BREASTFEEDING YOUR BABY

Here at St. Peter’s we encourage and support your decision to breastfeed.

Breast milk is the natural and best nutrition for your baby, but the art ofbreastfeeding takes time and skill. Be patient with yourself and your baby. The St. Peter’s nursing staff is here tosupport and assist you with learningthe skill of breastfeeding.

Introduction

The experience of breastfeeding is special for so many rea sons,including:

• The joyful bonding with your baby • The perfect nutrition only you can provide• The health benefits for both mother and baby• The cost savings

In fact, breast milk has disease-fighting antibodies that can helpprotect infants from several types of illnesses. And moth ers whobreastfeed have a lower risk of some health problems, includingbreast cancer and type 2 diabetes. Keep in mind that breastfeeding is a learned skill. It requirespatience and practice. For some women, the learning stagescan be frustrating and uncomfortable. And some situationsmake breast feeding even harder, such as babies born early orhealth problems in the mother. The good news is that it will geteasier, and support for breastfeeding mothers is growing. You are special because you can make the food that is unique lyperfect for your baby. Invest the time in yourself and your baby– for your health and for the bond that will last a lifetime.

The American Academy of Pediatrics(AAP) RecommendationsThe AAP recommends exclusive breastfeeding (giving your baby noother foods than breast milk) until around six months when yourbaby starts taking solids, followed by continued breastfeeding for oneyear or longer.

The World Health Organization (WHO)suggests two years, and as long as you andyour baby choose.

Breastfeeding is the best way to feed your baby.Your milk offers:1. The best nutrition for growing babies. It is the perfect blend ofproteins, fats, carbohydrates, vitamins, and minerals. It containsgrowth factors, hormones and immunologic agents and enzymes.

2. It changes as your baby grows.

3. It is easier for babies to digest.

4. It has antibodies to protect babies from getting sick.

5. Breastfed babies have fewer: ear infections, diarrhea, respiratoryinfections, meningitis, asthma, eczema, obesity, diabetes, child-hood leukemia, Hodgkin’s disease, SIDS, gastrointestinal diseasesincluding ulcerative colitis and crohn’s disease.

Benefits of breastfeeding for mothers include:1 The hormones of breastfeeding: prolactin and oxytocin can helpyou feel more confident and relaxed while caring for your baby.

2. Lowering your risk of breast cancer, ovarian cancer, type 2diabetes and osteoporosis.

3. Saving time – breastfeeding is easier once you and your babylearn how to breastfeed. (Nothing to buy, clean, sterilize or mix).

4. Saving money – formula and feeding supplies can cost $1,500.

5. Weight loss – you use calories to make milk.

– 1 –

– 2 –

Are There Disadvantages of Breastfeeding?1. Mother will be the primary parent feeding the baby. If baby is notfeeding at her breast, mother will need to pump her breasts to supply baby with her milk.

2. Breastfeeding may take some time, sometimes even weeks beforeboth mother and baby are comfortable and confident in their newbreastfeeding relationship, but most mothers say that breastfeedingis less work than formula feeding their baby after those first weeks.

How Milk Is MadeGrape-like clusters of tissue called alveoli cellsmake milk in your breast.

Oxytocin makes thesmooth muscle aroundthe cells contract andsqueezes the milk into the small tubes that arecalled ducts.

Your baby sucking releasesoxytocin which causes a“let-down” of milk, fromyour breast.

Your baby sucking also releases the hormoneprolactin. Prolactin tellsyour body to make milk.

Baby’s emptying milk fromthe breast, tells your bodyto make more milk.

Talk to your doctor, midwife or lactation consultant if you have anyhealth issues that may affect breastfeeding. Examples: Breast reductionor augmentation, problems getting pregnant, polycystic ovarian syndrome, thyroid disease, high blood pressure, diabetes, or swelling.

Mothers should not breastfeed if they are:• HIV positive

• Have untreated tuberculosis

• Using street drugs

• Taking chemotherapy

• Have human T-cell lymphotropic virus

• Receiving radiation therapies

• Have a baby who has galactosemia

How to Prepare For BreastfeedingNormal birth helps get breastfeeding off to a good start.

