1

Breastfeeding Basics

2021

Georganna Cogburn, MSHE, RD, LDN, IBCLC, RLC Region 1 Lactation Trainer

Continuing Professional Development Mountain Area Health Education Center

Georganna.cogburn@mahec.net 828-257-4754

Sonja Emerson, MSN, MPH, RN, IBCLC Clinical Education Nurse

Center of Ambulatory Nursing Excellence Mountain Area Health Education Center

Sonja.emerson@mahec.net 828-771-3543

1) All professional organizations recommend that breastfeeding is the preferred, optimal, normative

method of infant feeding and is the standard by which everything else is measured. It is

recommended that infants be exclusively breastfed for the first 6 months of life with continued

breastfeeding until 12 months of age and the addition of complementary foods at 6 months of age.

2) Making Behavioral Health Decisions

Our clients will make the decision to breastfeed based on the benefits and costs of

breastfeeding to her. As the health care provider, we should utilize open-ended questions

during the patient interview and then listen closely to identify the barriers to breastfeeding that

our clients are sharing with us. The most common barriers to breastfeeding are: lack of

confidence, time and social constraints, embarrassment, lack of support and fear of pain. The

goal is to provide clients with evidence-based information related to breastfeeding then support

the client’s decision about how to feed the infant.

An Open-ended Question begins with WHO, WHAT, WHY, HOW or TELL ME. A Close-ended

Question can usually be answered with a simple one word response, like yes or no.

3) Benefits of Breastfeeding

Infant Benefits Maternal Benefits

Lower risk of: Otitis media Respiratory tract infections Asthma Gastrointestinal Infection Necrotizing enterocolitis (preterm

infants) Sepsis (preterm infants) SIDS Atopic dermatitis Eczema Celiac disease Inflammatory bowel disease Obesity Type 1 diabetes Type 2 diabetes Childhood leukemia Higher intelligence scores

Lower risk of: Excessive blood loss post-delivery due to

more rapid involution of the uterus Postpartum depression Child abuse and neglect Diabetes Retaining weight post-delivery Rheumatoid Arthritis Cardiovascular disease Hyperlipidemia Hypertension Breast cancer (premenopausal) Ovarian cancer

Lactational amenorrhea = increased child spacing

Pediatrics, 2012: 129, e827 – e841

2

4) Perceived Breastfeeding Contraindications

a. I can’t breastfeed because I smoke.

i. Encourage mothers to decrease smoking, to not smoke around infant, and to

reduce infant exposure to second-hand smoke.

ii. Encourage the mother to breastfeed while supporting her efforts for smoking

cessation.

iii. Breastfeeding will help to reduce the risk of upper respiratory infections and

SIDS which are higher in infants exposed to smoke.

Breastfeeding Medicine, 2015: 10, 135 – 141

Pediatrics, 2012: 129, e827 – e841

b. I want to go out and have a drink with my friends, so I can’t breastfeed.

i. AAP and ABM recommends not breastfeeding for 2 hours after having a drink of

alcohol

ii. What is a drink?

1. 5 ounces of wine

2. 12 ounces of beer

3. 1.5 ounces of liquor

Breastfeeding Medicine, 2015: 10, 135 – 141.

Sachs et. al, Pediatrics, 2013:132, e796 – e809

Pediatrics, 2012: 129, e827 – e841

c. I smoke an occasional joint, can I still breastfeed?

i. ABM, AAP, ACOG, CDC recommend abstaining from marijuana use due to the

lack of long-term follow-up data on the neurobehavioral development of

infants.

ii. Mothers who admit to occasional or recreational use of marijuana should be

counseled to reduce or stop use while breastfeeding.

iii. Mothers who have positive urine test for THC should be advised to discontinue

use of marijuana while breastfeeding.

iv. Mothers should be educated on the effects of marijuana on the

neurobehavioral development of the infant and on second-hand smoke

exposure

Breastfeeding Medicine, 2015: 10, 135 – 141

Pediatrics, 2012: 129, e827 – e841

Pediatrics, 2013: e796 – e809

www.cdc.gov

d. I’m on Medication Assisted Treatment, so I can’t breastfeed.

i. Breastfeeding is not contraindicated in substance use disorder when the patient

is in a supervised medication assisted treatment program and has a negative

screen for HIV and illicit drugs.

