1. Something's Not Right - What Can I Do To Make This Work?

A good latch is the foundation of breastfeeding,” Solow says. The latch is the position of the baby’s mouth around the nipple. A proper latch-on is deep and asymmetrical, with more of the breast in the mouth near the baby's lower lip than the upper lip. So how do you get there?

• Timing is important. Feed your baby when he's hungry, but not too hungry. A baby who is rooting around for the breast is just starting to be hungry. This is the optimal time for breastfeeding.
• Hold your baby properly. Make sure his head is tilted back slightly, so the nipple looks like it's going to go up his nose. Then lightly touch his lower lip with the edge of the areola. Wait for his mouth to open wide. Now, using the heel of your other hand, push fast against his shoulder blade to bring him on to your breast chin first (to get more of the breast in his mouth near the lower lip). His chest, chin and cheeks should be pressed against your breast, and a bit of the areola should stick out of his upper lip. His nose should be clear.

2. How Do I Know If My Baby’s Getting Enough Milk?

Most babies do get enough milk when they nurse. That said, just because your baby seems to be nursing endlessly doesn’t mean she's getting enough milk. Sucking alone won’t feed a hungry baby, because sucking isn’t the same as swallowing. She might be nursing sleepily and not sucking strongly enough to get filled up, for example; and that in turn can reduce your milk production.

So, how can you tell if your baby is getting enough? Here are some signs that all is well:

• Your baby has a strong suck and is constantly gulping and swallowing while she nurses.
• our breast gets softer as your baby nurses.
• Your baby is gaining weight - infants generally gain about five to seven ounces per week for the first four months; and in months five and six, around four to five ounces per week. That said, it does vary, and some gain less or more than the average without there being a problem.
• Your baby usually pees enough to need six to eight diaper changes per day, and she generally poops three to five times daily. (Remember, though, that babies do vary).

Signs that your baby might not be getting enough milk:

• He cries a lot and refuses the breast, or he is constantly looking to for something to suck on after nursing. Your baby might go through periods of a few days at a time when he wants to nurse more, seems constantly hungry and is fussy. This could be a growth spurt; try to keep up with the demand and wait a few days to see if it passes.

3. How Can I Keep My Baby From Falling Asleep While Nursing?

Sucking sedates babies by causing the release of a “sleepy” hormone (known as CCK) in their bodies. It’s sweet, but it can be problematic; if your baby falls asleep mid-feeding, he won’t be satisfied and will want to chow down again too soon. So, if he’s catching z’s instead of milk, here are some options:

• Take off the breast and wake him up gently.
• When he’s alert, make sure he’s latched on well - if not try and try again. (It can take several tries to get a proper latch.)
• Once he's latched on, try compressing your breast to push the milk out - a big squirt of milk can be like a shot of coffee for a baby. If your milk isn't flowing well (it hasn't let down), you may be able to help it along.
• Baby's still asleep? Get physical: Take off his socks and gently tickle his feet. Undress him so the cool air wakes him up. And depending on the baby, you might even try singing or playing music. But pay attention: Some babies respond well to stimulation; others shut down.

4. I Don't Think My Milk is Flowing Well, What Can I Do?

Right after delivery, your letdown reflex kicks in, although you might not notice it happening. Hormones in your body are telling your milk ducts to release your milk, usually in response to your baby's suck, or even the anticipation of it (some women experience let-down every time they hear the baby cry!). In the first two weeks, if you feel contractions in your uterus, you’ll know your letdown reflex is working. Some women feel a tingling sensation in their breasts, but if you don’t notice a letdown response it doesn’t mean it’s not happening.

Still, if you're having trouble with letdown, help get your milk flowing:

• Try visualization: Relax your shoulders, breathe deeply and envision your milk coming down.
• Make sure you’re drinking enough to replenish your fluids.
• Did we say breathe deeply? Maybe you're exhausted and stressed out. Cut yourself some slack - think of yourself as a professional breast-feeder and your baby as your star client, and move "clean the kitchen" way down on your to-do list. Don’t make the bed - remember, you’re supposed to nap when your baby naps, and an open bed will be more conducive to that.
• Set very small goals and, when possible, delegate responsibilities to others. Worry can inhibit letdown, so try not to get anxious about what's happening in your body. Slow down and think about loving your baby. That might help get those hormones flowing.