Labor support starts with people you have selected to support youduring labor, staying out of bed and in upright positions, moving, useof a birth ball, showers, baths, massage, and trusting in the birthprocess. Drugs in labor can sometimes affect your baby’s latch andsuck in the first few days of birth.

At birthAsk for your baby to be placed skin to skin with his tummy downagainst your as soon as possible.

Why do I want my baby skin to skin • It keeps baby warm and is better than blankets or a heated crib.

• It keeps baby’s glucose (sugar) normal.

• Babies are less stressed.

• Babies get better sleep.

• Helps babies find the breast.

Keeping your preterm baby skin to skin in NICU is called kangaroocare and has even more benefits for your baby. Put your baby in justa diaper, between your breasts, with his (or her) head on your chestand cover bother of you with a blanket. Ask your nurse for help putting baby skin to skin. Baby’s other parent can do it too!

– 3 –

– 4 –

The first breastfeedingBabies held skin to skin usually find the breast and self-attach andbegin nursing within 1 to 2 hours of birth.

Let your baby nurse as long as they want on one breast, when theyfinish, they will let go or they may fall asleep. When your baby is fin-ished with one breast you can offer the other.

Breastfeeding should not hurt. Your nipples may be tender from thestretching but if you have pain, ask for help.

Getting baby to latchStart with baby’s nose opposite your nipple. You can stroke baby’slips with nipple or move your baby a few inches away from nipple toencourage him (or her) to open mouth wide. Pull baby close (withyour hand on his upper back/shoulders). Your baby’s chin will touchyour breast first then their lower lip followed by their upper lip.

How do you know you have a good latch• It feels comfortable, without pinching.

• You feel a deep, rhythmic tug of your breast.

• You may see little areola or more above your baby’s lips/lessbelow.

• He will have a mouth full of breast.

• Chin is against breast.

• Baby will suck for more than a few minutes.

• You may hear a gentle “kah” as your baby swallows.

Getting Breastfeeding Off To the Best StartNurse your baby early – as soon as possible after birth. Keep themskin to skin until they have had their first feeding and until their temperature and glucose are normal. Keep your baby with you –rooming in. You may want to hold off on their first bath (unless thereis a medical reason) until they have had a few feedings and theirtemperature and glucose are normal. Nurse your baby often, at least8-12 times in 24 hours. On the first day of life babies are often sleepy,but may want to nurse often (cluster feed) on the second day.

– 5 –

Colostrum is newborn milk, the milk that is in your breasts at birth.Mothers have this milk in their breasts by halfway through theirpregnancy. Colostrum may look thick and yellow or may look clear. It is low in fat, high in protein, and easily digested. Baby takes about1-2 teaspoons of colostrum per feeding in the first 2 days and is theperfect amount for baby who is learning how to suck, swallow, andbreathe. It coats and seals the baby’s gut to protect him from bacte-ria or viruses that could make him sick. It acts like a laxative andhelps baby pass the meconium (first stools) and may reduce the riskof newborn jaundice. Even one bottle of formula can change a baby’sgut for 2-4 weeks so we don’t offer formula unless it is medicallynecessary.

Newborn who has not latchedIf your baby has not latched by 12-24 hours after birth ask for abreast pump and begin pumping your breasts about 8 to 10 times in24 hours. Feed your baby your pumped colostrum/breast milk. A wellfed baby will have more energy to learn to breastfeed. Keep babyskin to skin and offer your breast at the first sign of feeding cues.(See page 9 for a list of feeding cues/cues that will tell you that yourbaby wants to nurse).

The most important things to remember if baby hasn’t latched:• pump your breasts to protect your milk supply

• feed your baby

• be patient while baby is learning – if he cries or is stressed, comfort him, don’t force him to keep trying when he is frustratedor hungry

• ask for lactation consult for support.

Making plenty of milkThe more your baby breastfeeds and softens your breasts, the moremilk you will make. This is called supply and demand. By day 2-3 yourbreasts feel fuller or firmer as your milk comes in.