Sachs et. al, Pediatrics, 2013:132, e796 – e809

3

Pediatrics, 2012: 129, e827 – e841

ACOG Committee Opinion No. 711, 2017:130, e81 – e94

Breastfeeding Medicine, 2015: 10, 135 – 141

www.cdc.gov

e. Breastfeeding and COVID-19

i. Pregnancy Concerns

1. During pregnancy the risk of contracting COVID-19 is the same as adults

who are not pregnant

2. Bodily changes that occur during pregnancy may increase the risk of

some infections.

3. Higher risk of severe illness when infected with virus from COVID-19

compared to non-pregnant women. A possible increased risk of adverse

pregnancy outcomes, like preterm birth.

4. Due to higher risk of infection, all pregnant patients should receive a flu

shot.

ii. Mother-to-Child Transmission

1. Virus has not been detected in amniotic fluid, cord blood, vaginal

discharge, neonatal throat swabs or breastmilk

2. After birth, transmission to infant is primarily through respiratory

droplets

iii. Key Teaching Points with COVID-19

1. Breastfeeding should be supported and encouraged for all infants.

2. Skin-to-skin care is beneficial for both parent and infant:

a. Parent-infant bonding

b. Increased initiation and duration of breastfeeding

c. Stabilization of blood glucose levels and respiration rates

d. Maintenance of infant body temperature

3. Separation of parent and infant will disrupt the natural process and

increase stress for the parent. Separation may be a reality for some

parents, especially if COVID-19 confirmed or too sick to care for their

infant.

4. A discussion should occur between the parent and provider prior to

delivery about hospital policies and possible separation of parent and

infant.

5. Parent should be educated about breastfeeding, the expression of

breast milk and the resources available to support breastfeeding

6. Parent should be educated prior to delivery about respiratory

precautions, washing hands and cleaning surfaces – REGARDLESS OF

FEEDING METHOD

7. Direct Breastfeeding:

a. Educate about protection from respiratory droplets using a face

mask

4

b. Hand hygiene, washing hands with warm soapy water prior to

touching the infant and prior to feeding

8. Too Sick to Breastfeed Directly:

a. Express milk to build and maintain milk supply using a dedicated

electric breast pump

b. Hand hygiene before touching pump parts and expressing milk

c. Clean pump parts following CDC Guidelines

d. Have a healthy person feed the infant, using protection from

respiratory droplets and hand hygiene

iv. COVID-19 Vaccine –Recommendations for Pregnancy and Breastfeeding

1. COVID-19 vaccine is recommended for all people 12 years of age and

older, including people who are pregnant, breastfeeding, trying to get

pregnant or who might become pregnant in the future

2. Benefits of receiving a COVID-19 vaccine outweigh any potential risk

during pregnancy

3. Vaccination when pregnant will build antibodies that might protect the

infant.

4. Antibodies have been found in cord blood and in breastmilk.

v. Breastfeeding and the COVID-19 Vaccine: Since March 8, 2021, four studies

have been published:

a. First study had 6 lactating women who received either Pfizer or

Moderna

b. Second study had 131 reproductive age women (84 pregnant,

13 lactating, 16 non-pregnant) who received either Pfizer or

Moderna

c. Third study, in Israel, all healthcare professionals, 84 lactating

women received Pfizer, 504 milk samples were tested

d. Fourth study from Spain, 33 lactating women received Pfizer, 93

milk and serum samples were analyzed

i. All studies found:

ii. Higher levels of SARS-CoV-2 specific IgG and IgA

antibodies in breast milk after the second dose

iii. Titers after vaccination were higher than the natural

response titers

iv. Maternal vaccination will result in the infant receiving

immunoglobulins via breastmilk

5) Understanding the Physiology of Milk Production

a. Stages of Milk Production

i. Mammogenesis – growth of mammary tissue in response to hormones – fetal,

adolescence, and through the first 16 weeks of gestation. Tissue development is

impacted by estrogen, progesterone, and prolactin. A teen conceiving 18

5

months or more after menarche will have sufficient mammary tissue to be

able to fully breastfeed her infant.

ii. Lactogenesis Stage I – 16 weeks gestation to day 2 post-delivery. Beginning of

secretory activity and milk production.

1. Colostrum is present after 20 weeks gestation and immediately after

delivery. Colostrum is a yellow sticky fluid secreted the first 3 to 5 days

post-delivery. Colostrum, the “First Milk”, has anti-infective properties,

seals the gut lining to prevent pathogens from adhering, establishes and

maintains gut integrity and has laxative properties which clears the

meconium.

