On Your Health

Check back to the INTEGRIS On Your Health blog for the latest health and wellness information for all Oklahomans, published three times a week.

Your Breastfeeding Questions, Answered.

We just wrapped up National Breastfeeding Month.  All month, we took your breastfeeding questions for Dr. Amanda Manceau-Kha, an OB/GYN at INTEGRIS. Here are her answers.

How long do I have to breastfeed to give my child the most health benefits? I’ve heard three months, but I’ve also heard one year.

The length of breastfeeding should be personalized for each mother and baby. Breast milk has all the nutrition babies need until they are six months old, although some pediatricians may recommend a liquid vitamin, too. Most specialists recommend breastfeeding for six months to one year. Various studies looking at visual function, cognitive development, neurodevelopmental outcomes, allergic conditions, obesity, prevention of some cancers, and gastrointestinal function observed the most benefit between six months and one year.

If my milk supply is low, what can I do about it?

Low milk supply can happen from insufficient extraction of milk by the infant, or insufficient milk production by the mother. Determining the reason why your milk is low is the first step. Low milk supply can happen for many reasons: breast surgery, nipple conditions, medications, hormones, infant suckling disorders, neuromotor delays, prematurity, malformed lip and palate, and poor latch. It is important to get yourself and your baby evaluated by a physician. Your baby’s latch is the No. 1 cause for both low milk supply and nipple pain. Lactation consultants are an excellent resource for help in this area. Occasionally, your doctor might prescribe medications to increase your milk quantity if medically necessary.

If I don’t produce enough milk for my baby, is it OK to supplement with formula?

First, it is important to work with your physician, your baby’s physician, and a lactation consultant to evaluate the needs of your baby.  It is OK to supplement with formula if indicated after thorough evaluation.

How do I know if my baby is getting enough milk?

Your baby needs routine health visits to evaluate if he or she is getting enough milk. Infant weight is monitored for appropriate growth. Your baby should also be making adequate wet and dirty diapers. Term infants generally lose approximately seven percent of their birth weight in the first three to five days of life. They typically regain their birth weight in the first two weeks of life. If an infant loses 10 percent of its weight or does not regain his or her birth weight appropriately, it is important that you discuss a management plan with your infant’s doctor and that your breastfeeding be observed by a professional.  Also, you can monitor your baby’s diapers: by day four or five after birth, babies should make at least six wet diapers a day.  By day four after birth, babies should make four or more bowel movements a day.

How do I know if my baby has eaten enough?

Breastfeeding is recommended whenever your baby shows signs of being hungry, such as waking from sleep, moving his or her head as though looking for the breast, sucking on hands or lips, and flexing arms and fingers. All babies breastfeed for different amounts of time. I recommend letting the baby finish breastfeeding on one side so that he or she gets all the milk from that breast, including the more fat-concentrated milk. Then see if your baby wants to drink from the other breast. Switch the side you start with each time. Most infants signal they are finished nursing by releasing the nipple and relaxing the facial muscles, arms and hands. It is important to discuss your baby’s nutritional needs at routine checkups.

 If I pump, how do I make sure the breast milk stays safe from bacteria or other contamination?

For infants who are healthy and not hospitalized, breast milk can be stored safely:
  • At room temperature for up to four hours.
  • In the refrigerator for three to five days (if collected under clean conditions).
  • In the freezer for up to six months.
  • Thawed breast milk can be stored in a refrigerator for up to 24 hours.
Milk should be placed in sealed, clean, glass or rigid plastic bottles, or specialized storage bags. Other safety tips:
  • Before combining milk from different sessions, let milk thaw in the refrigerator.
  • Never add warm milk to frozen milk.
  • Be sure to document the collection and storage date on each container.

What do I do if my baby falls asleep while eating?

Infants younger than two to three months tend to fall asleep while nursing. It is reasonable to waken the infant to encourage him or her to finishing nursing.

I have breast implants. Will that affect my ability to breastfeed?

Breast implant and augmentation surgery does not usually affect one’s ability to breastfeed, but it is important to work closely with your obstetrician and your pediatrician to ensure adequate milk supply. The difference between silicone content in silicone and non-silicone implants is insignificant, according to recent studies.  Furthermore, the silicone levels are shown to be lower in breast milk than cow’s milk and commercial store bought formula.