– 6 –

Getting Your Baby to Breast andPositioning (courtesy la leche leaque)There are many positions mothers and babies like to breastfeed in. Whatis important is that both of you are comfortable.

Laid-Back breastfeeding

Mother leans back, gets comfortable and lays baby with his tummyagainst her. Baby will often bob his head on your chest, looking for yourbreast. You can help him get to the breast. Baby may even latch himself.

• Dress yourself and your baby as you choose.

• Find a bed or couch where you can lean back and be well supported– not flat, but comfortably leaning back so when you put your babyagainst your body, gravity will keep him in position with his bodymolded to yours.

• Have your head and shoulders well supported. Let your baby’s wholefront touch your whole front.

• Your baby can rest on you in any position you like, just make sure yourbaby’s whole front is against you.

• Let your baby’s cheek rest somewhere near your bare breast.

• Help your baby do what they are trying to do – you’re a team.

• Hold your breast or not, as you like

• Relax and enjoy each other.

– 7 –

Cross cradle

Your baby’s tummy is facing you, and your nipple is to his (or her)nose. Hold your baby’s upper back/shoulders, and wait for a widemouth, and then bring your baby to your breast.

Football holdYour baby’s tummy is facingmother’s side, and your nipple isto your baby’s nose. Hold his (orher) upper back/shoulders, andwait for a wide open mouth,and then bring your baby toyour breast.

– 8 –

Side LyingMothers may like thisposition after acesarean birth orwhen needing rest.

Never place any-thing behind yourinfant.

Cradle HoldThis position may be easier for your baby after he or she has learned to latch well.

X

– 9 –

Information to Assist in theBreastfeeding Process

Feeding CuesFeeding cues are signs baby will give you when he is ready to eat.They include:

• Rooting is when the baby is turning his head looking for thebreast with his mouth open.

• Mouthing is when the baby is opening his mouth and moving histongue, trying to get his hand to his mouth.

• Crying is a late feeding cue and you will need to comfort yourbaby before he will nurse.

• Breastfeed whenever you see feeding cues.

• Babies often breast feed the best when they first start showingfeeding cues and before they are too hungry.

• You can even offer your baby your breast when you see signs thathe is just starting to wake up.

Rooming-InRooming in means your baby will stay with you in your post-partumroom. Rooming in can help you while you are learning to take care ofyour baby.

Parents can see baby’s feeding cues and offer breastfeeding sooner.

• You will learn how to take care of your baby better when he iswith you.

• Many mothers sleep better when baby is nearby.

–10 –

Sleepy Baby during BreastfeedingIf baby is sleepy after he begins nursing, try breast massage or com-pression in between sucks, or stroking his arms, legs, back or soles ofhis feet. Remember newborns are often sleepy for the first 12-24hours. You can always hand express and feed colostrum, or beginpumping breasts and feed any colostrum you pump with a feedingspoon. We suggest avoiding artificial nipples (including pacifiers) andbottles for 3 to 4 weeks until breastfeeding is well established.

In the first 1-2 days, unswaddle your baby and hold him (swaddlingdecreases his reflexes to nurse). Try a semi-reclined or slouched position and hold your baby skin to skin, in between your breasts andwatch for his feeding cues. To keep your baby safe when he is skin toskin, turn his head so his face is visible at all times unless he is nursing.Bring your baby close to your breast as soon as you see feeding cues.Sometimes the feel of your nipple against his cheek will make himturn toward your breast and try to latch. You can hand express milkfor baby to smell and taste. If your baby has been skin to skin with-out feeding cues by 5-6 hours from first breastfeeding try:

• taking baby away from your skin• change his diaper• gently wash his face or chest• talk to baby• gently play with baby’s arms or legs• gently sit him up, while supporting his head• gently roll baby side to side

Ask your nurse if you have questions about alternative feeding methods such as soft-feeder, spoon or SNS (Supplemental NursingSystem).

Care of the breastsNo special care of your breasts is needed during breastfeeding. Youmay want to avoid soap on your nipples because soap can be drying.(If you have a crack or open area on your nipple, we would suggestwashing with a mild soap once or twice a day). Many mothers likethe support of a well-fitting nursing bra. Some mothers wear breastpads (cotton reusable or disposable), but if they are used they shouldbe changed whenever they are wet.