2. Breast produces approximately 30 to 100ml/day (1 to 3 ounces/day) on

Day 1

3. Infant’s Stomach on Day 1 holds approximately 5 to 7 ml (1 tsp) at a

feeding – Size of a shooting marble

iii. Lactogenesis Stage II – onset of copious milk production from 30 to 72 hours

post-delivery triggered by a drop in progesterone. Early and frequent milk

removal establishes Prolactin receptor sites.

1. Lactogenesis II may be delayed in the following situations: retained

placental fragments; glandular or surgical procedures – insufficient

glandular tissue; preterm delivery; Type 1 diabetes; PCOS; Sheehan’s

syndrome; obesity; labor and delivery stressors; parity; C-section

delivery; high fluid load during delivery; infrequent removal of milk

2. Breast produces approximately 500 ml (16 ounces) of milk/day on Day 3

3. Infant’s Stomach on Day 3 holds approximately 22 to 27 ml (about 1

ounce) at a feeding – Size of a ping pong or golf ball

iv. Lactogenesis Stage III – maintenance of milk production (Day 9 to weaning).

Milk synthesis, the accumulation of milk in the breast, is controlled/affected by:

degree of breast fullness; infant appetite; breast storage capacity; length of

feeding; Feedback Inhibitor of Lactation

1. Breast produces approximately 750 to 900 ml ( 25 to 30 ounces) of

milk/day on Day 10

2. Infant’s stomach on Day 10 holds approximately 60 to 81 ml ( 2 to 3

ounces) at a feeding – Size of a large egg

b. Breastmilk Composition

i. Protein – Whey and Casein Proteins. Major components of whey protein are

Alpha-lactalbumin (HAMLET), Lactoferrin, Secretory IgA, Lyzozyme

ii. Carbohydrate – Disaccharide: Lactose breaks down to galactose + glucose.

Lactose functions to colonize the infant’s intestine with microflora; brain growth

and development; enhanced absorption of calcium and iron. Bifidus Factor is a

combination of several oligosaccharides which promote the growth of

Lactobacillus in the infant’s gut

6

iii. Lipids- provide up to 50% of the calories in human milk. Provides essential fatty

acids, cholesterol and transport of fat soluble vitamins to the infant. Fat content

may be affected by: breast fullness; time of day; number of days postpartum;

maternal diet; interval between feedings; pregnancy weight gain; maternal age

>35; smoking

6) Skin-to-Skin Contact – Why is it so important?

a. Facilitates breastfeeding within the first hour after birth.

b. Earlier establishment of effective sucking and feeding behaviors

c. Enhances maternal infant bonding

d. Improves neonatal temperature control

e. Improves infant metabolic stability

f. Improves neonatal blood sugar stability

g. Increases bowel movements and decreased risk for neonatal jaundice

h. Leads to longer breastfeeding duration

i. Maternal oxytocin release (uterine contractions, milk ejection, mother-infant interaction)

j. Enhances ability by infant to organize state and modulate motor system

k. Enhances the development of the infant gut biome

l. Keeps the mother and infant together during the entire postpartum stay which facilitates

breastfeeding

m. Increases breastfeeding frequency and decreases supplementation with formula

n. Mother gets increased rest and sleep

7) Positioning and Latch-on: Achieving a comfortable position and optimal latch is important to

breastfeeding success.

a. An optimal and effective latch is one where the infant has a big wide open mouth, the chin

touches the breast, the lips are flared, and the mouth is asymmetrical on the breast.

i. For a big wide open mouth, think of taking a bite of an apple, a big hamburger,

or a sub sandwich.

ii. An asymmetrical latch has more areola visible above the infant’s mouth than

below.

iii. An optimal and effective latch will assure effective transfer of milk and prevent

sore nipples.

iv. UNICEF UK – Baby Friendly Initiative – Poor Attachment -

https://www.youtube.com/watch?v=PSzbrtIT91s&feature=youtu.be

v. UNICEF UK – Baby Friendly Initiative – Positioning and Attachment -

https://www.youtube.com/watch?v=3nbTEG1fOrE&feature=youtu.be

b. An optimal breastfeeding position or combination of positions should be the one that is the

most comfortable for the mother, has the infant positioned chest-to-chest with the mother,

has the infant’s head slightly higher than his/her body and allows the infant to self-attach.

7

The optimal position promotes effective transfer of milk from the breast to the baby.