Can I take medicine while breastfeeding?

Be certain to tell your doctor and pharmacist that you are breastfeeding before initiating a new medication. According to the American Academy of Pediatrics, only about 10 percent of medications have been adequately evaluated for risk in pregnancy and lactation. Some may even decrease milk production, such as large quantities of antihistamines. LactMed is an excellent resource for patients and physicians.

I am a breast cancer survivor, and I was able to keep both breasts. Will I be able to breastfeed?

The majority of women are able to breastfeed and maintain adequate milk supply, with good technique, after breast cancer.  Be sure to discuss your past medical history with all medical providers involved in your care, especially your obstetrician and oncologist.

How often should a baby breastfeed?

In the first one to two weeks, most infants will breastfeed eight to 12 times per day.  In the first week of life, it is important to wake an infant if he or she has not fed in four hours. Look for signs your baby wants to feed, such as awakening, searching for the breast, bending arms and clenching their fists, or sucking on the hands, lips or tongue. Most infants do not cry until they are very hungry. Waiting until an infant cries is not recommended.

How much are babies actually getting in each feeding? I worry he isn’t getting enough.

  • After the first few days, your baby should eat three ounces every three to four hours.
  • At one month, four ounces every four hours.
  • By six months, he should eat six to eight ounces over four to five feedings per day.
The rate they eat from a bottle is faster than at the breast. Each baby consumes milk at a different rate. Again, I suggest monitoring your baby’s signs of hunger and satiety.

How do I know if my baby is latched on properly?

Your baby’s mouth should cover the majority of the areola of your breast, rather than suckling on just the nipple. Your baby’s shoulders and body should be facing you. Placing your baby skin-to-skin also triggers reflexes that help the baby latch on to your breast. A nurse or lactation consultant can help you find a good position. There are four suggested positions for feeding: football, cradle, cross cradle and side laying. To latch, cup your breast in your hand and stroke your baby’s lower lip with your nipple. The baby will open his or her mouth wide, like a yawn. Pull the baby close to you, directing the nipple toward the top of your baby’s mouth. Bring your baby to your breast—not your breast to your baby. If you feel pain or your baby's mouth is not wide open, gently break the suction with a clean finger between your baby’s gums and your breast and re-latch. See additional resources below.

Is there anything you recommend for sore nipples? Does it ever go away?

The most important thing regarding sore nipples is evaluation of your latch technique, as well as evaluation of your breasts and your baby’s lip and palate.  See above for proper latch technique. If your nipples are sore, expressing a small amount of breast milk onto the nipple may speed up the healing process. Gently massage breasts prior to feeding to soften them. Other tips:
  • Apply a heating pad, warm compress, warm shower or gel pack after feeding.
  • Try different breastfeeding positions to avoid sore areas.
  • If you have severe pain, your nipples are cracked or bleeding, or pain lasts more than one week, contact your obstetrician or lactation consultant.
If you notice a hard knot form in your breast along with nipple pain, you may have a blocked milk duct. Prolonged clogged ducts can lead to a breast infection called mastitis. It is fine to continue breastfeeding, which may help resolve it, but it is important to be evaluated by your physician, who may prescribe an antibiotic. If you have a blocked milk duct you might try:
  • Breastfeeding longer and more often on the breast that is blocked.
  • Manually express or use a pump to help remove the milk.
  • Apply heat with a warm shower or heating pad before feedings.

When will my baby sleep through the night and not require nighttime feedings?

Babies begin to sleep through the night and not require night feedings between two and four months.

Resources for Parents:

Lactation Consultants INTEGRIS Breast Pump Program Healthychildren.org from the American Academy of Pediatrics The American Congress of Obstetricians and Gynecologists LactMed (drug and lactation interaction database)
Amanda Manceau-Kha, Obstetrics and Gynecology Amanda Manceau-Kha, D.O., is an obstetrician and gynecologist specializing in women’s health. She earned her medical degree from Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, Florida and completed her internship and residency training at The University of Texas at Austin Dell Medical School. She earned her Bachelor of Science in Neuroscience from Vanderbilt University in Nashville, Tennessee. She is a member of the American Medical Association and was recently honored for her achievements in minimally invasive surgery by The Society of Laparoendoscopic Surgeons.

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