5. How Can I Boost My Milk Production?

Here are a few things you can do to give your milk production a boost.

• The simplest way to tell your body to make more milk is to ask for more. You can do this by getting better latches from baby, nursing her frequently and trying to make sure that she’s fully draining each breast (i.e. drinking all the milk in each breast at each feeding).
• Another way is by pumping. If you pump right after baby finishes nursing, your body will begin making more milk right away, and you’ll be ready for the next feeding. If you have a pump that starts out on a fast setting and then slows down to mimic baby’s suck, try pressing the reset button as it slows; this will stimulate your breast to produce more milk.
• Some holistic ways to boost milk production: take the herbs fenugreek and Blessed Thistle; or eat oatmeal, sesame seeds and, if you’re not allergic to nuts, almonds. And many moms rely on malt, which helps increase the milk production and can be found in Ovaltine as well as in dark beers like Guinness or nonalcoholic dark beer.
• Of course, make sure to drink plenty of fluids, eat right and get as much rest as you can. Naps aren’t a luxury; they’re a necessity.

6. Should I Wake Up My Baby To Nurse?

It depends on whether your baby is getting what she needs when she's awake. For the first three months, infants have tiny stomachs that they generally fill by eating around the clock - on average, about eight feedings during every 24-hour period. But the main thing is that she gets the right amount during any 24-hour period.  If she eats more often during waking hours, she can eat less often during sleeping hours. Do the math:

• If your baby is feeding frequently and efficiently during the day (see How do I know if my baby is getting enough milk?), you can let her sleep solidly for a four- or five-hour stretch during the night.
• But if your baby is only eating every four hours during the day and sleeping straight through a five-hour stretch at night, she may not be getting enough to eat in a 24-hour period You’ll need to wake baby up.  If it was our choice, we’d wake baby every 2 to 3 hours during the day and catch a bit more winks at night.  But if your baby still seems hungry, you may have to wake baby up at night also.
• If your baby wants to feed more frequently during the night than during the day, you can wake her from some of those longer daytime naps to eat, which may also help her begin to differentiate day and night.
• After the first few weeks, as the baby’s stomach grows, you probably won’t have to worry about waking her.

7. What Foods Should I Not Eat?

“Eat what you like,” Solow says. “Women all over the world, who eat many kinds of foods, nurse their babies - and most babies can tolerate most foods.” As an added bonus, since breastfed babies are exposed to an array of flavors, they usually do better when introduced to solids because they’re used to variety.

But some babies can be allergic to something in their mom's diet. Signs of a possible food allergy: eczema, blood in the stool, or fussiness (of course, fussiness can have many causes). In those cases, according to Solow, the culprit is usually dairy; consult your pediatrician.

8. My Baby Wants To Eat All The Time, What's Going On?

In the first three months, the average baby needs to eat about eight times a day, depending on the storage capacity of your breasts and her growing stomach. If your baby seems to be hungry much more often, there are two possible explanations:

• She’s hungry because she's not getting a full meal when she nurses. Here's how to figure out if your baby is getting enough milk.
• Your baby is going through a growth spurt. At around two, three and six weeks, and again at around three and six months, babies grow a lot in a short amount of time. When this happens, they needs the extra milk to support all the hard work they’re doing, and by feeding more often, they’re also helping you increase your milk supply, so you'll be able to keep up with their changing needs. Think of it this way: Sitting in your nursing chair most of the day now will pay off later when your baby will eat more efficiently and your milk capacity will enable her to go longer between feedings. Another plus: With growth spurts come sleeping spurts!
• Try not to satisfy your baby's hunger by offering her formula if you really want to keep breastfeeding. If you become dependent on formula, your milk might dry up. Another side effect from lower milk production is that the baby can become more frustrated at the breast and then refusing it. And this can lead to your baby preferring the bottle.