Regardless of the position used, the following should be observed:

i. Infant should be turned chest-to-chest with mom.

ii. Infant’s ear, shoulder and hip should be in a straight line.

iii. Infant’s head and shoulders and body should be supported.

iv. Infant’s hands are on either side of the breast.

v. Infant’s neck is slightly extended with the chin off of the chest.

c. Breastfeeding Positions

i. Cradle Hold

ii. Cross-Cradle

iii. Football or Clutch or Under the Arm

iv. Upright

v. Side-lying

vi. Laid-back Breastfeeding/Biological Nurturing/Natural Breastfeeding

vii. Natural Breastfeeding Mohrbacher, N. and Nesbitt, T. (2015)

http://www.naturalbreastfeeding.com/ and

https://www.youtube.com/user/NancyMohrbacher

viii. Global Health Media Project: Breastfeeding Series: Breastfeeding Positions for

Health Care Workers - https://www.youtube.com/watch?v=NS8UyAQexBg

8) Assessing That Breastfeeding is Providing Adequate Infant Nutrition

a. Infant Signs of Effective Breastfeeding:

i. Weight loss is less than 7%

ii. No weight loss after Day 3

iii. Gaining weight by Day 5

iv. Back to birth weight by Day 10

1. Gain 2/3 to 1 ounce per day for the first 4 months of life (4 to 7

ounces/week)

2. Gain ½ to 2/3 ounce per day, month 4 to 6 of life (3 to 5 ounces/week)

3. Gain ¼ t o1/3 ounces per day, month 6 to 12 of life ( 2 to 3

ounces/week)

v. Feeds/nurses 8 to 12 times per 24 hours

vi. Sustained rhythmic suck/swallow breathe pattern with periodic pauses

vii. Audible swallowing heard by Day 4

viii. Relaxed arms and hands after the feeding

ix. Moist mouth

x. Satisfied and content after feeding

xi. Alert, responsive, healthy with good color and firm skin

xii. After Day 5, more than 6 wet diapers per 24 hours. Urine is pale or clear yellow

by Day 4

xiii. After Day 5, 3 to 5 yellow, seedy stools per 24 hours that are larger than the size

of a quarter.

8

b. Infant Feeding Cues

i. Early Feeding Cues include:

1. Sucking movements

2. Sucking sounds

3. Hand-to-Mouth movements

4. Rapid eye movement

5. Soft cooing or sighing sounds

6. Restlessness

7. Crying is a late hunger cue and may interfere with effective

breastfeeding

ii. Infant Feeding Cues and Developmental Readiness

https://wicworks.fns.usda.gov/wicworks/WIC_Learning_Online/support/job_aid

s/cues.pdf

iii. Getting to Know Your Baby Birth to 6 Months

https://www.cdph.ca.gov/Programs/CFH/DWICSN/CDPH%20Document%20Libr

ary/Families/FeedingMyBaby/GettingtoKnowyourBaby-EN-2020.pdf

c. Newborn Behavior is Based on Six States of Consciousness

i. Deep Sleep/Quiet Sleep is restorative and anabolic for the infant. Can only be

aroused/awakened by very intense and disturbing stimuli. Need to wait until the

infant moves to a higher more responsive state to feed to help decrease

frustration with the feeding.

ii. Light Sleep/Active Sleep is where the infant spends most of his sleep state with

less regular breathing and rapid eye movement. He is storing and processing

information which is linked to learning. He is more responsive to internal stimuli

(hunger) and external stimuli (handling) in this state. He is awakened more

easily and is likely to remain awake if disturbed.

iii. Drowsy is the state where the infant may easily return to sleep or awaken

further. He responds to sensory stimulation slowly. To awaken the infant,

provide with something to hear, see or suck. If left alone, the infant typically

returns to a sleep state.

iv. Quiet Alert is the state where the infant is most responsive and will be more

responsive to breastfeeding. He is most attentive to the environment and will

focus on stimuli (nipple, voice, moving objects). The infant is very interactive

wanting to learn and play. As the infant gets older, they spend more time in this

state. For a very young infant, active effort is needed to control tiring.

v. Irritable/Fussy is the state where the infant has lots of bodily activity and may

become more sensitive to disturbing stimuli, like hunger, fatigue, noise,

excessive handling. Tends to become fussy as a result of the stimulation or

discomfort, like a wet diaper.

vi. Active Crying – Active Crying is a late hunger cue and is characterized by intense

crying for at least 15 minutes. Crying is how an infant communicates that

something is not right and their limits have been reached. Crying can be an

9

infant’s response to unpleasant stimuli from the environment or to internal

stimuli such as hunger, fatigue, or discomfort. An infant in this state must be

calmed down before feeding through skin-to-skin contact, walking, talking

calmly to the infant.