– 11 –

Breast milk collection, storage and handling guidelines for healthy newborn

Collecting• Wash your hands well with soap and water

• Assemble pump equipment

• Massage breasts, lifting and stroking to encourage milk flow

• Roll your nipples to encourage milk release

• Hand expression at the beginning or end of pumping may increasesupply

• If pumping session is replacing baby’s nursing-you may pumpapproximately 15-20 minutes or until breasts lighter and softer. (8-10 times per 24 hours) Pump both breasts at once, double electric pump offers more stimulation, to make more milk.

• If you are pumping to supplement your baby, pump for every supplemental feeding.

• Massaging and compressing breast while pumping may maximizeoutput and minimize pumping time.

• Wash pump parts (except tubing) in hot soapy water, rinse welland drip dry.

• After you are home, sanitize breast pump parts once a day.

Hand Expression of Breast Milk1. Position the thumb (above the nipple) and first two fingers (belowthe nipple) about 1” to 1-½” from the nipple, though not necessarilyat the outer edges of the areola. Use this measurement as a guide,since breasts and areolas vary in size from one woman to another.Be sure the hand forms the letter “C” and the finger pads are at 6 and 12 o’clock in line with the nipple. Note the fingers are positioned so that the milk reservoirs lie beneath them.

• Avoid cupping the breast

2. Push straight into the chest wall.

• Avoid spreading the fingers apart.

• For large breasts, first lift and then push into the chest wall.

3. Compress your fingers together

4. Repeat rhythically – press and compress

google handexpressing video @ Stanford

Avoid These Motions1. Do not squeeze the breast, as this can cause bruising.

2. Sliding hands over the breast may cause painful skin burns.

3. Avoid pulling the nipple which may result in tissue damage.

– 12 –

Press Compress Release

Storing breast milkCare should be taken in the collection, handling and storage of breastmilk. Use of reusable glass or hard sided (BPA free) plastic containerswith secure caps are preferable.

Plastic bags specifically made to store milk and/or fit into baby bottleare more awkward to handle, and may tear or leak. Label each con-tainer with date and time milk obtained, using water/smudge proofmarker and if taking it to daycare-include baby’s full name.

When milk is taken out of the freezer (and put into the refrigerator tothaw), it should be used within 24 hours.

Freshly pumped milk can be stored:

5 hours at room temperature.

5 days in the refrigerator.

5 months in freezer.

(See special guidelines for NICU baby)

Check CDC Proper handling and storage of Human Milk for HealthyFull term Infants

Breast Pump RentalWe have rental grade breast pumps that are best for establishing yourmilk supply. (ie: for babies who cannot breast feed yet due to prema-turity, illness or difficulty latching). Pumping should be comfortable.We will assist you with choosing the right size flange to fit your nipplefor comfort, teach you how to use the pump, how to clean equip-ment and how to store your milk for a healthy full term or pretermbaby. Ask for “breast pumping record” so you can keep track of whenyou pump and how much milk you pump. Pump for 15-20 minutes, 8-10 times in a 24 hour period. Ask about pump rentals for home ifyou will need to continue pumping after discharge.

Capital Region Breast Pump Rental Stations

Northeast Home Medical Equipment(518) 271-9600(They carry rental grade and retail pumps)

– 13 –

Babies R’ Us221 Wade Road ExtensionLatham, NY 12110(518) 783-10632(They carry rental grade and retail pumps, but do not accept insurance)

Marra’s Pharmacy217 Remsen StreetCohoes, NY 12047(518) 237-2110(Latina breast pumps for rental)

Common Breast Care Concerns

Flat or Inverted NipplesMany mothers have flat nipples after labor especially if you have had alot of IV fluids or muscle relaxants in labor. Inverted nipples are nipplesthat look like a slit, or fold, or draw into the breast. Your baby shouldstill be able to latch on to the areola and breast even if nipples are flator inverted. Nursing soon after birth when babies’ reflexes are strongmay help. If you can, try drawing out your nipple prior to baby latch-ing. If your nipple does not look drawn out when baby unlatchesplease ask to see a lactation consultant. We will want to carefullycheck how much milk you are making and how much baby is able to get.

