lanolin cream from your local pharmacy. Avoid soap on your nipples, which washes away your breasts' natural lubricants.
• Watch for mastitis — a bacterial infection causing painful breast swelling and sometimes fever. See your doctor if this happens; it's treated with antibiotics, and you can continue breastfeeding during treatment.

Storing expressed breast milk

Store expressed milk in a clean container, such as a glass bottle or breast milk storage bag, with the date marked. Plastic polyethylene bags (like commercial bottle liners) and containers made with BPA are not recommended, as they can affect milk quality. Never mix fresh breast milk with chilled or frozen milk — it can cause bacteria to grow and lead to food poisoning.

• 6 to 8 hours at room temperature (no warmer than 25°C/77°F).
• Up to 5 days in the refrigerator (below 4°C/39°F).
• 2 weeks in a refrigerator freezer compartment (not in the door).
• 3–6 months in the freezer compartment of a fridge with separate doors.
• 6–12 months in a separate chest-type freezer (below -20°C/-4°F).

Thaw frozen milk in the refrigerator and keep it there until you're ready for it — don't use a microwave to thaw or warm expressed milk, as it can affect milk quality.