Ways to Wake a Sleepy Baby

Unwrap/unswaddle the baby

Change the baby’s diaper

Place the baby skin-to-skin

Massage the infant’s back, abdomen, arms and legs

Doll’s eye technique

“Itsy-bitsy spider”

Ways to Calm a Fussy Baby

Swaddle

Walk

Talk Calmly

5 S’s to Calm a Fussy Baby (Happiest Baby on the Block – Harvey Karp, MD)

Swaddling

Side/Stomach Position

Swinging

Shushing

Sucking

d. Mother Signs:

i. Breast softens during feeding

ii. Mother experiences an increase in firmness, weight and size of the breast with a

noticeable increase in milk volume and change in composition by Day 5.

iii. Breast fullness is relieved by breastfeeding

iv. Feels a strong tug that is not painful

v. Nipples appear healthy and undamaged

vi. Relaxation or drowsiness during the feeding

vii. Increased thirst

viii. Uterine contractions or increased lochia during or after feeding

ix. Milk leaking from opposite breast while feeding

e. Hand Expression

i. Therapeutic Breast Massage in Lactation – https://vimeo.com/65196007

ii. Hand Expression – Stanford University -

https://med.stanford.edu/newborns/professional-

education/breastfeeding/hand-expressing-milk.html

iii. Hand Expression – Women’s Birth and Wellness Center; Chapel Hill, NC -

Rebecca Costello, IBCLC - https://www.youtube.com/watch?v=NTlEYpIuV8w

iv. UNICEF UK Baby Friendly Initiative – Hand Expression -

https://www.youtube.com/watch?v=K0zVCwdJZw0

9) Other Concerns in the Early Weeks – The first few weeks are thrilling, exhausting and stressful

for a new mother. The family is adjusting to having a new person in the household and dealing

with family and friends who want to visit to see the new baby. Depending on the type of

delivery, the mother may have difficulty moving and finding a comfortable position for

breastfeeding. She may be exhausted after delivery and need to rest but has an infant who

needs to be fed frequently and may have their days and nights mixed up. She may feel

10

overwhelmed with all the responsibilities of being a new parent and learning to breastfeed. She

may not have much support at home.

a. Recovery from Delivery

b. Lack of Sleep

c. Feeling Overwhelmed

d. Baby Blues

e. Appetite/Growth Spurts occur around 10 days, 3 weeks, 6 weeks and 3 months. They

happen when things have been going smoothly and the infant suddenly starts to eat

more frequently. Mothers interpret this increase in feeding frequency as a sign that

their body is no longer producing enough milk for their infant. Mothers should be

provided with anticipatory guidance that appetite/growth spurts are normal.

10) Strategies for the Early Weeks

a. Reassure the mother that what she is feeling is normal

b. Nap when the infant is napping

c. Limit visitors

d. Accept help from family and friends

e. Eat healthy foods and drink fluids, preferably water

f. Limit activity, even if feeling well. Take a break.

g. Ask for help with positioning and latch-on

11) Nutritional Needs: Maternal and Infant

a. Maternal Nutrient Needs

i. Basic Daily Plan for Healthy Eating:

1. Encourage 3 meals per day: ¼ of plate is protein, ¼ plate is grains or

starchy vegetables, ½ plate is non-starchy vegetables and fruit.

2. Snacks should be eaten when hungry between meals and consist of a

fruit and protein, or vegetable and protein, or grain or starchy vegetable

and protein.

3. Fluids: Consume 64 ounces of fluids daily, preferably water.

ii. Macro- and Micro-Nutrients of Concern

1. Energy: Average recommendation is 1800 – 2200 calories per day. May

need up to extra 500 calories per day for the first 6 months.

Carbohydrates are the most readily available energy source for the

body. Avoid refined carbohydrates.

2. Protein: 15% of calories

3. Fat: Diet should include the essential fatty acids which encompasses the

omega-3 fatty acids. It is recommended to consume 2 to 3 servings of

fish per week. Avoid: king mackerel, marlin, orange roughy, shark,

swordfish, tilefish, big eye tuna because of the high mercury level.