Prevention of Sore NipplesNipple tenderness is normal.

Nipple pain is not normal and usually caused by a latch that is notdeep enough.

Evaluate your baby’s positioning and latch:• Hold baby so he is facing you (tummy to tummy)• Baby well aligned• Your nipple opposite baby’s nose

• Let baby tilt head back, gape mouth wide open and bring him tobreast by supporting his back and shoulders

– 14 –

• Baby should look like his mouth is wide open on breast, lipsflanged out chin, (and maybe nose) touching breast

• You should feel tugging at breast but no pain after his first fewsucks.

Call your Lactation Consultant if nipple pain does not subside by day3-6 after birth.

Treatment of Sore NipplesCheck positioning and latch.

Massage breast for a minute or two before offering breast to stimulate milk flow

Begin breastfeeding on the breast/nipple that hurts less.

If needing to remove latched baby from breast- first break suction byinserting a clean finger into baby’s mouth, between his gums andholding it there while pulling baby away.

Call your Lactation Consultant if you see bleeding or cracks and/or ifsoreness doesn’t resolve in a few days.

If your nipple is cracked, rinse with warm water or saline (1 cup warmwater + ½ teaspoon salt) after nursing, and then apply a medicalgrade lanolin. Call your doctor or midwife if you see signs of infection.

EngorgementEngorgement is painfully swollen breasts which may occur betweenday 2 and day 4 after birth, or any time in the early weeks that babyis not feeding often enough or not effectively getting your milk out.

How to PREVENT engorgement:

• Begin breastfeeding as soon as possible after birth

• Breast feed often-at least 8-12 times in 24 hours

• Let your baby nurse until he finishes the first breast (do not limitbaby’s time at breast) and then offer the other.

• Assure good latch and good milk transfer

• Avoid artificial nipples (bottles or pacifiers) and unnecessary supplements while baby is learning to breastfeed.

– 15 –

Seek help if:

• Engorgement becomes severe or painful

• Your baby has trouble latching on

• You have a temperature >100.4, reddened area on the breast, and flu like symptoms – call your doctor or midwife as soon as possible.

How to TREAT engorgement:

• Water helps to relieve discomfort. Try a brief warm shower ordangle breasts in basin of luke warm water.

• Gentle massage or manual expression of breasts may relievepressure by allowing some milk to flow out.

• Reverse pressure softening: use fingertips on areola, completelysurrounding nipple, pressing in, to push fluids back away fromwhere baby’s mouth needs to latch.

• If baby still having difficulty latching because of breast tightness,use breast pump on a low setting – just enough to soften breastsso baby can latch.

• Breast feed more often, gently massaging or compressing breastin between sucks (when baby pauses). Let baby nurse until he orshe spontaneously comes off breast, then offer other breast.

• After breastfeeding you can treat the inflammation of engorge-ment with anti-inflammatory medicine as prescribed by your doctor, and use cold compresses to breasts – 20 minutes on and20 minutes off (try bag of frozen peas).

Plugged DuctA plugged duct is a hard, painful area of breast, swollen with milk. Trywarm compresses, a different position for baby while nursing, gentlemassage of breast from swollen area towards nipple while nursing.Plugged duct should resolve after a few feedings. Call your doctor ormidwife if it is not resolved by 24-48 hours, or if you have a fever(>100.4) or flu-like symptoms.

– 16 –

MastitisSymptoms of Mastitis are painful, hard, reddened area on breast withfever or flu like symptoms. This is an inflammation in the breast andmay be an infection. If both breasts are reddened and you have flulike symptoms notify your doctor right away.

Treatment of Mastitis• Rest, consider bed rest.

• Breastfeed frequently with a good latch, softening breast withfeeding.

• Anti-inflammatory medicine for fever and swelling as prescribedby your doctor.

• You may need an antibiotic.

• Call your lactation consultant so we can help you decrease the chance for mastitis recurring by improving breastfeedingpractices.

