• Discuss how you want to feed your baby with your partner and family.
• Talk to your healthcare provider, nurse, midwife, baby's doctor, WIC nutritionist and peer counselor, and ask them to help you:
  • Find a breastfeeding class.
  • Find breastfeeding support in the community.
  • Complete a breastfeeding plan, review it with your baby's doctor and give it to the hospital staff when your baby is born.
  • Talk to your supervisor or school counselor about continuing to breastfeed when you return to work or school.

Resource

• Information from Breastfeeding Families - I Wish Someone Had Told Me

• Bring your plan to the hospital and share it with your nurse.
• Speak with a lactation consultant or your peer counselor as soon as your baby is born.
• Practice skin to skin contact with your baby.
• Ask visitors to make visits short so you can rest and focus on feeding your baby.

Breastfeeding in the NICU

The Neonatal Intensive Care Unit (NICU) in a hospital provides high level, optimal care for newborn babies who need enhanced healthcare. Having an infant in the NICU can be overwhelming, but one of the best ways to support your baby is giving breastmilk. Here are some tips:

• Communicate your desire to provide breastmilk. Let your baby's NICU team know that you wish to provide breastmilk. Most NICU's have professionally trained breastfeeding staff available to help. Ask for a consultation and learn more here.
• Hold baby skin to skin. If your baby is medically stable, your NICU team will set aside time and assist your baby with laying directly on your chest. Studies show that all babies benefit from skin to skin time on their caregiver's chest.
• Establish your milk supply. If your baby is unable to suckle directly from the breast, use a breast pump and hand expression. Request information about safe storage and handling of your breastmilk. Breast pump rentals with enhanced features specially made for premature or sick babies may be available. Check with your insurance company or WIC (if a participant) to see what breast pump benefits you have before purchasing anything.
• Ask about human donor milk. If you are unable to provide breast milk yourself, some hospitals have human donor milk available which undergoes rigorous screening and pasteurization for safety. Ask if this is an option as needed.
• Take care of yourself. To care for your baby, you need to be healthy yourself. The Mayo Clinic has tips to keep a breastfeeding/pumping individual healthy.

First Week

• Breastfeed about 8-12 times every 24 hours. If you breastfeed more, you will produce more breast milk. You naturally start producing more milk between day 3 and 5.
• Talk to your lactation consultant or peer counselor if you are worried about your milk supply.
• Wake and feed your baby if they sleep longer than 3 hours during the day or 4 hours at night.
• Your baby may wake during the night to eat for the first few months. Babies have a small stomach and need to eat often. Breastmilk is designed to digest easily, making the baby get hungry quickly.
• Pay attention to hunger cues from your baby including their head turning towards your breast, fist gnawing, or lip smacking. Crying may be the baby's last resort to let you know they are hungry. Try to notice hunger cues before the baby starts to cry.
• As you make more milk, it's normal that they become larger, heavier and tender. Fullness can turn into engorgement when your breasts feel hard and painful. Prevent engorgement by emptying the breasts frequently by nursing at the breast or expressing milk by pump or hand expression.
• Getting a good latch with your baby takes practice. Learn steps to a good latch here.
• Rest when baby is sleeping.

Maintaining Breastfeeding

• After a few weeks, you can learn how to express breast milk by hand or with a breast pump. Keep your breast pump clean to protect your baby from germs. Learn more about breast milk storage safety here.
• The American Academy of Pediatrics recommends that infants are exclusively breastfed for the first 6 months after birth (see page 52).
• From 6 months to 1 year old, continue breastfeeding while gradually introducing solid foods into the baby's diet.
• After 1 year, continue breastfeeding if desired.
• It can be difficult for some individuals to continue breastfeeding for at least 6 months or longer. Remember any length of time breastfeeding is a success!
• Weaning is the process of switching a baby from breast milk to other foods and fluids.

Infant Safe Sleep and Breastfeeding

• After breastfeeding, make sure to place baby back into a safe sleep environment to sleep.
• Learn more about infant safe sleep here.

Breastfeeding, while wonderful and rewarding, can be challenging at times. Here is how others can become involved and offer support:

• Learn normal newborn feeding frequency, hunger cues, and signs of satiety (feeling full).
• Attend a breastfeeding class with the breastfeeding person and encourage them to join a location breastfeeding support group.
• Practice skin to skin frequently. This allows the breastfeeding person to rest, take a shower, or eat a meal. Skin to skin helps with soothing, bonding, establishing breastfeeding, and helps maintain infant's warmth.
• Help with non-feeding baby care like bathing, diaper changes, soothing and burping.
• Play with the infant when they are not feeding like taking a walk, reading, singing, talking about object around the house, or practicing tummy time.
• Offer encouragement frequently.

Resources

• How Dads Can Support Their Breastfeeding Partner
• 24 Hour Cribside Assistance for New Dads
• Resource Guide for Breastfeeding Families

There are several reasons a baby may not remain with the birth parent including adoption, foster care, parent illness or incapacity or incarceration. In the most difficult circumstances, a baby may have died.

Your body will still make milk to feed the absent child. Some parents choose to donate their breast milk in the following ways:

• Provide to current caregivers: Make arrangements to pump milk for the baby and donate directly to other caregivers. Proper handling and storage of your expressed breastmilk is essential.

Donate to a Milk Bank

Various non-profit organizations accept expressed breast milk. The donations are screened and pasteurized and then used for vulnerable or fragile babies who are not able to receive their own mothers' milk.

• Human Milk Bank Association of North American (HMBANA)
• Bronson Mothers' Milk Bank, Kalamazoo, Michigan

Other parents may stop their milk supply as quickly as possible. Do this in a safe and healthy way to avoid complications such as infection.

You can successfully breastfeed twins, triplets or more children with many benefits. You do not need to stop breastfeeding one child to start breastfeeding another or stop during pregnancy.

Resources

• La Leche League International
• Multiples of America
• Breastfeeding USA