4. A multivitamin/mineral supplement is recommended. Do not need to

continue taking the prenatal vitamins.

11

5. Vitamins and minerals with higher Recommended Daily Allowance with

lactation: Vitamin A, Vitamin C, Chromium, Copper, Iodine, Vitamin D,

Vitamin B9 (Folate)

iii. Supporting Breastfeeding in Special Situations

1. Exercise/Physical Activity

2. Vegetarians/Vegans – Increased risk of vitamin B12 deficiency so should

be supplemented

3. Desire to lose weight

4. History of overweight and obesity

5. Food Allergies/Intolerances to Dairy

b. Infant Nutrient Needs

i. Energy: Adequate to support normal body functions and assure optimal growth

ii. Protein: Needs are higher per unit of body weight for the first month, then

decreases as the growth rate decreases

iii. Fat: No restrictions for the first 2 years of life

iv. Water: Needs are met through breast milk for the first 6 months of life

v. Vitamin and Mineral Supplement is not recommended for the first year, unless

prescribed by the HCP

1. Vitamin D – AAP recommends a supplement of 400 IU per day

2. Vitamin B12 – concern if the mother is a vegetarian

3. Iron – AAP recommends a supplemental iron source starting at 4 to 6

months, typically iron-fortified cereal or meat

4. Fluoride – AAP and CDC recommends supplementation starting at 6

months for infants in communities with <0.3ppm fluoride in drinking

water

vi. Supporting Breastfeeding in Special Situations

1. Food Allergies

2. Colic

3. Appetite/Growth Spurts: 2 weeks, 6 weeks, 3 months and 6 months

4. Slow Growth/Not Feeding Well

vii. Supplementation: All aspects of infant feeding should be assessed when

determining the need to supplement a breastfed infant. Choice of supplement

should be expressed breast milk from the parent first, then pasteurized donor

milk, then infant formula. Supplement should be given by a method that is least

likely to interfere with breastfeeding. Should always start with small amounts of

the supplement

viii. If using formula, assure that the parent knows how to properly mix the formula.

Extra precautions are needed for infants less than 3 months of age, premature

infants and infants with compromised immune systems to protect against

Cronobacter. Water from a safe should source should be used when preparing

the formula. Measure water into the bottle prior to adding the powdered

formula to prevent under- or over-dilution of the formula.

12

https://www.cdc.gov/nutrition/InfantandToddlerNutrition/formula-

feeding/infant-formula-preparation-and-storage.html

ix. Paced Bottlefeeding - https://www.youtube.com/watch?v=TuZXD1hIW8Q

Resources to Use in Patient Education

Breastfeeding with COVID-19- WHO https://www.youtube.com/watch?v=dJlWAj0ZKjA

Human Milk Storage Guidelines – CDC https://www.cdc.gov/breastfeeding/pdf/preparation-of-

breast-milk_H.pdf

How to Clean Your Breast Pump Kit – CDC

https://www.cdc.gov/healthywater/pdf/hygiene/breast-pump-fact-sheet-p.pdf

Formula Compared to Breastmilk

https://www.cdph.ca.gov/Programs/CFH/DWICSN/CDPH%20Document%20Library/Families/Fee

dingMyBaby/FormulaComparedToBreastmilk.pdf

Formula Compared to Breastmilk Poster

https://www.cdph.ca.gov/Programs/CFH/DWICSN/CDPH%20Document%20Library/Families/Fee

dingMyBaby/FormulaComparedToBreastmilkPoster.pdf

Unicef UK – Baby Friendly Initiative – Poor Attachment -

https://www.youtube.com/watch?v=PSzbrtIT91s&feature=youtu.be

Unicef UK – Baby Friendly Initiative – Positioning and Attachment -

https://www.youtube.com/watch?v=3nbTEG1fOrE&feature=youtu.be

Natural Breastfeeding Mohrbacher, N. and Nesbitt, T. (2015)

http://www.naturalbreastfeeding.com/ and https://www.youtube.com/user/NancyMohrbacher

Global Health Media Project: Breastfeeding Series: Breastfeeding Positions for Health Care

Workers https://www.youtube.com/watch?v=NS8UyAQexBg

Infant Feeding Cues and Developmental Readiness

https://wicworks.fns.usda.gov/wicworks/WIC_Learning_Online/support/job_aids/cues.pdf