Other Breastfeeding CommonConcernsHow to know if your baby is gettingenoughBaby is probably getting enough if:

• He is meeting goals on breastfeeding log

• Breastfeeding 8-12 times a day (24 hours)

• You hear swallowing with breastfeeding

• Seems satisfied after breastfeeding (relaxed hands not offeringfeeding cues)

• Has urine and stools appropriate for day of life

• Urine is pale or light yellow (no brick dust urine after day three)

• Transitions stools from meconium to greenish stool to yellowmustardy stool.

• Is back to birth weight by 7-10 days and continues to steadily gain

• Seems alert, active and healthy

– 17 –

Call your Pediatrician if baby not meeting goals and call your lacta-tion consultant for follow up!

* Cluster feeding (frequent feeding) and a fussy baby are commonon their second day of life (until your breasts become full withmilk). And even after your milk is in, your baby may cluster feedlate afternoon/early evening, and during his/her growth spurts.

Going Back to WorkThe longer babies are breastfed the greater the health benefits formother and baby

Breastfeeding benefits your employer too, by reducing absences fromwork related to baby illness.

You can begin pumping at 3-4 weeks, once breastfeeding is wellestablished, but you don’t need to pump until 1-2 weeks beforereturning to work. You need to have enough milk for your first dayback, and will pump milk at work on day one, to feed your baby forday two.

First Week of WorkIt may be overwhelming-try starting with half days or starting backon a Thursday or Friday will give you a weekend break sooner.

Pumping at WorkIf you breastfeed your baby just before leaving for work, many mothers find pumping mid-morning, lunchtime and midafternoon (2-3 times in 8 hours) adequate. Nurse your baby again as soon asyou pick him up.

At home: relax, enjoy your baby, nursing as much as he wants in theevening and nighttime will protect your supply.

The American Academy of Pediatrics recommends exclusive breast-feeding for around the first 6 months and support for breastfeedingfor the first year and beyond as long as mutually desired by mother and child.

– 18 –

Choosing a PumpMost mothers prefer a double electric breast pump for its efficiencyand stimulation of both breasts simultaneously, may better protectmilk supply.

Rental-grade (hospital grade) electric pumps: almost always removemilk more thoroughly and effectively and are best for establishing milksupply (i.e. Pump dependent mother with baby in NICU).

Personal use pumpsThere are different pumps in this category, from expensive high qualitypumps to less expensive lower quality pumps. These pumps aredesigned to be used by only one person.

FDA Statement: You should never buy a used pump or share a personal use pump – there is no way to guarantee the pump can becleansed, disinfected and free of infectious diseases.

Talk to your pumping friends, a La Leche League leader orInternational Board Certified Lactation Consultant (IBCLC) to see what they recommend.

Alternate Methods of Feeding a MedicallyIndicated Supplement to a Breastfed Infant*Your own expressed or pumped breastmilk is always the best

supplement for your baby.Supplement Nursing System (SNS)

• Can be used at breast to offer supplement (formula or expressedmilk), for baby who is able to latch and suck at breast.

Cup Feeding

• Research indicates the safety & efficacy of cup feeding.

Spoon Feeding

• To collect drops of hand expressed colostrum if needed for babywho has not yet latched onto breast.

– 19 –

Special ConcernsMany times mothers have concerns regarding breastfeeding a pre-mature baby, twins, or triplets; low/over milk supply and nursingstrikes arise. We can help any concerns you are having breastfeedingplease call our office for a consultation.

We would like to evaluate you and your baby before making sugges-tions. If you are just looking for the support of other breastfeedingmothers, under the guidance of a lactation consultant remember, youmay become involved with our support group.

Other local support groups include LaLeche League and BreastfeedingUSA.

Nutrition/Diet While BreastfeedingNutrition for a healthier you:Use the Food Plate designed by the United States Department ofAgriculture (USDA) as a healthy eating guide. The Plate illustrates the5 Food Groups that are the building blocks for a healthy diet.