9. My Nipples Are Cracked And Aching, Should I Stop Nursing?

Although it takes time to get used to breastfeeding, and nipples can feel a bit sore at first, most pain is preventable with a good latch. If you continue to have pain after two weeks, your baby is most likely not latching on well. What to do?

• Don't stop nursing. Instead, correct your baby’s latch.
• You can alleviate some pain and make nursing easier while nipples heal by starting your breastfeeding session on the breast that isn’t sore. After your baby has eaten a bit, he won’t suck as hard. Then, when you put him on the sore breast, change the position of the nipple in your baby’s mouth, so he’s not near the sore part. Shorter but more frequent feedings can  also help alleviate the pain.
• Putting olive oil on the sore area when nursing can alleviate some friction - and resultant pain.
• It’s very important to make sure your nipples are dry in between feedings. Exposing them to the air helps dry and soothe them, and help them heal faster.  Another trick: rub a little breast milk on them and then let them air dry. And when you bathe, wash nipples in plain warm water – do not use soap, which can irritate or further dry the area – and dry gently.
• If you have wounds on your nipples, the situation is more severe. It’s still important to keep breasts dry between feedings, but try washing with soap and water just once a day when you bathe – and also salt water soaks (with mild saline) to help keep the wound free of infection. You can pick up saline solution at the drug store or mix your own using a cup of warm water and half a teaspoon of salt.  Of course, you can also seek a doctor’s advice.
• A doctor who tells you to stop nursing when your nipples are sore may not be properly informed. You can seek the help of a lactation consultant who is an expert in the field (the International Lactation Consultant Association  can put you in touch with a certified lactation consultant in your area.) Some consultants offer cheap or free lactation support groups - these are great places to learn about latching on, make friends and get support from other nursing mothers who have overcome the hurdles you are dealing with.

 

10. My Baby Has a Cold and Is Having Trouble Feeding - What Should I Do?

It's challenging to feed a baby with a cold, but there are things you can do to make your stuffed-up bundle more comfortable:

• Nurse her in a more upright position. This will make it easier for her to breathe.
• Try shorter and more frequent feedings.
• To clear your baby’s nose, use a bulb syringe (warning: Babies hate them!) or, even better, the Nosefrida. You can also talk to your doctor about saline drops.

11. I've Come Down With a Cold - Can I Still Nurse My Baby?

Yes. Here's why:

• You’re actually making your baby stronger and helping her fight colds by passing your antibodies to her in your breast milk.
• With almost any simple infection, you’re contagious before you even know you're sick. So you've already exposed your baby to whatever you have. Now that you do know you're sick, just make sure to wash your hands well and very frequently, and try not to sneeze on your baby.
• If she does catch your cold, she’ll probably get a less severe version.

12. Can My Baby Eat Too Much?

Yes. Sometimes a baby can get uncomfortable if he's drinking too much milk. This can be confusing for you, because his fussing might seem like a hunger signal, but feeding him more only causes more discomfort. One clue that a baby is drinking too much milk is lots of spitting up. What can you do?

• Feed him less by waiting a little longer between feedings, or offering one breast at a feeding instead of two. (If your baby doesn't fully empty a breast, that breast will start producing less milk.)
• If you feed baby at only one breast, make sure to start the other one at the next feeding. Wearing a rubber band or bracelet on your wrist and switching it to the other wrist at the end of every feeding is a great way to remember which breast you gave last.

13. Can I Still Nurse While On Medication?

That depends on the medication. Stay away from aspirin, for instance: If you need a painkiller, use Tylenol, Advil or any other over-the-counter Ibuprofen– or Acetaminophen–based painkiller.

As for other medicines, ask your doctor about any medication that he or she prescribed; also read the label and supporting materials that come with the drug. Or log on to LactMed - it's an easy-to-use database sponsored by the United States National Library of Medicine and regularly reviewed by doctors.