Getting to Know Your Baby Birth to 6 Months

https://www.cdph.ca.gov/Programs/CFH/DWICSN/CDPH%20Document%20Library/Families/Fee

dingMyBaby/GettingtoKnowyourBaby-EN-2020.pdf

Women’s Birth and Wellness Center: Breastfeeding 101/Hand Expression

https://www.youtube.com/watch?v=dIiTBHI_ftU

Therapeutic Breast Massage in Lactation – https://vimeo.com/65196007

Hand Expression - Stanford University https://med.stanford.edu/newborns/professional-

education/breastfeeding/hand-expressing-milk.html

Unicef UK Baby Friendly Initiative – Hand Expression -

https://www.youtube.com/watch?v=K0zVCwdJZw0

Infant Formula Preparation and Storage -

https://www.cdc.gov/nutrition/InfantandToddlerNutrition/formula-feeding/infant-formula-

preparation-and-storage.html

13

Paced Bottlefeeding You Tube Video – Best Feeding Lactation Services -

https://www.youtube.com/watch?v=TuZXD1hIW8Q

References

American Academy of Pediatrics (2012). Breastfeeding and the Use of Human Milk. Pediatrics, 129(3),

e827 – e 841. doi: 10.1542/peds.2011-3552

Baby Behavior: Tools for Medical Professionals https://lactation.ucdavis.edu/projects-services/baby-

behavior-tools-for-medical-professionals/

Baby Friendly Hospital Initiative http://www.babyfriendlyusa.org/

Bolman, M., Sajur, L., Oganesyan, K., Kondrashova, T., Witt, A.M. (2013). Recapturing the Art of

Therapeutic Breast Massage. Journal of Human Lactation. 29(3), 328 – 331.

Campbell, S.H., Lauwers, J., Mannel, R., & Spencer, B. (Eds) (2019). Core Curriculum for Interdisciplinary

Lactation Care. Burlington, MA: Jones & Bartlett Learning.

Centers for Disease Control and Prevention, www.cdc.gov

Chantry, CJ, Eglash, A, and Labbok, M. (2015). ABM Position on Breastfeeding- Revised 2015.

Breastfeeding Medicine 10(9), 407- 411. doi: 10.1089/bfm.2015.29012.cha

Colson, Suzanne. (2010). An Introduction to Biological Nurturing: New Angles on Breastfeeding. Hale

Publishing.

Colson, Suzanne, Frantz. Kittie, Mohrbacher, Nancy. (2011). Biological Nurturing® Laid-Back

Breastfeeding for Mothers. Geddes Productions.

Colson, Suzanne. (2010). Biological Nurturing™ Laid-back Breastfeeding. NTSC.

Colson, Suzanne. (2010) What Happens to Breastfeeding When Mothers Lie Back? Clinical Lactation,

1(1), 11 – 14.

Eglash, A., Simon, L. & The Academy of Breastfeeding Medicine (2017). ABM Clinical Protocol #8: Human

Milk Storage Information for Home Use for Full-Term Infants, Revised 2017. Breastfeeding Medicine, 12

(7), 390 – 395. DOI: 10.1089/bfm.2017.29047.aje.

Infant Nutrition and Feeding Guide https://wicworks.fns.usda.gov/resources/infant-nutrition-and-

feeding-guide

International Lactation Consultant Association, (2014). Clinical Guidelines for the Establishment of

Exclusive Breastfeeding.

International Lactation Consultant Association. (2013), Core Curriculum for Lactation Consultant

Practice. Boston: Jones and Bartlett Publishers.

International Lactation Consultant Association. (2017). Breastfeeding Management for the Clinician:

Using the Evidence. Boston: Jones and Bartlett Publishers.

Mohrbacher, N. (2011). The Magic Number and Long-Term Milk Production. Clinical Lactation, 2(1)15 –

18.

14

Mohrbacher, N. (2010). Breastfeeding Answers Made Simple: A Guide for Helping Families. Nancy

Mohrbacher Solutions, Inc.

Mohrbacher, N. and Nesbitt, T. (2015) Natural Breastfeeding http://www.naturalbreastfeeding.com/

and https://www.youtube.com/user/NancyMohrbacher

Morton, J. (2008). Breastfeeding Management, Teaching Tools for Physicians and Other Professionals.

http://breastmilksolutions.com/

Morton, J. (2011). Making Enough, The Key to Successful Breastfeeding… Planning for Day One.

http://breastmilksolutions.com/

Paced Bottlefeeding You Tube Video – Best Feeding Lactation Services -

https://www.youtube.com/watch?v=TuZXD1hIW8Q

Position of the Academy of Nutrition and Dietetics: Promoting and Supporting Breastfeeding. (2015).