The Fruit Group is composed of all fruits and 100% fruit juices. Fruitscan be fresh, frozen, canned, or dried. The Vegetable Group containsall vegetables and 100% vegetable juices. Vegetables can be raw orcooked, fresh, frozen, canned or dried; when choosing canned lookfor low sodium or no salt added varieties. Limiting sodium intake isan important part of healthy eating.

The Food Plate model encourages half of a person’s daily food con-sumption to be from these fruit and vegetable groups. Fruits andvegetables have essential vitamins and minerals and fiber that mayhelp protect against chronic conditions such as cardiovascular diseaseand certain cancers. To get a healthy variety, think rainbow of color;examples: red watermelon, orange sweet potatoes, yellow corn,green spinach, blueberries, purple plums, and black beans.

Any food made from wheat, rice, oats, cornmeal, barley or cerealgrain is a grain product. Bread, pasta, oatmeal, and cereals are grains.Whole grains contain the entire grain kernel: bran, germ andendosperm. They are richer in fiber, iron, and the B vitamins as aresult. Half of your grain consumption should be whole grains.Examples of whole grains are whole wheat bread, whole wheatcrackers, wheat pasta, and brown and wild rice.

– 20 –

Meat, poultry, seafood (shrimp, salmon, canned light tuna, pollock,and catfish) beans and peas, eggs, soy products (such as tofu, veggiesburgers, and tempeh), nuts and seeds are considered part of theProtein Group. The beans and peas are unique in that they representboth the vegetable and the protein groups. Select lean or low-fatmeat and poultry. Be cautious of processed meats that have addedsodium and choose unsalted nuts and seeds when consuming these.

Cow’s milk and foods made from milk such as cheese and yogurt aredairy. With cheese try the lower sodium varieties. This group is rich incalcium and vitamin D. These nutrients are linked to bone and dentalhealth enhancement as well as cancer and obesity prevention.

Make food choices that are low in “empty calories”. Empty caloriesare the calories from sugar and solid fat that are low in vital nutrients.Examples include soft drinks and desserts.

Keep these nutrition tips in mind whilebreastfeeding• Avoid shark, swordfish, king mackerel, and tilefish (found nearcoral reefs). They contain high levels of mercury. Limit white tunato no more than 6 ounces per week due to mercury content as well.

• “Eat to hunger” and use your appetite as a guide.

• Eat a wide variety and foods from all the above food groups.

• Drink fluids to stay hydrated and quench thirst. Drink when youare thirsty, and drink more if your urine is dark yellow.

• Coffee or caffeinated beverages should be consumed in modera-tion, up to 2 cups per day is suggested as a guideline.

• Limit the use of herbal teas and foods/beverages that are sweet-ened with artificial sweeteners. The effect of artificial sweetenerson breast milk and babies is not yet clear.

• Discuss any herbal supplements that you may be taking with yourphysician/provider. Some herbs can affect breastfeeding.

• Continue taking your prenatal vitamin/mineral supplement unlessotherwise directed, but keep in mind that it is an addition to ahealthy diet not a replacement.

BON APPETITE!

– 21 –

Use of Medications, Alcohol, Smokingand Recreational (Street) Drugs whileBreastfeedingMedicationsAlthough many medications are safe with breastfeeding please check with your doctor, pediatrician, or lactation consultant beforetaking medication, even over the counter medication and herbal supplements. (You can also check www.lactmed.com or www.kellymom.com for information about a medication).

AlcoholAlcohol passes freely into breast milk and in large amounts can causedrowsiness, slow growth or cause neurological developmental delaysin babies. It can also affect your “letdown”. After having a glass ofwine, beer or alcoholic beverage it takes about 30-90 minutes toreach its peak in your milk and about 1-1.5 to 2 hours to get out ofyour system. After the first month, many mothers may choose to, on an occasion have a celebratory drink of alcohol. If you have justfinished nursing and choose to have a drink, your baby would beexposed to very little alcohol if he nursed in another three hours.

SmokingCigarette smoking is harmful to mothers and we would like to helpyou with quitting, cutting down or limiting your baby’s exposure tosecond and third hand smoke. We would like to offer suggestionsabout breastfeeding if you do smoke cigarettes. The benefits ofbreastfeeding your baby is even more important if you have beensmoking while you were pregnant. Please ask for our teaching andsupport.

Recreational or Street Drugs:Marijuana, heroin, cocaine, amphetamines, hallucinogens are allstrongly discouraged in breast feeding. If you are using or dependentupon any illicit drug, breastfeeding is NOT advised. Mothers canbreastfeed while taking Methodone. Please ask us for more informa-tion and support.

– 22 –

Support For Breastfeeding MothersLactation consultants at St. Peter’s Hospital can be reached by callingthe Lactation Office at (518) 525-1400. Please leave your name, phonenumber and a brief message and one of our lactation consultants willreturn your call. Phone consults and office visits are available. (Pleasecall to schedule an appointment if you need to come in and see us.)

Lactation Consultants with contact emails Kathleen Burke – Kathleen.Burke@sphp.comHelen McGowan – Helen.McGowan@sphp.com Jamie Meehan – Jamie.Meehan@sphp.comJenelle Donzelli, Certified Lactation Counselor – Ambulatory SettingJenelle.Donzelli@sphp.com

Nancy Muztafago, Supervisor, Lactation Services/Certified LactationCounselor – Nancy.Muztafago@sphp.com

St. Peter’s Hospital Breast Feeding Support GroupGroup meets at St. Peter’s Hospital twice monthly. Refer to the breastfeeding support group sheet with dates for the next support groupand location. Call (518) 525-1388 for location and dates of the supportgroup.

WIC Breastfeeding Peer CounselorsPeer counselors are available for mothers who are WIC eligible.

La Leche LeagueMeetings and phone support are available, and information is avail-able on their website http://www.llli.org

Breastfeeding USAMeetings and phone support are available. And they also have greatinformation available on their website

ILCA International Lactation Consultant Association is a good resource ifyou are look for a lactation consultation in your home.

– 23 –

http:/www.ilca.orgYour breastfeeding support team:

Your baby’s pediatrician/family practice

Your obstetrician/midwife

La Leche League Leader

This information was reviewed with me:

Mother’s signature

Registered nurse’s signature

Date and time

Please schedule a follow-up visit for your newbornwith pediatrician within 24-48 hours of discharge.

– 24 –

FOR FURTHERINFORMATION:

St Peter’s Hospital Lactation Specialists(518) 525-1400

Breastfeeding Support GroupEvery two weeks at SPH;check www.sphcs.org fortimes and location

La Leche Leaguean international charity ofmother-to-mother supportllli.org

Breastfeeding USABreastfeedingUSA.orgConnect on Facebook andTwitter

Private Lactation ConsultantFind local contacts on ILCA.org

Dr Lorelei MichelsSpecializing in BreastfeedingMedicine(518) 763-3312

WICWomen, Infants, and Children(USDA)www.wmyhealth.orgWhitney Young office (518) 221-7183

kellymom.comProvides up-to-date informa-tion including some medica-tions while breastfeeding

Mother’s Milk Bank Northeast(617) 527-6261

BIBLIOGRAPHY

1. Cadwell, K. & Turner-Maffei,C. (2008). Pocket Guide forLactation Management.Sudbury, Massachusetts: Jonesand Bartlett.

2. Mannel, R.; Martens, P.; & Walker, M. (2008). CoreCurriculum for LactationConsultant Practice. Sudbury,Massachusetts: Jones andBartlett.

3. Walker, Marsha. (2011).Breastfeeding Management for the Clinician: Using theEvidence. Sudbury,Massachusetts: Jones andBartlett.

4. Wiessinger, D., West, D., & Pitman, T. (2010). TheWomanly Art of Breastfeeding.New York: Ballantine Books.

5. Mohrbacher, Nancy, (2010).Breastfeeding Answers MadeSimple. Texas Hale Publishing.

www.choosemyplate.gov/pregnancy-breastfeeding

ACADEMY OF NUTRITION AND

DIETETICS DIET MANUAL 2012

ST. PETER’S WOMEN’S & CHILDREN’S SERVICES

315 South Manning BoulevardAlbany, New York 12208

(518) 525-1388

www.sphcs.org

12/2014