Journal of the Academy of Nutrition and Dietetics. 115(3), 444 – 449.

Smillie, Christine. Baby-Led Breastfeeding. . . The Mother-Baby Dance. Geddes Production. 2010.

The Surgeon General’s Call to Support Breastfeeding

http://www.surgeongeneral.gov/topics/breastfeeding/index.html

Watson Genna, Catherine. Integrating Research Into Practice: Latch Techniques, USLCA Webinar,

January 2009.

Watson Genna, C. and Barak, D. (2010) Facilitating Autonomous Infant Hand Use During Breastfeeding.

Clinical Lactation, (1) 1, 15 – 20.

Watson Genna, Catherine. (2017). Supporting Sucking Skills in Breastfeeding Infants, Jones and Bartlett

Learning.

West, D. Marasco, L. (2009) The Breastfeeding Mother’s Guide to Making More Milk. McGraw Hill

Publishing.

Wilson-Clay, B. Hoover, K. (2010). The Breastfeeding Atlas. Manchaca: LactNews Press.

Witt, A.M., Bolman, M., Kredit, S. & Vanic, A. (2016). Therapeutic Breast Massage in Lactation for the

Management of Engorgement, Plugged Ducts, and Mastitis. Journal of Human Lactation. 32(1), 123 –

131.

COVID-19 References

New FAQs address healthcare workers questions on breastfeeding and COVID-19

https://www.who.int/news-room/detail/28-04-2020-new-faqs-address-healthcare-workers-questions-

on-breastfeeding-and-covid-19

WHO FAQ: Breastfeeding and COVID-19 https://www.who.int/docs/default-source/maternal-

health/faqs-breastfeeding-and-covid-19.pdf?sfvrsn=d839e6c0_1

Clinical Management of severe acute respiratory infection when COVID-19 is suspected

https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-

when-novel-coronavirus-(ncov)-infection-is-suspected

CDC: Pregnancy and Breastfeeding https://www.cdc.gov/coronavirus/2019-ncov/need-extra-

precautions/pregnancy-breastfeeding.html

ABM Statement on Coronavirus 2019 COVID-19

https://www.bfmed.org/index.php?option=com_content&view=article&id=138&fbclid=IwAR0hk75

15

ACOG Practice Advisory Novel Coronavirus 2019 (COVID-19) https://www.acog.org/clinical/clinical-

guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019

Breastfeeding Guidance Post-Hospital Discharge for Mothers or Infants with Suspected or Confirmed

SARS-Co-V-2 Infection https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-

infections/breastfeeding-guidance-post-hospital-discharge/

AAFP Statement on Breastfeeding and COVID-1(

https://www.aafp.org/dam/AAFP/documents/patient_care/public_health/AAFP-COVID-Breastfeeding-

Policy.pdf

CDC Coronavirus (COVID-19) https://www.cdc.gov/coronavirus/2019-ncov/index.html

Baird, Jk, Jensen, SM, Urba, WJ, Fox, BA and Baird, JR (2021) SARS CoV-2 antibodies detected in human

breast milk post-vaccination. BMJ doi: https://doi.org/10.1101/2021.02.23.21252328

Gray, KJ, Bordt, EA, Atveo, C, Deriso, E, Akinwummi, B, Young, N, Baez, AM, Shook, LL, Cvrk, D, James, K,

DeGuzman, RM, Brigida, S, Diouf, k, Goldfar, I, Bebell, LM, Yonker, LM, Fasano, A, Rabi, Sa, Elowitz, MA,

Edlow, AG (2021). COVID-19 vaccine response in pregnant and lactating women: a cohort study –

https://doi.org/10.1101/2021.03.07.21253094

Perl, SH, Uzan-Yulzari, A, Klainer, H, Asiskovich, L, Youngster, M, Rinott, E, Youngster, I (2021) SARS-CoV-

2-Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women. JAMA.

Doi:10.1001/jama.2021.5782

Esteve-Palau, E., Gonzalez-Cuevas, A., Guerrero, E. (2021) Quantification of Specific Antibodies Against

SARS-CoV-2 in Breast Milk of Lactating Women Vaccinated with an mRNA Vaccine – JAMA Open

doi:10.1001/jamanetworkopen.2021.20575